بسم الله الرحمن الرحيم

Third International Conference of Kurdistan Association for Gastroenterology and Hepatology GIT cancer in Iraq Prof ( Dr ) Monem Alshok Iraq Babylon MBChB MD CABM FRCP

“The greatest need we have today in the human cancer problem, except for a universal cure, is a method of detecting the presence of cancer before there are any clinical signs or symptoms.” Sidney Farber (1903-1973) Paediatric pathologist and “father” of modern chemotherapy.The Dana-Farber Cancer Institute in Boston is partly named after him.

Objective Any prevention programme? Any screening project? Do we have a new pathways to earlier diagnosis?

We study the prevalence & percentage of GI cancer in Babylon during the period of 1992-1999 From 167 registered cases : Gastric ca makes about 46% & CRC represents 26% and comparing these data with that registered by *ICR from 5196 patients with GIT cancer , stomach makes 27.15% and CRC represents about 22.36%. * Iraqi Cancer Registry reports, Ministry of Health 1976-1985, 1986-1988, 1989-1991, 1992-1994, 1995-1997 and 1998-2000

In a study on 172 cases of CRC in Kirkuk (61%) weren't knowing about colon cancer screening and (68%) of those who knew about screening weren't willing to be screened in the future. It seems that during recent periods We found an insignificant rise in the number of cases of GC while there was a significant increase number of CRC .This is similar to the study done in Bablon after 2004 IJG issue1 Vol6 Dr.Summer SaadAbdulhussain ,Dr. Osama Hasan Othman2008 – 2012

GIT Cancer There was a change in the pattern of gastrointestinal cancer(1965 – 2006 ) , particularly GC and CRC in Iraq, which might be attributed to dietary factors& enviromental factors *. On the other side there was a significant increase number of early staging cancer. *Albahrani ,TOFIQ JMSVol 1 No 1 , 2014

In Kurdistan region The total number of cases registered with all sources in 2007, 2008 and 2009 were 1444, 2081 and 2356 respectively. CRC 5.62% in females, GC 2.45% and 7.3% in males , GC 4.22% . Asian Pacific Journal of Cancer Prevention, Vol 12, 2011

Cancer screening Early diagnosis of non-symptomatic cancer aiming at the reduction of morbidity and mortality . Screening refers to the use of simple tests across a healthy population in order to identify individuals who have disease, but do not yet have symptoms Population-based screening: offered systematically to all individuals in the defined target group within a framework of agreed policy, protocols, quality management, monitoring and evaluation Opportunistic screening: offered to an individual without symptoms of the disease when they present to a health care practitioner for reasons unrelated to that disease.

Success of Screening depends on The target disease should be a common form of cancer, with high associated morbidity or mortality; Effective treatment, capable of reducing morbidity and mortality, should be available; Test procedures should be acceptable, safe, and relatively inexpensive.

How might these impact on clinical practice in the foreseeable future? The Bowel Cancer Screening Programme will achieve the intended 16% reduction in overall bowel cancer mortality. Different screening strategies may be required to effectively screen for right-sided bowel cancer. As in this study *77% of detected lesions are L sided . * Gut doi:10.1136/gutjnl-2011-300843 Colorectal cancer

GIT cancer screening: CRC Faecal occult blood (FOB) screening for CRC in men and women aged 50 to 74. 95% of the target group should be invited; A minimum of 45% of invitees should be examined, but it is recommended to aim for a rate of at least 65% . Current issues: 3 tests: FOBT (guaiac and immunological), sigmoidoscopy, colonoscopy http://eu-cancer.iarc.fr/ (2007)

When to screen – which cancer sites to screen? Sensitivity: Ability of the test to identify positive results Proportion of actual positives which are correctly identified as such (i.e. the percentage of people with cancer who are correctly identified as having cancer) TRUE POSITIVE rate Never 100% Specificity Ability of the test to identify negative results Proportion of negatives which are correctly identified (i.e. the percentage of healthy people who are correctly identified as not having cancer) TRUE NEGATIVE rate

Positive predictive value (PPV): The probability to have cancer following a positive test result Proportion of positive test results which are TRUE POSITIVE Negative predictive value (NPV): The probability to be healthy following a negative test result Proportion of negative test results which are TRUE NEGATIVE BUT: PPV and NPV vary with prevalence

Likelihood ratio (+): The ratio of the probability of a positive test result when having cancer over the probability of a positive test result when not having cancer The higher LR (+), the higher the positive predictive power of the test Likelihood ratio (-): The ratio of the probability of a negative test result when having cancer over the probability of a negative test result when not having cancer The lower LR (-), the higher the negative predictive power of the test Odds ratio: The overall power of a test to discriminate between an ill and healthy condition Ratio of LR(+)/LR(-) The higher the odds ratio the higher the predictive power of the test

Screening Proven effectiveness and acceptable unfavourable side-effects population-based screening more efficient than screening of individual patients Population-based screening aims to improve public health. This can collide with interests of individual participants Organising a screening programme is complex. Effects only visible after a long period.

CRC

CRC

GC