Evaluating the Success of Current Standard of Care in Breast Cancer Treatment: A Retrospective Study in Bangladesh
Authors: Md Arifur Rahman, Qamruzzaman Chowdhury, Ferodus Ara Begum, Ayasha Shiddika, Md Nurunnabi (Roney), Sharmin Akhter Rupa, Mashud Pervez, S. M. Khodeza Nahar Begum, Salma Sultana
Institution: Bangladesh Specialized Hospital
Introduction
Breast cancer remains a leading cause of morbidity and mortality among women globally, with significant disparities in outcomes between high-income and low- and middle-income countries (LMICs). In Bangladesh, late-stage diagnoses and limited access to targeted therapies contribute to poor survival rates. This study aims to evaluate the effectiveness of the current standard-of-care breast cancer treatment in Bangladesh, with a particular focus on luminal subtypes, disease progression, and survival outcomes.
Methods
This retrospective observational study was conducted at Bangladesh Specialized Hospital, analyzing the medical records of 1,088 breast cancer patients. Data on patient demographics, tumor characteristics, treatment protocols, and survival outcomes were extracted. Kaplan-Meier survival analysis and the Cox proportional hazards model were employed to assess progression-free survival (PFS) and overall survival (OS) across luminal subtypes.
Results
Among the study population, Luminal A was the most common subtype (38.60%), followed by TNBC (22.89%) and Luminal B subtypes (19.76%). HER2-positive subtypes accounted for 11.58% of cases. Kaplan-Meier analysis revealed that Luminal A had the most favorable prognosis (68.06% survival at 365 days), whereas HER2-positive and TNBC subtypes exhibited the worst survival outcomes (17% and 22.89% survival, respectively). The Cox proportional hazards model confirmed that Luminal A had a statistically significant protective effect (HR: 0.25, 95% CI: 0.09-0.73, p=0.01), whereas HER2-positive patients had a fourfold higher risk of progression compared to Luminal A. Patients with stable disease had a median PFS of 407.5 days, while those with disease progression had a median PFS of only 75.0 days. Treatment patterns revealed that radiation therapy (50.55%) and chemotherapy (40.44%) were the most commonly administered modalities, while lumpectomy was performed in 38.97% of patients.
Conclusion
This study highlights significant disparities in breast cancer treatment efficacy and survival outcomes based on molecular subtypes in Bangladesh. Luminal A subtypes demonstrated the best prognosis, while HER2-positive and TNBC cases exhibited the highest progression risks. The limited availability of targeted therapies and inconsistent surgical practices may contribute to suboptimal outcomes in high-risk subtypes. Integration of molecular subtyping, expansion of targeted therapy access, and improvements in early detection programs are crucial for optimizing breast cancer care in resource-limited settings.
