Cancer in the Arab World: Magnitude of the Problem

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Cancer in the Arab World Magnitude of the Problem

• Inas Elattar, DrPH
• Professor of Biostatistics
• Department of Biostatistics Epidemiology
• NCI, Egypt
• APHA
• November, 2004

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Introduction

• Cancer incidence in Arab countries is increasing.
  This is due partly to
• Reduction in the incidence of infectious diseases
• Increase in the population average age
• Westernization of social and dietary habits
• Increase smoking
• Increase of the incidence of hepatitis B and C
• Wrong use of plastic materials, pesticides and
  insecticides
• Low socioeconomic status

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Cancer Databases in Arab World
Yemen
National Cancer Registry
Regional Cancer Registry
No Registry
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Source of Data

• National Population-based Cancer Registries
• Gulf Center for Cancer Registration, 2000
• Qatar, Oman, Bahrain, and UAE
• Saudi Arabia, 1999-2000
• Kuwait, 2001
• Jordan, 1999
• Regional Population-based Cancer Registries
• Egypt Gharbiah 1999
• Algeria Algiers, Constantine, Oran, Setif,
  Globocan 2002
• Tunisia Tunis, Sousse, Sfax, Globocan 2002
• All others Globocan 2002, IARC

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Age-Adjusted Incidence Rates in Arab World, Males
121
180
166
180
96
180
114
123
72
123
88
154
99
60
81
99
178
123
102
178
178
178
Rates/100,000
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Age-Adjusted Incidence Rates in Arab World,
Females
120
167
159
167
87
216
78
118
77
127
90
85
137
61
94
89
176
118
84
176
176
176
Rates/100,000
7
Male to Female Ratio, All Cancer Sites
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ASR of Stomach Cancer in Arab World
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ASR of Colorectal Cancer in Arab World
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ASR of Liver Cancer in Arab World
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Relative Frequency of Liver Cancer, NCI - Egypt
1975-2002
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Egypt Mortality Statistics, 2001 Most common
sites (The Cancer Database, 2001)
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Trend of HCC Mortality in Egypt, 1981-1996
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ASR of Lung Cancer in Arab World
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Prevalence of Smoking in Arab World
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ASR of Prostate Cancer in Arab World
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ASR of Bladder Cancer in Arab World
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Histological Type of Bladder Cancer

• The first differential pattern which
  characterizes bilharzial bladder cancer is the
  histological type of the tumor
• SCC type is the most frequent type of cancer in
  countries with a high prevalence of
  schistosomiasis
• SCC type is rare in industrialized countries
• TCC type is considered typical for chemically
  induced bladder cancer
• TCC type is low in areas with schistosomiasis

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Changing Pattern of Bladder Cancer Type, NCI
1975-2002
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ASR of Lymphomas in Arab World
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Age Specific Incidence Rates (ASIR) of Lymphoma
in Selected Arab Countries (Males)
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ASR of Leukemias in Arab World
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ASR of Breast Cancer in Arab World (Females)
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Age Specific Incidence Rates (ASIR) of Breast in
Selected Arab Countries (Females)
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ASR of Cervical Cancer in Arab World
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ASR of Cancer of Uterus in Arab World
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ASR of Cancer of Ovary in Arab World
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Cancer in Arab WorldMain conclusions

• Lung High prevalence of smoking
• Liver Endemicity of hepatitis B C
• Bladder Smoking, Schistosoma
• NHL Low SES, malnutrition, parasitic viral
  infections (Epstein-Barr)
• Prostate Increasing with aging population
• Breast Leading cancer similar to developed
  countries, present at younger age
• Cervix High in Algeria, 50 of cases are
  diagnosed in late stage

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Most Common Cancer Sites among Males
Egypt Tunisia Algeria Jordan Kuwait
Bladder Lung Lung Lung Colorectal
Liver Bladder Bladder Bladder NHL
NHL Prostate Stomach Prostate Prostate
Lung Larynx Prostate NHL Lung
Leukemia Colorectal Colorectal Skin Liver
Colorectal NHL Nasopharynx BrainCNS BrainCNS
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Most Common Cancer Sites among Males
KSA UAE Bahrain Oman Qatar
NHL Lung Lung Stomach Lung
Liver Stomach Prostate NHL Bladder
Leukemia Prostate Bladder Prostate Liver
Colorectal Colorectal Colorectal Lung Colorectal
Lung NHL Stomach Leukemia Prostate
Prostate Bladder Liver Colorectal Leukemia
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Most Common Cancer Sites among Females
Egypt Tunisia Algeria Jordan Kuwait
Breast Breast Breast Breast Breast
NHL Colorectal Cervix Colorectal Colorectal
Leukemia Cervix Colorectal Ovary Thyroid
Liver Leukemia Ovary Thyroid NHL
Colorectal NHL NHL Skin Cervix
Ovary Stomach Thyroid Uterus Uterus
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Most Common Cancer Sites among Females
KSA UAE Bahrain Oman Qatar
Breast Breast Breast Breast Breast
Thyroid Cervix Lung Cervix NHL
Leukemia Leukemia Ovary NHL Skin
Colorectal Thyroid Thyroid Leukemia Thyroid
NHL NHL Liver Ovary Colorectal
Ovary Stomach Kidney/NHL Stomach Hodgkins Disease
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National Cancer Institute, Cairo, Egypt
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National Cancer Institute, Cairo, Egypt

• The National Cancer Institute (NCI) is the
  largest comprehensive cancer center in Egypt
• The present hospital with its 550 beds is
  overloaded by patients referred from allover the
  country
• During the years 2001-2002 38,400 new patients
  visited the NCI
• 19,568 (51) were malignant cases
• Half of the cases were males
• 11 were children, less than or equal to 18 years
• About 54 of the cases were between the ages 41
  through 65 years

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19,568 New Cancer Cases by Systems, NCI 2001-2002