Download Cancer in the Eastern Mediterranean Region

Cancer in the North Africa
Diaa Marzouk
Prof Of Public Health
Faculty of Medicine, Ain Sams University
Presentation Outline
• Cancer in North Africa Countries according to HDI
• Cancers in the Eastern Mediterranean Region &Arab
Countries
• Risk Factors of Cancer in North Africa
• Prevention of Cancer in North Africa
Human Development Index
of Countries (HDI) in North Africa
•The United Nations Development Program's Human Development
Statistical Update released in 2008, divided the populations according to
the Human Development Index (HDI)
•HDI has some drawbacks
Population
HDI
Egypt
0.716
Morocco
0.644
Libya
0.840
Tunisia
0.762
Algeria
0.748
MEDITERRANEAN ONCOLOGY SOCIETY, 2008
http://www.mosepi.org/hdi.pdf
• The Mediterranean Oncology Society, 2008
correlated between the HDI and the Age
Standardized Rates in the various populations
by sex.
Male Cancer Age Standardized rates in
Mediterranean Countries according to HDI
MEDITERRANEAN ONCOLOGY SOCIETY, 2008
http://www.mosepi.org/hdi.pdf
Female Cancer Age Standardized rates in
Mediterranean Countries according to HDI
MEDITERRANEAN ONCOLOGY SOCIETY, 2008
http://www.mosepi.org/hdi.pdf
Cancer in Arab World
Inas Elattar, National Cancer Institute, Egypt, 2005
Globocan Database Created by the International
Agency for Research on Cancer (IARC) in 2002
• The age standardized incidence (ASRI) of all
cancers in the Eastern Mediterranean Region
is currently 3 to 4 times lower than in the
industrialized countries
• Half of the cancers in the Region occur before
age 55 which is 10–20 years younger than in
industrialized countries.
• but is expected to double in the next 15 years
as risk factor exposure increases including
population aging.
• The mortality/incidence ratio is 70%, which is high (40% in
America, 55% in Europe), indicating significantly lower survival
rates from diagnosed cancer.
• The top five cancers in the Region when males and females
are combined are
 breast,
 bladder,
 lung,
 oral and
 colon cancer
(IARC) in 2002
Cancers in the Eastern Mediterranean Region
World Health Organization 2009
Countries Rank order of incidence of
Cancer in North Africa
Egypta
Moroccob
Tunisia
Libya
1st
2nd
Breast
NHL
Rectum Thyroid
Lung
Breast
Bladder Breast
3rd
Bladder
Liver
Bladder
Lung
Source: GLOBACAN, IARC, 2002,
a Gharbiah population-based cancer registry report 2000–2002
b National cancer registry
4th
Liver
Colon
Colon
Cervix
5th
Lung
Stomach
NHL
Colon
Cancer and Pollution
• While a widespread public belief strongly associates
cancer and pollution, the burden of cancer due to
environmental factors is less than 2% in developed
countries
• They are particularly high levels of pollution, or in
particular occupations where chemical exposure is
high.
• Where such circumstances can be identified, specific
measures can usually be taken to protect the at risk
population.
Prevalence of Tobacco Smoking and Overweight / Obesity
in the Eastern Mediterranean Region
Prevalence of tobacco
smoking a (%)
Egypta
Moroccob
Tunisia
Libya
Prevalence of BMI≥25 b
(%)
Males >
15 yrs
Females
> 15 yrs
Males
Females
35.0
34.5
61.9
--
1.6
0.6
7.7
--
64.5
30.6
42.8
--
69.7
47.8
65.4
--
Cancer and Infections
• Infections are associated with a much greater fraction of the
cancer burden in developing countries (26%) than in
developed countries (8%)
• It is estimated that cancers due to infections represent 11% of
the cancer burden in North Africa and 16% of the cancer
burden in west Asia. This percentage may be higher in specific
countries.
• In some countries or regions it may be as important as
smoking or dietary factors, resulting in marked differences in
the pattern of cancer,
• e.g. the high incidence of both bladder and liver cancer in
Egypt. Control of the infection process also results in cancer
control.
Cancer and Infections
• Human papillomaviruses (HPVs): HPV infection is
the main cause of cervical cancer.
• Hepatitis B and hepatitis C viruses, develop after
many years of infection Liver cancer
• Human T]cell leukaemia / lymphotropic virus
(HTLV•
]1):
• Human immunodeficiency virus (HIV): people are at
greater risk of Kaposi sarcoma.
Cancer and Infections
• Epstein•
]Barr virus (EBV): Infection with EBV
has been linked to an increased risk of
lymphoma.
• Helicobacter pylori: This bacterium can cause
stomach ulcers and stomach cancer
Egypt
The National Cancer Registry Program of
Egypt
The Supreme Committee of the Program decided
• to start by population-based registration of
incident cancer cases in 2008 and
• to explore the possibility of establishing a
national cancer database through hospital
based registries.
Gharbiah Registry, Egypt
• Governorate of Gharbiah already has a registry that
was established 10 years ago and will be included is
the national registry program in a subsequent phase.
• By the end of the current phase, Egypt will be
covered by a network of population based registries
that fairly represents the entire country.
• In Beheira, Damietta, Menia, Assiut, Sohag and
Aswan Governorates
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
The National Cancer Registry of Egypt: (NCRPE)
Overview & Objectives
• It aims to develop a reliable source of information on cancer
incidence in Egypt.
• It collects cancer incidence data from population-based cancer
registries covering approximately 22 percent of Egypt
population on
 patient demographics,
 primary tumor site,
 tumor morphology and
 stage at diagnosis, and
 follow-up for vital status.
Overview & Objectives (cont)
• NCRPE data will be available for researchers,
clinicians, public health officials, legislators,
policymakers, community groups, and the
public.
• NCRPE staff work to guide all registries to
achieve data content acceptable for pooling
data and improving national estimates.
• Computer applications are developed to unify
cancer registration systems and to analyze and
disseminate population-based data.
Is cancer a problem in Egypt?
• A: Yes, but magnitude is unknown
– • More than 50% of the new cancer cases in the world
occur in developing countries
– Burden of the problem will increase:
• - Better Diagnosis
• - More exposure to Risk Factors
• -Increased Life Expectancy
Egyptian Population Pyramid / Distribution of Cancer
among Population
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
Does Gharbiah represent Egypt?
• Compare by Human Development Index (HDI
• The Age Standardized Incidence rate is more
or less similar to whole Egypt
The Gharbiah Population-based Cancer
Registry GPCR
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
Does Gharbiah represent Egypt?
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ
Prevention
• Cancer prevention involves eliminating or minimizing
exposure to known environmental causes of cancer.
• It is estimated that more than 50% of the cancers in
the world are attributable to three factors:
 tobacco,
 infection and
 unhealthy lifestyle (diet, obesity and lack of physical
exercise).
• The attributable fraction associated with these three
factors differs between developing and developed
countries.
Prevention
• These cancers can either be prevented (bladder and
lung), or detected early (breast, oral and colon),
although the methods used and cost‐benefit ratios
will vary according to incidence and available
resources.
• The striking predominance of breast cancer, ranked
first in incidence even when males are included,
suggests that this cancer should be given a
particularly high priority in both regional and
national cancer control plans.
• Thank you for your Attention