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.     

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!     

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.     

Cancer Incidence in Thailand, 1995-1997

There are five population-based cancer registries in Thailand in different regions of the country. Four of them ‍(Chiang Mai, Khon Kaen, Bangkok, and Songkhla) have been operating since 1988 and the other (Lampang) since ‍the early 1990’s. These registries have published regular 3-year cancer incidence reports since the first in 1993 for ‍the period 1989-1991. The objective of this article is to summarize the figures of cancer incidence in Thailand during ‍1995-1997. The population of Thailand in 1996, at the middle of the period, was 27 million males and 27.5 million ‍females. Information of cancer cases residing in the five provinces was collected and abstracted from different ‍sources. Age-standardized incidence rate (ASR) of cancer in males and females was calculated for each registry and ‍that for the whole country was estimated using the five registries as representatives for the four geographical regions ‍of Thailand. The estimated number of new cancer cases in 1996 for the whole country was 35,539 men and 38,476 ‍women and the ASRs were 149.2 and 125.0 per 105 population in men and women respectively. Cancer incidences ‍greatly differed from region to region. Lung cancer was the commonest in Chiang Mai and Lampang in the Northern ‍region in both sexes. The incidence of liver cancer in Khon Kaen in the Northeastern region outnumbered all the ‍others in both sexes; cholangiocarcinoma was the major type of liver cancer. In Bangkok, lung cancer was the most ‍important cancer in males and breast cancer was in females. Though it was lung and cervix uteri cancer that ranked ‍the first in men and women in Songkhla, the rate of oral and pharyngeal cancer was exceptionally higher than in ‍other registries. The geographical variability in cancer patterns in Thailand reflects exposure of the population to ‍different risk factors unique to the different regions. In the study as a whole, there are some methodological weak ‍points in estimating the ASRs and number of cancer cases for the whole country, but the results are the most reliable ‍cancer statistics from Thailand at the moment. In conclusion, both a country-wide and region-specific cancer control ‍programmes are needed for Thailand. The national one would be for the cancers common to all regions, and the ‍provincial-level emphasis should be on cancers which are the major problems in the area.     

Incidence of digestive cancers and occupational exposure to asbestos.

While the role of exposure to asbestos in the development of several cancers such as mesotheliomas and bronchopulmonary cancers is now well established, the possible relationship between digestive cancers, other than peritoneal mesotheliomas, and occupational exposure to asbestos is still controversial. The great majority of the studies are based on mortality data. The aim of the study was to analyse the relationship between digestive cancer incidence and occupational exposure to asbestos in a population of subjects for whom precise occupational exposure data and precise incidence data were available. The population consisted of salaried and retired workers from a company using asbestos to manufacture fireproof textiles and friction materials. There were 1454 men (79.9%) and 366 women (20.1%). A cumulative exposure index and a mean exposure concentration in fibres/ml for each subject were calculated with the aid of an in-house job-exposure matrix. The number of cases of digestive cancer observed was compared with the expected and Standardized Incidence Ratio (SIR) was estimated. Precise occupational exposure data allowed us to study the dose-response relationship between asbestos exposure and risk of digestive cancer using Cox model. Fifty-six digestive cancers occurred in the study population over the 18-year follow-up period for 48.4 expected (SIR = 1.16 [0.87-1.50]). Comparing with incidence in the county, SIR was not significant for any of the digestive localization, but for peritoneum. However, even after taking into account the potential confounders via the Cox model, there was a significant dose-response relationship between the occurrence of digestive cancers and the mean exposure concentration, even after exclusion of peritoneum cancers. Our study provides initial evidence suggesting a relationship between occupational exposure to asbestos and the risk of digestive cancer: first, it is a study of incidence although the risk evidenced is not significant; secondly, a dose-effect relationship is demonstrated in the whole population. However, these preliminary results require confirmation by more powerful studies focusing on larger series.     

Incidence of and survival from oligodendroglioma in Denmark, 1943–2002

We established the nationwide, population-based incidence of oligodendroglioma in Denmark during 59 years of monitoring and compared the overall survival of patients with oligodendroglial tumors during the periods 1943–1977 and 1978–2002. On the basis of reports in the Danish Cancer Registry, 1,304 cases of oligodendroglioma were included in the study. We calculated sex- and age-specific incidence rates in 5-year age intervals and for 5-year calendar periods. Overall survival was estimated by the Kaplan-Meier method. In the period 1943–2002, the incidence rate of oligodendroglioma was less than 1 case per 100,000 person-years, but varied somewhat when viewed across isolated periods. Comparison of the incidence rate before and after the introduction of CT scanning did not reveal a significant difference in the incidence rate. The median survival increased from 1.4 years (95% confidence interval [CI], 1.0–1.6) to 3.4 years (95% CI, 2.6–4.2) during the period of study. The overall incidence of oligodendroglioma showed a relatively stable pattern over nearly 60 years of monitoring. Overall survival improved significantly during the study period, which could partly be due to improved diagnostic methods and treatment options.     

Incidence and survival of cancers in the elderly population in Iran: 2001-2005

Objective: This study concerns the incidences of different types of registered cancers among the Iranian elderly population. The aim owas to estimate the 5-year survival of cancers between 2001 and 2005, according to elderly age groups and history. Since data on the health status of the Iranian elderly are non existent, these findings will, in part, fill the gap in geriatric knowledge in Iran. Methods: Data from the national cancer registry department of the Ministry Health and Medical Education (MOH & ME), which are pathology-based registration data, were used as the main source of information on incident types of cancers in Iran from 2001-2005. The coverage rate was nearly 80% of majority types of cancers and almost 100% of pathologically diagnosed forms of cancers in the elderly. Survival estimates calculated by Kaplan-Meier method. The survival probability was calculated for the overall cohorts, as well as gender and anatomical sites of tumor. Results: The highest incidence of cancerin five-year cohort was for skin cancer among the elderly population. The youngest aged group (60-74) years had high incidences (64.3%) of all types of cancers. Incidence rates of breast and thyroid cancers in old women were greater than in elderly men. In terms of survival rate, relative risk reflects significant association with gender (RR= 1.03; 95% CI: 0.84-0.95), P = 0.00. Conclusion: Based on the results in this study, the incidence of cancers in the elderly population increases with age. The mean age of the five-year survival cohorts was 88.2 years old. The incidence rates of cancers in old men are generally higher than in elderly wemon.     

Cancer survival in Cuba, 1994-1995

The population-based cancer registry in Cuba is a national cancer registry established in 1964; cancer registration is entirely done by passive methods. Data on survival from 13 cancer sites or types registered during 1994-1995 are reported. Follow-up has been carried out predominantly by passive methods, with median follow-up ranging from 13-54 months. The proportion with histologically verified diagnosis for various cancers ranged between 34-100%; death certificates only (DCOs) comprised 8-50%; 50-89% of total registered cases were included for the survival analysis. The 5-year age-standardized relative survival for selected cancers were breast (69%), colon (41%), cervix (56%), urinary bladder (64%), rectum (48%) and non-Hodgkin lymphoma (49%). The 5-year relative survival by age group showed no distinct pattern or trend, and was fluctuating. A decreasing survival with increasing clinical extent of disease was noted for all cancers studied. The data on survival trend revealed that the 5-year relative survival of most cancers diagnosed in 1994-1995 was greater than that in 1988-1989.     

Serum sialyl-Tn antigen levels in patients with digestive cancers

Serum levels of sialyl-Tn antigen (STN) were measured using a one-step radioimmunoassay kit in 257 patients with digestive cancers, 121 patients with benign digestive diseases, and in 64 healthy controls. With 45 U/ml regarded as the cutoff value, the positive rates of serum STN in digestive cancers were as follows: pancreas 40.0%, stomach 28.1, colon and rectum 27.8, biliary tract 25.0, liver 7.1, and esophagus 0%. In benign digestive diseases, the positive rate of STN was low (4.1%). In gastric and colorectal cancers, simultaneous measurements of STN and carcinoembryonic antigen (CEA) revealed that the positive rates of STN, CEA, and STN and/or CEA were 28, 42, and 55%, respectively. There was no significant correlation between STN and CEA in these cancers. STN may be a useful serum marker for digestive cancers, especially gastric and colorectal cancers.     

Serum determination of CA 19-9 in patients with digestive cancers and its diagnostic evaluation

The precision of CA 19-9 RIA kit was evaluated by recovery, reproducibility and dilution test with very satisfactory results. The CA 19-9 value in sera from 52 healthy individuals and from 224 patients with gastric intestinal cancer and other benign disease, showed an increased positive rate in several cases of gastric intestinal cancer. For example, the positive rate in pancreatic cancer, bile duct cancer, colo-rectal cancer, gastric cancer, esophagus cancer, primary biliary cirrhosis diabetes mellitus, liver cirrhosis and chronic hepatitis was 60%, 75%, 55.6%, 45.6%, 20%, 28.6%, 22.7%, 13.7% and 1.7% respectively. By contrast, values from patients with acute hepatitis, fulminant hepatitis, fatty liver, gastric duodenal ulcer, pancreatitis, and primary liver cancer were within the normal range. In this study, CA 19-9 RIA were found to be significant as an adjunct in the management of patients with gastrointestinal cancer, especially pancreatic cancer, and bile duct cancer.     

Survival of patients with oesophageal and gastric cancers in Europe

The EUROCARE study is a European Union project to collect survival data from population-based cancer registries and analyse them according to standardised procedures. We investigated and compared oesophageal and gastric cancer survival in 17 countries between 1985 and 1989. Time trends in survival over the 1978–1989 period were also investigated in 13 countries. The overall European 1-year relative survival rates were 33% for oesophageal cancer and 40% for gastric cancer. The corresponding 5-year relative survival rates were 10 and 21%, respectively. Important intercountry survival differences exist within Europe for oesophageal and gastric cancer. Taking the European average as the reference, the relative risk (RR) of death at 5 years was at least 30% higher in Denmark, Poland, Estonia and Slovenia for oesophageal cancer and in Denmark, England, Scotland and Poland for gastric cancer. In the other countries survival figures were close to the European average. Gender had little influence on survival, whilst age at diagnosis was inversely related to prognosis. There was a slight improvement between 1978 and 1989 in 5-year overall relative survival rates for both oesophageal cancer (RR=0.80, 95% confidence interval (CI) 0.72–0.90) and gastric cancer (RR=0.88, 95% CI 0.82–0.94). Differences in quality of care and stage at diagnosis can explain in part the differences in survival found in the EUROCARE countries. Significant improvement in prognosis has still to be achieved.     

Cancer survival in Shanghai, China, 1992-1995

The Shanghai cancer registry, established in 1963, is the oldest one in mainland China; cancer registration is entirely done by passive methods. The registry contributed data on 52 cancer sites or types registered during 1992-1995 for this survival study. The methods of follow-up have been a mixture of both active and passive ones, with median follow-up ranging 3-81 months. The proportion with histologically verified diagnosis for various cancers ranged from 14-95%; death certificates only (DCOs) ranged from 0-2% and 98-100% of total registered cases were included for survival analysis. The top ranking cancers on 5-year age-standardized relative survival (%) were thyroid (90%), non-melanoma skin (86%), penis (84%), corpus uteri (82%) and testis (80%). The corresponding survival rates for common cancers were lung (16%), stomach (30%), liver (9%), breast (78%) and colon (48%). The 5-year relative survival by age group reveals an inverse relationship for most cancers. An increasing trend in the 5-year absolute andrelative survival was noted for all cancers registered in 1992-1995 compared to 1988-1991.     

Cancer survival in Bhopal, India, 1991-1995

The Bhopal population-based cancer registry was established in 1986 under the national cancer registry programme to investigate the after-effect of a gas leak in 1984. Cancer registration is done entirely by active methods. The registry is contributing data on survival for 16 cancer sites or types registered during 1991-1995. Follow-up of cases was done by active methods with median follow-up time ranging between 8-44 months for different cancers. The proportion with histologically verified diagnosis for various cancers ranged between 61-100%; death certificates only (DCOs) comprised 0-2%; 50-92% of total registered cases were included for survival analysis. The 5-year age-standardized relative survival rates for common cancers were mouth (34%), cervix (31%), breast (25%), tongue (12%), oesophagus (3%) and lung (1%). The 5-year relative survival by age group showed that survival was the highest in the youngest age group (45 years and below) for a majority of cancers. A decreasing survival with increasing clinical extent of disease was noted for most cancers studied.     

Cancer survival in Costa Rica, 1995-2000

The Costa Rica national tumour registry was founded in 1976 and nationwide data collection commenced in 1980. Cancer registration is predominantly done by passive methods. The registry contributed data on survival for invasive cancers of breast and cervix and in situ cancer of the cervix registered during 1995-2000. Followup has been carried out predominantly by passive methods, with median follow-up ranging from 31-47 months. The proportion of cases with histological confirmation of cancer diagnosis was 92% for invasive cancers and almost 100% for in-situ cancer of the cervix; death certificates only (DCOs) comprised 3%, and 78-86% of total cases registered were included for survival analysis. The one-, three- and five-year relative survival were 93%, 77% and 68%, respectively for breast cancer; the corresponding figures for invasive cervix cancer were 83%, 61% and 54%, respectively. The five-year relative survival for in-situ cervix cancer was 99%. A decreasing survival with increasing age group at diagnosis was noted for in-situ cancer of the cervix, while it fluctuated for invasive breast and cervix cancers. A decreasing survival with increasing clinical extent of disease was noted for invasive breast and cervix cancers.     

Cancer survival in Manila, Philippines, 1994-1995

The population-based cancer registry in Manila, Philippines, called the Philippine Cancer Society-Manila Cancer Registry, was established in 1983. Cancer registration is pursued by active methods. The registry contributed survival data on a random sample of total incident cancers of breast (500), cervix (500), colon and rectum (300) registered in 1994-1995. Follow-up has been carried out by passive and active methods, with median follow-up ranging between 15-33 months for different cancers. The proportion of histologically verified diagnosis for various cancers ranged between 78-88%; 74-83% of the total submitted cases were included for survival analysis. Complete follow-up at five years was available in 75-82% of cases. Five-year age-standardized relative survival rates was the highest for cancer of the breast (52%) followed by colon (49%), cervix (36%) and rectum (31%). Five-year relative survival by age group did not display any pattern or trend and was fluctuating. A decreasing survival with increasing extent of disease was noted for all cancers.