cancer incidence report 2004

Kingdom of Saudi ArabiaMinistry of Health

Saudi Cancer Registry

Cancer Incidence ReportSaudi Arabia

2004

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Report prepared by: Haya S. Al-Eid, BDS, DFE, CTR

Suad Omer Arteh, MA

Reviewed by: Shouki Bazarbashi, MD Ali Al-Zahrani, MD, PhD

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AcknowledgmentForewordThis annual report presents the cancer incidence data for the start of the second decade of the Saudi Cancer Registry operation. Analysis of the last 10 years trends in cancer incidence will be presented in a separate report in the near future.

The Saudi Cancer Registry (SCR) is in continuous evolution. Starting with the name, we have personalized our name to be more descriptive of our identity (from National to Saudi Cancer Registry). We are fortunate in being now overseen by the Higher counsel for health services which will hopefully help in overcoming many of the obstacle that we face in our operation. We are in the process of changing software from the International Agency Against Cancer (IARC) supported CanReg program to a custom-made web-based program that will hopefully connect all our regional offices instantaneously and willfacilitate data cleaning and filtering of duplication.We are also working toward registering mortality data so that both cancer incidence and mortality can be presented, and projection of incidence and prevalence based on current data.

In an effort to disseminate the data the Saudi Cancer Registry makes every effort to participate in any major cancer conference or symposium. More and more people are becoming aware of the valuable data collected by the registry. Over the past 12 months we have responded to data request. The SCR is committed to provide all requesters with the required available data and believe that our data is much underutilized. Epidemiological studies using our data need to be encouraged and is one way this data should be used for.

In addition we are looking forward to a starting fruitful collaboration with several nongovernmental agencies in the country to include but not restricted to the Saudi Cancer Society and the Saudi Oncology Society as well as others.

Shouki Bazarbashi, MDChairmanRiyadh, April 2008

The Saudi Cancer Registry is funded by The Ministry of Health. The work of the Saudi Cancer Registry including the production of this report is the result of teamwork by our valuable cancer registrars, main office staff and members of theboard of directors.

Special thanks to the support provided by the Ministry of Health represented by his Excellency the Minister of Health Dr. Hamad Al Manea and the deputy Minister of Health Dr. Mansour Al Hawasi. In addition we continue to be in debt for the support of King Faisal Specialist Hospital and Research Center leadership represented by Dr. Qasem Al Qasabi and Dr. Adnan Ezzat.

We also would like to record our thanks to the support from The Saudi Cancer Society represented by Dr. Abdullah Al Amro in their effort to support the registry in many aspects.

Many thanks to several pharmaceutical companies who have supported us with unrestricted grants. In particular we would like to thank Roche Oncology, Merck AG and Sanofi-Aventis for their support

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IntroductionPart IV Cancer Incidence among Non-Saudis

This part presents the incidence of cancer cases among Non-Saudis including the most common types of cancer. The analysis of the Non-Saudis is performed separately due to the nature of the expatriate population in Saudi Arabia in which a large part of the population, particularly among males, falls in the 25- 44 age group.

Part V Incidence Tables

Part V contains the following detailed tables for all newly diagnosed cancer types among Saudis and Non-Saudis for 2004:

• Distribution of cancer cases among Saudis by age group and sex

• Distribution of cancer cases among Non-Saudis by age group and sex

• Cancer Incidence (per 100,000 population) among Saudis by age group and sex

• Cancer Incidence (per 100,000 population) among Non-Saudis by age group and sex

• Age-standardized incidence rate and relative frequencies among Saudis by cancer site, sex and administrative regions

Part VI Appendices

Appendix A: Regional listing of all health care facilities from which cancer cases have been reported. The objective is to receive feedback from facilities that have not been included in order to improve our case-finding and reportingprocesses.

Appendix B: Names of the members of the Board of Directors.

Appendix C: Data request form which may be copied, filled and submitted to the SCR MainOffice.

Appendix D: Copy of the cancer registration abstract form which is completed by cancer registrars for each cancer case.

This is the eighth incidence report published by the Saudi Cancer Registry of Saudi Arabia. Previous publications include the 1994 Summary Report, 1994-1996 Incidence Report, 1997-1998 Incidence Report, 1999-2000 Incidence Report, 2001 Incidence Report, 2002 and 2003 Incidence Report.

The structure of this report can be outlined as follows:

Part I Materials and Methods

This part of the report contains information about the background of the Saudi Cancer Registry and methods used in collecting and analyzing the data. We present the basics of coding and classificationof tumor topography, morphology and extent of disease at the time of diagnosis. Also we describe the software programs we have used to analyze the data.

Part II Overview of Cancer Incidence

Part II contains figures and tables that show overallcancer incidence in Saudi Arabia for the year 2004. We present these figures and tables mainly by sexand in certain areas we have it analyzed by different age groups. There are bar charts representing the age distribution of cancer incidence for the year 2004 among Saudis by sex and age groups. We present incidence and morphology tables for the most common types of cancers among adults and children. In addition, tables list the total number of cases, the Age-Standardized Incidence Rate (ASR) per 100,000 population, Crude Incidence Rate (CIR) and Cumulative rates by primary site and sex. Separate bar charts depict the most common types of cancer, by sex, in each of the 13 administrative regions of Saudi Arabia.

Part III Incidence of Selected-Sites

In this part the incidence of the most common cancers among Saudi males and females are outlined. A standardized layout presents data for all patients and for both sexes where applicable. For each selected site the number and the percentage of all newly diagnosed cases for the year 2004, the ASR for each sex, and the specific cancer rank for bothsexes. In addition, ASR for the specified canceramong Saudis is compared with ASR among other populations from selected countries.

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Table of Contents

Acknowledgment ......................................................................................................................................................... 3Foreword ....................................................................................................................................................................... 3Introduction .................................................................................................................................................................. 5

PART I ................................................................................................................................................... 9

Background on Saudi Arabia .................................................................................................................................... 10Saudi Cancer Registry ............................................................................................................................................... 10Definitions of Statistical Terms ................................................................................................................................ 13

PART II ................................................................................................................... 15

Cancer in Saudi Arabia 2004 ................................................................................................................................... 16Adult Cancers in Saudi Arabia, 2004 (above 14 years) ...................................................................................... 22Childhood Cancers in Saudi Arabia 2004 (14 years and below) ..................................................................... 24Cancer in the 13 Administrative Regions of the Kingdom ............................................................................... 26International Comparison of Age-Standardized Incidence Rates .................................................................. 31

PART III .................................................................................................................. 33

Cancer Incidence for Specific Sites, 2004 ............................................................................................................. 35Female Breast (C 50) ................................................................................................................................................ 36Colo-rectal (C18-C20) ............................................................................................................................................. 38Non-Hodgkin Lymphoma (C82-C85; C96) .......................................................................................................... 40Leukemia (C91-C95) ................................................................................................................................................. 42Thyroid (C 73) ............................................................................................................................................................ 44Liver (C 22) ................................................................................................................................................................. 46Lung (C33-C34) ......................................................................................................................................................... 48Hodgkins disease (C 81) .......................................................................................................................................... 50Skin (Non-Melanoma) (C 44) ................................................................................................................................. 52Brain, Nervous System ( ........................................................................................................................................... 54Prostate (C 61) ........................................................................................................................................................... 56Stomach (C 16) .......................................................................................................................................................... 58Bladder (C 67) ............................................................................................................................................................ 60Corpus Uteri (C 55) ................................................................................................................................................. 62Ovary Cancer (C 56) ................................................................................................................................................ 64

PART IV .................................................................................................................. 67

Cancer Among Non-Saudi Population 2004 ........................................................................................................ 69

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PART V .................................................................................................................... 71

Table 5.1.1 Age Distribution of Cancer Cases among Saudi Males, 2004 ..................................................... 72Table 5.1.2 Age Distribution of Cancer Cases among Saudi Females, 2004 ................................................. 73Table 5.1.3 Cancer Incidence Cases among Saudi Males by Age Group (per 100,000), 2004 .................. 74Table 5.1.4 Cancer Incidence Cases among Saudi Females by Age Group (per 100,000), 2004 ............. 75Table 5.2.1 Age Standardized Rates and Relative Frequencies among Saudi Males by Cancer Site and Administrative Region, 2004 .............................................................................................................. 76-79Table 5.2.2 Age Standardized Rates and Relative Frequencies among Saudi Females by Cancer Site and Administrative Region, 2004 .............................................................................................................. 80-83Table 5.3.1 Age Distribution of Cancer Cases among non-Saudi Males, 2004 ............................................. 84Table 5.3.2 Age Distribution of Cancer Cases among non-Saudi Females, 2004 ........................................ 85Table 5.3.3 Incidence Rates for Cancer Cases among non-Saudi Males by Age Group (per 100,000), 2004 ............................................................................................................................. 86Table 5.3.4 Incidence Rates for Cancer Cases among non-Saudi Females by Age Group (per 100,000), 2004 ............................................................................................................................. 87

PART VI .................................................................................................................. 89

APPENDIX A: Reporting Health Care Facilities .................................................................................. 90-93APPENDIX B: Members of SCR Board of Directors ......................................................................... 94-95APPENDIX C: SCR Data Request Form ...................................................................................................... 96APPENDIX D: Cancer Registration Abstract Form ................................................................................... 97

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PART IMATERIALS AND METHODS

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Saudi Arabia is a vast country extending over four-fifths of the Arabian Peninsula. It stretchesfrom the Arabian Gulf in the east to the Red Sea in the west. It is approximately 2,149,700* square kilometers in area and is divided into 13 administrative regions (Figure 1.1).

Figure 1.1 Administrative Regions of Saudi Arabia

Figure 1.2 Population Pyramid of Saudis (%) by Sex and Age Group, 2004

Saudi Cancer Registry

The Saudi Cancer Registry (SCR) of Saudi Arabia is a population-based registry established in 1992 under the jurisdiction of the Ministry of Health (MOH) by the order of His Excellency the Minister of Health. The SCR commenced reporting cancer cases from 01 January 1994.

Objectives:

The primary goal of the SCR is to define thepopulation-based incidence of cancer in Saudi Arabia. Additional objectives include programs for early detection and cancer screening, as well as cancer research projects.

Organizational Structure:

A Board of Directors was appointed to include representatives from the MOH, King Faisal Specialist Hospital and Research Center (KFSH&RC), and the Medical Services Departments of the Ministry of Defense and Aviation, Ministry of Interior, the National Guard, King Saud University, King Faisal University, King Abdul-Aziz University and King Khalid University. The Board is charged with the responsibility of overseeing the SCR’s establishment, defining demographic and cancer-related data to becollected, approving research requests, and reporting findings, as well as disseminating informationcollected while ensuring the confidentiality of alldata reported to the SCR.

* Source: Demographic and Health Indicators for Countries of the East Mediterranean, WHO, Regional Office for the EM, 1999** Source: Census 2004, Central Department for Statistics (CDS) data, Ministry of Planning,(web site http:\\www.planning.gov.sa).

Figure 1.3 Population Pyramid of non-Saudis (%) by Sex and Age Group, 2004

Background on Saudi Arabia

The Saudi national population for year 2004 was 16,527,340**. Of these, 8,287,370 were males and 8,239,970 were females. The Non-Saudi population in 2004 was 6,150,922**; of these 4,269,870 were males and 1,881,052 females.

Figures 1.2 and 1.3 show the Saudi and Non-Saudi population pyramids by sex and age group respectively.

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Figure 1.4 Organizational Chart of the Saudi Cancer Registry of Saudi Arabia

Format

The format of the current report is similar to the previous reports.

The SCR Main Office, including administrative and technical staff, is located in the premises of the KFSH&RC in Riyadh. Additionally, five regionalbranches and four hospital-based offices were setup to ensure comprehensive data collection from all over the Kingdom (Figure 1.4).

Regional Offices:

1 Central Region: King Khalid University Hospital in Riyadh, covering Riyadh, Qassim, and Hail Health Regions.

2 Eastern Region: King Fahad Hospital of the University, Al Khobar, covering Dammam, Al Ahsa, and Hafr Al-Batin Health Regions.

3 Western Region: King Abdulaziz Hospital and Cancer Center, Jeddah, covering Jeddah, Makkah, Taif and Qunfudah Health Regions.

4 Southern Region: King Khalid University, Abha, covering Asir, Baha, Najran, Jazan and Bisha Health Regions.

5 Madinah/Northern Region: King Fahad Hospital, Madinah, covering Madinah, Tabuk, Jouf and Northern Health Regions.

Offices at the Medical Service Division or OncologyDepartment of the following establishment

1 Ministry of Defense and Aviation, Armed Forces Hospital, Riyadh

2 King Abdulaziz Medical City.3 Ministry of Interior, Security Forces Hospital,

Riyadh.4 King Faisal Specialist Hospital and Research

Centre, Riyadh.5 King Abdul Aziz University Hospital, Jeddah

Each of the SCR offices operates under thesupervision of a member of the Board of Directors who is responsible for the daily management of that office. Staffing consists of tumor registrars andsecretarial staff.

The SCR Main Office indirectly supervises the regionaloffices and is responsible for ensuring the accuracyand quality of data collected in all of the regions. Quality control processes include verification ofsite, morphology, and staging information as well as case linkage (tumor and patient), and consolidation of data. The Main Office also prepares periodicreports for dissemination of information to the medical community, government establishments, international organizations and the media.

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A ministerial decree has categorized cancer as a mandatory notifiable disease. This ensures theopportunity for comprehensive data collection. The SCR strives for full access to cancer data from all Ministry of Health, governmental and private hospitals, as well as clinics and laboratories throughout the Kingdom. Cancer data are abstracted from patients’ medical records, based on clinical and/or histopathological diagnosis, by SCR-trained cancer registrars.

The data abstract (see appendix D) includes personal identification (name, ID Number, sex,age), demographic information (address, telephone number, nationality), and tumor details (diagnosis date, primary site, histology, behavior, grade, stage, basis of diagnosis). The primary site (topography) and histology (morphology) of the malignancies are identified and coded according to the International

Classification of Diseases for Oncology 3rd Edition (ICD-

O-3), published by the World Health Organization (WHO), 2000.

Effective from year 2001, changes were made in coding of cancer types and behaviors as well as staging according to International guidelines. The new SEER Summary Stage 2000 guidelines should result in increased accuracy and consistency in the coding of stage. There are some differences in the staging according to different time period and some sites are coded differently using the new staging guidelines. However, the new criteria and guidelines should improve the usefulness of staging as a predictor of prognosis and survival as the changes reflect a new understanding ofthe natural history of cancer. The new guidelines, SEER Summary Stage Manual 2000, is available on the web at: http:/seer.cancer.gov/tools/ssm/. Cases diagnosed on or after 01 January 2004 are classifiedaccording to the updated ICD-O-3. Improvements in the understanding of cancer pathology over the last decade are reflected in the changes to ICD-O-3. While there have not been any changes in the primary site codes, there are significant changesregarding histology (cell types). Leukemias and lymphomas, particularly are affected. Some cases that were previously considered benign are now

The computer software programs used for data entry and incidence tables output are CanReg 4.31, developed by the International Agency for Research on Cancer, (IARC) Lyon, France.

The second part of the report includes the overall cancer incidence in Saudi Arabia and the relevant epidemiological and clinicopathological details for the 14 most common cancers among Saudi nationals for the year 2004. For each cancer site, the number and the percentage of all newly diagnosed cases for the year 2004, the age-standardized incidence rate (ASR) per 100,000 population for each sex, and the specific cancer rank in comparison to all cancersfor both sexes are presented. Useful international statistics for the specified cancer include theranking of the cancer worldwide. The source for this information is summarized on page 66.

counted as malignant. Also small number of cancers that were previously coded as borderline tumors are now considered benign. Counts of ovarian cancers, lymphomas and leukemias as well as some hematopoietic diseases will change due to changes in either reportability or definition. However,as with the new staging guidelines, the ICD-O changes reflect advances in the understanding ofthe pathology and behavior of cancers.

It should be noted that ICD-O-3 codes are converted to ICD-10 for analysis purposes. Since the WHO has not yet converted the ICD-10 hematopoietic disease behavior changes, our software, CanReg 4.31, cannot include these cases for analysis and they have been excluded. Every effort is made to accurately code patient and tumor information, to ensure that all data can be reviewed, linked, and consolidated, as appropriate. This way each malignancy is counted only once for statistical analysis.

Data management

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* Doll R. Payne P. Waterhouse J. Cancer incidence in Five Continents Vol. I. International Union

Against Cancer. 1966

1. An arithmetic line graph represents the age-specific incidence rate (AIR) for all agegroups at five-year intervals. The graph isplotted by sex, where applicable.

2. A table lists the percentages of the most common histology sub-types for each specific cancer.

3. A pie chart shows the distribution of the clinical stages of each cancer such as localized, regional, distant metastasis and unknown.

4. A bar chart shows regional distribution of ASR for particular cancer across the admin-istrative regions by males and females.

5. A bar chart shows comparison of age-standardized incidence rate (ASR) for each cancer type in Saudi Arabia with ASR in selected countries.

In reviewing the data, its collection and analysis, two qualifying statements can be made:

Definitions ofTerms

Age-Specific Incidence Rate (AIR)

The number of cancer cases occurring during a specific period in a population of a specific ageand sex group, divided by the number of midyear population of that age and sex group.

Age-Standardized Rate (ASR)

The Age-standardized rate is a summary measure of a rate that a population would have if it had a standard age structure. Standardization is necessary when comparing several populations that differ with respect to age structure. The most frequently used standard population is the World Standard Population (see below). The calculated incidence is known as the World Standardized Incidence Rate. The rate is expressed per 100,000 populations.

Notification

The data included in this report were abstracted up to June 2005. 2004 incident cases which are identified after this date (late reporting) will benoted in subsequent incidence reports. It is anticipated that the number of late-reported cases will decrease as case ascertainment processes are improved.

The relevant data incorporate details for all patients presented over the year 2004. For each cancer there are five figures:

a. The number of patients presenting with malignant disease from Riyadh region exceeds the anticipated number per population. The reason for this is that Riyadh has many referral centers providing patients from outside the region with cancer-related care. Many of these patients fail to provide their permanent address, but instead, provide a temporary Riyadh address. This situation is partially resolved through tumor and patient linkage of cases from all regions based on identifiers suchas national ID.

b. As previously noted, the software used in analyzing this report, CanReg 4.31, does not include in situ cases in the incidence tables. These cases were added to the total cancer cases in the overview.

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An incidence rate is defined as the rate at which anew event occurs in a population. It is calculated as the number of new cases of disease arising in a population over a defined time period, divided bythe population at risk of developing that disease.

Mean

The simple mathematical average of two or more numbers.

Median

The midpoint of the range numbers that are arranged in order of value.

Metastasis

Metastasis is the distant spread of cancer from its original site to other organs of the body, including lymph nodes, skeletal and or visceral organs.

Range

Is the difference between the maximum and minimum values in a set of observations.

Rank

This measure reflects the importance of a specificcancer site relative to other sites, in terms of the number of registrations. Ranking illustrates the most and least frequent cancer sites in a population according to their frequency.

Ratio

The relation between two quantities. The first quantity as numerator and the second asdenominator

Relative Frequency

This statistic is defined as the number of specificcancer cases registered relative to the total number of all cancer. It is expressed as a percentage.

Summary Stage

Staging is the grouping of cancer cases into broad categories based on the extent of disease.

The crude incidence rate for a cancer site is the total number of cases registered as a proportion of the total population. It denotes the approximate number of cases occurring in each 100,000 individuals. All rates are thus, expressed as per 100,000 population.

Cancer rates vary greatly with age and the crude rate is strongly influenced by the demo-graphic structure of the population. Hence, if the population structure changes over time the crude rate over that period may be artificially altered. Itis not appropriate to compare crude rates across geographical areas of cancer registries with different population age structures. Therefore, in order to assess time trends in registration data or compare incidence across geographical areas or between registries it is necessary to first standarize the rateswith respect to age.

Cumulative Incidence rate

Cumulative incidence is the probability or risk of individuals developing the disease during a specifiedperiod. For cancer, it is expressed as the number of new born children (out of 100, or 1000) who would be expected to develop a particular cancer before the age of 65 (or 70, or 75) if they had the rates of cancers currently observed. Like the age standardized rate, it permits comparison between populations of different age structures. In this report the age ranges 0-64 and 0-74 years are used. The cumulative rate is the summation of the cancer age-specific rates; which are computed for five-yearage intervals. The cumulative rate is five times thesum of the age-specific rates calculated over thefive-year age groups.

ICD-10

The World Health Organization’s International Classification of Diseases, tenth edition.

ICD-O-3

The World Health Organization’s International Classification of Diseases for Oncology, 3rd Editionhas been the standard coding system for neoplasms for over 25 years. The coding system includes a four character code for primary site, a four-digit numeric code for cell type, one-digit code for behavior and a one-digit code for tumor aggressiveness (grade).

Crude Incidence Rate Incidence Rate

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PART IIOVERVIEW OF CANCER INCIDENCE

2004

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* ICD-10 conversion failure** Unknown nationalities, in situ cases and ICD-10 conversion failures are excluded from analysis

As shown in table 2.1, 8,913 cases were analyzed, of which 6,969 (78%) were Saudis and 1,944 (22.%) were Non-Saudis. Among the Saudis, 3,478 (49.9%) were male and 3,491 (50.1 %) were female. The male to female ratio was 99.6:100. The crude incidence rate (CIR) of all cancers among the Saudi population was 41.9/100,000 (41.6/100,000 among males and 42.1/100,000 among females). The overall age-standardized incidence rate (ASR) for all Saudis with a world standard population reference was 69.7/100,000 (70.2/100,000 in males and 69.3/100,000 in females). For all sites, the age-specific incidence rate (AIR) increased with age for both males and females. After the age of 64 years, the increase was nearly two folds for males compared to females. The median age at diagnosis was 59 years for men (Range 0-110) and 49 years for women (Range 0-100). The five geographicregions with the highest ASR were Riyadh region at 91.9/100,000, Eastern region at 89.9/100,000, Tabuk region at 74.8/100,000, Makkah region at 74.6/100,000, and Jouf region at 64.9/100,000.

Between January 01 and December 31, 2004, the total number of cancer incident cases reported to the SCR was 9381. Overall, cancer was slightly more in men than in women. Cancers affected 4,778 (50.9%) males and 4,603 (49.1%) females, with a male to female ratio of 104:100. 7,138 cases were reported among Saudis, 1,987 among Non-Saudis. The total number of cases excluded from analysis included 256 cases of unknown nationalities. Other exclusions were 191 in situ cases. The current software program CanReg-4 version 4.31, does not include in situ cases in the statistical analysis. Also, 27 were ICD-O-3 coded cases that failed to convert to ICD-10 codes as described in the Data Management (see page 12). This puts the total number of exclusions from the analysis as 468 cases. Table 2.1 illustrates the distribution of the cases by sex.

Diagnosis of malignancy was confirmed histologicallyand/or cytologically in 97.3% of the cases. Clinically confirmed cases were 0.2%; radiologically confirmedcases were 1.9%; and cases confirmed by DeathCertificate were 0.1%. The method of diagnosiswas unknown for 0.6% of the cases.

Reported Cancer Incidence Cases in Saudi Arabia, 2004

Table 2.1 Distribution of Cancer Cases in Saudi Arabia by Nationality and Sex 2004

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Dr. Suliman Alsagaby


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Cancer among Saudis 2004

Figure 2.1 Percentage Distribution of Cancer Incidence among Saudis by Sex according to Age Group, 2004

The total number of cancer cases analyzed among Saudis during the year 2004 were 6,969. Of those cases 49.9 % (3,478) were reported among men and 50.1% (3,491) among women.

Figure 2.2 Percentage Distribution of Most Frequent Types of Cancer by Sex among Saudis, 2004

* 5 cases (2 male and 3 female) of unknown age are included only in the total as they may not be added to any age group.

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Table 2.2 Ten Most Common Cancers among Saudis, 2004 (All Ages)

Figure 2.3 Ten Most Common Cancers among Saudis by Sex, 2004

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Figure 2.5 Age Standardized Rate (ASR) Regional Distribution (per 100,000) of All Sites of Cancer among Saudis, 2004

Figure 2.4 Age-Specific Incidence Rates (AIR) for All Cancers among Saudis, 2004

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Table 2.3 Number, Percentage, ASR, CIR, and Cumulative Rates (per 1000) of New Cases by Primary Site and Sex among Saudis, 2004

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Between January and December 2004, the total number of adult cancer incidence cases reported was 8,595. Overall cancer was slightly more in males than in females. Cancer affected 4,341 (50.5%) males and 4,254 (49.5%) females, with a ratio of

104:100. Of all cases, there were 6,549 Saudis, 1,883 of Non-Saudis and 163 of unknown nationalities. As shown on table 2.4, the total number of analysed cases were 8,220.

Adult Cancers in Saudi Arabia, 2004 (>14 years)

Table 2.4 Distribution of Reported Adult Cancer Cases in Saudi Arabia by Nationality and Sex 2004

Figure 2.6 Ten Most Common Cancers among Saudi Adults, 2004

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Table 2.5 Number and Proportion of Morphological Types for the Most Common Types of Cancer among Saudi Adults, 2004

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Table 2.5 continued .....

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The total incident cases reported among children (0-14 years) between January and December 2004 were 713. This represents 7.6 % of the total number of cancers in Saudi Arabia. The reported incidents show that cancer was more common among boys than girls. 400 (56.1%) cases were reported among boys and 313 (43.9%) among girls, with a male to female ratio of 128:100. Of all the

cases reported there were 584 Saudis, 115 non-Saudis and 14 of “unknown nationality”. Based on table 2.6, the total number of cases analyzed was 685 including 584 (85.3%) Saudis and 101 (14.7%) non-Saudis. Among Saudis, 318 (54.5%) were male and 266 (45.5%) were female. The male to female ratio among Saudis was 120:100.

Childhood cancer is very important, not only because of the age of occurrence, but also because 41.7% of the Saudi population is under 15 years of age. In addition to this, recent years have shown a breakthrough for the cure of many childhood cancers. Childhood cancers accounted for 8.2% of all cancer among Saudis. The leading cancer

among Saudi children was leukemia, which accounted for 30%, followed by Brain (CNS) then Hodgkins disease and NHL. Figure 2.7 shows the top ten sites by sex and frequency, and table 2.7 shows the number and proportion of the morphological types for the most common types of cancer.

Childhood Cancers in Saudi Arabia, 2004 (≤14 years)

* ICD-10 conversion failure ** Unknown nationalities, in situ cases and ICD-10 conversion failures are excluded from analysis

Figure 2.7 Ten Most Common Cancers among Saudi Children by Sex, 2004

Table 2.6 Distribution of Reported Childhood Cancer Cases in Saudi Arabia by Nationality and Sex, 2004

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Table 2.7 Number and Proportion of Morphological Types for the Most Common Types of Cancer among Saudi Children, 2004

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The following bar charts list the most common cancer sites in the 13 administrative regions of Saudi Arabia by sex. These sites are listed on the basis of the total number of cases reported by permanent address (region) at the time of diagnosis. In most regions breast cancer was the leading cancer among women, while among men Colo-rectal, NHL, liver and Leukemia

interchange. It is worth noting that the major regions such as Riyadh, Makkah and Eastern Province represent the majority of cases. This can be attributed to the increasing number of people seeking medical attention in these urbanized cities with modern hospital facilities where permanent addresses may not be documented in source records.

Cancer in the 13 Administrative Regions of the Kingdom

Figure 2.8.1 Riyadh Region, 2004 (Percentage Distribution)

Figure 2.8.2 Makkah Region, 2004 (Percentage Distribution)

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Figure 2.8.3 Eastern Region, 2004 (Percentage Distribution)

Figure 2.8.5 Northern Region, 2004 (Percentage Distribution)

Figure 2.8.4 Madinah Region, 2004 (Percentage Distribution)

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Figure 2.8.7 Jazan Region, 2004 (Percentage Distribution)

Figure 2.8.8 Hail Region, 2004 (Percentage Distribution)

Figure 2.8.6 Qassim Region, 2004 (Percentage Distribution)

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Figure 2.8.11 Asir Region, 2004 (Percentage Distribution)

Figure 2.8.10 Baha Region, 2004 (Percentage Distribution)

Figure 2.8.9 Najran Region, 2004 (Percentage Distribution)

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Figure 2.8.12 Tabuk Region, 2004 (Percentage Distribution)

Figure 2.8.13 Jouf Region, 2004 (Percentage Distribution)

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Worldwide, it is estimated that around 11 million people developed cancer in 2002. Of these, 53.7% were in developing countries and 46.5% were in developed countries. According to 2002 estimates, the most common cancer site among all men was lung cancer. However, in developed countries prostate was the leading cancer followed by lung, colo-rectal, and stomach.

While in developing countries, lung cancer was firstfollowed by stomach, liver, esophagus and colo-rectal cancers. Among women, breast cancer was the most common followed by colo-rectal, lung and corpus uteri cancers in developed countries. While in the developing countries breast cancer was followed by cancers of the cervix, stomach and lung.

International Comparison of Age-Standardized Incidence Rates

Figure 2.9.A Comparison of ASR* for Saudi Males with Selected Countries**

Figure 2.9.B Comparison of ASR* for Saudi Females with Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 66

Part002.indd 31 15-04-2008 10:46:34 AM

32

Part002.indd 32 15-04-2008 10:46:35 AM

PART IIICANCER INCIDENCE FOR MOST COMMON SITES

2004

Part003.indd 33 15-04-2008 10:43:12 AM

Part003.indd 34 15-04-2008 10:43:12 AM

35

In this section, the incidence of the most common cancers among Saudi males and females are outlined in accordance to their

relative frequencies. The relevant data incorporate details for all patients presented over the period of January through December 2004

Cancer Incidence for Most Common Sites, 2004

Table 3.1 Most Common Cancers among Saudis, 2004

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36

Figure 3.1.2 Stage Distribution of Female Breast Cancer, 2004

Figure 3.1.1 Age-Specific Incidence Rate (AIR) for Female Breast Cancer in Saudi Arabia, 2004

Table 3.1.1 Morphological Distribution of Female Breast Cancer in Saudi Arabia, 2004

There were 783 female breast cancer cases analyzed for year 2004. Breast cancer ranked first amongfemales accounting for 22.4% of all newly diagnosed female cancers (3,491). The ASR was 15.4/100,000 for female population. The five regions with the highest

ASR were Eastern region at 22.6/100,000, Riyadh region at 19.4/100,000, Makkah region at 19.1/100,000, Jouf region at 17.5/100,000 and Qassim region at 12.6/100,000. The median age at diagnosis was 47 years (Range 18-96 years).

Female Breast (C 50)

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37

Figure 3.1.4 Comparison of ASR* for Female Breast Cancer among Saudi Females with ASR in Selected Countries**

Figure 3.1.3 ASR* Regional Distribution of Female Breast Cancer in Saudi Arabia, 2004


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38

Figure 3.2.1 Age-Specific Incidence Rate (AIR) for Colo-rectal Cancer in Saudi Arabia, 2004

Figure 3.2.2 Stage Distribution of Colo-rectal Cancer, 2004

There were 647 cases of colo-rectal cancer accounting for 9.3% of all newly diagnosed cases in year 2004. This cancer ranked first among malepopulation and third among female population. It affected 366 (56.6%) males and 281 (43.4.%) females with a male to female ratio of 130:100. The overall ASR was 7.3/100,000. ASR for males was 8.3/100,000 and for females 6.3/100,000.

The five regions with the highest ASR wereEastern region at 9.8/100,000, Northern region at 9.6/100,000, Riyadh region at 9.6/100,000, Tabuk region at 8.2/100,000 and Makkah region at 7.4/100,000. The median age at diagnosis was 60 years among males (range 19-105 years) and 58 years among females (range 16-100 years).

Colo-rectal (C18-C20)

Table 3.2.1 Morphological Distribution of Colo-rectal Cancer in Saudi Arabia, 2004

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39

Figure 3.2.4 Comparison of ASR* for Colo-rectal Cancer among Saudis with ASR in Selected Countries**

Figure 3.2.3 ASR* Regional Distribution of Colo-rectal Cancer in Saudi Arabia, 2004


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40

Figure 3.3.1 Age-Specific Incidence Rate (AIR) for NHL in Saudi Arabia, 2004

Table 3.3.1 Morphological Distribution of NHL in Saudi Arabia, 2004

There were 556 cases of Non-Hodgkin Lymphoma accounting for 8% of all newly diagnosed cancers in year 2004. This cancer ranked second among male population and fourth among female population. It affected 332(59.7%) males and 224(40.3%) females with a male to female ratio of 148:100. The overall ASR was 5.2/100,000. ASR for males was 5.9/100,000 and 4.5/100,000 for females.

The five regions with the highest ASR were Riyadh region at 6.8/100,000, Makkah region at 6.6/100,000, Eastern region at 5.5/100,000, Jouf region at 5.1/100,000 and Najran regions at 4.4/100,000 each. The median age at diagnosis was 46 years among males (range 2-103 years) and 53 years among females (range 1-94 years).

Non-Hodgkin Lymphoma (C82-C85; C96)

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41

Figure 3.3.3 ASR* Regional Distribution of NHL Cancer in Saudi Arabia, 2004

Figure 3.3.4 Comparison of ASR* for NHL Cancer among Saudis with ASR in Selected Countries**

Figure 3.3.2 Stage Distribution of NHL Cancer, 2004


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42

Figure 3.4.1 Age-Specific Incidence Rate (AIR) for Leukemia in Saudi Arabia, 2004

Table 3.4.1 Morphological Distribution of Leukemia in Saudi Arabia, 2004

There were 435 cases of leukemia accounting for 6.2% of all newly diagnosed cancers in year 2004. This cancer ranked third for males and fifthamong females and affected 241(55.4%) males and 194(44.6%) females with a male to female ratio of 124:100. The overall ASR was 3.1/100,000. ASR for males was 3.4/100,000 and 2.7/1000,000 for females.

The five regions with the highest ASR were Najranregion at 5.7/100,000, Qassim region at 4.8/100,000, Tabuk region at 4.2/100,000, Riyadh region at 4.1/100,000 and Jouf region at 3.5/100,000. The median age at diagnosis is 20 years among males (range 0-90 years) and 20 years among females (range 0-88 years).

Leukemia (C91-C95)

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43

Figure 3.4.3 Comparison of ASR* for Leukemia among Saudis with ASR in Selected Countries**

Figure 3.4.2 ASR* Regional Distribution of Leukemia in Saudi Arabia, 2004


Part003.indd 43 15-04-2008 10:43:15 AM

44

There were 415 cases of thyroid cancer accounting for 6% of all newly diagnosed cases in year 2004. This cancer ranked second among female population and 14th among male population. It affected 87 (21%) males and 328 (79%) females with a male to female ratio of 100:266. The overall ASR was 3.5/100,000. ASR was 1.6/100,000 for males and

Figure 3.5.2 Stage Distribution of Thyroid Cancer, 2004

5.3/100,000 for females. The five regions with thehighest ASR were Riyadh region at 6.1/100,000, Northern region at 4.5/100,000, Jouf region at 4.5/100,000, Eastern region at 4 /100,000 and Hail region at 3.4/100,000. The median age at diagnosis was 43 years among males (range 17-90 years) and 37 years among females (range 5-92 years).

Table 3.5.1 Morphological Distribution of Thyroid Cancer in Saudi Arabia, 2004

Figure 3.5.1 Age-Specific Incidence Rate (AIR) forThyroid Cancer in Saudi Arabia, 2004

Thyroid (C 73)

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45

Figure 3.5.3 ASR* Regional Distribution of Thyroid Cancer in Saudi Arabia, 2004

Figure 3.5.4 Comparison of ASR* for Thyroid Cancer among Saudis with ASR in Selected Countries**


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46

Figure 3.6.1 Age-Specific Incidence Rate (AIR) for Liver Cancer in Saudi Arabia, 2004

Figure 3.6.2 Stage Distribution of Liver Cancer, 2004

Table 3.6.1 Morphological Distribution of Liver Cancer in Saudi Arabia, 2004

There were 324 cases of liver cancer accounting for 4.6% of all newly diagnosed cases in year 2004. This cancer ranked fifth in males, and eleventh in femalesand affected 231 (71.3%) males and 93 (28.7%) females with a male to female ratio of 248:100. The overall ASR was 3.9/100,000. ASR was 5.5/100,000 for males and 2.2/100,000 for females.

The five regions with the highest ASR were Riyadhregion at 8.7/100,000, Tabuk region at 5.5/100,000, Madinah region at 3.7/100,000, Eastern region at 3.6/100,000 and Hail region at 3.4/100,000. The median age at diagnosis was 66 years in males (range 1-110 years) and 63 years in female (range 1-98 years).

Liver (C 22)

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47

Figure 3.6.4 Comparison of ASR* for Liver Cancer among Saudis with ASR in Selected Countries**

Figure 3.6.3 ASR* Regional Distribution of Liver Cancer in Saudi Arabia, 2004


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48

Figure 3.7.1 Age-Specific Incidence Rate (AIR) for Lung Cancer in Saudi Arabia, 2004

Table 3.7.1 Morphological Distribution of Lung Cancer in Saudi Arabia, 2004

There were 296 cases of lung cancer accounting for 4.2% of all diagnosed cases in year 2004. Lung cancer ranked fourth among male population and 16th among female population. It affected 233 (78.7%) males and 63 (21.3%) females with a male to female ratio of 369:100. The overall ASR was 3.1/100,000. ASR was 5.5/100,000 for males and 1.5/100,000 for females.

The five regions with the highest ASR were Eastern region at 7.6/100,000, Makkah region at 5.4/100,000, Jouf region at 4.2/100,000, Tabuk region at 3.7/100,000 and Riyadh region at 3.1 /100,000. The median age at diagnosis was 63 years among males (range 0-94 years) and 61 years among females (range 17-90 years).

Lung (C33-C34)

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49

Figure 3.7.2 Stage Distribution of Lung Cancer, 2004

Figure 3.7.4 Comparison of ASR* for Lung Cancer among Saudis with ASR in Selected Countries**

Figure 3.7.3 ASR* Regional Distribution of Lung Cancer in Saudi Arabia, 2004


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50

There were 264 cases of hodgkins disease accounting for 3.8% of all newly diagnosed cases in year 2004. This cancer ranked seventh among male and tenth in female population. It affected 166 (62.9%) males and 98 (37.1%) females with a male to female ratio of 167:100. The overall ASR was 1.65/100,000. ASR was 2.1/100,000 for males

and 1.2/100,000 for females. The five regions withhighest ASR were Northern region at 3.2/100,000, Tabuk region at 2.3/100,000, Eastern region at 2.3100,000, Najran region at 2.2/100,000 and Madinah region at 1.9/100,000. The median age at diagnosis was 21 years (range 2-76 years) in males and 21 year in females (range 4-85).

Table 3.8.1 Morphological Distribution of Hodgkins disease in Saudi Arabia, 2004

Figure 3.8.2 Stage Distribution of Hodgkins disease, 2004

Figure 3.8.1 Age-Specific Incidence Rate (AIR) for Hodgkins disease in Saudi Arabia, 2004

Hodgkins disease (C 81)

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51

Figure 3.8.3 ASR* Regional Distribution of Hodgkins disease in Saudi Arabia, 2004

Figure 3.8.4 Comparison of ASR* for Hodgkins disease among Saudis with ASR in Selected Countries**


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52

There were 261 cases of skin cancer accounting for 3.7% of all newly diagnosed cases in year 2004. This cancer ranked eleventh for males and sixth for females. It affected 136(52.1%) males and 125(47.9%) females with a male to female ratio of 109:100. The overall ASR was 2.95/100,000. ASR was 3.0/100,000 for males and 2.9/100,000 for females.

Figure 3.9.2 Stage Distribution of Skin Cancer in Saudi Arabia, 2004

The five regions with the highest ASR were Najranregion at 4.8/100,000, Jouf region at 3.7/100,000, Riyadh region at 3.4/100,000, Qassim region at 3.1/100,000 and Asir region at 3.0/100,000. The median age at diagnosis was 67 years among males (range 17-101 years) and 65 years among female (range 3-99 years).

Figure 3.9.1 Age-Specific Incidence Rate (AIR) for Skin Cancer in Saudi Arabia, 2004

Table 3.9.1 Morphological Distribution of Skin Cancer in Saudi Arabia, 2004

Skin (Non-Melanoma) (C 44)

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53

Figure 3.9.4 Comparison of ASR* for Skin Cancer among Saudis with ASR in Selected Countries**

Figure 3.9.3 ASR* Regional Distribution of Skin Cancer in Saudi Arabia, 2004


Part003.indd 53 15-04-2008 10:43:19 AM

54

There were 247 cases of brain and nervous system cancer accounting for 3.5% of all newly diagnosed cases in year 2004. This cancer ranked ninth for both males and females. It affected 147(59.5%) males and 100(40.5%) females with a male to female ratio of 147:100. The overall ASR was 2.5/100,000. ASR was 2.3/100,000 for males and 1.5/100,000

Brain, Nervous System (C70-C72)

for females. The five regions with the highest ASRwere Tabuk region at 3.9/100,000, Eastern region at 2.9/100,000, Madinah region at 2.5/100,000, Riyadh region at 2.5/100,000 and Hail region at 1.9/100,000. The median age at diagnosis was 35 years among males (range 0-88 years) and 22 years among female (range 0-90 years).

Figure 3.10.2 Stage Distribution of Brain Cancer in Saudi Arabia, 2004

Figure 3.10.1 Age-Specific Incidence Rate (AIR) for Brain Cancer in Saudi Arabia, 2004

Table 3.10.1 Morphological Distribution of Brain Cancer in Saudi Arabia, 2004

Part003.indd 54 15-04-2008 10:43:19 AM

55


Figure 3.10.3 ASR* Regional Distribution of Brain Cancer in Saudi Arabia, 2004

Figure 3.10.4 Comparison of ASR* for Brain Cancer among Saudis with ASR in Selected Countries**

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56

Figure 3.11.1 Age-Specific Incidence Rate (AIR) for Prostate Cancer in Saudi Arabia, 2004

Figure 3.11.2 Stage Distribution of Prostate Cancer, 2004

Table 3.11.1 Morphological Distribution of Prostate Cancer in Saudi Arabia, 2004

There were 214 cases of prostate cancer accounting for 6.2% of all newly diagnosed cases among males in year 2004. The ASR was 5.1/100,000 among male population. This cancer ranked sixth among males. The five regions with

the highest ASR were Eastern region at 9.3/100,000, Riyadh region at 6.7/100,000, Makkah region at 5.7/100,000, Qassim region at 4.7/100,000 and Asir region at 4.1/100,000. The median age at diagnosis was 71 years (range 25-107 years).

Prostate (C 61)

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57

Figure 3.11.4 Comparison of ASR* for Prostate Cancer among Saudi Males with ASR in Selected Countries**

Figure 3.11.3 ASR* Regional Distribution of Prostate Cancer in Saudi Arabia, 2004


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58

Stomach (C 16)

Table 3.12.1 Morphological Distribution of Stomach Cancer in Saudi Arabia, 2004

Figure 3.12.2 Stage Distribution of Stomach Cancer, 2004

There were 211 cases of stomach cancer accounting for 3% of all newly diagnosed cases in year 2004. This cancer ranked tenth among male population and 14th among female population. It affected 141(66.8%) males and 70(33.2%) females with a male to female ratio of 201:100. The overall ASR was 3.1/100,000. ASR was 4.1/100,000 for male and 2/100,000 for females.

The five regions with the highest ASR were Madinah region at 3.3/100,000, Tabuk region at 3.3/100,000, Riyadh region at 2.8/100,000, Qassim region at 2.7/100,000 and Eastern region at 2.6/100,000. The median age at diagnosis was 65 years among males (range 28-103 years) and 64 years among female (range 17-92 years).

Figure 3.12.1 Age-Specific Incidence Rate (AIR) for Stomach Cancer in Saudi Arabia, 2004

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59

Figure 3.12.4 Comparison of ASR* for Stomach Cancer among Saudis with ASR in Selected Countries**

Figure 3.12.3 ASR* Regional Distribution of Stomach Cancer in Saudi Arabia, 2004


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60

Figure 3.13.1 Age-Specific Incidence Rate (AIR) for Bladder Cancer in Saudi Arabia, 2004

Table 3.13.1 Morphological Distribution of Bladder Cancer in Saudi Arabia, 2004

Figure 3.13.2 Stage Distribution of Bladder Cancer, 2004

There were 201cases of bladder cancer accounting for 2.9% of all newly diagnosed cases in year 2004. This cancer ranked eighth among male population and 20th among female population. It affected 160(79.6%) males and 41(20.4%) females with a male to female ratio of 390:100. The overall ASR was 2.4/100,000. ASR was 3.7/100,000 for males and 1/100,000 for females.

The five regions with the highest ASR were Tabuk region at 5.5/100,000, Northern region at 4.5/100,000, Jouf region at 3.0/100,000, Makkah region at 2.8/100,000 and Eastern region at 2.6/100,000. The median age at diagnosis was 67 among males (range 6-110 years) and 60 among females (range 16-100 years).

Bladder (C 67)

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61

Figure 3.13.4 Comparison of ASR* for Bladder Cancer among Saudis with ASR in Selected Countries**

Figure 3.13.3 ASR* Regional Distribution of Bladder Cancer in Saudi Arabia, 2004


Part003.indd 61 15-04-2008 10:43:22 AM

62

There were 117 cases of corpus uterine cancer among females accounting for 3.4 % of all newly diagnosed cases for females in year 2004. This cancer ranked seventh among female population. The ASR was 2.8/100,000 for female population.

The five regions with the highest ASR were Easternregion at 5/100,000, Jouf region at 4/100,000, Riyadh region at 3.9/100,000, Madinah region at 3.2/100,000 and Tabuk region at 3.1/100,000. The median age at diagnosis was 61 years (range 18-92 years).

Figure 3.14.1 Age-Specific Incidence Rate (AIR) for Corpus uterine Cancer in Saudi Arabia, 2004

Table 3.14.1 Morphological Distribution of Corpus uterine Cancer in Saudi Arabia, 2004

Figure 3.14.2 Stage Distribution of Corpus uterine Cancer, 2004

Corpus uteri (C 54)

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63

Figure 3.14.4 Comparison of ASR* for Corpus uterine Cancer among Saudi Females with ASR in Selected Countries**

Figure 3.14.3 ASR* Regional Distribution of Corpus uterine Cancer in Saudi Arabia, 2004


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64

Figure 3.15.1 Age-Specific Incidence Rate (AIR) for Ovarian Cancer in Saudi Arabia, 2004

Figure 3.15.2 Stage Distribution of Ovarian Cancer, 2004

Table 3.15.1 Morphological Distribution of Ovarian Cancer in Saudi Arabia, 2004

There were 108 cases of ovarian cancer among females accounting for 3.1% of all newly diagnosed cases among females in year 2004. This cancer ranked eighth among female population. The ASR was 2.2/100,000 for females. The five regions

with the highest ASR were Tabuk region at 3.7/100,000, Riyadh region at 3.4/100,000, Baha region at 2.9/100,000, Eastern region at 2.7/100,000 and Makkah region at 2.4/100,000. The median age at diagnosis was 51years (range 6-93 years).

Ovary Cancer (C 56)

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65


Figure 3.15.4 Comparison of ASR* for Ovarian Cancer among Saudi Females with ASR in Selected Countries**

Figure 3.15.3 ASR* Regional Distribution of Ovarian Cancer in Saudi Arabia, 2004

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66

** References:

Part003.indd 66 15-04-2008 10:43:23 AM

PART IVCANCER AMONG NON-SAUDIS

2004

Part004.indd 67 15-04-2008 10:51:33 AM

Part0

04.in

dd 6

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-04-

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10:5

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e 19

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wer

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and

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. T

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to f

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ly, t

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re

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ly 1

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and

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age-

grou

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pres

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2004

, app

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of a

ll ca

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curr

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befo

re t

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f 15,

28

% o

ccur

red

betw

een

the

ages

15

to 4

0 ye

ars,

54.

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ere

betw

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the

ages

41

-64,

and

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occ

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afte

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64.

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med

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age

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(ran

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nd 4

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es (

rang

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).

Tab

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.1 T

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com

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Can

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non-

Saud

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004

Tabl

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2 D

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of C

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am

ong

Diff

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t N

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Freq

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Can

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mon

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2004

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Figu

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Saud

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re 4

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Table 5.1.1 Age Distribution of Cancer Cases among Saudi Males, 2004

Part0

05.in

dd 7

215

-04-

2008

10:5

2:29 A

M

73

Table 5.1.2 Age Distribution of Cancer Cases among Saudi Females, 2004

Part0

05.in

dd 7

315

-04-

2008

10:5

2:30 A

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74

Tabl

e 5.

1.3

Can

cer

Inci

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e C

ases

am

ong

Saud

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es b

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ge G

roup

(pe

r 10

0,00

0), 2

004

Part005.indd 74 15-04-2008 10:52:32 AM

75

Table 5.1.4 Cancer Incidence Cases among Saudi Females by Age Group (per 100,000), 2004

Part0

05.in

dd 7

515

-04-

2008

10:5

2:35 A

M

76

Tabl

e 5.

2.1

Num

ber,

Rel

ativ

e Fr

eque

ncie

s, A

ge S

tand

ardi

zed

and

Cru

de R

ates

for

All

Can

cer

Cas

es A

mon

g Sa

udi M

ales

by

Site

and

Adm

inis

trat

ive

Reg

ion,

200

4

Part005.indd 76 15-04-2008 10:52:38 AM

77

Tabl

e 5.

2.1

cont

inue

d ...

......

Part005.indd 77 15-04-2008 10:52:40 AM

78

Tabl

e 5.

2.1

cont

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d ...

......

Part005.indd 78 15-04-2008 10:52:42 AM

79

Tabl

e 5.

2.1

cont

inue

d ...

......

Part005.indd 79 15-04-2008 10:52:43 AM

80

Tabl

e 5.

2.2

Num

ber,

Rel

ativ

e Fr

eque

ncie

s, A

ge S

tand

ardi

zed

and

Cru

de R

ates

for A

ll C

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r C

ases

Am

ong

Saud

i Fem

ales

by

Site

and

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ion,

200

4

Part005.indd 80 15-04-2008 10:52:45 AM

81

Tabl

e 5.

2.2

cont

inue

d ...

......

Part005.indd 81 15-04-2008 10:52:47 AM

82

Tabl

e 5.

2.2

cont

inue

d ...

......

Part005.indd 82 15-04-2008 10:52:49 AM

83

Tabl

e 5.

2.2

cont

inue

d ...

......

Part005.indd 83 15-04-2008 10:52:51 AM

84

Tabl

e 5.

3.1

Age

Dis

trib

utio

n of

Can

cer

Cas

es a

mon

g no

n-Sa

udi M

ales

, 200

4

Part005.indd 84 15-04-2008 10:52:53 AM

85

Tabl

e 5.

3.2

Age

Dis

trib

utio

n of

Can

cer

Cas

es a

mon

g no

n-Sa

udi F

emal

es, 2

004

Part005.indd 85 15-04-2008 10:52:54 AM

86

Tabl

e 5.

3.3

Inci

denc

e R

ates

for

Can

cer

Cas

es a

mon

g no

n-Sa

udi M

ales

by

Age

Gro

up (

per

100,

000)

, 200

4

Part005.indd 86 15-04-2008 10:52:57 AM

87

Tabl

e 5.

3.4

Inci

denc

e R

ates

for

Can

cer

Cas

es a

mon

g no

n-Sa

udi F

emal

es b

y A

ge G

roup

(pe

r 10

0,00

0), 2

004

Part005.indd 87 15-04-2008 10:53:13 AM

88

Part005.indd 88 15-04-2008 10:53:14 AM

PART VIAPPENDICES

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90

Part006.indd 90 15-04-2008 11:26:06 AM

91

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92

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93

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94

Part006.indd 94 15-04-2008 11:26:07 AM

95

Part006.indd 95 15-04-2008 11:26:07 AM

96

Part006.indd 96 15-04-2008 11:26:15 AM

97

Part006.indd 97 15-04-2008 11:26:18 AM

98

Part006.indd 98 15-04-2008 11:26:24 AM

cancer incidence report 2004

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