Objective: The aim is to identify the ideal screening age for women in developing countries and to determine the suitable method for early detection of breast cancer based on age and readiness of the community. Materials and Methods:A 30-year retrospective review (from 1984 to 2014) was undertaken at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. Medical records of those diagnosed with breast cancer from the outpatient department and hospital admission records were reviewed, focusing mainly on demographic data, age, and time at presentation. Radiological and histopathological records were also reviewed for confirmation of diagnosis. Age-based statistical review was undertaken of the female population within the hospital catchment area. Results:The total number of patients was 1.832, accounting for 0.8 % affected patients when plotted against the 235,339 females within the catchment area. Considering the standard screening age of 40 years, patients were divided into two groups: group I included those below the age of 40 years at the time of diagnosis, accounting for 641patients (35%), and group II included those above the age of 40 years, accounting for 1191 patients (65%). Group I patients were mostly reassured in primary healthcare centers, diagnostic modalities were used with reservation, relying solely on ultrasonography 276 (43%); whereas in group II patients, mammography was used liberally, which aided in the diagnosis in all 1191 (100%). Conclusion:Despite the undisputable notion that breast cancer has higher predilection for women above the age of 40 years, there is a substantial subset of affected younger women in developing countries, which contradicts this concept. However, the scarcity of structured sessions in developing countries dictates Western-based early detection strategies, but the validity of such programs is culture-governed. Rigorously tailored screening programs directed towards individual communities are mandatory. Reducing the screening age by a decade in developing countries may increase the capture of early breast cancer and improve the outcomes.

79 Background: Due to the lack of structured breast cancer screening programs in developing countries early detection is generally based on international western criteria. This principle is not valid in many instances since women withdraw from voluntary involvement in such activities. In addition breast cancer in developing countries is characterized by younger age and advanced disease at the initial presentation. This review aims to identify the suitable screening age for women in developing countries in order to develop a reliable national structured screening programs. Methods: This retrospective study was undertaken at King Fahd Hospital of the University, eastern province of Saudi Arabia between 1984-2010. Medical records of patients diagnosed with from the outpatient department and hospital admission records was reviewed. It mainly focused on demographic data and the time of presentation. Radiological and histo-pathological records were also reviewed. Results: The total number of patients reviewed was 483. The majority of patients were within the reproductive age group. Considering the standard screening age is 40 years, patients are divided into two groups, group I included those below the age of 40 years accounting for 193 patients (40%), while group II above the age of 40 years accounting for 290 patients (60%). Patients in group I were mostly reassured and were mainly diagnosed initially using ultrasonography, while in group II mammography aided in diagnosis. Conclusions: Despite the undisputable concept that breast cancer has higher predilection for women above the age of 40 years, yet in developing countries, a substantial subset of affected younger women contradicts this concept. The need for breast cancer screening cannot be overemphasized, yet, international screening guidelines for breast cancer cannot be fully implemented in developing countries. Therefore, it is mandatory that screening programs should be tailored according to individual communities. Dropping the screening age by a decade may possibly increase the capture of early breast cancer and improve the outcome.