1. بسم الله الرحمن الرحيم

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

3. “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 ( ) Paediatric pathologist and “father” of modern chemotherapy.The Dana-Farber Cancer Institute in Boston is partly named after him.

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

5. 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 , , , , and

6. 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

7. 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

8. 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

9. 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.

10. 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.

11. 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: /gutjnl Colorectal cancer

12. GIT cancer screening: CRC
Faecal occult blood (FOB) screening for CRC in men and women aged 50 to % 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
(2007)

13. 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

15. 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

16. 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

17. 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.

18. CRC

19. CRC

20. GC