According to mortality estimates from the World Health Organization (WHO), cancer is the fourth leading cause of death in the Eastern Mediterranean Region (EMR), after cardiovascular diseases , infectious/parasitic diseases and injuries [1-3]. The largest increase in cancer incidence among WHO regions over the next 15 years will likely occur in the EMR, where breast cancer (BC) is recorded as the most common type of female malignancy in almost all national registries of tumors [1-4]. In most EMR countries (e.g., Iran and Iraq), in addition to being the most important cancer, there are other characteristics that justify greater efforts to control BC, including the tendency of this disease to affect women more young people, the obvious increase in incidence rates and prevalence of advanced stages at presentation associated with more aggressive behavior of the tumor resulting in higher mortality rates [6,7]. Although patient survival depends on many determinants such as: age, race, genetic background, socioeconomic status and quality of care, the two most important determinants of survival from BC in the EMR are early diagnosis and adequacy of treatment [5- 7] . Obviously, there is an urgent need to better understand the molecular events of the disease and seek more effective biomarkers for BC prevention, early diagnosis, drug development and personalized treatment. BC is a complex genetic disease characterized by an accumulation of molecular molecule alterations, resulting in high clinical heterogeneity [8,9]. Different types of BC have variable histopathological and biological characteristics, different clinical outcomes, and different responses to therapy. Based on such a high degree of heterogeneity and based on their growth patterns (histological t...... middle of paper ...... examinations of the validity of these GEP tests currently available in the United States and the EU and their validation for different populations is limited [22,23]. Due to significant differences in histopathology (hormone receptor status, grading and staging), demographic parameters, survival and other factors of BC in Asia compared to Caucasians, a great deal of effort has been spent to develop and validate a specific prognostic signature in these populations [5-7, 23-25]. clinical outcomes in Asia and only one of them was conducted in the EMR where GEP was reported for Saudi women [24,25]. GEP between Western and Saudi populations, further highlighting the importance of finding specific genetic signatures in the EMR. [25].