Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Apr 24, 2020; 11(4): 217-242
Published online Apr 24, 2020. doi: 10.5306/wjco.v11.i4.217
Correlation between breast cancer and lifestyle within the Gulf Cooperation Council countries: A systematic review
Lara Theresa Annette Tanner, Kwok Leung Cheung
Lara Theresa Annette Tanner, Kwok Leung Cheung, School of Medicine, University of Nottingham, Derby DE22 3DT, United Kingdom
Author contributions: Tanner LTA and Cheung KL wrote the manuscript; all authors approved the final version of the article.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors confirm that the manuscript was prepared according to the PRISMA 2009 checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kwok Leung Cheung, MD, Professor of Breast Surgery and Medical Education, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, United Kingdom. kl.cheung@nottingham.ac.uk
Received: December 18, 2019
Peer-review started: December 18, 2019
First decision: December 25, 2019
Revised: March 12, 2020
Accepted: March 26, 2020
Article in press: March 26, 2020
Published online: April 24, 2020
Abstract
BACKGROUND

In the six Gulf Cooperation Council countries (GCCCs), Bahrain, Saudi Arabia, Kuwait, Oman, Qatar and the United Arab Emirates, breast cancer (BC) is the greatest cause of cancer incidence and mortality. Obesity and physical inactivity are established risk factors for BC globally and appear to be more of a problem in high income countries like the GCCCs.

AIM

To determine whether obesity and physical inactivity are associated with BC incidence in the GCCCs using the United Kingdom as a comparator.

METHODS

This systematic review was carried out according to PRISMA guidelines. A cancer registry and a statistical data search was done to identify the BC incidence over the past two decades and the prevalence of obesity and physical inactivity in the GCCCs. Additionally, a systematic search of the databases, MEDLINE, Web of Science, and PubMed between 1999 and 2019 was performed to determine whether obesity and physical inactivity are risk factors for BC in the GCCCs. All papers were critically appraised according to their research methods and were assessed for quality and risk of bias.

RESULTS

BC was the top malignancy in each GCC country. Women tended to be diagnosed with BC at a younger age than women in the United Kingdom. The greatest 10-year increase in BC incidence was seen in Saudi Arabia (54.2%), approximately seven times the rate of increase seen in the United Kingdom (7.6%). The prevalence of obesity and physical inactivity was greater in all the GCCCs in comparison to the United Kingdom. A total of 155 full studies were reviewed of which 17 were included. Of those, eight looked at the prevalence of obesity and physical inactivity in the Gulf States and nine looked at these as risk factors for BC. Only one study found an association between BC and obesity (odds ratio = 2.29). No studies looked solely at the link between physical inactivity and BC.

CONCLUSION

The prevalence of obesity and physical inactivity was high within the GCCCs, but the majority of the included studies found no positive correlation between obesity or physical inactivity and BC. A high proportion of women in this study were pre-menopausal which could contribute to the negative findings.

Keywords: Breast cancer, Obesity, Physical inactivity, Females, Gulf Cooperation Council Countries

Core tip: Breast cancer (BC) is the most prolific female cancer worldwide with an estimated 2.08 million new cases and over half a million deaths reported in 2018. The Gulf Cooperation Council countries are a largely under researched region yet have experienced an incline in BC incidence over the past 20 years. The prevalence of obesity and physical inactivity in the Gulf region is significantly high, both of which are known risk factors for BC. A positive correlation between BC and these risk factors in the Middle East is currently inconclusive, highlighting the importance of more research within the Gulf Cooperation Council countries.