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. 2018 Oct 22;13(10):e0206148.
doi: 10.1371/journal.pone.0206148. eCollection 2018.

Breast Cancer Mortality in Saudi Arabia: Modelling Observed and Unobserved Factors

Free PMC article

Breast Cancer Mortality in Saudi Arabia: Modelling Observed and Unobserved Factors

Refah Mohammed Alotaibi et al. PLoS One. .
Free PMC article


Background: Breast cancer is one of the most dangerous and frequently occurring cancers among women, and it also affects men. We aimed to determine the prevalence and factors associated with mortality among patients with breast cancer in Saudi Arabia.

Method: Data for this analysis of breast cancer mortality among Saudi Arabians were obtained from the Saudi Arabian Cancer Registry at the King Faisal Hospital and Research Centre. Both descriptive and inferential statistical analyses were conducted using proportions, chi-squared tests, and the Cox regression model. Frequentist and Bayesian inferential statistics were used to estimate the risk ratios. A frailty term was specified to control for suspected heterogeneity across regions. Bayesian and deviance information criteria were used to discriminate between the frequentist and Bayesian frailty models, respectively.

Results: Out of 5,411 patients, 708 (13.08%) deaths occurred that were attributable to breast cancer. Of those, 12 (1.69%) were men. Among patients who died of breast cancer, 353 (49.86%) had tumours that originated on the left side and 338 (47.74%) on the right side. In terms of the stage or extent of breast cancer, 318 (44.92%) deaths occurred among patients who had distant metastases, followed by 304 (42.94%) who had regional metastases and 86 (12.15%) with localized cancers. Men were 72% more likely than women to die from breast cancer. Divorcees were twice as likely to die, compared to their married counterparts. Patients whose tumours were classified as Grade IV had the highest mortality rate, which was 5.0 times higher than patients with Grade I tumours (credible interval (CrI); 1.577, 14.085) and 3.7 times higher than patients with Grade II tumours (CrI; 1.205, 9.434).

Conclusion: There is a high prevalence of breast cancer mortality among Saudi Arabian women, with the highest prevalence among divorced women. Though the prevalence of breast cancer mortality among men is lower than that of women, men had a higher risk of death. We therefore recommend an intensive health education programme for both men and women. These programmes should discuss the consequences of divorce, the prevalence of breast cancer among men, and early diagnoses and treatments for breast cancer.

Conflict of interest statement

The authors have declared that no competing interests exist.


Fig 1
Fig 1. Graphical representation of the Cox proportional hazards assumption with the extent or stage variable.
Fig 2
Fig 2. The Kaplan-Meier survival probability among men and women.
Fig 3
Fig 3. Kaplan-Meier survival probability on patients marital status.
Fig 4
Fig 4. Kaplan-Meier survival probability on patients with extent or stage of the cancer.

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Grant support

The author(s) received no specific funding for this work.