Epidemiological, Clinical, and Pathological Characteristics of Invasive Breast Cancer in Bedouin and Jewish Women in southern Israel: A Retrospective Comparative Study

Background: Invasive Breast Cancer (IBC) is a leading cause of cancer-related death among women in Israel, regardless of ethnicity. This study compared IBC epidemiological, clinical, and pathological characteristics in Bedouin and Jewish patients in southern Israel. Methods: Medical records of 1514 Jewish and 191 Bedouin women with IBC treated at Soroka Medical Center between 2014-2021 were analyzed retrospectively. Baseline measures and tumor characteristics were compared between groups. Overall survival (OS) was analyzed using log-rank test. Multivariate analysis was performed using Cox proportional hazard model. Results: Bedouins were diagnosed at a significantly younger age (median 48vs62 years, p<0.001), had a significantly larger tumor (median 2.5vs2.13cm, p<0.001), and significantly higher rate of metastasis (18.8%vs12.7%, p = 0.03). Interestingly, Bedouins had a lower death rate compared to Jews (20%vs30.9%, p = 0.029), but median OS showed no difference between groups. When comparing treatment options, both surgery (124.5vs29.6months, p<0.001) and radiation therapy were associated with better OS (109.5vs59.6months, p<0.001), while chemotherapy was associated with worse OS (95.5vs109.5months, p=0.001). In a multivariate analysis, Surgery and radiation therapy remained significant, while age, tumor size, triple negative status, and metastasis were associated with worse OS. Discussion: Despite a previous study showing worse OS for Bedouins than Jewish patients, we did not find a similar trend. This is likely due to improved cancer screening and prevention in Bedouin patients as a direct result of increased number of community clinics in Bedouin settlements. Moreover, Bedouins' access to healthcare improved as their lifestyle transformed from semi-nomadic to more modernized.