An increase that also affects young women

Breast cancer is diagnosed in an increasing number of women in Lebanon, and the reported progression in patients under the age of 50 is particularly noteworthy. Professor Naji Saghir, head of the department of haematology and oncology at the medical centre of the American University of Beirut, reports that more than 3,000 cases are now registered each year, compared with less than 1,000 a few years ago. It also highlights an increase in diagnoses among younger women. However, these observations do not mean that all generations are experiencing the same increase in risk: they combine the real evolution of the disease, better identification of cases and changes in access to examinations. The distinction is decisive in understanding what is happening in Lebanon, without turning a worrying trend into insufficiently substantiated statistical certainty.

The 50-year threshold does not mark a biological boundary between two different diseases. It is used here to identify a category of patients whose presence appears to be more visible among new diagnoses. Medical evidence does not provide the exact proportion of cases occurring before that age, nor does it provide a detailed annual series by age group. It would therefore be abusive to announce that young patients now represent a majority or to calculate a precise rate of progression. Stronger information is more limited: the overall number of diagnoses is increasing and specialists are seeing more cases in women under the age of 50. To go further, rates reported to the female population of each age should be compared, not only the gross number of cases received by hospitals.

From 1,000 to 3,000 cases: what the number actually measures

The shift from less than 1,000 to more than three thousand annual cases is the most spectacular figure in the alert. However, it should not be read as a threefold increase in individual risk. Part of the increase may reflect better awareness, more consultation and more frequent detection of previously ignored tumours. Professor Saghir explicitly acknowledges that the evolution of diagnostics contributes to the observed increase. To properly interpret this progression, it would be necessary to know the comparative periods, the methods of recording, the coverage of registers and the distribution of cases by age. The available evidence does not provide these details, which precludes a definitive epidemiological conclusion.

However, the gross figure remains important for the organization of care. More patients diagnosed mean more specialized consultations, anatomopathological examinations, operations, drug treatments and prolonged follow-up. An increase in cases may also increase the need for psychological support and social support, especially for women who work or raise children. Even when improved screening explains part of the progression, the health system must absorb additional records. The issue is therefore twofold: whether the risk actually increases, but also ensuring that each diagnosis gives access to rapid and continuous management.

Still uncertain causes, factors to study

The causes of the observed increase are not fully established. The specialist refers to a phenomenon that goes beyond Lebanon and also concerns other cancers, including those of the colon and lung. The hypothesis of exposure to pollutants is discussed in the interview, with a reminder of their possible effects on cell DNA. But this explanation is not evidence that pollution would be responsible for the increase in breast cancer among Lebanese women under the age of 50. A cause-effect relationship would require studies comparing exposures, history, lifestyles and disease rates. Consolidating a plausible biological pathway with a proven cause would be an abusive simplification of a complex phenomenon.

The issue of young women also requires special attention to the family history and characteristics of tumours, without assuming that all early cancers are hereditary. Individual factors and living conditions can vary considerably from patient to patient. Age at diagnosis is not sufficient to establish the origin of a disease. For public health officials, the priority should be to have sufficient data to separate diagnosed cases before the age of 40, between the ages of 49 and 50. This would make it possible to observe trends more accurately and adapt information strategies to the groups concerned.

Economic crisis reduces early diagnosis

The Lebanese paradox is of particular concern: treatment is progressing, but economic difficulties undermine access to examinations. Professor Saghir observed a decline in early diagnosis since the financial crisis, in different categories of population. Income constraints and spending on daily living can cause women to postpone a consultation, imaging exam or follow-up appointment. This delay does not necessarily mean a lack of awareness. An individual may be aware of the importance of testing while abandoning an examination for financial or logistical reasons. The problem, therefore, is not simply to convince women to consult: it is also necessary to make the consultation really accessible.

The consequences of late diagnosis can be considerable. A tumor detected at a limited stage can sometimes be treated with conservative surgery and appropriate care. When the disease is discovered later, therapeutic options can become heavier and follow-up needs more complex. However, it should not be assumed that any woman who has postponed her examination will develop an advanced form: evolutions vary according to tumour biology. The fact remains that late access reduces the possibility of receiving the most suitable treatments on time. In the Lebanese context, the continuity of consultations, the availability of reviews and financial support are therefore becoming as important as awareness-raising campaigns.

Surgical progress reduces the scope of some interventions

The evolution of operational techniques is one of the most concrete changes described by Professor Saghir. For some patients, partial breast surgery associated with radiation therapy may provide a therapeutic outcome comparable to that of complete ablation. However, this possibility depends on the characteristics of the tumour, its extent and medical indications. It does not mean that mastectomy has become useless, nor that all women can choose between the two interventions. The decision is based on an individualised clinical evaluation. The advantage of this progress is to allow, where conditions permit, less mutilating treatment without abandoning the disease control objective.

Treatment of lymph nodes has also evolved. When a tumor is small, the medical team can focus on the analysis of the sentinel ganglion, rather than systematically removing all the ganglions from the breast. If the results allow, more extensive intervention can be avoided. This approach potentially reduces some of the sequelae of ganglionary surgery. Again, the indications depend on the medical record and the results of the examinations. Progress is not the application of a single procedure to all patients, but the ability to adjust the intervention to the true extent of the disease.

Pronostic, relapse and treatments: figures to be interpreted with caution

The specialist points to improved therapeutic outcomes. It refers to recovery rates of at least 80-90% for early-stage cancers and a range of 30-50% for third-stage cancers. These values are reported in a clinical interview and are not standardized national rates for all Lebanese patients. Their interpretation depends in particular on the definition of recovery, the type of tumour, the treatment received and the duration of follow-up. However, they illustrate the significant gap between early detection and more advanced disease, as well as progress in management.

The risk of disease returning after five years is also presented as highly variable, with a range of 10 to 50% depending on the case. Such a wide range cannot be used to predict the fate of a particular patient. Rather, it reflects the diversity of breast cancers. Medical teams use the biological characteristics of the tumour and, in some situations, genomic tests to refine the risk assessment. Hormonal receptors, among other things, help guide therapeutic decisions. This individualization can help avoid chemotherapy when it does not provide sufficient benefit, or recommend it when it appears necessary. The decision cannot be inferred from the patient’s age alone.

Modern treatments open up possibilities, provided access to them

Progress is not limited to surgery. Professor Saghir mentioned the improvement of hormonal treatments and medicines that can curb the multiplication of cancer cells. Some approaches can be used after initial treatment to reduce the risk of recurrence, depending on the characteristics of the disease. Therapeutic opportunities have also expanded for advanced cancers, with treatments that sometimes prolong survival and maintain a satisfactory quality of life. This evolution should not be presented as a guaranteed cure. The choice of drugs depends on specific medical parameters and individual response to treatments.

In Lebanon, the decisive question is real access to these innovations. A drug available in the medical literature is not necessarily accessible to all patients. Cost, financial coverage, supply disruptions and the need for regular consultations can create inequalities. The interview places particular emphasis on the decline in early diagnosis since the economic crisis; it does not provide an quantified balance sheet of salary interruptions or expenses incurred by families. Therefore, these difficulties should not be presented as quantified when they are not. On the other hand, they are essential questions for measuring the gap between scientific progress and their concrete benefit to patients.

Testing for children under the age of 50 requires an appropriate response

The observed increase in diagnoses before 50 years requires examination of screening and guidance. A campaign designed primarily for older women may not respond to all the situations encountered in young patients. But it would be equally imprudent to recommend an identical examination, at the same age and frequency, for all women. Personal history, family history and risk factors influence the behaviour to be maintained. Medical consultation allows for the assessment of these elements and the selection of appropriate examinations, if necessary. The public health message must therefore combine vigilance and precision, without multiplying unnecessary examinations or trivializing the signs that merit evaluation.

The problem is not limited to the age of the first examination. It also concerns the time between an abnormality found and obtaining a diagnosis, then between diagnosis and the beginning of treatment. In order to measure progress, health authorities should follow these deadlines, as well as the proportion of cancers detected at different stages. The figures quoted by the specialist give a warning signal, but they are not sufficient to establish a detailed national strategy. The documentary priority remains the publication of recent data, comparable and disaggregated by age. It is on this condition that concern about women under the age of 50 can be translated into measurable health decisions.