Neoadjuvant Therapy in Nonmetastatic Breast Cancer in Kurdistan, Iraq

The core management of nonmetastatic breast cancer includes surgical tumor removal by either breast-conserving surgery (BCS) or mastectomy. The use of neoadjuvant chemotherapy (NACT) has shown the potential to downstage locally advanced breast cancer (LABC) and reduce the extent of breast or axillary surgery. This study aimed to assess the treatment approach for nonmetastatic breast cancer in the Kurdistan region of Iraq and to compare its alignment with the current international recommendations for cancer treatment.

We retrospectively reviewed the records of 1,000 patients with prespecified eligible inclusion criteria who underwent either BCS or mastectomy for nonmetastatic invasive breast cancer at oncology centers in the Kurdistan region of Iraq between the period 2016 and 2021.

Of 1,000 patients (median age, 47 years [range, 22-85 years]), 60.2% underwent mastectomy and 39.8% underwent BCS. The proportion of patients treated with NACT has increased over time, with 8.3% of patients receiving neoadjuvant treatment in 2016 compared with 14.2% in 2021. Similarly, BCS increased from 36.3% in 2016 to 43.7% in 2021. Most patients who underwent BCS had early breast cancer with low nodal involvement burden.

The increasing trends of BCS practice in LABC along with the increased use of NACT in the Kurdistan region in recent years comply with international guidelines. Our large multicenter, real-life series emphasizes the need to implement and discuss more conservative surgical approaches, enhanced with the broader use of NACT, through education and information programs for health providers and patients, in the context of multidisciplinary team discussions, to deliver high-quality, patient-centric breast cancer care.