Breast cancer patterns in Saudi Arabia (2007–2022): a nationwide cancer registry surveillance study

Breast cancer patterns in Saudi Arabia (2007–2022): a nationwide cancer registry surveillance study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Breast cancer patterns in Saudi Arabia (2007–2022): a nationwide cancer registry surveillance study nuha alsaleh, Shatha Alderewish, Shima Maghdi, Maria Arafah, Mohamed Alghamdi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8707496/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Population-based cancer registry surveillance is essential for monitoring breast cancer burden and guiding cancer control planning; however, national surveillance evidence from Saudi Arabia remains limited. Using the Saudi Cancer Registry (SCR), we describe the distribution of age at diagnosis, geographic location, registry stage, histology, and grade among Saudi women diagnosed with breast cancer between 2007 and 2022. Methods We performed a retrospective descriptive study of all Saudi female breast cancer cases registered in the SCR from January 1, 2007, to December 31, 2022. The staging and other demographic variables collected for this analysis were each coded according to SEER guidelines. STATA version 16 was used for analyses, and descriptive statistics are presented as mean (± SD) for continuous variables and frequencies and percentages for categorical variables. Results The average age at diagnosis among 40,755 cases was approximately 50 years. The highest case volume was from Makkah, Riyadh, and the Eastern Province. Invasive ductal carcinoma (no special type) was most common, and grade II/III tumors were the most frequent. At diagnosis, about one-third were localized, while a considerable percentage had regional or distant involvement, with variation by age group and region. Conclusions National cancer registry surveillance show marked regional differences as well as continued incidence of late-stage diagnosis of breast cancer in Saudi Arabia. The findings advocate the need for a stronger emphasis on early detection, enhancing equitable access to diagnosis, and informing regional-specific cancer control planning. Trial registration: Not applicable. breast cancer cancer registry epidemiology stage at diagnosis Saudi Arabia Figures Figure 1 Figure 2 1. Introduction The most commonly diagnosed female cancer in the world is breast cancer, which is a prominent cause of cancer morbidity and mortality. Although survival and detection rates have improved in many high-income countries, there is still wide variation in detection by age, stage at diagnosis, and burden by geographical area, which is partly explained by differences in population structure, screening policies, and health system capacity [ 1 ]. One of the main ways these patterns are systematically recorded is through population-based cancer registries, which can generate reliable estimates of cancer burden over time and inform the planning of cancer control activities at the national level [ 2 ]. In Saudi Arabia, breast cancer is the leading reported cancer among women and is a large public health issue. Data from the National Registry show a continuous rise in reported incidence over the last decades, in parallel with rapid demographic shifts, urbanization, and greater access to health services [ 3 ]. Although studies exploring certain properties of breast cancer in institutional or regional samples exist, there is little recent research that adequately addresses national trends and long-term patterns. National registry surveillance is therefore essential to monitor stage at diagnosis and regional disparities, and to guide cancer control and early detection strategies. The Saudi Cancer Registry (SCR) was established to document and monitor the occurrence of cancer in all administrative districts in the country. Descriptive data of the cancer registries reports information on various demographic features, as well as on the tumor morphology, histological grade, and summary stage at diagnosis, all of which are coded following standardized manual instructions for classification, so that data can be efficiently compared to that of other regions or time periods [ 3 ]. While registry data lack information on molecular subtype, treatment, and outcomes, they do offer strong potential as a surveillance system for the burden of cancer and diagnostic patterns at the population level. Age distribution, regional distribution, histological pattern, and stage at diagnosis are important performance measures of a cancer control program, from the standpoint of public health and health system planning. Specifically, stage at diagnosis reflects disease awareness, screening attendance, diagnostic process, and oncology facility accessibility rather than just personal prognosis [ 4 ]. Chronic late-stage presentation may thus be an indicator of structural deficiencies in early detection, access to care, or diagnostic care. This population-based registry surveillance study uses Saudi Cancer Registry data to characterize breast cancer diagnosis patterns among Saudi women from 2007 to 2022. We describe trends in age at diagnosis, geographic distribution, histology, tumor grade, and SEER summary stage at diagnosis over the 17-year period. These findings aim to support cancer control planning, strengthen early detection strategies, and inform region-specific interventions to improve equitable access to diagnostic services. 2. Methods 2.1 Study Design and Setting This retrospective, population-based cancer registry surveillance study used data from the Saudi Cancer Registry (SCR) to describe national breast cancer diagnosis patterns in Saudi Arabia from 2007 to 2022. The SCR was created in 1992 as a national registry under the National Registries Department of the Saudi Health Council, Ministry of Health, Saudi Arabia. Cancer is a notifiable disease in the Kingdom, and all cancer cases must be registered at the national level in governmental, private, and military hospitals, clinics, and laboratories across all administrative provinces of the country. 2.2 Study Population The total sample size was 40,755 Saudi women who were diagnosed with primary breast cancer from January 1, 2007, through December 31, 2022. Cases were defined by topography codes ranging from C50.0 to C50.9 in the International Classification of Diseases for Oncology, Third Edition (ICD-O-3), which are specific locations for breast cancer. All non-Saudi patients and records with missing data with regard to sex and year of diagnosis were excluded. 2.3 Data Collection and Registry Scope Cancer data in patients were obtained from medical records and abstracted by SCR-certified tumor registrars only for those patients with clinical and/or histopathological evidence. Information on demographic characteristics, age at diagnosis, region of residence, as well as tumor morphology, histological grade, and stage at diagnosis has been consistently collected and coded using the SCRs’ standardized coding structures. Tumor grade, histology, and stage were categorized according to SEER standards. The registry is intended to provide baseline data for analysis and monitoring of cancer diagnosis trends over time at the population level. Information on molecular subtype (estrogen receptor, progesterone receptor, HER2) treatment, recurrence, and outcomes is not included in the SCR intentionally. Therefore, the analysis in this study was purposely limited to the measurable items reliably recorded by the cancer registry and within a system of surveillance and health care rather than one of diagnosis or prognosis. 2.4 Analytical Focus Age at diagnosis, time trends, geographic distribution, histology, and SEER summary stage at diagnosis were analyzed as public health surveillance indicators of breast cancer burden and diagnostic timing. Stage at diagnosis was explored not with regard to the individual's prognosis, but rather as a surveillance measure of diagnostic timing, screening uptake, and accessibility to oncology services by region. 2.5 Statistical Analysis The SCR supplied data in Microsoft Excel format, and these data sets were checked and cleaned, removing incomplete or duplicate records, prior to analysis. All statistical analyses used were conducted in STATA 16 software (StataCorp, College Station, TX; RRID: SCR_012763). Descriptive statistics, including means and standard deviations for continuous variables and frequencies and percentages for categorical variables, were used. Age-standardized incidence rates (ASRs) were calculated using the World Standard Population (WSP) to allow for comparison across regions. 2.6 Ethical Considerations This study was approved by the Institutional Review Board, King Saud University Medical City, King Saud University – College of Medicine, Riyadh, Saudi Arabia (Research Project No. E-25-9595; Ref. No. 25/0386/IRB; Approval date: 04 May 2025). The study utilized de-identified secondary registry data and did not require individual informed consent. 3. Results 3.1 Patient Characteristics, Age Distribution, and Geographic Distribution A total of 40,755 Saudi female breast cancer cases were registered in the Saudi Cancer Registry between 2007 and 2022. The mean age at diagnosis was 50.12 years (SD ± 12.99). Figure 1 below shows that the largest proportion of cases occurred among women aged 40–49 years (30.7%), followed by 50–59 years (26.5%); overall, 50.3% of cases were diagnosed before age 50. Regionally, the highest proportions of reported cases were from Makkah (25.5%), Riyadh (23.6%), and the Eastern Province (15.9%), representing nearly two-thirds of all cases during the study period. 3.2 Histological Subtypes, Tumor Grade, and Stage at Diagnosis Histological subtype distribution is presented in Table 1 below. Invasive ductal carcinoma of no special type (IDC–NST) was the most common morphology (76.7%). Other histological subtypes included invasive lobular carcinoma (5.8%), mixed invasive carcinoma (5.4%), and ductal carcinoma in situ (2.7%). Tumor grade distribution across age groups is shown in Supplementary Figure S1 . Stage at diagnosis was assessed using SEER summary stage categories. Approximately one-third of cases were diagnosed at localized stage, while a substantial proportion presented with regional involvement, and a smaller proportion were diagnosed at distant stage. Stage distribution differed by age group, with women aged ≤ 39 years more likely to present with regional or distant disease, and women aged ≥ 60 years more likely to be diagnosed at a localized stage (χ² test, p < 0.001). In multivariable logistic regression analysis, younger age at diagnosis remained associated with late-stage disease (AOR = 1.25, 95% CI 1.19–1.32). 3.3 Regional Variation in Incidence and Stage Distribution Age-standardized incidence rates (ASRs) and stage distribution differed across regions. The highest ASRs were reported in Makkah (31.5/100,000), Riyadh (30.2/100,000), and the Eastern Province (29.8/100,000). Lower ASRs were observed in southern regions such as Najran (21.8/100,000) and Jazan (22.3/100,000), with statistically significant variation across regions (p < 0.001) (Fig. 2). Stage distribution also varied by region, with a higher proportion of localized-stage diagnoses reported in more urbanized regions, while regional and distant-stage diagnoses were more frequent in peripheral regions. 4. Discussion This nationwide, retrospective population-based cancer registry surveillance study provides an overview of breast cancer diagnosis patterns among Saudi women over a 17-year period (2007–2022). A total of 40,755 cases were recorded in the Saudi Cancer Registry, with the largest case volume reported in Makkah, Riyadh, and the Eastern Province. Overall, the findings indicate a persistent burden of late-stage presentation at diagnosis alongside marked regional variation, highlighting the importance of strengthening early detection strategies and improving equitable diagnostic access as part of national cancer control planning. The observed increase in reported incidence over time may reflect improved detection, expanding access to diagnostic services, and strengthened cancer registration, although changes in underlying risk factors cannot be excluded [ 1 , 2 , 5 ]. The young age at diagnosis in the present study is reflected in the descriptive statistics above and suggests that breast cancer in Saudi Arabia is diagnosed at younger ages than in many Western populations [ 6 – 8 ]. More than half of the diagnoses were made before age 50, and the group of women at ages 40–49 had the highest number of diagnoses. This pattern deviates from the global age distributions in international cancer surveillance data and is also similar to what national registry-based studies from Saudi Arabia have reported, in which median ages at diagnosis were in the late forties to early fifties [ 1 , 6 ]. Differences in population age structure, screening practices, and health-care organization may contribute to this earlier age distribution and should be considered when planning age-appropriate early detection strategies. There was marked variation in stage at diagnosis by age and location. Younger women were more likely to be diagnosed with regional or distant-stage disease, while older women were more likely to present with localized disease. Stage at diagnosis is a key population-level surveillance indicator that reflects multiple health-system factors, including breast cancer awareness, screening uptake, diagnostic pathways, timeliness of referral, and access to oncology services [ 4 ]. Therefore, the higher proportion of locally advanced and metastatic tumors among younger women may reflect differences in early detection opportunities and diagnostic delays, although biological and clinical factors may also contribute [ 4 , 9 , 10 ]. There was also pronounced geographical heterogeneity in incidence and stage distribution. Higher age-standardized incidence rates and case volumes were observed in Makkah, Riyadh, and the Eastern Province, whereas lower incidence rates and higher proportions of late-stage cases were more prominent in peripheral regions. These geographic patterns may reflect differences in access to screening services, diagnostic imaging capacity, and referral pathways across regions, and they highlight the importance of region-specific strategies to strengthen early detection and improve equitable diagnostic access [ 11 , 12 ]. The histologic patterns observed in this registry surveillance study were generally consistent with global cancer registry reports, with invasive ductal carcinoma of no special type remaining the predominant morphology. The distribution of tumor grade and histologic subtypes aligns with findings from prior registry-based studies in Saudi Arabia and comparable settings [ 1 , 6 ]. These results reinforce the value of national cancer registries for monitoring population-level diagnostic patterns over time, while also highlighting the need to interpret registry data primarily as surveillance indicators rather than as direct measures of tumor biology or clinical outcomes. These findings have direct relevance for national cancer control planning and the strengthening of early detection efforts in Saudi Arabia. The high proportion of diagnoses among women aged 40–59 years, together with the persistent burden of late-stage presentation, supports prioritizing timely diagnostic pathways, awareness initiatives, and evidence-informed screening strategies. In addition, the observed regional disparities in incidence and stage distribution highlight the need for region-specific interventions to reduce inequities in access to early detection and diagnostic services across the country [ 12 , 13 ]. In the context of cancer control, population-level registry-based analyses are fundamental for routine monitoring of diagnostic patterns, early detection performance, and gaps in access to timely diagnosis. In settings where organized screening coverage is still developing, national registry surveillance can provide essential evidence on age-specific burden, stage distribution, and geographic disparities that may not be captured by institutional series. This information supports planning of screening strategies and allocation of resources, while future research should link registry surveillance with clinical and molecular data to strengthen risk stratification and outcome monitoring [ 12 , 13 ]. This study has several limitations. As a retrospective analysis of national cancer registry data, the available variables were limited to those routinely collected by the Saudi Cancer Registry, and information on molecular subtype, treatment, recurrence, and patient outcomes was not available. In addition, some potentially important clinical and socioeconomic variables were not captured in the registry dataset. Therefore, the findings should be interpreted primarily as population-level surveillance indicators of breast cancer burden and diagnostic patterns over time. However, key strengths include the nationwide scope, large sample size, and extended study period, which provide a robust platform for monitoring long-term trends and regional disparities in breast cancer diagnosis in Saudi Arabia. 5. Conclusion This nationwide cancer registry surveillance analysis of Saudi women diagnosed with breast cancer between 2007 and 2022 demonstrates a consistent pattern of younger age at diagnosis, regional variation in burden, and a persistent proportion of late-stage presentation. These findings support strengthening early detection pathways, improving equitable access to timely diagnostic services across regions, and guiding region-specific cancer control planning. Future work should integrate registry surveillance with clinical and molecular data to better understand risk profiles and outcomes and to inform targeted interventions. Abbreviations SCR - Saudi Cancer Registry SEER - Surveillance, Epidemiology, and End Results ASR - Age-standardized incidence rate WSP - World Standard Population ICD-O-3 - International Classification of Diseases for Oncology, Third Edition IDC–NST - Invasive ductal carcinoma, no special type ILC - Invasive lobular carcinoma DCIS - Ductal carcinoma in situ LCIS - Lobular carcinoma in situ Declarations Ethics Approval and Consent to Participate This study was approved by the Institutional Review Board, King Saud University Medical City, King Saud University – College of Medicine, Riyadh, Saudi Arabia (Research Project No. E-25-9595; Ref. No. 25/0386/IRB; Approval date: 04 May 2025). The study utilized de-identified secondary registry data and did not require individual informed consent. Availability of data and materials The data underlying this article are derived from the Saudi Cancer Registry (SCR). Access to these data is restricted; requests may be made directly to the SCR in accordance with their data-sharing policies. Competing interests The authors declare that they have no conflicts of interest relevant to this work. Funding This research received no external funding. Author Contributions TA contributed to conceptualization, project administration, supervision, and visualization. SA contributed to methodology, formal analysis, and software. MA contributed to data curation and investigation. SM contributed to validation. MAlg contributed to resources. NA drafted the original manuscript and led the review and editing process. Funding acquisition was not applicable. All authors read and approved the final manuscript. Acknowledgment: The authors thank the Saudi Cancer Registry for providing access to data used in this study. References Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74:229–63. https://doi.org/10.3322/caac.21834 . Parkin DM. The evolution of the population-based cancer registry. Nat Rev Cancer. 2006;6:603–12. https://doi.org/10.1038/nrc1948 . Al-Rawaji A, Al-Zamzami A, Al-nemari A, et al. Cancer Incidence Report: Saudi Arabia 2022. Saudi Arabia: Saudi Health Council; 2022. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391:1023–75. https://doi.org/10.1016/S0140-6736(17)33326-3 . Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/caac.21660 . Basudan A. Breast Cancer Incidence Patterns in the Saudi Female Population: A 17-Year Retrospective Analysis. Medicina. 2022;58:1617. https://doi.org/10.3390/medicina58111617 . DeSantis CE, Ma J, Gaudet MM, et al. Breast cancer statistics, 2019. CA Cancer J Clin. 2019;69:438–51. https://doi.org/10.3322/caac.21583 . El Saghir NS, Khalil MK, Eid T, et al. Trends in epidemiology and management of breast cancer in developing Arab countries: A literature and registry analysis. Int J Surg. 2007;5:225–33. https://doi.org/10.1016/j.ijsu.2006.06.015 . Anderson BO, Ilbawi AM, El Saghir NS. Breast Cancer in Low and Middle Income Countries (LMICs): A Shifting Tide in Global Health. Breast J. 2015;21:111–8. https://doi.org/10.1111/tbj.12357 . Sankaranarayanan R, Swaminathan R, Brenner H, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol. 2010;11:165–73. https://doi.org/10.1016/S1470-2045(09)70335-3 . Jemal A, Ward EM, Johnson CJ et al. Annual Report to the Nation on the Status of Cancer, 1975–2014, Featuring Survival. JNCI: Journal of the National Cancer Institute 2017;109. https://doi.org/10.1093/jnci/djx030 World Health Organization. Guide to cancer early diagnosis. Geneva: World Health Organization; 2017. Jensen OM, Parkin DM, MacLennan R, et al. editors. Cancer registration: principles and methods. Lyon: Internat. Agency for Research on Cancer [u.a.]; 1991. Table Table 1 The overall frequencies and percentages of different breast cancer morphologies Breast Cancer Morphology Frequency (n) Percentage (%) IDC, NST 31284 76.74 IDC, a special type 935 2.29 ILC 2373 5.82 ILC, special type 15 0.04 Salivary gland-type tumor 34 0.08 Neuroendocrine carcinoma 21 0.05 Mixed invasive carcinoma 2194 5.38 Invasive carcinoma, unspecified 1198 2.94 DCIS 1096 2.69 DCIS, special type 135 0.33 LCIS 104 0.26 LCIS, special type 0 0.0 Mixed in situ carcinoma 9 0.02 In-situ carcinoma, unspecified 22 0.05 Paget's disease 74 0.18 Phyllodes Malignant 270 0.66 Sarcoma 83 0.2 Neoplasm, malignant 918 2.25 Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigureS1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8707496","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":598424138,"identity":"1001485f-8911-42ce-b590-1f2252adb148","order_by":0,"name":"nuha alsaleh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYDCCA0DM2MDAwAekDjA22IC4jQeI0sIGYjM2pIG5JGk5DBfECfhuH2B7zLvDTp6N//CDAx93nLdb234YaEuNTTQuLZLnEtiNec8kG7ZJpBkcnHnmdvK2M4lALcfSchtwaDE4w8AmzdvGzNgmwWBwmLftdrLZAaAWoAsJaam3b+M//uHw37ZzyWbnHxKl5XBiG0OOwWHGtgN2ZjcI2CJ5hrFNcm7b8eQ2iZyCg71tyQlmN4C2JODxC98Z5mMSb9uqbfv5j2988LPNzt7sfPrDBx9qbHBqgUQKEkgEcxNwKscC7ElRPApGwSgYBSMDAAAXR2biIhjbPgAAAABJRU5ErkJggg==","orcid":"","institution":"King Saud University","correspondingAuthor":true,"prefix":"","firstName":"nuha","middleName":"","lastName":"alsaleh","suffix":""},{"id":598424139,"identity":"bc2445d5-c1ff-4435-8b7a-16eca940803c","order_by":1,"name":"Shatha Alderewish","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Shatha","middleName":"","lastName":"Alderewish","suffix":""},{"id":598424140,"identity":"7a1e0d94-1097-4e83-9978-ea18974f740d","order_by":2,"name":"Shima Maghdi","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Shima","middleName":"","lastName":"Maghdi","suffix":""},{"id":598424141,"identity":"4ddcadde-67b6-43ec-a912-4a717c12be40","order_by":3,"name":"Maria Arafah","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Arafah","suffix":""},{"id":598424142,"identity":"af98b4e6-913b-4972-9eb5-0588867271ed","order_by":4,"name":"Mohamed Alghamdi","email":"","orcid":"","institution":"hammadi hospital","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"Alghamdi","suffix":""},{"id":598424143,"identity":"eb6e131b-df72-4559-8787-425ecfe7beba","order_by":5,"name":"Tamrah Alrammah","email":"","orcid":"","institution":"third cluster health","correspondingAuthor":false,"prefix":"","firstName":"Tamrah","middleName":"","lastName":"Alrammah","suffix":""}],"badges":[],"createdAt":"2026-01-27 07:57:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8707496/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8707496/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104168444,"identity":"d1a32304-7fea-4c57-8b28-13c1baae7064","added_by":"auto","created_at":"2026-03-08 14:32:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114956,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eAge Distribution of Breast Cancer Cases Among Saudi Women Diagnosed Between 2007 and 2022\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8707496/v1/c66273e50050cb5b474da67b.png"},{"id":104168447,"identity":"75c0a884-c55b-48d5-a42c-2deba2fe10fa","added_by":"auto","created_at":"2026-03-08 14:32:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":93389,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eDistribution of Breast Cancer Stage at Diagnosis Among Saudi Women, 2007 - 2022\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8707496/v1/d442ad254186a57d8cabaa10.png"},{"id":105729121,"identity":"fb5fcc14-b59f-40b0-afc0-32e19bbc5417","added_by":"auto","created_at":"2026-03-30 11:13:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":838568,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8707496/v1/798ff6d7-e338-4dfe-a613-83591814f6af.pdf"},{"id":104168446,"identity":"50a5c1a1-d7a2-4e72-ac98-237c2dd66014","added_by":"auto","created_at":"2026-03-08 14:32:20","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":216002,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigureS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8707496/v1/8f79067bbd833fc42ffc9e08.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Breast cancer patterns in Saudi Arabia (2007–2022): a nationwide cancer registry surveillance study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe most commonly diagnosed female cancer in the world is breast cancer, which is a prominent cause of cancer morbidity and mortality. Although survival and detection rates have improved in many high-income countries, there is still wide variation in detection by age, stage at diagnosis, and burden by geographical area, which is partly explained by differences in population structure, screening policies, and health system capacity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. One of the main ways these patterns are systematically recorded is through population-based cancer registries, which can generate reliable estimates of cancer burden over time and inform the planning of cancer control activities at the national level [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Saudi Arabia, breast cancer is the leading reported cancer among women and is a large public health issue. Data from the National Registry show a continuous rise in reported incidence over the last decades, in parallel with rapid demographic shifts, urbanization, and greater access to health services [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although studies exploring certain properties of breast cancer in institutional or regional samples exist, there is little recent research that adequately addresses national trends and long-term patterns. National registry surveillance is therefore essential to monitor stage at diagnosis and regional disparities, and to guide cancer control and early detection strategies.\u003c/p\u003e \u003cp\u003eThe Saudi Cancer Registry (SCR) was established to document and monitor the occurrence of cancer in all administrative districts in the country. Descriptive data of the cancer registries reports information on various demographic features, as well as on the tumor morphology, histological grade, and summary stage at diagnosis, all of which are coded following standardized manual instructions for classification, so that data can be efficiently compared to that of other regions or time periods [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While registry data lack information on molecular subtype, treatment, and outcomes, they do offer strong potential as a surveillance system for the burden of cancer and diagnostic patterns at the population level.\u003c/p\u003e \u003cp\u003eAge distribution, regional distribution, histological pattern, and stage at diagnosis are important performance measures of a cancer control program, from the standpoint of public health and health system planning. Specifically, stage at diagnosis reflects disease awareness, screening attendance, diagnostic process, and oncology facility accessibility rather than just personal prognosis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Chronic late-stage presentation may thus be an indicator of structural deficiencies in early detection, access to care, or diagnostic care.\u003c/p\u003e \u003cp\u003eThis population-based registry surveillance study uses Saudi Cancer Registry data to characterize breast cancer diagnosis patterns among Saudi women from 2007 to 2022. We describe trends in age at diagnosis, geographic distribution, histology, tumor grade, and SEER summary stage at diagnosis over the 17-year period. These findings aim to support cancer control planning, strengthen early detection strategies, and inform region-specific interventions to improve equitable access to diagnostic services.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design and Setting\u003c/h2\u003e \u003cp\u003eThis retrospective, population-based cancer registry surveillance study used data from the Saudi Cancer Registry (SCR) to describe national breast cancer diagnosis patterns in Saudi Arabia from 2007 to 2022. The SCR was created in 1992 as a national registry under the National Registries Department of the Saudi Health Council, Ministry of Health, Saudi Arabia. Cancer is a notifiable disease in the Kingdom, and all cancer cases must be registered at the national level in governmental, private, and military hospitals, clinics, and laboratories across all administrative provinces of the country.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Population\u003c/h2\u003e \u003cp\u003eThe total sample size was 40,755 Saudi women who were diagnosed with primary breast cancer from January 1, 2007, through December 31, 2022. Cases were defined by topography codes ranging from C50.0 to C50.9 in the International Classification of Diseases for Oncology, Third Edition (ICD-O-3), which are specific locations for breast cancer. All non-Saudi patients and records with missing data with regard to sex and year of diagnosis were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data Collection and Registry Scope\u003c/h2\u003e \u003cp\u003eCancer data in patients were obtained from medical records and abstracted by SCR-certified tumor registrars only for those patients with clinical and/or histopathological evidence. Information on demographic characteristics, age at diagnosis, region of residence, as well as tumor morphology, histological grade, and stage at diagnosis has been consistently collected and coded using the SCRs\u0026rsquo; standardized coding structures. Tumor grade, histology, and stage were categorized according to SEER standards.\u003c/p\u003e \u003cp\u003eThe registry is intended to provide baseline data for analysis and monitoring of cancer diagnosis trends over time at the population level. Information on molecular subtype (estrogen receptor, progesterone receptor, HER2) treatment, recurrence, and outcomes is not included in the SCR intentionally. Therefore, the analysis in this study was purposely limited to the measurable items reliably recorded by the cancer registry and within a system of surveillance and health care rather than one of diagnosis or prognosis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Analytical Focus\u003c/h2\u003e \u003cp\u003eAge at diagnosis, time trends, geographic distribution, histology, and SEER summary stage at diagnosis were analyzed as public health surveillance indicators of breast cancer burden and diagnostic timing. Stage at diagnosis was explored not with regard to the individual's prognosis, but rather as a surveillance measure of diagnostic timing, screening uptake, and accessibility to oncology services by region.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe SCR supplied data in Microsoft Excel format, and these data sets were checked and cleaned, removing incomplete or duplicate records, prior to analysis. All statistical analyses used were conducted in STATA 16 software (StataCorp, College Station, TX; RRID: SCR_012763). Descriptive statistics, including means and standard deviations for continuous variables and frequencies and percentages for categorical variables, were used. Age-standardized incidence rates (ASRs) were calculated using the World Standard Population (WSP) to allow for comparison across regions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Ethical Considerations\u003c/h2\u003e \u003cp\u003eThis study was approved by the Institutional Review Board, King Saud University Medical City, King Saud University \u0026ndash; College of Medicine, Riyadh, Saudi Arabia (Research Project No. E-25-9595; Ref. No. 25/0386/IRB; Approval date: 04 May 2025). The study utilized de-identified secondary registry data and did not require individual informed consent.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Patient Characteristics, Age Distribution, and Geographic Distribution\u003c/h2\u003e \u003cp\u003eA total of 40,755 Saudi female breast cancer cases were registered in the Saudi Cancer Registry between 2007 and 2022. The mean age at diagnosis was 50.12 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;12.99). Figure\u0026nbsp;1 below shows that the largest proportion of cases occurred among women aged 40\u0026ndash;49 years (30.7%), followed by 50\u0026ndash;59 years (26.5%); overall, 50.3% of cases were diagnosed before age 50. Regionally, the highest proportions of reported cases were from Makkah (25.5%), Riyadh (23.6%), and the Eastern Province (15.9%), representing nearly two-thirds of all cases during the study period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Histological Subtypes, Tumor Grade, and Stage at Diagnosis\u003c/h2\u003e \u003cp\u003eHistological subtype distribution is presented in Table\u0026nbsp;1 below. Invasive ductal carcinoma of no special type (IDC\u0026ndash;NST) was the most common morphology (76.7%). Other histological subtypes included invasive lobular carcinoma (5.8%), mixed invasive carcinoma (5.4%), and ductal carcinoma in situ (2.7%). Tumor grade distribution across age groups is shown in Supplementary Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eStage at diagnosis was assessed using SEER summary stage categories. Approximately one-third of cases were diagnosed at localized stage, while a substantial proportion presented with regional involvement, and a smaller proportion were diagnosed at distant stage. Stage distribution differed by age group, with women aged\u0026thinsp;\u0026le;\u0026thinsp;39 years more likely to present with regional or distant disease, and women aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years more likely to be diagnosed at a localized stage (χ\u0026sup2; test, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In multivariable logistic regression analysis, younger age at diagnosis remained associated with late-stage disease (AOR\u0026thinsp;=\u0026thinsp;1.25, 95% CI 1.19\u0026ndash;1.32).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Regional Variation in Incidence and Stage Distribution\u003c/h2\u003e \u003cp\u003eAge-standardized incidence rates (ASRs) and stage distribution differed across regions. The highest ASRs were reported in Makkah (31.5/100,000), Riyadh (30.2/100,000), and the Eastern Province (29.8/100,000). Lower ASRs were observed in southern regions such as Najran (21.8/100,000) and Jazan (22.3/100,000), with statistically significant variation across regions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;2). Stage distribution also varied by region, with a higher proportion of localized-stage diagnoses reported in more urbanized regions, while regional and distant-stage diagnoses were more frequent in peripheral regions.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis nationwide, retrospective population-based cancer registry surveillance study provides an overview of breast cancer diagnosis patterns among Saudi women over a 17-year period (2007\u0026ndash;2022). A total of 40,755 cases were recorded in the Saudi Cancer Registry, with the largest case volume reported in Makkah, Riyadh, and the Eastern Province. Overall, the findings indicate a persistent burden of late-stage presentation at diagnosis alongside marked regional variation, highlighting the importance of strengthening early detection strategies and improving equitable diagnostic access as part of national cancer control planning. The observed increase in reported incidence over time may reflect improved detection, expanding access to diagnostic services, and strengthened cancer registration, although changes in underlying risk factors cannot be excluded [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe young age at diagnosis in the present study is reflected in the descriptive statistics above and suggests that breast cancer in Saudi Arabia is diagnosed at younger ages than in many Western populations [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. More than half of the diagnoses were made before age 50, and the group of women at ages 40\u0026ndash;49 had the highest number of diagnoses. This pattern deviates from the global age distributions in international cancer surveillance data and is also similar to what national registry-based studies from Saudi Arabia have reported, in which median ages at diagnosis were in the late forties to early fifties [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Differences in population age structure, screening practices, and health-care organization may contribute to this earlier age distribution and should be considered when planning age-appropriate early detection strategies.\u003c/p\u003e \u003cp\u003eThere was marked variation in stage at diagnosis by age and location. Younger women were more likely to be diagnosed with regional or distant-stage disease, while older women were more likely to present with localized disease. Stage at diagnosis is a key population-level surveillance indicator that reflects multiple health-system factors, including breast cancer awareness, screening uptake, diagnostic pathways, timeliness of referral, and access to oncology services [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, the higher proportion of locally advanced and metastatic tumors among younger women may reflect differences in early detection opportunities and diagnostic delays, although biological and clinical factors may also contribute [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere was also pronounced geographical heterogeneity in incidence and stage distribution. Higher age-standardized incidence rates and case volumes were observed in Makkah, Riyadh, and the Eastern Province, whereas lower incidence rates and higher proportions of late-stage cases were more prominent in peripheral regions. These geographic patterns may reflect differences in access to screening services, diagnostic imaging capacity, and referral pathways across regions, and they highlight the importance of region-specific strategies to strengthen early detection and improve equitable diagnostic access [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe histologic patterns observed in this registry surveillance study were generally consistent with global cancer registry reports, with invasive ductal carcinoma of no special type remaining the predominant morphology. The distribution of tumor grade and histologic subtypes aligns with findings from prior registry-based studies in Saudi Arabia and comparable settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These results reinforce the value of national cancer registries for monitoring population-level diagnostic patterns over time, while also highlighting the need to interpret registry data primarily as surveillance indicators rather than as direct measures of tumor biology or clinical outcomes.\u003c/p\u003e \u003cp\u003eThese findings have direct relevance for national cancer control planning and the strengthening of early detection efforts in Saudi Arabia. The high proportion of diagnoses among women aged 40\u0026ndash;59 years, together with the persistent burden of late-stage presentation, supports prioritizing timely diagnostic pathways, awareness initiatives, and evidence-informed screening strategies. In addition, the observed regional disparities in incidence and stage distribution highlight the need for region-specific interventions to reduce inequities in access to early detection and diagnostic services across the country [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the context of cancer control, population-level registry-based analyses are fundamental for routine monitoring of diagnostic patterns, early detection performance, and gaps in access to timely diagnosis. In settings where organized screening coverage is still developing, national registry surveillance can provide essential evidence on age-specific burden, stage distribution, and geographic disparities that may not be captured by institutional series. This information supports planning of screening strategies and allocation of resources, while future research should link registry surveillance with clinical and molecular data to strengthen risk stratification and outcome monitoring [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has several limitations. As a retrospective analysis of national cancer registry data, the available variables were limited to those routinely collected by the Saudi Cancer Registry, and information on molecular subtype, treatment, recurrence, and patient outcomes was not available. In addition, some potentially important clinical and socioeconomic variables were not captured in the registry dataset. Therefore, the findings should be interpreted primarily as population-level surveillance indicators of breast cancer burden and diagnostic patterns over time. However, key strengths include the nationwide scope, large sample size, and extended study period, which provide a robust platform for monitoring long-term trends and regional disparities in breast cancer diagnosis in Saudi Arabia.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis nationwide cancer registry surveillance analysis of Saudi women diagnosed with breast cancer between 2007 and 2022 demonstrates a consistent pattern of younger age at diagnosis, regional variation in burden, and a persistent proportion of late-stage presentation. These findings support strengthening early detection pathways, improving equitable access to timely diagnostic services across regions, and guiding region-specific cancer control planning. Future work should integrate registry surveillance with clinical and molecular data to better understand risk profiles and outcomes and to inform targeted interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eSCR -\u0026nbsp;\u003c/strong\u003eSaudi Cancer Registry\u003cbr\u003e\u003cstrong\u003eSEER -\u003c/strong\u003e Surveillance, Epidemiology, and End Results\u003cbr\u003e\u003cstrong\u003eASR -\u003c/strong\u003e Age-standardized incidence rate\u003cbr\u003e\u003cstrong\u003eWSP -\u003c/strong\u003e World Standard Population\u003cbr\u003e\u003cstrong\u003eICD-O-3 -\u003c/strong\u003e International Classification of Diseases for Oncology, Third Edition\u003cbr\u003e\u003cstrong\u003eIDC\u0026ndash;NST -\u003c/strong\u003e Invasive ductal carcinoma, no special type\u003cbr\u003e\u003cstrong\u003eILC -\u003c/strong\u003e Invasive lobular carcinoma\u003cbr\u003e\u003cstrong\u003eDCIS -\u0026nbsp;\u003c/strong\u003eDuctal carcinoma in situ\u003cbr\u003e\u003cstrong\u003eLCIS -\u003c/strong\u003e Lobular carcinoma in situ\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board, King Saud University Medical City, King Saud University – College of Medicine, Riyadh, Saudi Arabia (Research Project No. E-25-9595; Ref. No. 25/0386/IRB; Approval date: 04 May 2025). The study utilized de-identified secondary registry data and did not require individual informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data underlying this article are derived from the Saudi Cancer Registry (SCR). Access to these data is restricted; requests may be made directly to the SCR in accordance with their data-sharing policies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest relevant to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTA contributed to conceptualization, project administration, supervision, and visualization. SA contributed to methodology, formal analysis, and software. MA contributed to data curation and investigation. SM contributed to validation. MAlg contributed to resources. NA drafted the original manuscript and led the review and editing process. Funding acquisition was not applicable. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the Saudi Cancer Registry for providing access to data used in this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74:229\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3322/caac.21834\u003c/span\u003e\u003cspan address=\"10.3322/caac.21834\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParkin DM. The evolution of the population-based cancer registry. Nat Rev Cancer. 2006;6:603\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/nrc1948\u003c/span\u003e\u003cspan address=\"10.1038/nrc1948\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Rawaji A, Al-Zamzami A, Al-nemari A, et al. Cancer Incidence Report: Saudi Arabia 2022. Saudi Arabia: Saudi Health Council; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000\u0026ndash;14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391:1023\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(17)33326-3\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(17)33326-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209\u0026ndash;49. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3322/caac.21660\u003c/span\u003e\u003cspan address=\"10.3322/caac.21660\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasudan A. Breast Cancer Incidence Patterns in the Saudi Female Population: A 17-Year Retrospective Analysis. Medicina. 2022;58:1617. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/medicina58111617\u003c/span\u003e\u003cspan address=\"10.3390/medicina58111617\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeSantis CE, Ma J, Gaudet MM, et al. Breast cancer statistics, 2019. CA Cancer J Clin. 2019;69:438\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3322/caac.21583\u003c/span\u003e\u003cspan address=\"10.3322/caac.21583\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Saghir NS, Khalil MK, Eid T, et al. Trends in epidemiology and management of breast cancer in developing Arab countries: A literature and registry analysis. Int J Surg. 2007;5:225\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijsu.2006.06.015\u003c/span\u003e\u003cspan address=\"10.1016/j.ijsu.2006.06.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson BO, Ilbawi AM, El Saghir NS. Breast Cancer in Low and Middle Income Countries (LMICs): A Shifting Tide in Global Health. Breast J. 2015;21:111\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/tbj.12357\u003c/span\u003e\u003cspan address=\"10.1111/tbj.12357\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSankaranarayanan R, Swaminathan R, Brenner H, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol. 2010;11:165\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S1470-2045(09)70335-3\u003c/span\u003e\u003cspan address=\"10.1016/S1470-2045(09)70335-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJemal A, Ward EM, Johnson CJ et al. Annual Report to the Nation on the Status of Cancer, 1975\u0026ndash;2014, Featuring Survival. JNCI: Journal of the National Cancer Institute 2017;109. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/jnci/djx030\u003c/span\u003e\u003cspan address=\"10.1093/jnci/djx030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Guide to cancer early diagnosis. Geneva: World Health Organization; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJensen OM, Parkin DM, MacLennan R, et al. editors. Cancer registration: principles and methods. Lyon: Internat. Agency for Research on Cancer [u.a.]; 1991.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003cem\u003eThe overall frequencies and percentages of different breast cancer morphologies\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"594\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast Cancer Morphology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eIDC, NST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e31284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e76.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eIDC, a special type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eILC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e2373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e5.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eILC, special type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eSalivary gland-type tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eNeuroendocrine carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eMixed invasive carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e2194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e5.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eInvasive carcinoma, unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e1198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eDCIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e1096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eDCIS, special type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eLCIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eLCIS, special type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eMixed in situ carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eIn-situ carcinoma, unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003ePaget\u0026apos;s disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003ePhyllodes Malignant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eSarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eNeoplasm, malignant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"breast cancer, cancer registry, epidemiology, stage at diagnosis, Saudi Arabia","lastPublishedDoi":"10.21203/rs.3.rs-8707496/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8707496/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePopulation-based cancer registry surveillance is essential for monitoring breast cancer burden and guiding cancer control planning; however, national surveillance evidence from Saudi Arabia remains limited. Using the Saudi Cancer Registry (SCR), we describe the distribution of age at diagnosis, geographic location, registry stage, histology, and grade among Saudi women diagnosed with breast cancer between 2007 and 2022.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe performed a retrospective descriptive study of all Saudi female breast cancer cases registered in the SCR from January 1, 2007, to December 31, 2022. The staging and other demographic variables collected for this analysis were each coded according to SEER guidelines. STATA version 16 was used for analyses, and descriptive statistics are presented as mean (\u0026plusmn;\u0026thinsp;SD) for continuous variables and frequencies and percentages for categorical variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe average age at diagnosis among 40,755 cases was approximately 50 years. The highest case volume was from Makkah, Riyadh, and the Eastern Province. Invasive ductal carcinoma (no special type) was most common, and grade II/III tumors were the most frequent. At diagnosis, about one-third were localized, while a considerable percentage had regional or distant involvement, with variation by age group and region.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNational cancer registry surveillance show marked regional differences as well as continued incidence of late-stage diagnosis of breast cancer in Saudi Arabia. The findings advocate the need for a stronger emphasis on early detection, enhancing equitable access to diagnosis, and informing regional-specific cancer control planning.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Breast cancer patterns in Saudi Arabia (2007–2022): a nationwide cancer registry surveillance study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 14:32:15","doi":"10.21203/rs.3.rs-8707496/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"244d95cb-f7fb-4150-91e2-08036c9f8966","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T07:43:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 14:32:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8707496","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8707496","identity":"rs-8707496","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}