National Cancer Registry Past, Present and Future

1
National Cancer RegistryPast, Present and Future

• Presented by
• Ali Shamseddine, MD.
• Professor, Head Hematology Oncology
• AUB
• VP /NCR

2
History of Cancer Registration

• The first systematic collection of information on
  cancer was in 1728 in the general census of
  cancer in London.
• The first reliable cancer statistics appeared in
  mortality figures for the city of Verona in 1842.
• The International Association of Cancer
  Registries (IACR) was formed in 1966.

3
Population-based cancer registries world-wide
Country Establishment year Notification
Germany (Hamburg) USA (NY) USA (Connecticut) Denmark Canada (Saskatchewan) England Wales (SW region) England Wales (Liverpool) New Zealand Canada (Manitoba) Slovenia Canada (Alberta) USA (EL Paso) Hungary Norway Former USSR Former German Democratic Republic Finland Iceland 1929 1940 1941 1942 1944 1945 1948 1948 1950 1950 1951 1951 1952 1952 1953 1953 1953 1954 Voluntary Compulsory Compulsory Compulsory Compulsory Voluntary Voluntary Compulsory Voluntary Compulsory Compulsory Voluntary Compulsory Compulsory Compulsory Compulsory Compulsory Voluntary
4
Cancer registry (CR)

• Aim
• Systematic collection, storage, analysis,
  interpretation, and reporting of data on subjects
  with cancer
• Types
• Hospital-based CR
• Population-based CR

5
Hospital-based CR

• Record information on new cancer patients seen in
  a particular hospital
• Objective
• To contribute to patient care by providing
  readily accessible information on the subjects
  with cancer, the treatment they received the
  results

6
Population-based CR

• Seek to collect data on all new cases occurring
  in a well defined population.
• Objective
• -Produce statistics on the occurrence of cancer
  in a defined population (Incidence, prevalence,
  CFR)
• -Provide a framework for assessing and
  controlling the impact of cancer in the community

7

• The Lebanese National Cancer RegistryThe Past
  (before 1998)

8

• The idea of establishing a National Cancer
  Registry started in the 1970
• Other registries in the Arab world at that time
  Kuwait, Egypt, Iraq
• Meanwhile efforts started to establish
  hospital-based cancer registries

9
National Based Studies

• The only national-based study was that of Abou
  Daoud
• in 1966.
• Pathology Reports of 8 Medical Institutions in
  Lebanon (1
• year from 01/08/1964-31/07/1965)
• Sample Size 1,950 cases (1,507 Lebanese, 443
  Non-Lebanese)
• Results
• Males Skin (17.0), Bladder (9.1), Lung (7.1),
  Larynx (5.7)
• Females Breast (16.4), Cervix and Uterine
  (14.1), Skin (10.7)
• Cancer Incidence Rates
• 74.9 per 100,000 for males
• 75.6 per 100,000 for females
• Adjusted Crude Incidence Rates
• 102.8 per 100,000 for males
• 104.1 per 100,000 for females
• Abou Daoud KT Cancer 19 1293-1300, 1966.

10
Lebanese Hospital-based CR

• AUBMC
• 1970 Founded (Drs. Kamal Bikhazi and Elizabeth
  Morton)
• 1971 Dr. Philip Salem appointed as first AUBMC
  tumor registry head.
• 1983 Reactivated (Dr. Ghaleb Saab)
• 1984
• HDF (Drs. Najib Taleb and Edgard Gedeon)

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Hospital Based Studies
Publication Sample Size Hospital Results Male Results Female
Saab G, Int. J Epidemiol 1985 1,256 AUB -MC Lung Bladder (12.7) Lymphoma (11.7) Bladder (low incidence)
Geahchan N, ARC, Paris Oct. 1986 2,355 10 Pathology Centers other than AUB Bladder (16.3) Lung (14) Leukemia-Lymphoma (13.1) Breast (27.2) Lymphoma-Leukemia (10.7) Cervix (7)
Ghosn M Leb Med J 1992 541 Hôtel-Dieu de France- Beirut Lung (19) Bladder (16.7) Prostate (11.6) Breast (36.1) Uterine(15.2) Digestive Tract (12.3)
Taleb N Leb Med J 1994 (Review) Bladder (18) Lung (14) Prostate (11), Breast (30) Uterus (12) Colorectal (6),
Saghir N Leb Med J 1998 10,220 AUB - MC Lung (17), Bladder (9.8), Larynx (8.6), Breast (35.5) Cervix Uteri (10.4) Colorectal (4.9)
Adib SM Ann Epidemiol 1998 9364 AUB- MC Lung(17.8), Bladder(10), Larynx (8.9) Breast(35.2), Cervix uteri(10.6) , Lymphoma(5.2)
12

• Mir Amin Meeting, 1994---? special committee was
  set up to create
• a NCR under the auspices of MOPH
• This committee met for about 5 years without any
  practical results.

13
The Lebanese National Cancer Registry

• The Present (1998-2008)

14
Overview

• 1998 The establishment of the LCEG
• 2001 The Italian Cooperation signed an agreement
  with the Ministry of Public Health (MOPH) of
  Lebanon to fund in 2002 activities leading to a
  National Cancer Registry in Lebanon.
• Report 2002 The report 2002 was supported by the
  NCDP and MOPH
• Report 2003 Funded and supported by LSMO and the
  Italian Cooperation under the umbrella of MOPH.
• 2005 NCR oversight committee.
• 2008 Reports 2003(Revised) and 2004,collection
  of 2005,2006 and 2007 data.

15
The Lebanese Cancer Epidemiology Group (LCEG)

• Founded in 1998
• A network of all hospitals with oncology
  specialists and all pathology laboratories.
• To study cancer caseload and to estimate
  incidence rates at the national level.
• All cases diagnosed in the year 1993, and for
  each 5-year interval thereafter, are registered.

16
The Lebanese Cancer Epidemiology Group

• Fifteen Hospitals
• American University of Beirut-Medical Center
• Hotel-Dieu de France University Hospital
• St George University Hospital
• Hammoud Hospital
• Hopital Libanais
• Hopital Notred-Same des Secours
• Khoury General Hospital
• Makassed Hoapital
• Middle-East Hospiatl
• Rizk Hospital
• Sacre-Coeur Hospital
• St Geaorge Hospital
• Sahel Hospital
• Zahraa Hospital
• Barbir Hospital

Pathology Laboratories Dr. Albert Aoun Dr. Fady
Assi Dr. Akram El-Ahadab Dr. Mouin Soussi
17
Cancer incidence in postwar Lebanon The first
population-based estimates, 1993 and 1998.
Shamseddine et al. Annals of Epidemiology, 2004
(1998 data)The Lebanese Cancer Epidemiology
Group
18
Findings were based on 2856 and 4388 incident
cases reported and registered in Lebanon in
the year 1998 and 1993 respectively.Crude and
age-standardized rates (ASRs) per 100,000
population were calculated and results were
contrasted with estimates from developed and
developing countries in the region.
Crude Incidence Rates (1993-1998)
1998 1993
141.4 91.7 Males
126.85 84.4 Females
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Crude incidence and age-specific incidence Males

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Cancer incidence 1993 and 1998 Possible causes
for the increase in crude incidence rates

• Improvement in detection rate
• Reporting and data gathering of various cancers
  due to the marked rise in the number of
  diagnostic facilities
• After 1991, a proliferation in the number
  health-care institutions as well as a significant
  upsurge in modern diagnostic technologies,
  equipment and services
• MRIs (n 12)
• CT Scans (n 54)
• Colonoscopy and gastroscopies (over 30 suites)
• mammograms, cytology and pathology labs. Ammar W
  et al. Leb Med J 199846149-155. Soweid A et
  al Gastrointest Endosc 200154279-281.
• During the past decade alone, the number of
  oncology specialists in the country has risen
  from 20 to around 80 physicians (Lebanese Cancer
  Society).
• Several risk factor awareness campaigns and
  screening programs became part of national public
  policies with wide advertisement and coverage.

27
Cancer incidence 1993 and 1998Breast Cancer

• Breast cancer was the most frequent malignancy in
  females in Lebanon (Over one third of all female
  cancers).
• Same rates observed in all earlier hospital-based
  studies in the country. Azar HA. Cancer in
  Lebanon and the near east. Cancer
  January-February 19621566-74. Ghosn M et al.
  The cancer registry at the Hotel Dieu de France
  Hospital. Leb Med J 1992404-10. El-Saghir NS
  et al. Cancer in Lebanon analysis of 10220 cases
  from the American University of Beirut Medical
  Center. Leb Med J 1998464-10.
• ASR (38.9 per 100,000, 1998)
• Lower than that observed for the US (90.7), UK
  (68.8), France (78.8) or Israel (77.4)
• Much higher than other developing countries of
  the region such as Algeria

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Breast Cancer

• The age pattern at diagnosis is typical of that
  in low-risk countries
• Increase in the rate up to the 5th decade, around
  menopause, and a decrease thereafter.
  Rodriguez-Cuevas Et al. Breast carcinoma presents
  a decade earlier in Mexican women than in women
  in the United States or European countries.
  Cancer 200191863-868
• Median age at diagnosis was 52 years (range
  22-92)
• Around 43 of cases presenting before the age 50
  compared to median age of 63 years for developed
  countries such as the US. Bosch X. Early
  development of breast cancer in Mexican women.
  The Lancet Oncology 20012194

29
Public Health Implications

• Breast Cancer In Lebanon causes for the rise
• Screening programs are widely adopted by most
  academic and health centers
• Changes in certain reproductive factors
• Mean age at marriage of women has increased from
  23.2 years in 1970 to 27.5 in 1996
• Total fertility rate has steadily declined from
  4.4 to 2.5
• United Nations. Health and reproduction. In
  The female and male in Lebanon a statistical
  profile. The Lebanese Republic, 2000 pp.57-65

30

• Should we screen for breast cancer among younger
  age groups (below 40 years) and what type of
  screening should we adopt?
• Screening of high-risk groups (MRI).
• Unification of the screening programs and
  training of the radiology technicians.

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Tobacco Associated Cancers

• Bladder Cancer
• Lung Cancer

32
Public Health Implications Bladder Cancer

• Incidence rates in Lebanon are high, in
  particular among males.
• Incidence rates parallel those observed in
  developed countries such France, the USA, UK and
  Israel.
• Rates have always been this high in national and
  hospital based studies in the country.Abou-Daoud
  KT. Morbidity from cancer in Lebanon. Cancer
  1966191293-300. Azar HA. Cancer in Lebanon and
  the near east. Cancer January-February
  19621566-74. Ghosn M et al. The cancer
  registry at the Hotel Dieu de France Hospital.
  Leb Med J 1992404-10. El-Saghir NS et al.
  Cancer in Lebanon analysis of 10220 cases from
  the American University of Beirut Medical Center.
  Leb Med J 1998464-10.
• Tobacco smoking was identified as a major risk
  factor for bladder cancer.Abou- Daoud KT. Cancer
  of the bladder and cigarette smoking, coffee and
  alcohol drinking in Lebanon. Leb Med J
  19803251-257.

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Bladder Cancer

• Internationally, a stronger relationship between
  smoking and bladder cancer is reported in women
  than in men. Brennan P et al. The contribution
  of cigarette smoking to bladder cancer in women
  pooled European data. Cancer Causes Control
  200112411-7
• A small proportion of bladder cancer can be
  attributed to coffee drinking especially in
  nonsmokers. Sala M et al. Coffee consumption and
  bladder cancer in non-smokers a pooled analysis
  of case-control studies in European countries.
  Cancer Causes Control 200111925-31
• Other causative agents
• Bilharsia (Egypt, Iraq)
• Exposures to paint components, polycyclic
  aromatic hydrocarbons, diesel exhausts, and
  aromatic amines Zeegers Mpet al. Occupational
  risk factors for male bladder cancer results
  from a population based case cohort study in the
  Netherlands. Occcup Envoron Med 200158590-6

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Public Health Implications Bladder Cancer

• Role of HPV in bladder cancer!!
• ? Two of the HPVs (16 and 18) are known to be
  high risk for the incidence of bladder cancer.
  The association between bladder cancer and HPVs
  was found to be ranging between 2.5-81.
  Soulitzis N et al. p53 Codon 72 Polymorphism and
  its Association with Bladder Cancer. Cancer
  Letters, 2002. Lopez-Batran A et al. Human
  Papillomavirus and Bladder Cancer. Biomed and
  Pharmacother, 1997.
• The role of HPV among Bladder Cancer should be
  investigated.
• Should we design a retrospective cohort study on
  bladder cancer patients?

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Public Health ImplicationsLung Cancer

• Lung cancer has long been closely linked to
  tobacco smoking. Doll R, Peto R. The cause of
  cancer. Oxford Oxford University Press, 1981
• In countries with prolonged smoking history,
  about 90 of cases of lung cancer in men are
  related to tobacco. Parkin DM. Global cancer
  statistics in the year 2000. The Lancet Oncology
  20012533-542
• In various countries, national trends in lung
  cancer incidence and mortality reflect the
  maturity of the smoking epidemic. Gilliland FD,
  Samet JM. Lung cancer. Cancer Surv
  199419-20175-95

36
Public Health Implications Lung Cancer

• Lebanon may have reached this maturity in men,
  the trend in women is certainly still increasing.
• Smoking prevalence rates among men have long been
  in the range of 50-60. Khogali M et al. Dar el
  fatwa, Aisha Bakar, CVD Project. Spring-Summer
  1999
• In women, smoking prevalence have considerably
  increased
• 1960s 28 Abou- Daoud KT. Cancer of the bladder
  and cigarette smoking, coffee and alcohol
  drinking in Lebanon. Leb Med J 19803251-257
• 1992 35 Nuwayhid I et al. In Deeb M, ed.
  Beirut a health profile 1984-1994. Beirut, AUB,
  1997
• 1999 47 57 Khogali M et al. Dar el fatwa,
  Aisha Bakar, CVD Project. Spring-Summer 1999.
  Chidiac C. The profile of the Lebanese smoker
  prevalence, characteristics and risk factors. USJ
  1998 (unpublished paper)

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Public Health Implications Lung Cancer

• Lung cancer rate among women doubled during
  recent years and this can be expected to continue
  its rise as smoking is increasingly seen in
  successive birth cohorts with prevalence rates
• 30-39 years 54
• Over 60 years 16
• Nuwayhid I et al. Morbidity, mortality and risk
  factors. In Deeb M, ed. Beirut a health profile
  1984-1994. Beirut, AUB, 1997

38
Primary PreventionLung Cancer

• Effective anti-smoking programmes should be
  implemented to prevent future rise. School
  children and women should be particularly
  targeted.
• Distribution channels should include mass media,
  MOPH institutions, Ministry of Social Affairs
  institutions, schools, NGOs and places of work.

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Public Health Implications Prostate Cancer

• Significant increase in the crude incidence of
  prostate cancer from 1993 to 1998 (9.1 and 17.6
  per 100,000 respectively).
• The second most common type of malignancy in men.
  
• Surveillance and detection bias
• National awareness campaigns promoting screening
  for prostate cancer in 1994

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Age specific incidence ratesMales 1993
42
Distribution of the 5 most common Male cancers
diagnosed and or treated at AUBMC during
1983-2000 (N4220)
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Age specific incidence ratesMales 1998
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Public Health Implications Colorectal Cancer

• Rise of colon cancer in females from 2.8 per
  100,000 in 1993 to 6.7 in 1998.
• ASRs were lower than in the USA, France, and
  Israel and higher than in Kuwait and Algeria.
• The major influences on colon cancer
• Environmental exposures
• Sedentary lifestyle
• Alcohol
• Dietary habits high fat consumption and low
  fruit, vegetable, and fiber intake
• The risk may be decreased among recent
  post-menopausal HRT users. Nanda K et al.
  Hormone replacement therapy and the risk of
  colonrectal cancer a meta-analysis. Obstet
  Gynecol 199993880-8

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Colorectal Cancer

• Large increase in the number of endoscopy suites
  (from less than 10 in 1990 to over 30 in 2001).
• Over 30,000 gastroscopies and colonoscopies done
  yearly. Soweid A et al. GI endoscopy in Lebanon
  past, present and future. Gastrointest Endosc
  200154279-281
• Recent increase in the use of HRT in Lebanon,
  promoted as a preventive measure against
  osteoporosis.

46
Public Health ImplicationsBrain Cancer

• Significant increase in Brain cancer among
  females between 1993-1998.
• Cellular phones effects!!!
• ? Radio-frequency radiation emitted by cell
  phones and brain tumors?? Some studies show
  increased risk of brain tumors with an OR of 2.4
  for ipsilateral use of cell phones (Hardell L. et
  al Ionizing radiation, cellular telephones and
  the risk for brain tumours. European Journal of
  Cancer Prevention, 2001). While other studies do
  not show that the hand-held cellular telephones
  causes brain tumors, they admit that their data
  are not sufficient to evaluate the risks among
  long-term, heavy users. Inskip P et al.
  Cellular-Telephone Use and Brain Tumors. The New
  England Journal of Medicine 2001, Johanssen C et
  al. Cellular telephone and cancer- a nationwide
  cohort study in Denmark. J Natl Cancer Inst,
  2001.
• Researchers conclude that even small
  risks would be of considerable public health
  importance. Inskip P.

47
NCR Objectives - 2001

• The major objectives of the registry were
• To establish and maintain a cancer incidence
  reporting system.
• To be an informational resource for the
  investigation of cancer and its causes
• To provide information to assist public health?
  officials and agencies in the planning and
  evaluation of cancer prevention and cancer
  control programs.
• To provide a primary source of unbiased?
  population-based cases for investigators seeking
  to conduct case-control or cohort studies,
  clinical trials and survival analysis.

48
NCR Report 2002

• NCR obtained its data in 2002 from only one
  source, that of the MOPH Drug Dispensing Center
  (DDC). NCR presented its 2002 report, admitting
  that it had covered no more than 40 of all
  cases.
• Salim Adib, 2004

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Limitations

• 1. Incompleteness of data only 40 of the cases
  were captured in the 2002 report
• 2. Epidemiological measures only relative
  frequencies no incident measures
• 3. Incompleteness of cancer-specific data
  specifically for cancer pathology
• 4. Data retrieval there is a need for a unified
  and systematic process for cancer data retrieval

51
Data Collection 2003

• In 2003, LSMO in cooperation with LCEG decided to
  continue their support of the 2003 data
  collection (5 years from the 1998 data). At the
  same time, the NCDP and MOPH continued their
  efforts to gather the 2003 data.
• Funds provided by the Italian Cooperation in
  Lebanon and LSMO.
• These efforts led to a better data collection for
  the year 2003.

52
NCR Committee

• In May 2005 the decree 230/1 was issued from the
  HE Dr. Mohammad Jawad Khalifeh, Minister of
  Public Health, creating an oversight Committee
  for the National Cancer Registry in Lebanon.

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The Lebanese National Cancer RegistryThe
Future
54
The Lebanese National Cancer Registry (NTR)
Function

• Define the size of the cancer problem
• Determine patterns of occurrence of various
  cancers
• Monitor cancer trends over time.
• Guide planning and evaluation of cancer control
  programs
• Prevention
• Screening
• Treatment
• Help set priorities for allocating health
  resources.
• Advance clinical, epidemiologic and health
  services research.

55

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Data Collection

• A consistent system for data collection must be
  defined.
• Issue a ministerial decree or a mandate law that
  categorizes cancer as a mandatory notifiable
  disease.
• The NCR must have full access to cancer data
  from
• All governmental and private hospitals
• Clinics
• Pathology and hematology laboratories.
• The registry must
• Provide a unified software package
• Set-up and training to these centers

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Data Collection

• Clinical data are coded by a trained tumor
  registrar by means of the International
  Classification of Disease (ICD-O3)
• The registrar will check for missing information
  on abstracts collected from different health
  sources (avoid duplication).
• Data entry and analysis using the CANREG-4 cancer
  registration computer software developed by
  International Agency for Research on Cancer (IARC)

58
National Cancer RegistryConfidentiality and
Consent Data Ownership and Publication Rights
Data Quality Legal and Ethical Aspects of
Cancer Data

• To be discussed in the afternoon workshop

59
Patients Follow-Up

• Follow up of cancer patients is the systematic
  process of obtaining accurate information at
  least annually, on the patient's health, vital
  status, and progression of disease.

60

• An adequate staff and budget must be provided to
  handle follow-up volume. The staff must be
  trained and qualified to represent the
  institution in this process.

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NCRAnnual Caseload
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Figure1. Cancer Cases in Lebanon (1990-2010)
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Crude Incidence Rate of All Cancers in Lebanon
1990-2010
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NCRStaff Requirements for 2006

• Registry Manager
• Manages
• Supervises
• Coordinates the activities of the registry
• Tumor Registrar
• Data collection/cross checking
• Data coding
• Data mainteinance
• Administrative Assistant
• Data collection
• Data entry
• General assistance
• Driver or office boy ?
• Research assistants as needed.

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Marketing NCR Information and Services

• The registry must develop customer bases and
  create a demand for registry services.

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• Potential markets for cancer data services are
  numerous and include national organizations,
  private agencies, hospitals, physicians,
  pharmaceutical companies as well as the general
  public. Increasing the usage of cancer data is a
  matter of exposing the registry's potential
  customers to the services it offers.

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• The NCR can only continue if it is reinforced by
  a major contribution that is independent from
  financial uncertainties, bureaucratic
  inconsistencies and poor managerial
  decisions.Only a firm and written commitment
  from the MOPH to provide continuous support can
  make the NCR a success.

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• NATIONAL CANCER REGISTRYCANCER IN LEBANON
• 2003 2004

69
DEMOGRAPHIC CHARACTERISTICS OF INCIDENT CANCER
CASES IN LEBANON 2003 2004
GENDER (2003)
GENDER (2004)
N 7197 cases
N 7142 cases
50.1
49.9
70
DEMOGRAPHIC CHARACTERISTICS OF INCIDENT CANCER
CASES
IN LEBANON 2003-2004
N7197 N7142
71
MEAN AGE IN YEARS BY SEXCANCER CASES 2003-2004
72
DIFFERENCES IN AGES BY GENDER FOR SELECTED CANCER
TYPES
Lung
73
DIFFERENCES IN AGES BY GENDER FOR SELECTED CANCER
TYPES
Colorectal
74
DIFFERENCES IN AGES BY GENDER FOR SELECTED CANCER
TYPES
Leukemia
75
DIFFERENCES IN AGES BY GENDER FOR SELECTED CANCER
TYPES 2003
Lymphoma
45
40
35
30
25
20
15
10
5
0
Male
Female
76
DIFFERENCES IN AGES BY GENDER FOR SELECTED CANCER
TYPES 2004
Non-Hodgkin Lymphoma
77
DIFFERENCES IN AGES BY GENDER FOR SELECTED CANCER
TYPES 2004
Hodgkin Lymphoma
78
INCIDENT CANCER CASES BY AREA OF RESIDENCE,
LEBANON 2003
40,9
18,8
16,8
10,5
BEIRUT
6,3
7,9
MOUNT-LEBANON
NORTH-LEBANON
SOUTH-LEBANON
NABATIEH
BEKAA
79
INCIDENT CANCER CASES BY AREA OF RESIDENCE,
LEBANON 2004
80
RELATIVE FREQUENCY OF CANCER SITES BY GENDER
2003
45
Males
40
Females
35
30
25
20
15
10
5
0
Colon
Rectum
Lung
Prostate
L Leukemia
Bladder
M Leukemia
Other leukemia
Breast
NHL
2004
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SITES OF PEDIATRIC CANCERS, LEBANON
2003
Leukemia
Meninges and brain
Bone and cartilage
Kidney
Non-Hodgkin's lymphoma
Soft/connective tissue
Eye
2004
Testis
Hodgkin's lymphoma
Lung and trachea
Others
82



PRIMARY SITES N AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 CRUDE RATES ASR
    UN UN 0-14 0-14 15-24 15-24 25-34 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75 75    
Oro-pharynx 72 12 12 0.18 0.18 0.55 0.55 0.70 0.70 1.49 1.49 9.62 9.62 17.47 17.47 11.33 11.33 17.00 17.00 4.03 3.79
Stomach 114 12 12 0.18 0.18 0.55 0.55 0.70 0.70 4.48 4.48 8.25 8.25 19.06 19.06 36.26 36.26 56.65 56.65 6.39 6.17
Colon-rectum 281 26 26 0.55 0.55 0.28 0.28 4.55 4.55 9.96 9.96 23.37 23.37 43.69 43.69 87.25 87.25 147.30 147.30 15.74 15.43
Liver 33 3 3 0.18 0.18 0.28 0.28 0.35 0.35 0.50 0.50 2.06 2.06 3.18 3.18 17.00 17.00 11.33 11.33 1.85 1.77
Pancreas 58 4 4 0.00 0.00 0.00 0.00 0.00 0.00 1.49 1.49 8.25 8.25 9.53 9.53 23.80 23.80 17.00 17.00 3.25 3.38
Larynx 103 11 11 0.00 0.00 0.00 0.00 0.35 0.35 2.49 2.49 9.62 9.62 15.89 15.89 35.13 35.13 59.49 59.49 5.77 5.62
Lung 546 51 51 0.92 0.92 0.28 0.28 1.40 1.40 13.45 13.45 55.67 55.67 112.00 112.00 175.63 175.63 280.44 280.44 31.6 31.62
Skin melanoma 55 5 5 0.18 0.18 1.10 1.10 0.00 0.00 3.49 3.49 6.19 6.19 5.56 5.56 12.46 12.46 31.16 31.16 3.08 3.04
Prostate 587 79 79 0.00 0.00 0.00 0.00 0.35 0.35 0.50 0.50 14.43 14.43 81.02 81.02 264.01 264.01 424.91 424.91 32.89 29.88
Testis 79 2 2 1.48 1.48 3.31 3.31 8.75 8.75 9.96 9.96 5.50 5.50 2.8 2.8 0.00 0.00 2.83 2.83 4.43 4.29
Kidney 67 5 5 0.74 0.74 0.28 0.28 0.70 0.70 2.49 2.49 6.87 6.87 13.50 13.50 19.26 19.26 17.00 17.00 3.75 3.81
Bladder 569 80 80 0,18 0,18 0.00 0.00 2.80 2.80 11.46 11.46 32.99 32.99 101.67 101.67 193.76 193.76 311.60 311.60 31.88 29.51
CANCER INCIDENCE RATES AMONG MALES IN LEBANON 2003
83



PRIMARY SITES N AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 CRUDE RATES ASR
    UN 0-14 0-14 15-24 15-24 25-34 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75 75    
Meninges brain 102 3 2.96 2.96 2.48 2.48 4.9 4.9 8.47 8.47 9.62 9.62 14.30 14.30 7.93 7.93 11.33 11.33 5.87 5.87
H lymphoma 78 3 0.92 0.92 3.59 3.59 8.40 8.40 2.99 2.99 6.19 6.19 3.97 3.97 7.93 7.93 17.00 17.00 4.37 4.17
NH lymphoma 170 8 2.03 2.03 1.93 1.93 3.15 3.15 14.94 14.94 13.06 13.06 23.03 23.03 39.66 39.66 62.32 62.32 9.52 9.70
Multiple myeloma 39 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.19 6.19 8.74 8.74 15.86 15.86 11.33 11.33 2.18 2.40
Leukemias 170 11 7.95 7.95 3.86 3.86 2.80 2.80 10.96 10.96 10.31 10.31 14.30 14.30 26.06 26.06 45.32 45.32 9.52 9.31
All cancers 3565 380 22.36 22.36 25.12 25.12 47.61 47.61 109.5 109.5 263.9 263.9 545.7 545.7 1078.7 1078.7 1682.6 1682.6 199.71 191.29
ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates
CANCER INCIDENCE RATES AMONG MALES IN LEBANON 2003
84



PRIMARY SITES N AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 CRUDE RATES ASR
    UN UN 0-14 0-14 15-24 15-24 25-34 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75 75    
Oro-pharynx 95 28 28 0.8 0.8 0.5 0.5 0.9 0.9 2.7 2.7 5.6 5.6 13.8 13.8 1.5 1.5 2.3 2.3 4.9 4.75
Stomach 149 31 31 0.0 0.0 0.8 0.8 0.6 0.6 7.3 7.3 14.4 14.4 15.3 15.3 2.3 2.3 8.1 8.1 7.6 7.45
Colon-rectum 309 78 78 0.0 0.0 0.5 0.5 1.3 1.3 7.3 7.3 17.0 17.0 37.2 37.2 9.1 9.1 13.6 13.6 15.8 15.45
Liver 57 10 10 0.5 0.5 0.0 0.0 0.3 0.3 1.4 1.4 5.6 5.6 5.8 5.8 1.7 1.7 1.8 1.8 2.9 2.85
Pancreas 59 3 3 0.0 0.0 0.0 0.0 0.3 0.3 2.3 2.3 6.3 6.3 10.2 10.2 1.5 1.5 3.1 3.1 3.0 2.95
Larynx 104 17 17 0.0 0.0 0.0 0.0 0.0 0.0 0.9 0.9 6.9 6.9 24.0 24.0 3.1 3.1 2.9 2.9 5.3 5.20
Lung 563 104 104 0.8 0.8 0.0 0.0 3.8 3.8 8.6 8.6 45.2 45.2 92.5 92.5 16.0 16.0 18.5 18.5 28.8 28.15
Skin melanoma 24 7 7 0.0 0.0 0.8 0.8 0.0 0.0 2.7 2.7 1.9 1.9 0.0 0.0 0.2 0.2 0.8 0.8 1.2 1.20
Prostate 552 113 113 1.5 1.5 0.3 0.3 0.0 0.0 0.5 0.5 10.1 10.1 66.3 66.3 19.4 19.4 35.2 35.2 28.2 27.6
Testis 72 10 10 0.7 0.7 2.5 2.5 7.3 7.3 7.7 7.7 1.9 1.9 0.7 0.7 0.0 0.0 0.3 0.3 3.7 3.60
Kidney 61 11 11 0.7 0.7 0.0 0.0 0.3 0.3 1.8 1.8 5.6 5.6 10.2 10.2 1.5 1.5 1.0 1.0 3.1 3.05
Bladder 561 159 159 0.7 0.7 0.3 0.3 1.0 1.0 5.4 5.4 27.6 27.6 70.6 70.6 14.9 14.9 25.5 25.5 28.7 28.05
CANCER INCIDENCE RATES AMONG MALES IN LEBANON 2004
85



PRIMARY SITES N AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 AGE-SPECIFIC RATES per 100,000 CRUDE RATES ASR
    UN 0-14 0-14 15-24 15-24 25-34 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75 75    
Meninges brain 107 7 2.2 2.2 1.3 1.3 4.5 4.5 9.5 9.5 5.6 5.6 18.9 18.9 1.1 1.1 0.3 0.3 5.5 5.35
H lymphoma 82 6 1.7 1.7 4.0 4.0 5.1 5.1 5.9 5.9 8.8 8.8 3.6 3.6 0.0 0.0 0.5 0.5 4.2 4.10
NH lymphoma 273 23 2.7 2.7 1.5 1.5 4.5 4.5 16.8 16.8 28.2 28.2 33.5 33.5 5.3 5.3 8.9 8.9 13.9 13.65
Multiple myeloma 53 4 0.3 0.3 0.0 0.0 0.3 0.3 0.5 0.5 5.6 5.6 9.5 9.5 1.4 1.4 2.6 2.6 2.7 2.65
Leukemias 164 10 5.7 5.7 3.5 3.5 4.1 4.1 5.9 5.9 11.9 11.9 11.7 11.7 2.7 2.7 4.9 4.9 8.4 8.20
All cancers 3586 675 21.5 21.5 20.3 20.3 39.1 39.1 99.36 99.36 234.7 234.7 455.2 455.2 86.78 86.78 137.9 137.9 183.2 179.30
ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates ASRAge-standardized rates
CANCER INCIDENCE RATES AMONG MALES IN LEBANON 2004
86
AGE-ADJUSTED CANCER RATES PER 100,000 IN SELECTED
COUNTRIES (1997-2002)
450
400
350
300
250
ASR/Males
200
150
100
50
0
Algiers
Sao
Canada
Beijing
Lebanon
Kuwait
Bas-Rhin
Saar
Paolo
87



PRIMARY SITES N AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 CRUDE RATES CRUDE RATES ASR
    UN 0-14 0-14 15-24 15-24 25-34 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75 75      
Oro-pharynx 46 2 0.59 0.59 1.44 1.44 0.63 0.63 3.52 3.52 1.96 1.96 7.59 7.59 9.93 9.93 16.55 16.55 2.54 2.54 2.59
Stomach 88 10 0.00 0.00 0.58 0.58 0.94 0.94 6.17 6.17 9.82 9.82 14.41 14.41 23.17 23.17 38.62 38.62 4.85 4.85 5.13
Colon-rectum 151 24 0.20 0.20 0.86 0.86 2.51 2.51 7.93 7.93 25.52 25.52 39.44 39.44 81.65 81.65 154.4 154.4 8.32 8.32 14.65
Liver 26 4 0.00 0.00 0.00 0.00 0.44 0.44 2.62 2.62 2.82 2.82 14.34 14.34 13.79 13.79 1.43 1.43 1.43 1.43 1.53
Pancreas 50 0 0.00 0.00 0.31 0.31 0.00 0.00 5.24 5.24 6.07 6.07 24.27 24.27 30.34 30.34 2.76 2.76 2.76 2.76 2.93
Lung bronchus 224 13 0.00 0.00 0.63 0.63 7.49 7.49 19.63 19.63 49.30 49.30 70.62 70.62 121.37 121.37 12.34 12.34 13.35 13.35 13.17
Bone 32 2 1.73 1.73 0.00 0.00 0.44 0.44 3.93 3.93 1.52 1.52 2.21 2.21 0.00 0.00 1.76 1.76 1.76 1.76 1.92
Skin melanoma 26 6 0.00 0.00 0.63 0.63 1.76 1.76 5.24 5.24 2.28 2.28 6.62 6.62 8.28 8.28 1.43 1.43 1.43 1.43 1.55
Breast 1302 137 0.58 0.58 17.26 17.26 134.82 134.82 244.09 244.09 203.28 203.28 221.78 221.78 262.05 262.05 71.74 71.74 71.76 71.76 78.26
Cervix uteri 81 4 0.29 0.29 0.31 0.31 4.41 4.41 16.36 16.36 13.69 13.69 24.27 24.27 11.03 11.03 4.46 4.46 4.46 4.46 4.95
Corpus uteri 88 10 0.29 0.29 0.63 0.63 3.08 3.08 14.40 14.40 16.69 16.69 25.38 25.38 30.34 30.34 4.85 4.85 4.85 4.85 5.30
Ovary 16 8 0.00 0.00 0.00 0.00 0.00 0.00 5.89 5.89 3.79 3.79 2.21 2.21 0.00 0.00 0.88 0.88 0.88 0.88 1.06
Kidney 38 7 0.29 0.29 0.31 0.31 2.20 2.20 2.62 2.62 4,55 4,55 11.03 11.03 8.28 8.28 2.09 2.09 2.09 2.09 2.21
Bladder 106 21 0.00 0.00 0.31 0.31 2.20 2.20 10.47 10.47 21.24 21.24 33.10 33.10 71.71 71.71 5.84 5.84 5.84 5.84 6.25

CANCER INCIDENCE RATES AMONG FEMALES IN LEBANON
2003
88



PRIMARY SITES N AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 CRUDE RATES ASR
    UN 0-14 0-14 15-24 15-24 25-34 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75 75    
Meninges brain 60 5 1.44 1.44 3.77 3.77 4.41 4.41 5.89 5.89 2.28 2.28 9.93 9.93 5.52 5.52 3.31 3.31 3.31 3.35
Thyroid 73 16 0.86 0.86 2.51 2.51 9.25 9.25 12.43 12.43 6.07 6.07 7.72 7.72 16.55 16.55 4.02 4.02 4.02 4.24
H lymphoma 45 5 0.39 0.39 3.46 3.46 3.45 3.45 3.52 3.52 3.93 3.93 3.79 3.79 1.10 1.10 0.00 0.00 2.48 2.41
NH lymphoma 133 12 0.79 0.79 3.17 3.17 3.77 3.77 5.73 5.73 9.16 9.16 21.24 21.24 29.79 29.79 66.20 66.20 7.33 7.52
Multiple myeloma 27 0 0.00 0.00 0.00 0.00 0.00 0.00 1.32 1.32 1.96 1.96 5.31 5.31 8.83 8.83 16.55 16.55 1.49 1.57
Leukemia 102 5 4.32 4.32 2.02 2.02 2.51 2.51 5.73 5.73 7.20 7.20 13.65 13.65 16.55 16.55 44.13 44.13 5.62 6.32
All cancers 3577 347 18.47 18.47 20.18 20.18 49.58 49.58 233.82 233.82 456.12 456.12 497.58 497.58 723.83 723.83 1078.53 1078.53 197.14 190.70
CANCER INCIDENCE RATES AMONG FEMALES IN LEBANON
2003
89
CANCER INCIDENCE RATES AMONG FEMALES IN LEBANON
2004



PRIMARY SITES N AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 CRUDE RATES CRUDE RATES ASR
    UN 0-14 0-14 15-24 15-24 25-34 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75 75      
Oro-pharynx 31 5 0.5 0.5 0.5 0.5 0.3 0.3 2.0 2.0 2.4 2.4 1.4 1.4 0.5 0.5 1.0 1.0 1.6 1.6 1.55
Stomach 134 30 0.5 0.5 0.3 0.3 0.6 0.6 4.8 4.8 9.0 9.0 13.9 13.9 3.2 3.2 5.1 5.1 6.7 6.7 6.70
Colon-rectum 283 65 0.4 0.4 0.0 0.0 1.7 1.7 1.0 1.0 23.4 23.4 34.2 34.2 5.2 5.2 14.0 14.0 14.2 14.2 14.2
Liver 42 10 0.0 0.0 0.3 0.3 0.0 0.0 1.6 1.6 3.6 3.6 3.5 3.5 0.9 0.9 1.8 1.8 2.1 2.1 2.10
Pancreas 57 8 0.0 0.0 0.0 0.0 0.0 0.0 2.4 2.4 4.2 4.2 7.7 7.7 1.5 1.5 2.5 2.5 2.9 2.9 2.85
Lung bronchus 215 38 0.2 0.2 0.0 0.0 0.6 0.6 3.6 3.6 22.2 22.2 34.2 34.2 5.5 5.5 6.4 6.4 10.8 10.8 10.75
Bone 39 6 1.8 1.8 1.6 1.6 1.7 1.7 2.4 2.4 1.2 1.2 0.7 0.7 0.3 0.3 0.5 0.5 2.0 2.0 1.95
Skin melanoma 23 3 0.0 0.0 0.0 0.0 0.0 0.0 2.4 2.4 1.2 1.2 2.1 2.1 0.6 0.6 0.8 0.8 1.2 1.2 1.15
Breast 1383 267 0.2 0.2 1.3 1.3 11.1 11.1 96.9 96.9 194.2 194.2 183.3 183.3 16.9 16.9 19.3 19.3 69.5 69.5 69.15
Cervix uteri 94 20 0.0 0.0 0.0 0.0 0.9 0.9 6.0 6.0 11.4 11.4 12.5 12.5 1.3 1.3 1.5 1.5 4.7 4.7 4.70
Corpus uteri 125 29 0.0 0.0 0.0 0.0 0.0 0.0 3.6 3.6 18.0 18.0 20.2 20.2 1.7 1.7 2.8 2.8 6.3 6.3 6.25
Ovary 166 35 0.3 0.3 1.0 1.0 1.6 1.6 8.2 8.2 23.4 23.4 14.6 14.6 3.1 3.1 3.1 3.1 8.3 8.3 8.30
Kidney 37 6 0.9 0.9 0.3 0.3 0.6 0.6 0.4 0.4 3.6 3.6 3.5 3.5 0.6 0.6 1.3 1.3 1.9 1.9 1.85
Bladder 110 37 0.4 0.4 0.5 0.5 0.3 0.3 1.2 1.2 6.6 6.6 12.5 12.5 1.6 1.6 5.1 5.1 5.5 5.5 5.50
90



PRIMARY SITES N AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 AGE-SPECIFIC RATES PER 100,000 CRUDE RATES ASR
    UN 0-14 0-14 15-24 15-24 25-34 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75 75    
Meninges brain 80 2 1.8 1.8 2.4 2.4 2.0 2.0 3.6 3.6 8.4 8.4 9.8 9.8 1.3 1.3 0.5 0.5 4.0 4.00
Thyroid 111 24 0.2 0.2 1.8 1.8 4.9 4.9 8.4 8.4 9.0 9.0 9.1 9.1 1.0 1.0 0.8 0.8 5.6 5.55
H lymphoma 56 4 0.4 0.4 4.2 4.2 2.9 2.9 2.4 2.4 6.0 6.0 3.5 3.5 0.1 0.1 0.5 0.5 2.8 2.80
NH lymphoma 212 22 0.7 0.7 1.3 1.3 4.3 4.3 5.6 5.6 21.6 21.6 19.5 19.5 6.3 6.3 6.4 6.4 10.7 10.60
Multiple myeloma 35 2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.2 4.2 6.3 6.3 1.0 1.0 1.8 1.8 1.8 1.75
Leukemia 106 1 5.0 5.0 2.9 2.9 2.6 2.6 2.0 2.0 4.2 4.2 11.8 11.8 2.4 2.4 1.5 1.5 5.3 5.3
All cancers 3606 652 15.4 15.4 21.3 21.3 37.1 37.1 170.4 170.4 405.8 405.8 432.1 432.1 60.1 60.1 85.2 85.2 181.3 180.30
CANCER INCIDENCE RATES AMONG FEMALES IN LEBANON
2004
91
AGE-ADJUSTED CANCER RATES PER 100,000 IN SELECTED
COUNTRIES (1997-2002)
300
250
200
150
ASR/Females
100
50
0
Algiers
Sao
Canada
Beijing
Lebanon
Kuwait
Bas-
Saar
Paolo
Rhin
92
AGE DISTRIBUTION () OF INCIDENT CANCER CASES
IN LEBANON 2004 (N7197)
93
CHANGES IN INCIDENCE RATES(partially valid
because of uncertain denominators)
ASR 1966 1998 2004
Males 102.8 154.2 179.3
Females 104.1 134.8 180.3
94
Acknowledgements

• Ministry of Public Health
• Lebanese Cancer Epidemiology Group
• AUB Registry Staff
• NCDP Staff
• NCR Committee and Staff
• Italian Cooperation Group
• Lebanese Society of Medical Oncology
• Lebanese Cancer Society
• Lebanese Society of Pathology
• Lebanese Society of Hematology

95
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