Long-term epidemiological trends of breast cancer in Saudi Arabia: Insights from 20 years of national registry data

<h2>Abstract</h2><h3>Background</h3> Breast cancer is the most common malignancy among women in Saudi Arabia, and national data indicate a steady rise in case counts over the past two decades. However, detailed assessments of trends in age at diagnosis, stage distribution, morphology, and regional variation remain limited. <h3>Methods</h3> This study analysed breast cancer cases among Saudi women recorded in the Saudi Cancer Registry between 2003 and 2022. Tumours were coded using ICD-O-3 and staged according to SEER Summary Stage 2000. Trends in case counts, age distribution, stage, morphology, and geographic variation were examined. Annual percent changes (APC) were calculated to quantify changes over time. <h3>Results</h3> A total of 36,905 breast cancer cases were identified. Annual case count nearly tripled during the study period, with significant APC increases across all age groups, particularly among older women. The median age at diagnosis was 49 years, and infiltrating ductal carcinoma accounted for approximately 78% of cases. The proportion of localised disease increased over time. Localised-stage case counts showed the highest APC of 12.5%. Regional and distant-stage disease accounted for substantial shares of cases overall, approximately 40% and 15%, respectively. Geographic analyses showed consistently higher age-standardised incidence rates in the Eastern Province with notable increases across most administrative regions. <h3>Conclusion</h3> Breast cancer case burden in Saudi Arabia has risen over the past 20 years, with persistent late-stage presentation and a comparatively young age at diagnosis. These findings underscore the need for stronger early detection efforts, expanded access to diagnostic services, and risk-adapted screening strategies that reflect the demographic profile of Saudi women. Continued monitoring of national trends will be essential to ensure that services can respond effectively to future needs.