cancer in the arab world: magnitude of the problem inas elattar, drph professor of biostatistics...
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Cancer in the Arab World: Magnitude of the Problem
Inas Elattar, DrPH
Professor of BiostatisticsDepartment of Biostatistics & Epidemiology
NCI, Egypt
APHANovember, 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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YemenYemen
Regional Cancer Registry
National Cancer Registry
No Registry
Cancer Databases in Arab World
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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
96
88
114
99 154
102
180180
123
123
60
180166
121
72
99
123
178
178
178178
81
Rates/100,000
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Age-Adjusted Incidence Rates in Arab World, Females
87
90
78
85 137
84
167167
118
127
61
216159
120
77
89
118
176
176
176176
94
Rates/100,000
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Male to Female Ratio, All Cancer Sites
0.0 0.5 1.0 1.5 2.0
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
M/F ratio
Ratio <1 Ratio >1
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ASR of Stomach Cancer in Arab World
3.3
4.1
2.9
1.5
5.2
6.5
5.6
3.8
3.1
3.0
2.9
7.2
6.7
4.3
2.7
8.1
11.2
13.2
5.2
5.9
5.3
3.8
0 5 10 15
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
Males
Females
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ASR of Colorectal Cancer in Arab World
33.1
13.2
14.8
4.5
7.6
9.0
4.4
15.8
5.0
6.9
5.5
44.6
11.5
14.0
4.7
7.5
12.5
4.1
13.5
5.5
6.3
5.8
0 10 20 30 40 50
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
Males
Females
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ASR of Liver Cancer in Arab World
2
1.1
3.6
2.7
0.7
7.3
3.1
8.7
1
1.2
6
5.5
2
10.3
6.1
4.1
7.4
5.9
14
0.8
2.5
21.4
0 5 10 15 20 25
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
Males
Females
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Relative Frequency of Liver Cancer, NCI - Egypt 1975-2002
1975-85 1990 1995 2000
Year
0
2
4
6
81975-97 2001-02
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Egypt Mortality Statistics, 2001 Most common sites (The Cancer Database, 2001)
425
550
797
834
1662
1869
2006
2023
2497
3197
0 1000 2000 3000 4000
Prostate (2%)
Pancreas (2.5%)
Stomach (3.7%)
Colorectal (3.9)
Lung&Bronchus (7.7%)
Bladder (8.7%)
Breast (9.3%)
Brain (9.4%)
Lymph&Leuk (11.6%)
Liver (14.8%)
Number of cases
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Trend of HCC Mortality in Egypt, 1981-1996
1.0
1.2
1.5
2.0
2.3
2.5
2.3
2.5
1.4
2.1
2.4
3.23.3
3.0
4.2
4.6
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
80 82 84 86 88 90 92 94 96
Rate/1
00
,0
00
Females
Males
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ASR of Lung Cancer in Arab World
36.1
1.2
2.0
4.1
3.5
4.1
5.8
12.3
2.0
1.9
3.6
61.9
6.1
8.8
9.4
16.3
11.3
36.6
33.5
16.9
27.8
14.0
0 10 20 30 40 50 60 70
USA
Saudi Arabia
Oman
UAE
Jordan
Kuwait
Qatar
Bahrain
Algeria
Tunisia
Egypt
Rates/100,000
Males
Females
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Prevalence of Smoking in Arab World
8%
2%
1%
10%
2%
1%
3%
7%
8%
18%
19%
16%
18%
48%
30%
37%
17%
44%
62%
40%
0% 20% 40% 60% 80%
Saudi Arabia (1996-2001)
Oman (1995)
UAE (1996)
Jordan (1999)
Kuwait (1996)
Qatar (1999)
Bahrain (2001)
Algeria (1997-98)
Tunisia (1997)
Egypt (2000)
Percent
Males
Females
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ASR of Prostate Cancer in Arab World
124.8
10.6
12.6
3.6
8
19.3
8.7
11.8
5.6
8.7
6.6
0 25 50 75 100 125
USA
Jordan
Kuwait (5th)
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
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ASR of Bladder Cancer in Arab World
6.5
1.5
3.9
1
3.9
3.7
1.5
1.1
1.1
5.3
24.5
13.3
8.1
3.7
4.7
14.5
3.6
21.2
8.1
13.5
26.3
0 5 10 15 20 25 30
USA
Jordan
Kuwait (5th)
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
Males
Females
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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
*
*
*
** * * *
**
** *
** *
* *
**
* ** *
+
+
+
++
+
+
+
++++
+ +++
+++
+++
+
+
1975 1980 1985 1990 1995 2000
Year
0
10
20
30
40
50
60
70
80
SCC
TCC
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ASR of Lymphomas in Arab World
13.5
6
7.1
5
5.7
6.9
7.3
19.6
4.2
4.6
11.9
20.3
10.7
13.3
7.2
6.9
9.1
10.4
12.0
6.5
7.4
17.7
0 5 10 15 20 25
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
Males
Females
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Age Specific Incidence Rates (ASIR) of Lymphoma in Selected Arab Countries (Males)
0
20
40
60
80
100
120
140
Age groups (years)
ASI
R
EgyptSaudi ArabiaKuwaitJordan
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ASR of Leukemias in Arab World
7.4
6
2.8
3
3.8
2.6
4.1
4.5
2.1
3.8
5.8
11.2
7.0
4.8
3.4
1.8
6.3
5.9
12.9
3.2
4.6
7.0
0 5 10 15
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
Males
Females
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ASR of Breast Cancer in Arab World (Females)
101.1
42.6
36.0
13.9
12.9
56.0
14.9
50.7
23.5
19.6
49.6
0 20 40 60 80 100 120
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
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Age Specific Incidence Rates (ASIR) of Breast in Selected Arab Countries (Females)
0
50
100
150
200
250
300
<5 5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
44-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
475
+
Age groups (years)
ASI
R
EgyptBahrainKuwaitJordan
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ASR of Cervical Cancer in Arab World
6.8
1.5
6.8
2.1
6.5
4.4
7.0
10.5
15.6
7.7
2.8
0 5 10 15 20
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
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ASR of Cancer of Uterus in Arab World
22.8
5.5
5.8
2.4
3.6
5.5
1.3
12.0
1.5
2.1
3.1
0 5 10 15 20 25
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
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ASR of Cancer of Ovary in Arab World
10.6
6.2
4.0
2.2
1.4
8.2
6.0
7.2
3.7
2.7
5.0
0 5 10 15
USA
Jordan
Kuwait
Saudi Arabia
UAE
Bahrain
Oman
Qatar
Alegria
Tunisia
Egypt
Rates/100,000
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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 Brain&CNS Brain&CNS
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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 InstituteNational Cancer Institute , ,Cairo, EgyptCairo, 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
1590
1211
1718
376
513
2357
909
305
3729
509
845
515
1242
3056
693
0 1000 2000 3000 4000
Others
Leukemia
Lymphoma
Thyroid &other endocrine
Eye & brain
Urinary system
Female genital
Male genital
Breast
Skin
Soft tissue
Bones & joints
Respiratory system
Digestive system
Lip, oral cavity &pharynx
Number of cases