Retinoblastoma in Karachi,Pakistan

The objective was to assess epidemiologic aspects of retinoblastoma development in Karachi, Pakistan. Incident ‍cases, diagnosed clinically or microscopically and registered at Karachi Cancer Registry (KCR) during 1st January ‍1998 to 31st December 2002 were reabstracted, rechecked and reanalyzed for this purpose. One hundred and one ‍cases of retinoblastoma were reported to KCR over the 5 years (1998-2002). Fifty-seven were residents of Karachi, ‍34 (59.6%) males and 23 (40.4%) females. The gender ratio (M:F) was 1.5. The mean age at diagnosis was 3.96 years ‍(95% CI 2.92; 4.99) and 3.85 years (95% CI 2.72; 4.98) in males and females respectively. The annual crude incidence ‍of retinoblastomas in Karachi was 4.0/100,000 and 2.4/100,000 in children under the age of 5 and 10 years respectively, ‍the corresponding age standardized rates being 5.3/100,000 and 4.8/100,000. The age groups at risk of developing ‍retinoblastoma, associated morbidity and possibility of almost 100% 5-year survival with available treatments, calls ‍for ophthalmologic screening of all infants below 1 year, and high-risk children until the age of 7 years. In order to ‍detect retinoblastoma, as early as possible, health education for parents and health providers, and improved training ‍of ophthalmologists is essential. Genetic testing for siblings and children of retinoblastoma cases and identification ‍of high-risk children would be helpful, but lacks financial feasibility in developing countries at present. Future ‍health care planning should focus on capacity building for neonatal ophthalmologic screening, handling of parents’ ‍and children’ emotional reactions and opportunities for education, occupational training and cosmetic rehabilitation ‍for surviving retinoblastoma patients.     

Rising Incidence of Gastric Malignancies in Karachi, 1995- 2002

Introduction: South Asia is an enigma for gastric cancer, a low risk region with a contradictory high prevalencefor Helicobacter pylori. Patients and Methods: To examine the demographics, pathology and trends of gastriccancer in Pakistan, epidemiological data of 335 gastric malignancies, registered at Karachi Cancer Registry(KCR) for Karachi South (KS), during 1st January 1995 to 31st December 2002 were reviewed. Trends werestudied by categorizing the cases into two time periods ‘1995-7’ and 1998-2002’. Results: Ninety six cases ofgastric cancers were registered in the 1995-7 period, 61 in males and 35 in females. In males, the ASR (world),and crude incidence rate (CIR) per 100,000 were 3.9 and 2.3 respectively. In females, the values were 3.0 and 1.5.In the 1998-02 period 239 cases of gastric cancer were registered, 156 cases in males and 83 in females. The ASRand CIR per 100,000 were 6.0 and 3.4 in males and 3.6 and 2.1 in females. An 18% increase was observed inmales and 14% in females during the seven year study period. The male to female ratio was 2:1.The mean age ofmale patients was 51.9 years [95% CI 45.8; 58.1; SD ±17.9] in 1995-7 and 53.7 years [(95% CI 51.6; 55.9; SD±14.0] in 1998-02. In females the mean age for the two periods was 48.8 years (95% CI 42.5; 55.0; SD ±18.2] and48.4 years [95% CI 45.4; 51.5; SD ±13.9] respectively. Age-specific curves showed a gradual increase in riskfrom the second until the seventh decade. The majority of the cases presented as poorly or moderatelydifferentiated distal (non-cardia) cancers with a regional spread. Conclusion: Gastric cancers in Karachi fallinto the prototype of a low risk developing country pattern. The incidence is increasing, most marked in malesabove 40 years of age. Larger pathology-based studies are required to comment on the precise morphologicalsub-types of gastric adenocarcinoma. Etiological studies focused on different strains of H. pylori are required toaddress the gastric cancer enigma, whilst examining possible protective environmental or genetic factors.     

Pediatric brain tumours at a tertiary care hospital in Karachi.

The objectives of this study were to determine the epidemiology of brain tumors during infancy and childhood and to define and segregate childhood brain tumors vis-a-vis their morphological characteristics. The present study includes pediatric brain tumors, ICD-10 category C71 encountered during 10 years (January 1989 through December 1998) at a tertiary care hospital in Karachi. Eighty one cases were included, 58 (71.6%) in males and 23 (28.4%) in females with a male to female ratio of 2.5:1. The cases were divided into 3 age groups each covering five years of life (0-4, 5-9, 10-14 years), with the greatest number in the second age group i.e. 5-9 years followed by the third age group and the 0-4 year age group. The mean age for all cases, both genders was 8.8 years (95% CI 7.9; 9.6) with a marginal variation for cases occurring in the cerebrum and cerebellum. The malignancies occurred at a younger age in the males for each subcategory by site and morphology. The morphological distribution of cases was astrocytoma (28 cases, 34.6%), primitive neuroectodermal tumor or PNET (40 cases; 49.4%), ependymoma (8 cases, 10%), mixed glioma (4 cases; 5%) and a case of oligodendroglioma. The 81 malignancies included in this study were further categorized by site into two groups, supratentorial (27 cases; 33.3%) and infratentorial (54 cases; 66.7%). The morphological categorization of supratentorial tumors was astrocytoma (17 cases; 63%), ependymoma (5 cases; 18.5%), mixed glioma (2 cases; 7.4%). PNET with rhabdoid differentiation, oligodendroglioma and pinealoblastoma comprised 1 case (3.7%) each. The 17 supratentorial astrocytoma were sub-categorized as follows - pilocytic astrocytoma (5 cases; 29.4%), grade II astrocytoma (6 cases; 35.3%); grade III astrocytoma (2 cases; 11.8%), anaplastic astrocytoma (1 case; 5.9%) and glioblastoma multiforme (3 cases; 17.7%). The morphological categorization of infratentorial tumors was astrocytoma (11 cases; 20.4%), medulloblastoma (38 cases; 70.4%), ependymoma (3 cases; 5.6%) and mixed glioma - astroependymoma (2 cases, 3.7%). The morphological sub-categorization of infratentorial astrocytoma was pilocytic astrocytoma (7 cases, 63.6%), with gemistocytic astrocytoma, grade II, grade III and anaplastic astrocytoma comprising 1 (9.1%) case each. The morphological categorization of medulloblastoma was classical medulloblastoma (15 cases; 39.5%), desmoplastic medulloblastoma (8 cases; 21.1%), medulloblastoma with astrocytic differentiation (12 cases; 31.5%), medulloblastoma with neural differentiation (2 cases; 5.3%), and neuroblastic medulloblastoma (1 case; 2.6%). The pediatric brain tumors in Karachi reflect a developing country scenario, with a strong male predisposition and a late presentation with a peak in the 5-9 year age group. There is a predominance of medulloblastoma and a paucity of astrocytomas. The current study is a single institution study and needs cautious interpretation. Population-based studies are required to determine the cancer burden due to pediatric malignancies of the brain in this population and for the morphological categorization of brain tumors in Karachi.     

Epidemiology of Soft Tissue Sarcomas in Karachi South,Pakistan (1995-7)

Introduction: The present study was conducted with the objective of examining epidemiological characteristicsof soft tissue sarcomas (STSs) in Karachi. Patients and methods: Epidemiological data of 96 (63 male and 33female) incident STS cases registered at Karachi Cancer Registry (KCR) for Karachi South (KS), from 1stJanuary 1995 to 31st December 1997, were reviewed. Results: The age standardized rate (ASR) world per100,000 were 3.3 (2.9%) and 2.1 (1.6%) in males and females, respectively, with mean ages of of 41.4 years (95%CI 35.77; 46.97) and 40.2 years (95% CI 31.27; 49.03). The age-specific curves showed a gradual increase in riskfrom the first until the eighth decade in both genders, with the highest peak at 75+ in females and 70-74 years inmales. In males, 8 (12.7%) STS cases were diagnosed in the pediatric age group (0-14), 12 (19.1%) in adolescentsand young adults (15-24 years), 19 (30.1%) in adults 25-49 years of age and 24 (38.1%) in the 50 years+ agegroup. In females the respective frequencies were 11%, 26%, 30% and 33%. The most common histologicaltumor was rhabdomyosarcoma, though the occurrence of the histological subtypes was age-dependent.Rhabdomyosarcomas and Ewing’s sarcomas were more frequent in children and adolescents whereasfibrosarcomas, leiomyosarcomas, liposarcomas, malignant fibrous histiocytomas (MFHs) and schwannomaswere encountered in the elderly. Conclusion: Karachi falls into a high risk region for STS, observed in a relativelyyounger population, with a male predominance, high frequency of rhabdomyosarcoma and advanced stage atdiagnosis. Information on grading and staging remain incomplete for most cases, which negatively affect diseasemanagement and survival.     

Rhabdomyosarcoma in Karachi 1998-2002

The epidemiological features of rhabdomyosarcoma (RMS), an uncommon malignancy composed of cells with ‍histopathologic features of striated muscle, were studied in Pakistan. Incident RMS cases recorded at the Karachi ‍Cancer Registry during 1998 to 2004 were reviewed and to ensure maximum completness of data, only those registered ‍between 1998 and 2002 were considered for the present study. Two hundred and seventeen cases were reported to ‍the Karachi Cancer Registry during this five-year period. One hundred and forty eight of the patients (60.4% ‍males; 39.6% females) were residents of Karachi. The crude and standardized annual incidence rates/100,000 were ‍0.3 for males and 0.2 for females. The incidence was 0.5 in children below 15 years of age. The primary RMS sites in ‍males were head and neck (28.1%), extremities (25.8%), genitourinary (GU) tract (17.9%), trunk (9.0%), orbit ‍(7.9%), and retroperitoneum (3.4%). RMS occurred at other sites in 7.9% of the patients. Corresponding frequencies ‍in females were head and neck (35.6%), extremities (16.9%), GU tract (16.9%), trunk (8.5%), orbit (8.5%) and ‍other sites in 13.6%. Approximately 60% of the cases were childhood RMS and three fourths were below 21 years. ‍The mean age of RMS cases all sites, males, was 18.5 years (95% CI 15.6; 21.4); for childhood RMS, 7.5 years (95% ‍CI 6.0; 9.2); and for adult RMS 34.2 years (95% CI 28.3;40.2). In females, the corresponding figures were 18.2 ‍(95% CI 13.7; 22.7); 6.6 (95% CI 5.0; 8.1) and 33.9 (95% CI 27.5; 40.5), respectively. One hundred cases were ‍retraceable, and the mean survival time, RMS all sites and ages in both genders, was 1.5 years (95% CI 1.1; 1.9). The ‍5-year survival was 10%, and 3-year survival was 30% whereas 16.7% of the patients died within a year of diagnosis. ‍The indicators of poor prognosis, a late presentation, rapid evolution, advanced disease, tumor burden (tumor size ‍> 5.cms) and regional lymph node involvement, are characteristic of RMS in Karachi. ‍Recent advances in RMS multimodality treatment protocols have improved RMS prognosis in patients with ‍limited disease. Pakistan should focus on early diagnosis and prompt treatment of malignancies. This requires health ‍education for the general population to create awareness and training of health professionals at all levels to promote ‍early diagnosis. An RMS group is required , which would monitor the treatment, recurrence, patient education and ‍provide psychosocial support. Cytogenetic studies are advised for a better understanding of biologic differences in ‍RMS cases in this population. ‍     

Patho-epidemiology of Lung Cancer in Karachi (1995-2002)

The objective of the study was to provide an overview of the demographics of lung cancer, the number one cancer ‍killer of men in Karachi South (1995-2002). Lung cancer cases recorded at Karachi Cancer Registry during 1st ‍January 1995 to 31st December 2004 were analyzed. To allow for maximum data completion, cases recorded from ‍1st January 1995 to 31st December 2002 were included for final analysis. Trends were studied by analyzing the age ‍standardized incidence rates (ASR)s in 2 time periods, 1995-1997 and 1998-2002. Odds ratio for sex, age-groups, ‍ethnicity, religion, and residence by socio-economic categories were calculated by considering all malignancies (except ‍tobacco-associated malignancies) for each group, registered at KCR for the same period as controls. Cancer of the ‍lung ranked the most frequent malignancy in men in Karachi in the entire 1995-2002 period, though it did not ‍feature amongst the first 10 malignancies in the females. In the 1995-1997 period, the ASR per 100,000 population ‍for cancer of the lung was 21.4 and 2.9 in males (M) and females (F) respectively. The mean age of the patients was ‍60.4 years (95% CI, 59.1-61.7) M and 53.7 years (95% CI 48.9-58.5) F. In the 1998-2002 period the incidence rate ‍increased to 25.5 per 100,000 (M) and 4.2 per 100,000 (F). Thus between 1995 and 2002, the incidence of lung cancer ‍registered a 19% increase in men and almost 100% in women. The component of adenocarcinoma in females remained ‍stable during 8 years, but increased 55% in males. Histologic confirmation was 80%; majority of cancer cases ‍presented as grade 3 and grade 4 lesions (62.3%), and were discovered at advanced stages (stage III 35.7%; stage IV ‍55.8%).The odds ratio (OR) in men was 4.5 (95% CI 3.7; 5.4). The risk of developing lung cancer increased with age, ‍the highest risk being observed in the 65+ age group. A marginally higher risk was observed in the higher socioeconomic ‍categories for men and in the lower socio-economic categories for women. A higher risk was also observed ‍for men who were residing along the coastal belt, and for ethnicities belonging to Southern Pakistan (Sindhi and ‍Mohajir) residing in Karachi South. In conclusion, Pakistan at present falls into a low risk lung cancer region in ‍females and a moderate risk region for males and the highest registered increase between 1995 and 2002 was observed ‍in the older age groups (65+). It is however a cause of concern that the overall lung cancer incidence rates continue ‍to rise. The age specific rates though stable in the younger age groups (35-49 years), are at present equivalent to ‍contemporary rates in high- risk countries. These rates correspond with the trends of smoking prevalence in the ‍younger age groups in the last 2 decades. Published studies have given alerts to increase in the smoking habits of the ‍present day youngsters and with an expanding population the country can expect a substantial increase in lung ‍cancer. This threat can only be averted by implementation of stringent anti-tobacco rules and health education; ‍prohibition of smoking in educational institutions at all levels and a ban on the sale of cigarettes to minors.     

Incidence and Trends of Prostate Cancer in Karachi South, 1995- 2002

Introduction: Cancer prostate (CaP) is a commonly diagnosed cancer in western men, but there is sparseinformation about the demographics of this malignancy in Pakistan. The study objective was to provide anoverview of CaP in Karachi, Pakistan. Methodology: Epidemiological data of 282 incident CaP cases registeredat Karachi Cancer Registry (KCR) during 1st January 1995 to 31st December 2002 were reviewed. Incidenceand trends were studied in 2 time periods, 1995-7 and 1998-2002. Results: In 1995-7, CaP accounted forapproximately 3.4% of the cancers in males and ranked 8th in hierarchy with an age standardized incidencerate (ASR) world and crude incidence rate (CIR) per 100,000 of 6.0 and 2.8 respectively. During 1998-2002, CaPaccounted 4.6% of the cancers, ranked 4th with an ASR world and CIR per 100,000 of 10.1 and 4.4. Thus anapproximate 60% increase was observed between 1995 and 2002. Mean ages of the patients were 67.0 and 67.4years. Age-specific curves showed a gradual increase in risk from the fifth decade onwards. A marginal downstaging was also observed in period 2, more apparent in the more educated Mohajir and Punjabi ethnicities.Conclusion: Karachi falls into a low risk region for CaP, with a rapidly increasing incidence and a marginaldown staging. The probable reasons for the lower incidence are a low life expectancy, lack of availability oraccessibility to health care and lack of public awareness. Implementation of CaP screening and public healtheducation is a necessity today. The low incidence of CaP in Pakistan may be an artefact!     

Evaluation of a Cancer Awareness Campaign: Experience with a Selected Population in Karachi

The incidence and prevalence of cancer is rapidly increasing in both developed and developing countries. Themost common cancers reported in Pakistan are breast and cervical cancers in females, and lung and oral cancers inmales. Public awareness of cancer can play a vital role in its prevention, early diagnosis and treatment. A pilot surveyconducted by the Cancer Support Group (CSG) of Aga Khan University Hospital from 2001 till 2004 to gauge thepublic awareness of cancer in Pakistan revealed that people were afraid of cancer and had little knowledge about itsprevention and early detection. The survey also identified several social, religious and cultural misconceptions whichhinder cancer screening and treatment. In order to create awareness amongst the general public, especially theyoung generation, members of the CSG also organized fifteen health education sessions in schools, colleges, hospitalsand communities in Karachi which were attended by more than 1,500 people. With the help of the results generatedin the pilot project, education material was designed and developed for these health education sessions. Ten percentof the participants contacted CSG members for some unusual finding after administering a self screening teststaught in these sessions. This indicates the importance of holding cancer awareness sessions and the positive feedbackobtained suggests that people would like to have cancer awareness sessions continued.     

Time Trends in the Incidence of Cancer Cervix in Karachi South, 1995-2002

Introduction: The objective of the study was to determine the trends of cancer cervix in Karachi Southduring an eight (1995-2002) year period. Methodology: Cancer cervix cases recorded at Karachi Cancer Registryduring 1st January 1995 to 31st December 2002 were analyzed. Trends were studied by analyzing the agestandardized incidence rates (ASR)s in 2 time periods, 1995-97 and 1998-2002. Results: Cancer cervix rankedsixth in the 1995-97 period the age standardized incidence rate (ASR) world and crude incidence rate (CIR) per100,000 were 6.81 and 3.22. It reached the fifth ranking in the 1998-2002 period with an ASR and CIR of 7.5and 4.0 per 100,000. Thus between 1995 and 2002, the incidence of cervical cancer registered an approximate10% increase. The mean age of the cancer cases was 53.27 years (SD 11.6; 95% CI 50.58, 55.96; range 32-85years) and 50.68 years (SD 11.7; 95% CI 48.8, 52.5; range 51 years) in period 1 and 2 respectively. Themorphological components of squamous cell carcinoma and adenocarcinoma remained stable during this period,though a marginally higher component and increasing incidence of adenocarcinoma was observed throughout.A negligible down staging was observed in the 1998-2002 period. Localized malignancy was observed in 30.8%in period 2 as compared to 25.7% in period 1 and the component of carcinoma in situ increased from 0%percent in period 1 to 1.3% in the second period. Despite this two thirds of the cases still presented with aregional or distant spread of disease. Conclusion: Pakistan at present falls into a low risk cancer cervix region.The cause of concern is the steadily increasing incidence especially in the younger birth cohorts, the advanceddisease at presentation; insignificant in-situ cancers and no preventive intervention or awareness practices inplace.     

Trends and morphology of central nervous system malignancies in Karachi

Introduction: This study was conducted to assess the patterns of primary central nervous system (CNS) malignancies in Karachi South (KS), a moderate risk population in Asia. Materials and Methods: Data for 321 registered cases were reviewed and analyzed in two periods 1995-1997 (111 cases, 75 (67.6%) male (M); 36 (32.4%) female (F)) and 1998-2002 (210 cases, 124 (59.1%) M; 86 (40.9%) F). Results: Age standardized incidence rate per 100,000, crude incidence rate and relative frequency in 1995-1997 were 3.5, 2.8 and 3.5% (M) and 1.8, 1.6 and 1.7% (F). Corresponding figures for 1998-2002 were 3.3, 2.7 and 2.7% (M) and 3.3, 2.7 and 2.1% (F). Mean age of male and female patients during 1995-1997 was 33.3 years (SD± 20.4) and 30.7 years (SD±19.6). Mean ages for 1998-2002 were 33.2 years (SD±19.5) and 28.7 years (SD±18.5) for males and females respectively. In males, 199 malignancies were reported, 106 (86.9%) cases in the brain, 10 (5.5%) in meninges and 12 (6.0%) in the spinal cord; 122 cases were observed in females, 177 (89%) cases in the brain, 8 (6.6%) each in the meninges and spinal cord. The most common morphology was astrocytoma (72 (36.2%) (M); 40 (32.7%) (F)). Mean age of low grade astrocytoma was 27.8 years (M) and 27.0 years (F); anaplastic astrocytomas, 40.5 years (M), 34.1 years (F) and glioblastoma, 45.7 years (M) and 38.3 years (F). Youngest cases were registered for cerebellum and brain stem. Conclusion: The incidence of CNS malignancies is stable in males and gradually increasing in females. Astrocytoma is the commonest morphology; they affect a younger age group and show an age gradient in proportion to tumor grade. The mean age varied by sub-site and histology. Focus should be directed towards the understanding the biological nature and risk factors prevalent in this population.     

Cancer of the Oral Cavity and Pharynx in Karachi - Identification of Potential Risk Factors

The objective of the study was to provide an overview of the demographics of cancer of the oral cavity and ‍pharynx in Karachi South (1995-2001), and identify potential risk factors. Cases recorded for Karachi South, at ‍Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analysed. For maximum completion ‍of data cancer cases, recorded from 1st January 1995 to 31st December 2001 were included for final analysis. The age ‍standardized incidence rates per 100,000 population (ASIRs) for cancer of the oral cavity (excluding salivary gland) ‍in Karachi South were 17.1 and 16.5 in males and females whereas the ASIRs for cancer of the pharynx (excluding ‍nasopharynx) were 7.1 and 2.4 in males and females, respectively. The oral pharyngeal ratios were 2.4 and 6.9 for ‍males and females and gender ratios (M F) were 1.04 for the oral cavity and 3.0 for the pharynx. The mean ages were ‍51 years (95% CI 49.6; 52.2) and 56.1 years (95% CI 54.4; 57.8) respectively. Cancer of the oral cavity ranked 2nd in ‍Karachi in both genders. Cancer of the pharynx ranked 7th in males and 14th in females. Approximately 97% of the ‍oral cavity and pharyngeal cancers were histologically confirmed. The majority of the oral (47.1%) and pharyngeal ‍(51.9%) cancer cases presented as grade II lesions, and were discovered at advanced stages. Of the cancers reported ‍during 1995-2001, 60.4% of the oral and 78.1% of the pharyngeal lesions had spread to a distant site at the time of ‍diagnosis. Squamous cell carcinoma comprised 96.5% and 91.8% of the totals. The incidences of these cancers are ‍comparable to the highest risk regions of the world. As distinct from other geographical areas oral cancer is as ‍common in females as in males, which may reflect the pattern of exposure to known risk factors such as betal quid, ‍arecanut and tobacco and the absence of alcohol as a risk factor in both genders. Apergillus contamination of ‍arecanut could also be a risk factor but no confirmation studies or quantification is available. Despite the common ‍risk factors, incidence of pharyngeal cancer is three times higher in men as compared with women. The keys to ‍reducing the incidence and mortality due to oral and pharyngeal cancers are prevention and control, emphasizing ‍cessation of tobacco use and cancer screening. However a targeted cancer and tobacco control program does not ‍presently exist in Pakistan. ‍     

Cancer of the Oral Cavity - Trends in Karachi South (1995-2002)

The objective was to study the time trends in site-specific oral cancer incidence and to determine the age-and ‍socio-economic profile over time in Karachi South. Oral cancer ranks second in this population, in both genders. ‍The incidence is the highest reported worldwide. Incident oral cancer cases received at the Karachi Cancer Registry ‍during 1st January 1995 to 30th June 2004 were reviewed. To ensure maximally complete data, cases registered ‍between 1st January 1995 and 31st December 2002 were considered for the present study. Cases of lymphoma, leukemia ‍and melanoma were not included. Trends were studied by grouping cases into two periods, 1995-1997 and 1998- ‍2002. ‍A total of 2253 cases of oral cancer were registered in Karachi South for the 8 year study period accounting for ‍8.8% of all cancer cases. Overall, the most common site was the mucosa cheek (55.9%), followed by the tongue ‍(28.4%), palate (6.8%), gum (4.4%), lip (3.1%) and floor of the mouth (1.4%). About 30% of cases occurred in ‍patients 40 years and younger and 23% occurred in patients 65 years and older. Sub-categories of oral cancer ‍showed variation in trends, but an earlier onset of disease in period two was evident for all categories. The incidence ‍of lip cancer in men decreased, the rates remained level in females. An increased incidence was observed for tongue, ‍but a more dramatic increase in the cheek was evident in both sexes, despite no improvement during the past decade ‍in detection of early, localized lesions. A strong socio-economic factor with a poorer, low literacy profile of oral ‍cancer was apparent in the entire study period. The evidence that the largest increase in incidence has occurred in ‍this population may unfavorably affect the mortality rates. ‍Oral cancer trends are an interplay of prevalent risk factors, the level of prevalence, preventive education and ‍intervention. Cost effective and efficient cancer control focused around the target populations would be beneficial ‍for Pakistan. Educational campaigns should include information on oral hygiene, awareness of risk factors and ‍symptoms and the importance of seeking early professional help when any of these are recognized. Audio-visual ‍media involvement is imperative in view of the literacy status of the target population. Capacity building is required ‍by the Government to increase the availability and accessibility of professionals. Population screening would reduce ‍the incidence of oral cancer, but requires careful planning, and extensive financial resources. Mobilization of general ‍practitioners, health visitors, volunteer organizations and medical students for early detection of oral cancer is the ‍essential need of today. ‍     

Incidence and Current Trends of Colorectal Malignancies in an Unscreened,Low Risk Population

Introduction: Karachi falls into a low risk region for colorectal (CRC). The incidence rate is known butdetailed epidemiology and pathology data regarding the disease are not available. The aim of this study is todescribe CRC with reference to incidence, gender; topographic sub-site, tumor morphology, grade and stage atdiagnosis and to determine the trends of incidence. Materials and Methods: Four hundred and seventy threecases of colorectal cancer submitted to the Karachi Cancer Registry for Karachi South, years 1995-2002 werereviewed. Cases were analyzed in two time periods (1995-7 and 1998-2002) to facilitate the study of time trends.Results: A total of 151 CRC cases were registered during period one [86 (57%) males; 65 (43%) females] and322 cases [210 (65%) males; 112 (35%) females] in period two. Age standardized rate (ASR) world per 100,000,crude incidence rate (CIR) and relative frequency in period one were 5.3, 3.2 and 4.1% in males and 5.5, 3.2and 3.2% in females respectively. Corresponding figures for period two were 7.1, 4.5 and 4.7% for males and5.2, 2.8 and 2.7% in females. The male, female ratio was equal for colon (1:1). Men had more rectal cancers(2:1) and overall CRC (1.7:1). The mean age of the patients varied with sub-site and gender from 43.7 years to51.2 years. Cancers of the rectum presented at a relatively earlier age. Less then 5% of the cases were diagnosedin adolescents, 50% above 50 years of age and only 30% above 60 years. The ratio under-40 to above-40 forCRC patients was 0.3, which is much higher than the international average, indicating a younger age group atrisk. The first cases were observed in adolescents (15-19 years) and a peak was observed in the seventh decade.Colon to rectum ratio was 1:1 in males and 2:1 in females. Most cases presented with advanced disease, thoughsome down staging was observed in period 2 (1998-2002). Conclusion: The current low but increasing incidence(especially in men), the younger age and advanced stage of CRC at diagnosis reflects a low risk, unscreenedpopulation. With existing prevalence of high risk factors in Pakistan, the low CRC incidence may be an artifact.There are concerns that an aging population over the next decade and changing lifestyle patterns may translateinto a higher CRC incidence. Screening must be considered as part of the health sector planning for the futureand include the high risk younger age groups.     

Karachi Cancer Registry (KCR): Age-Standardized Incidence Rate by Age-Group and Gender in a Mega City of Pakistan

Objectives: To estimate the cancer incidence by age group and gender for the population of Karachi Division by analyzing the Karachi Cancer Registry data of 2017-19. Settings: The population of Karachi division is 16.1 million according to national census 2017. ‘Karachi Cancer Registry’ which is a part of ‘National Cancer Registry’ is collecting data from eight major hospitals in Karachi since 2017. For outcome measures, cancer counts and the age standardized incidence rates (ASIR) per 100,000 population were computed for age groups (0–14, 15–19 and ≥20 years), in both genders and all cancer site/type. Methods: The population denominators were based on the population of Karachi division estimated at 16.1 million in the population census, 2017. Counts and age-standardized incidence rates (ASIR) were calculated for each of the three age categories. Results: From Jan 2017 till Dec 2019 a total of 33,309 malignant cases were recorded in KCR database comprising 17,490 (52.5%) females and 15,819 (47.5%) males. ASIRs in age groups 0-14, 15-19 and ≥ 20 years, among female were 11.5, 2.4 and 223.6 and in males were 17.6, 3.2 and 216.7 respectively. The commonest diagnosis in children, adolescent and adults were (1) among females: children; bone (3.12),  leukemia (2.09) brain/CNS (1.26); in adolescents: bone (0.78), brain/CNS (0.27), connective and soft tissue (0.11), in adults: breast cancer (76.07), oral cancer (16.68) and ovary (10.89) respectively, and (2) among males: children; bone (4.56),  leukemia (2.79) and brain/CNS (1.88); in adolescent; bone (1.19), brain/CNS (0.31) and leukemia (0.21) and in adults: oral cancer (42.83), liver (16.10) and bone (13.37) respectively. Conclusion: Oral Cancer, a largely preventable cancer is the leading cancer in Karachi adult males while in female adults Breast Cancer is the leading cancer followed by Oral Cancer. In children and adolescents Bone, Leukemia and Brain/CNS malignancies are most common.     

Evaluation of Common Risk Factors for Breast Carcinoma in Females: a Hospital Based Study in Karachi,Pakistan

Background: Breast malignancies are one of the leading causes of deaths in females worldwide. There are anumber of risk factors associated with breast cancer but in Karachi Pakistan there are insufficient data available.Materials and Methods: A case control study was conducted on females in age group between 30-80 years. Thisstudy was accomplished by retrospective data collection in Aga Khan University Hospital Karachi, Pakistan.A total of 108 females with primary malignancy of breast were included along with 108 matched controls.Relationship of various factors with disease was studied using logistic regression to calculate odds ratios with95 % confidence intervals. Results: A total of 14 variables were analyzed and based on and 7 were found to berisk factors: old age, family history of breast cancer, family history of other carcinomas, personal history ofbreast carcinoma, early age of menarche, older age of mother at first delivery and lower number of children.Five factors, parity, breast feeding, history of oral contraceptive pills intake, past history of oophorectomy andhysterectomy showed protective associations. One variable, use of hormonal replacement therapy, showed acontroversial link and one other, marital status, was not significant in this study. Conclusions: It is concluded thatmost of the well-known risk factors for breast cancer are also associated with the disease in the female populationof Karachi, Pakistan. High risk patients should be the focus with the help of this study so that screening can bemore effective for early diagnosis before clinically evident breast malignancy.