Clinicopathologic features of invasive lobular breast carcinoma in Syria: An epidemiological analysis from the country’s main cancer center in 2025.

Abstract

e13032 Background: Invasive lobular carcinoma (ILC) is a distinct histological subtype of breast cancer that arises from the lobules. ILC accounts for approximately 10–15 % of all invasive breast cancers worldwide. Global epidemiological data on ILC indicates increased incidence rates over recent decades, likely influenced by improved detection methods. However, comprehensive population-based data on ILC in Syria and similar conflict-affected health systems remain limited. Methods: This retrospective study analyzed data from Al-Bairouni University Hospital, Syria’s main cancer center. It serves 65-70% cases nationwide. We included all patients diagnosed with primary Invasive Lobular Carcinoma in the Breast between January 1 and December 31, 2025. Abstracted variables included demographics (age, governorate of residence) and tumor data (stage, grade). Institutional ethical approval was obtained prior to data collection. Results: A total of 189 patients were diagnosed with ILC of the breast during 2025 (Table 1). The average age at diagnosis was 54.1 years, 3.7% of patients were Male, and 22.7% were smokers. At presentation, 81% were high grade, and 28.7% of all cases had advanced/metastatic disease. Ki-67 testing was unavailable in approximately 40% of cases. The highest patient load originated from Damascus (48.1%) and Rural Damascus (9%), followed by the central governorates of Homs and Hama (10%). Notably, patients from more distant and underserved governorates such as Deir ez-Zor (3.2%), Aleppo (8%), and Al-Hasakeh with Raqqa (8%) accounted for a significant proportion of the cancers presenting to our center. Analysis revealed significant differences in advanced disease rates at diagnosis across molecular subtypes (χ²(3) = 8.65, p = 0.034), with a linear trend of increasing metastatic presentation from Luminal A (18%) to Triple Negative (40%) (p = 0.012). No significant differences were observed in age, gender distribution, smoking rates, or tumor grade across subtypes. Caution is warranted in interpreting Triple Negative results due to the small sample size (n = 10). Conclusions: This study represents the first comprehensive analysis of invasive lobular carcinoma in Syria. Notably, a high prevalence of high-grade tumors was observed, which may reflect diagnostic limitations. In addition to lack of long-term follow-up which makes it difficult to assess overall and disease-free survival, underscoring the need for improved oncologic infrastructure and cancer registries in resource-limited settings. Disease characteristics. Diagnosis 2025 Cases Male cases Average Age Smokers (%) High grade (2,3 grade) Advanced/Metastatic at diagnosis Luminal A 72 3 53.1 25% 84.3% 18% Luminal B 73 3 54.5 23.2% 79% 24.3% HER2 Enriched 34 1 55.6 17.7% 81% 32.3% Triple Negative 10 0 52.2 20% 80% 40%