Are Syrian refugees breast cancer patients diagnosed at advanced stage? Is it a myth or reality?

Abstract

Abstract Background: Syrian refugees(SR) are said to be diagnosed at more advanced stage comparing to host nations but almost all studies lack of control arm consisting of host nations. The aim of this cross sectional retrospective study is to compare clinicopathologic features and time to reach of treatment in two groups which are SR breast cancer patients and Turkish citizens(TC) counterparts. Methods: This study was retrospective cross sectional study including breast cancer patients from monocenter in Turkey treated between 2014-2021. Patients were divided into two groups; Syrian refugees (SR) and Turkish citizens (TC). Clinicopathologic features, neoadjuvant treatment approach and time to reach treatment were investigated in two groups. Mann Whitney U test, Chi square test were used for comparision of two groups, SPSS version 25 was used for analysis and p value ≤0.05 was considered statistically significant Results: Syrian refugees ratio was 88/490 (%18), mean age at diagnosis was 45 years for SR while in TC population it was 50 years (p:0,003). There was no difference between intrinsic subtypes, Luminal subtype 45.5% to 54.4%, HER 2 positive 39.8% to 34.3%, Triple negative14,8% to 11.3% in SR and TC respectively (p>0,05) . Ratio of denovo metastatic was 20/87 (23%) in SR while in TC population it was 85/398(21.3%) (p>0,05).Upfront operation in patients who should have been offered neoadjuvan chemotheraphy was 33.3%(11/33) in SR, and it was 43/170(25.4%) in TC population (p>0,05). Median time to reach neoadjuvant chemotheraphy(ChT) in SR was 47 days (16-75) while in TC that time was 37 days(3-141) p>0,05. In upfront operated patients, median time to surgery in SR was 42 days(14-165) while in TC it was 40 days (11-134) p>0,05. In metastatic setting median time to initiate ChT in SR was 38 days (14-118) while in TC it was 41 days (11-141) p>0,05. Conclusion: SR were younger than counterparts but breast cancer subtypes were similar in both groups. Denovo metastatic ratio and neoadjuvant approach were similar between two groups showed SR could reach oncologic treatment equally to Turkish counterpart. In the aspect of treatment delay, there was no difference in time to initiate treatment between SR and TC.