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,
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 99
154 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 Stomach Cancer in Arab World

9. ASR of Colorectal Cancer 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, 2001 Most 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
The decline in the prevalence of Schitosoma Haematobium infection in the Nile Delta during recent decades provided the opportunity to confirm the causal relationship between Schistosomiaisis and bladder cancer. Histopathology reports from bladder cancer patients diagnosed during the past 22 years at the National Cancer Institute were reviewed. From 1975 to 1990, the percentage of patients with SCC type ranged from 50 to 70% and those with TCC type ranged from 10 to 30%. Beginning in 1990, a gradual decrease in the percentage of SCC type reaching a low of 22% in the year This decrease was accompanied by an increase in TTC reaching of around 50%. A similar pattern was seen in Mansoura (figure x)

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)4

22. ASR of Leukemias in Arab World

23. ASR of Breast Cancer in Arab World (Females)

24. Age Specific Incidence Rates (ASIR) of Breast in Selected Arab Countries (Females)4

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 World Main 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
Egypt
Tunisia
Algeria
Jordan
Kuwait
Bladder
Lung
Colorectal
Liver
NHL
Prostate
Stomach
Larynx
Leukemia
Skin
Nasopharynx
Brain&CNS

30. Most Common Cancer Sites among Males
KSA
UAE
Bahrain
Oman
Qatar
NHL
Lung
Stomach
Liver
Prostate
Bladder
Leukemia
Colorectal

31. Most Common Cancer Sites among Females
Egypt
Tunisia
Algeria
Jordan
Kuwait
Breast
NHL
Colorectal
Cervix
Leukemia
Ovary
Thyroid
Liver
Skin
Stomach
Uterus

32. Most Common Cancer Sites among Females
KSA
UAE
Bahrain
Oman
Qatar
Breast
Thyroid
Cervix
Lung
NHL
Leukemia
Ovary
Skin
Colorectal
Liver
Stomach
Kidney/NHL
Hodgkins Disease

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 : 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