Introduction:

Breast cancer is the non-inhibited growth of abnormal cells being developed in different areas of the breast. This can happen in different tissues, such as the ducts that transmit the milk, in milk-producing tissues, or in non-endocrine tissues. Cancer is the second cause of deaths in most advanced countries in the world, the pattern of incidence of different types of cancers varies across different populations and is associated with factors like: occupational, social, cultural and ethnic issues (possibly inheritance), geographical and cultural issues [1]. The study of breast diseases is widespread because it often catches up with women who are the main hub of families and improves their quality of life as an improvement in the quality of the community [2]. A large number of breast cancer sufferers are diagnosed each year and some die [3]. More than 211,000 American women are infected every year. The breast cancer is also seen in the men, but it is far less pronounced in the men [4]. According to a study by Globocan by the International Agency for Research on Cancer, affiliated with the World Health Organization in 2010, About 1050300 new cases of breast cancer have been observed, of which about 44.84% occurred in developing countries and its incidence is increasing in these countries. In Iran, breast cancer has been cited as the most common cancer in women, with 21.4 % of women's cancers. Similarly, in Tehran, this cancer is estimated to be the most common cancer in women (25.5% of all women cancers). which showed the nature incidence of 22.4 per 100,000 people in 1998. Another study showed the incidence of cancer in the country by 15 per 100,000 [5]. Risk factors for breast cancer include a wide range of risk factors from the molecular to the social factors that can vary between different communities, so that estimates of mortality for 1990, more than 6 times of 3/4 in China to 26.7 in northern Europe have been different or, for example, the incidence of breast cancer in the children of Japanese immigrants to Hawaii after a while is similar to that of the destination country. Since many of the risk factors of this cancer can be modified and can be altered by the intervention of interventions, it can provide information in different regions of the country to provide information based on evidence and therefore the Cost-Provide more appropriate effectiveness for each region [6].

According to the extensive results of researchers around the world, breast cancer is among the cancers that are partly inherited. That is, the defective genes transmitted from the father or mother or genes in the individual themselves cause it to emerge. Therefore, with regard to the possibility of transmission of this type of cancer between generations, there are many experiments in the world breast cancer diagnosis clinics that are performed by molecular and genetic methods and the quality of serving people for premature recognition, diagnosis of persons at risk, determining the probability of response to treatment, survival rate, etc. [7].

Chest-x-ray radiography is one of the most non-invasive methods used in the assessment of the breast, both in screening and detecting cases of disease. The predictive value of chest-x-ray varies greatly from study to study. As in previous studies, its sensitivity in cancer diagnosis has been mentioned from 33% to 98% and its specificity has been mentioned from 38% to 91% [13,18].

Another non-invasive method used in breast evaluation, especially in dense breasts, is ultrasound [11]. Ultrasound is also valuable in evaluating uncertain mammographic findings. Regarding the value of ultrasound in diagnosis of the nature of breast diseases, different results have been reported. It is noted that its sensitivity is 70 % to 90 % [14,18]. As the standard for the diagnosis and definitive nature of breast disease pathology, and this method because aggressiveness is not welcomed by patients, doctors sought to use non-invasive methods are more. However, the use of these methods requires systematic studies to determine their diagnostic value according to the current medical conditions in the country. Therefore, in this study, we have tried to evaluate the current status of chest-x-ray and ultrasound reports and their compatibility with the definitive diagnosis of breast lesion [19]. Due to the widespread use of chest-x-ray and ultrasound by the surgeon, the results of this study can be effective in screening, diagnosis and follow-up of breast cancer patients in the country because it is in fact a research based on real evidence in the country.

Materials and methods:

The present study is a cross-sectional study that was performed to investigate the epidemiology of breast cancer risk factors in Tehran from 2011 to 2020. The population under study, young women under the age of 25 years with three methods (ultrasound, chest X-ray and a biopsy of the breast) with confirmed breast lumps and breast disease clinics in Tehran were referred. Demographic information, family history of breast cancer, history of pregnancy and lactation were then entered into a questionnaire by the trainees. All patients underwent a classic examination of both breasts by a general surgeon and the examination results (based on findings such as mass profile and axilla status The basis of the surgeon's clinical judgment) was recorded as 4 groups: benign, malignant, normal and suspected. For each patient who presented with an ultrasound, chest-x-ray, or both, the imaging response was reported as normal, benign, suspected, and malignant based on the available imaging date. In some cases, if the imaging was not done, an ultrasound, chest x-ray, or both were requested based on age and breast density status. Finally, the data were entered into SPSS software version 22 and analyzed by analysis of variance.

Findings:

In this study, participants with a mean age (18.23±3.29) were the youngest 11 years old and the highest 25 years old. Most people were in the age group between 15 to 20 years (60%). The difference between the two groups in terms of age in this study is significant (001/0< P). Also, the mean weight of individuals (64±8.7) with a minimum weight of 41 and a maximum of 128 kg, most of whom (59%) were in the weight group between 60 and 80 kg. In this study, almost half of the women had university education (47%) and undergraduate education (21%) and all of them were students. 56% of women had a family history of breast cancer and 32% of women had a history of menstrual disorders, which was significantly associated with this disorder and breast cancer.

A total of 1,200 chest-x-rays and 1,450 ultrasounds from 1,650 patients who presented with breast mass complaints were reviewed and compared with the pathology report. 900 of these patients had breast cancer and 750 had benign breast diseases. In 900 patients with cancer, 770 chest-x-rays were performed prior to sampling, of which 68% were reported to be malignant and 32% of X - ray report did not match the pathology response.  In 750 patients with benign breast masses, 430 chest-x-ray reports were recorded, all of which were performed prior to breast biopsy. Of the 430 chest-x-rays recorded, 70% did not match the chest-x-ray report with the pathology report. False positives and false negatives are shown in Table1. Accordingly, in this study, which is in fact an evidence-based study and review of the current situation of these two imaging methods in the country, chest-x-ray sensitivity was 42% and its specificity was 68%.