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Background: Currently, there are no data on the prevalence of breast arterial calcification (BAC) in Saudi women. Furthermore, there are no data on the relationship between BAC and coronary artery calcium score (CACS) as a coronary artery disease (CAD) risk factor in Saudi women who undergo mammography., Objective: Examine the role of BAC as a potential female-specific risk factor for CAD in Saudi women in order to investigate the relationship between BAC and CACS in women who undergo a screening mammography, and study the relationship between BAC and CAD risk factors, including age, diabetes mellitus, hypertension, chronic kidney disease (CKD), dyslipidemia, and family history of CAD., Design: Retrospective, medical records review., Setting: Single tertiary care center., Patients and Methods: The study cohort included women who had mammograms and a CACS scan, and for whom data on CAD risk stratification and CAD risk factors had been collected within one year of each other from 2014 to 2017. Women with CAD were excluded from the study., Main Outcome Measures: Breast arterial calcification as a marker for coronary artery disease., Sample Size: 307 Saudi women., Results: BAC was found in 142 (46%) patients in the study population. BAC+ women were significantly older than the BAC- women (P=.001), and a strong association was found between BAC and CACS (P=.0001), diabetes (P=.0001), hypertension (P=.021), and CKD (P=.0031). However, no association was found between BAC and tobacco smoking, dyslipidemia, and family history of CAD. In addition, a strong correlation was found between CACS and the components of the BAC score (P less than .001). Multivariate linear regression analysis revealed that age, CAC, and CKD are the only strong predictors of BAC., Conclusions: The proportion of BAC in Saudi women is 46%, and there may be a strong association between BAC and CAC, age, hypertension, and CKD. A large-scale prospective research study is necessary to validate the role of BAC on screening mammography as a CAD risk stratification tool and before routine reporting of BAC on a mammography report., Limitations: Because this was a retrospective study, patient selection bias cannot be excluded., Conflict of Interest: None.

Objectives: To describe the histopathological patterns of benign breast diseases (BBD) among Saudi patients., Methods: This is a retrospective review of BBD reports of Saudi patients of both genders and all age  groups seen between January 2006 and December 2013 at King Fahad Hospital, Madinah, Kingdom of Saudi Arabia., Results: Out of the total 1005 breast biopsies, 603 cases (60%) were BBD. The female to male ratio was 30.7:1. The overall mean age for BBD was 27.5 years, with an age range of 14-80 years. The most common lesion was fibroadenoma (FA) accounting for 44.3% of cases (mean age: 23.5 years), followed by 23.4% fibrocystic change (FCC) (mean age: 37.1 years). Both lesions had a peak occurrence in the third decade. Inflammatory lesions constituted 13.9% of cases. Most common were granulomatous mastitis (3.5%), chronic mastitis (3.3%), and acute mastitis with abscess (3.1%). Other major lesions encountered were fibroadenomatoid hyperplasia (3.1%), intraductal papilloma (2.8%), and benign phylloides tumor (2.6%). All benign diagnoses in male patients were gynecomastia and most patients (68.4%) were under 40 years., Conclusion: In this study, BBD constituted 60% of breast lumps, and were mostly FA and FCC. The BBD peaked at the 20-29 year age range.

Background: A significant number of mothers have breastfed their babies from one breast only or from one breast more than the other. They presented to the breast clinic with complaints that mainly involve the breast that was not used or less used for breastfeeding., Methods: The database of the Breast Unit at King Fahd Hospital, Jeddah, Saudi Arabia, was reviewed from April 1998 to March 2010. The lactation history of any patient coming to the breast clinic was documented, including number of children, duration of lactation, and the way they performed breastfeeding., Results: During the study period, 54 patients have breastfed their babies exclusively from one breast (Group 1), and 21 have breastfed from one breast more than the other (Group 2). Patients gave different reasons for this practice, with nipple retraction being the commonest. In Group 1, 46 of 54 (85%) presented with complaints in the breast that was not used for breastfeeding (unsuckled), and only eight of 54 (15%) presented with complaints in the used (suckled) breast (p = 0.000). In Group 2, 13 of 21 (62%) presented with complaints in the breast that was less used for breastfeeding (less suckled), five of 21 (24%) presented with complaints in the breast more used for breastfeeding (more suckled), and three of 21 (14%) presented with complaints in both breasts equally (p = 0.418)., Conclusion: Mothers who practice unilateral breastfeeding are candidates for future development of different breast problems in the unsuckled/less suckled breast.

Objective: The objective of this study was to characterize the histopathological patterns of female breast lesions encountered at a secondary level care centre in Al Hassa, Saudi Arabia, with special emphasis on multiplicity of benign lesions, their proliferative nature and level of risk for progression., Methods: In this retrospective, hospital record-based descriptive study, all histopathology records of patients attending King Fahd Hospital in Hofuf, Al Hassa between January 2001 and December 2007, were reviewed using a structured compilation form. Nine and hundred-sixty nine histopathology reports were legible and included. Data regarding type of specimens, age, laterality of the lesions and the prominent cellular morphology were analyzed., Results: Out of 969 records reviewed, benign lesions accounted for 60.1%, followed by malignancy (21.4%) and inflammatory lesions (18.5%). Multiple benign lesions were found in 51.1% and more than two lesions in 21.1% of cases. Non-proliferative breast lesions with low risk were reported in 81.4%, intermediate risk lesion without hyperplastic atypia in 14.6%, while high risk lesions with atypia were only 4.0%. Infiltrating ductal carcinoma was the dominant lesion among the latter and 62.1% of cases were diagnosed before the age of 50 years., Conclusion: Benign breast lesion multiplicity is frequent among Saudi female patients; with or without atypia these lesions represent a sizable risk of potential progression to breast cancer. Meticulous follow up with frequent screening may be useful for prevention of cancer development and early intervention in affected patients.

Objective: The importance of benign proliferative and non-invasive breast lesions as a risk factor preceding the development of invasive mammary carcinoma is well established in the literature. The objective of this study is to estimate the magnitude of benign proliferative diseases as well as mammary intra-epithelial neoplasia in the Western region of the Kingdom of Saudi Arabia (KSA), in order to encourage nationwide breast cancer screening programs for early detection of the high risk proliferative and pre-invasive breast lesions., Methods: We reviewed histopathology records (reports and slides of selected cases) of 2129 breast cases including mastectomies and breast biopsies from January 1985 to December 2002 in King Abdul-Aziz University Hospital and King Khalid National Guard Hospital, Jeddah, KSA. All the cases and diagnosis are listed and reclassified using systematized nomenclature of medicine (SNOMED) coding system and then regrouped based on the associated risk factors of developing breast carcinoma., Results: Two thousand one hundred and twenty-nine reports were reviewed and 2343 diagnosis were identified as some cases had more than one diagnosis. The total of benign diagnosis were 1504 after exclusion of malignant diagnosis (558), normal breast tissue, gynecomastia, and non-mammary tissue (281). All diagnosis (1504) were reclassified based on anatomical prognostic indicators into non-proliferative (1283/1504), proliferative (140/1504), atypical hyperplasia (AH) (8/1504), and carcinoma in situ (CIS) (73/1504). We compare our findings with the literature and we found that the percentage of benign non-proliferative diagnosis was 85.3% that is higher than the literature 69.7%. Proliferative diseases were 9.3% and atypical hyperplasia was 0.5%, which was lower than the literature 26.2% and 3.6%. On the other hand, CIS diagnosis was 4.9%, which is much higher than the reported literature 1.7%. The study findings could be explained on the basis of higher prevalence of benign breast lesions in our population, or it is related to the number of cases studied, or to the diagnostic criteria followed initially., Conclusion: These findings should encourage us to refine our diagnostic criteria of proliferative diseases, AH and CIS (mammary intraepithelial neoplasia [MIN]). In addition, we strongly encourage a breast cancer screening program, nationwide.

Objective: The incidence and pattern of breast diseases varies within countries. There is virtually no information on breast diseases found in the Northern region, Kingdom of Saudi Arabia (KSA). This study hopes to provide data in this area., Methods: We reviewed the histological and clinical records of 708 patients who presented to General Surgery in Prince Abdul-Rahman Al-Sudairy Central Hospital, Sakaka, Al-Jouf, KSA, with breast complaints over an 8-year period (June 1994 and June 2002). Breast findings were categorized in terms of benign, inflammatory, malignant, congenital and functional. Benign diseases were also evaluated in terms of their proliferative status and cancer risk., Results: The findings in order were benign breast disease in 245 (48.9%) were most common, inflammatory disease, 213 (42.5%), and finally cancer of the breast in 43 (8.6%). Fibroadenoma was the most common benign disease. Twenty-seven (5.4%) of benign breast disease were lesions with a cancer relative risk ranging from 1.6-4.4. Breast abscess was the most common inflammatory disease. Ductal carcinoma was the most common breast cancer. Breast cancer was bulky and presented late in mostly premenopausal women., Conclusion: Breast diseases are common among our patients. Although benign disease is the most common, some patients have lesions that have a small but definite cancer risk. Of concern is the pattern of advanced breast cancer, which presents mostly in young premenopausal women. A concerted educational program is needed to acquaint the patients with the significance of breast masses.

Objective: The aim of this case series study is to evaluate the outline and pattern of male and female breast diseases in Saudi Arabia. Also to compare 8 studies of literature discussing the profile of malignant and benign female breast diseases in the Kingdom. We hope that this study will assist us to appreciate the prototype breast diseases in our region., Methods: Our study consisted of 1084 consecutive male and female breast lesions. Data on these specimens, received in the time frame of 15 years between January 1984 and March 2000, was retrieved from the records of the laboratory. The outline of breast lesions were tabulated and classified into inflammatory, benign and malignant lesions., Results: In female breasts, benign lesions comprised 57% of all lesions (mean age 28.5), most commonly reported being fibroadenoma 47%, fibrocystic disease 22% and fibroadenosis 14%. Malignant lesions comprised 32.5% of all lesions (mean age 48.49), most commonly reported being ductal carcinoma 88% and lobular carcinoma 4.5%. Inflammatory lesions comprised 11% of all lesions (mean age 35.0), most commonly reported lesion being chronic mastitis 31% and ductectasia 19%. Male benign lesions comprised 55 cases (87%). Eight cases (13%) of malignant lesions, 6 ductal carcinomas and 2 metastatic adenocarcinomas, were also identified., Conclusion: The rates for female breast lesions varied in different studies but benign fibroadenoma constituted the most common breast lesion and secondly ductal carcinoma. The mean age for malignant lesion in 7 different studies came to be 44.05. In the male breast, carcinomas constituted 3% of all breast carcinomas. Gynecomastia being the most common male breast lesion constituting 54%.