Cancer in the Arab World: Magnitude of the Problem

1. Cancer in the Arab World: Magnitude of the Problem Inas Elattar, DrPH Professor of Biostatistics Department of Biostatistics & Epidemiology NCI, Egypt APHA November, 2004

2. 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

3. Cancer Databases in Arab World Yemen National Cancer Registry Regional Cancer Registry No Registry

4. 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

5. Age-Adjusted Incidence Rates in Arab World, Males 121 180 166 180 96 180 114 123 72 123 88 154 99 60 81 99 178 123 102 178 178 178 Rates/100,000

6. Age-Adjusted Incidence Rates in Arab World, Females 120 167 159 167 87 216 78 118 77 127 90 85 137 61 94 89 176 118 84 176 176 176 Rates/100,000

7. Male to Female Ratio, All Cancer Sites

8. ASR of StomachCancer in Arab World

9. ASR of ColorectalCancer in Arab World

10. ASR of Liver Cancer in Arab World

11. Relative Frequency of Liver Cancer, NCI - Egypt 1975-2002

12. Egypt Mortality Statistics, 2001Most common sites (The Cancer Database, 2001)

13. Trend of HCC Mortality in Egypt, 1981-1996

14. ASR of Lung Cancer in Arab World

15. Prevalence of Smoking in Arab World

16. ASR of Prostate Cancer in Arab World

17. ASR of Bladder Cancer in Arab World

18. 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

19. Changing Pattern of Bladder Cancer Type, NCI 1975-2002

20. ASR of Lymphomas in Arab World

21. Age Specific Incidence Rates (ASIR) of Lymphoma in Selected Arab Countries (Males)

22. ASR of Leukemias in Arab World

23. ASR of BreastCancer in Arab World (Females)

24. Age Specific Incidence Rates (ASIR) of Breast in Selected Arab Countries (Females)

25. ASR of Cervical Cancer in Arab World

26. ASR of Cancer of Uterus in Arab World

27. ASR of Cancer of Ovary in Arab World

28. 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

29. Most Common Cancer Sites among Males

30. Most Common Cancer Sites among Males

31. Most Common Cancer Sites among Females

32. Most Common Cancer Sites among Females

33. National Cancer Institute, Cairo, Egypt

34. 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

35. 19,568 New Cancer Cases by Systems, NCI 2001-2002