Trends of Head and Neck Cancers in Urban and Rural India

Background:The sub-site predilection of head and neck squamous cell carcinoma (HNSCC) reflects the risk ‍profile of a community and there are suggestions that these are changing over time. Objective: To determine the ‍change in head and neck cancer in rural and urban populations in India. Methods: Cancer registry data of an urban ‍and a rural population were reviewed over a period of 13 and 11 years, respectively. Age adjusted rates (AAR) and ‍age specific incidence rates were used for data analysis. Results: Oral cancers formed the majority of the head and ‍neck cancers with a predilection for tongue, except in rural males, in whom the pharynx was the predominant subsite. ‍Overall there was a reduction in the incidence of HNSCC, which was more pronounced in urban females and ‍rural males (p< .001). Among the sub-sites, oral cavity cancers showed a decreasing trend in urban females (p< .01) ‍and rural males (p< .01). However, the trend was towards increase of incidence of tongue cancers. Pharyngeal ‍cancer showed reduction in urban females (p< .01), whereas it increased in rural females. The recent increase in ‍incidence of young adults with HNSCC reported in developed countries was not observed. Conclusions: Overall, ‍incidence of HNSCC is reducing. This may be attributed to the decreased prevalence of tobacco use.The increase in ‍incidence of tongue cancer may suggest factors other than tobacco and alcohol in its genesis.     

Improving Cancer Care in India: Prospects and Challenges

The World Cancer Report, a 351 - page global report issued by International Agency for Research on Cancer ‍(IARC) tells us that cancer rates are set to increase at an alarming rate globally (Stewart and Kleiues 2003). Cancer ‍rates could increase by 50 % to 15 million new cases in the year 2020. This will be mainly due to steadily aging ‍populations in both developed and developing countries and also to current trends in smoking prevalence and the ‍growing adoption of unhealthy lifestyles. The report also reveals that cancer has emerged as a major public health ‍problem in developing countries, matching its effect in industrialized nations. Healthy lifestyles and public health ‍action by governments and health practitioners could stem this trend, and prevent as many as one third of cancers ‍worldwide. ‍In a developing country such as India there has been a steady increase in the Crude Incidence Rate (CIR) of all ‍cancers affecting both men and women over the last 15 years. The increase reported by the cancer registries is nearly ‍12 per cent from 1985 to 2001, representing a 57 per cent rise in India's cancer burden. The total number of new ‍cases, which stood at 5.3 lakhs Care lakh is 100,000 in 1985 has risen to over 8.3 lakhs today. The pattern of cancers ‍has changed over the years, with a disturbing increase in cases that are linked to the use of tobacco. In 2003, there ‍were 3.85 lakhs of cases coming under this category in comparison with 1.94 lakhs cases two decades ago. Lung ‍cancer is now the second most common cancer among men. Earlier, it was in fifth place. Among women in urban ‍areas, cancer of the uterine cervix had the highest incidence 15 years ago, but it has now been overtaken by breast ‍cancer. In rural areas, cervical cancer remains the most common form of the disease (The Hindu 2004).     

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. ‍     

Oral Cancers in Mumbai,India: a Fifteen Years Perspective with Respect to Incidence Trend and Cumulative Risk

Objective: We estimated the time trends in the incidence and the risk of developing an oral cancer in Mumbai, ‍Indian population using the data collected by the Bombay Population Based Cancer Registry during the 15 year ‍period from 1986 to 2000. ‍Methods: A total of 9,670 oral cancers (8.2% of all neoplasms) were registered, of which 6577 were in males and ‍3093 in females (10.7% and 5.4% of the respective totals for the two genders) . For evaluation of the trend, we ‍applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage ‍changes were also computed for the incidence rates to evaluate the time trend. ‍Results: In males, a statistically significant decreasing trend in the overall age-adjusted incidence rates were ‍observed during the period 1986 to 2000, with an yearly decrease of 1.70%. This decrease was significant for men ‍above the age of 40, but for young adult men below the age of 40, there was no significant decrease, the level being ‍stable. In females, the overall decreasing trend in the age-adjusted incidence rates of oral cancers was not significant, ‍but in the age group 40-59, a significant decline was observed. The probability estimates indicated that one out of ‍every 57 men and one out of every 95 women will contract any oral cancer at some time in their whole life and 97% ‍of the chance is after he or she completes the age of 40. ‍Conclusion: The observed decreasing trend in oral cancers in Indian men may be attributed to a decrease in the ‍usage of pan and tobacco. The high prevalence of the usage of smokeless tobacco among young adult men and ‍women may explain the stable trend in oral cancer incidence in this group. These findings help to strengthen the ‍association between tobacco use and oral cancer risk. ‍     

Karachi Cancer Registry Data – Implications for the National Cancer Control Program of Pakistan

Cancer registries play a major role in providing the data to justify establishment, implementation and monitoring of ‍cancer control programs, therefore stability in cancer registration is of pivotal importance. An erroneous assessment of the ‍cancer burden can have long-term negative implications for the limited health resources of a country. Thus, registries ‍starting simultaneously with cancer control programs clearly cannot be adequate for the purpose. The Karachi Cancer ‍Registry (KCR) is the first population-based registry of Pakistan, with 9 years proven data stability (1995-2003) for Karachi ‍South (KS), a location with a population distribution similar to that for the country in general as regards age, gender, and ‍religion. It also has the distinction of being the only district in the country with representation of all ethnic and socioeconomic ‍groups of the country. The primary recommended strategy for the ‘National Cancer Control Program’ (NCCP), ‍Pakistan based on the assessment of eight common cancers in Karachi and the WHO estimates would be identical. A curb ‍on the epidemic levels of tobacco and areca nut use would reduce malignancies in males by 43.7% and in females by ‍17.8% . WHO estimates put these figures at 45% and 18.5% for males and females respectively. Primary prevention in the ‍form of diet control, checks on preservatives, dyes, and pesticides; protection from occupational hazards, control of biological ‍agents and solar UV protection would help control of another half of the malignancies. ‍Resource restrictions put high technology methods beyond the scope of Pakistan today. Early detection of cancers of ‍accessible sites, though not an urgent requirement, would be warranted for oral, cervical and breast cancer, after sufficient ‍capacity building, initially in the high-risk groups. In females, this could help target 47.6% (approximately half) of the ‍malignancies and in men 13% of the total. Establishment of equitable pain control and a palliative care network throughout ‍the country is an urgent and essential measure as more than 70% of cancer patients report with very advanced stages of ‍malignancy. The estimated annual incident cancer cases for Pakistan, year 2000 on the basis of KCR data were 138,343 for ‍males and 135,054 for females; approximately twice the number cited by WHO for the same year. The argument that higher ‍KCR estimates reflect an urban catchment population may be justified, the urban: rural ratio being 2:1 in Pakistan. Evidencebased ‍strategies, however ,support the counter argument, that the rising incidence of cancer in Pakistan is primarily attributable ‍to risk factors equally prevalent in the rural and urban areas viz. increasing tobacco use, low socio-economic conditions, ‍dietary deficiencies and prevalence of oncogenic viruses. ‍Pakistan has a significant cancer burden and rising trends of risk factors - it is a country in dire need of a Cancer Control ‍Program. KCR data along with WHO estimates can form the initial framework of a NCCP in Pakistan; the lack of a national ‍cancer registration should not deter initiatives. Benefits of an immediate, prompt and targeted implementation established ‍today will be realized after 20–30 years. Otherwise the country should be prepared to face epidemic proportions of the ‍disease in the next decade or two. Prerequisite ‘qualification criteria’ or ‘sincerity of intent test’ for NCCP funding by ‍international donors should be legislation against tobacco and areca nuts in Pakistan and stringent evaluative criteria.     

Assessing Cancer Burden in Rural India : An Analysis by Cause of Death Statistics

India lacks nationwide cancer registration and systematic death registration. Gaining insight into the magnitude ‍of the cancer problem in India depends mainly on14 population based cancer registries, which provide relatively ‍accurate statistics although the area and population cover by these registries is minimal at about 7% (20% Urban ‍and 1 % Rural). With estimation of cancer burden from other sources, paucity of adequate data on the one hand ‍and the complex pathogenesis of disease on other makes for complexity in dealing with rural populations. However, ‍surveys of cause of death do reveal some interesting patterns that may very well be of use for international comparisons. ‍In this paper an attempt has been made to estimate the cancer burden in rural India using the information available ‍from surveys of cause of death for rural populations conducted by the Government of India. ‍     

Comparison of Cancer Incidence in Iran and Iranian Immigrants to British Columbia,Canada

Migrant studies provided strong evidence about the role of environment and life style in cancer risk. Iran has ‍experienced many immigrants to other countries with different cultures and environment. This study compares ‍cancer incidence rates in Iran, Iranian immigrants to British Columbia (BC), Canada, and the BC general population. ‍Cancer incidence rates were computed from two population-based cancer registries in Iran and from the BC cancer ‍registry. A listing of common Iranian surnames and given names was produced to identify Iranian immigrants ‍within the BC cancer registry. Age-standardized rates (ASRs) were calculated using mid year census data. The ‍overall cancer incidence rate for Iranian female immigrants was intermediate between rates for Iran and the BC ‍general population, and the rate for Iranian male immigrants was lower as compared to the other population groups. ‍For female Iranian immigrants, the incidence of breast cancer was increased four-fold, and for colorectal cancer ‍two-fold, as compared to Iranian rates. A dramatic decrease was found in the incidence of both stomach and ‍oesophageal cancers for Iranian immigrants of both sexes. For male Iranian immigrants, the incidence of prostate ‍cancer was increased as compared to Iranian rates. Differences in incidence rates of specific cancers were observed ‍between BC Iranian immigrants and Iran, with cancer patterns in Iranian immigrants being more similar to the BC ‍general population. This warrants further investigation into differences in lifestyle and cancer detection ‍     

Decreasing Trend in the Incidence of Stomach Cancer in Mumbai,India, during 1988 to 1999

The time trend in incidence of stomach cancer in males and females in Mumbai, India during 1988 to 1999 was ‍estimated using data collected by the Bombay Population-based Cancer Registry. During the 12-year period, a total ‍of 3657 stomach cancer cases (3.9% of all cancers) were registered by the Bombay Population-based Cancer Registry ‍of which 2467 (5.1% of all male cancers) were in males and 1184 (2.6% of all female cancers) in females. For evaluation ‍of the trend, we applied a linear regression model based on the logarithm of the observed incidence rates. The annual ‍percentage changes were also computed for the incidence rates for evaluating the time trend. A statistically significant ‍decreasing trend in the overall age-adjusted incidence rates of stomach cancer was observed during the period 1988 ‍to 1999, with an yearly decrease of 4.44% in males and 2.56% in females. This decrease was most striking in males ‍in the age groups 40-59 and 60+, and in females only in the age group 40-59. The probability estimates indicated that ‍one out of every 92 men and one out of every 187 women will contract a stomach cancer at some time in their whole ‍life and 95% of the chance is after his or her 40th birthday. The decreasing trend in the age-adjusted incidence rates ‍of stomach cancer in both the sexes indicates that there is a critical change in the etiology of this cancer. The findings ‍may provide clues relating to various life-style and environmental changes impacting on stomach cancer incidence.     

Cumulative Risk and Trends in Prostate Cancer Incidence in Mumbai,India

Background: Information relating to cancer incidence trends in a community forms the scientific basis for the ‍planning and organization of prevention, diagnosis and treatment of cancer. We here estimated the cumulative risk ‍and trends in incidence of prostate cancer in Mumbai, India, using data collected by the Bombay Population-based ‍Cancer Registry from the year 1986 to 2000. ‍Methods: During the 15 year period, a total of 2864 prostate cancer cases (4.7% of all male cancers and 2.4% of ‍all cancers) were registered by the Bombay Population-based Cancer Registry. For evaluation of the trend, we ‍applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage ‍changes were also computed for the evaluation. Cumulative incidence rates percentages were calculated by adding ‍up the age specific incidence rates at single ages and then expressed as a percentage. ‍Results: Analysis of the trends in age-adjusted incidence rates of prostate cancer during the period 1986 to 2000 ‍showed no statistically significant increase or decrease and the rates proved stable across the various age groups (00- ‍49, 50-69 and 70+) also. The probability estimates indicated that one out of every 59 men will contract a prostate ‍cancer at some time in his whole life and 99% of the chance is after he reaches the age of 50. ‍Conclusion: The stability in age adjusted-incidence rates indicates that there are no changes in the etiological ‍factors for prostate cancer in Mumbai, India. These findings may be of general interest because changes in diagnostic ‍practices are confounded in the time trends of prostate cancer change in many western countries preventing inferences ‍on the changes in risk. ‍     

Breast Cancer in Iran: Results of a Multi-center study

Introduction: Breast Cancer is the most common cancer in Iranian women. This study aims to demonstrate the ‍characteristics of breast diseases- and especially breast cancer- according to pathologic records in Tehran, Iran. ‍Methods: In this cross-sectional study, all records of pathologic specimens (biopsy or mastectomy) categorized as ‍“breast diseases” from 1996 to 2000 in five teaching hospitals in Tehran were studied. For each patient, sex, age, ‍breast pathology, pathological staging of malignant lesions, side and location of the tumor and the type of surgery ‍were reviewed by a trained general practitioner. SPSS version 10 was used for statistical analysis. Results: The mean ‍age of women with breast cancer was 48.8. The highest frequency of malignancies was observed in the 40-49 age ‍group (31.8%). Twenty-three percent of breast cancers were observed in women younger than 40 years. About 83 ‍percent of malignant lesions in women were in T2, T3 or T4 at diagnosis. Only about 4 percent of women with breast ‍cancers had tumors in stage I or in-situ carcinomas. Nearly 70 percent of the cancers were detected only after lymph ‍node involvement. Only 4.3 percent of our female cases had the chance of conservative mastectomy. Twenty-eight ‍percent of specimens from biopsies in women were malignant. Discussion and Conclusion: In Iran, breast cancer ‍affects women at least one decade younger than their counterparts in developed countries. A considerable proportion ‍of our cases (96%) were in stage II or III at diagnosis. These results show advanced cases at presentation in Iran ‍which further mandate a national cancer detection program involving more effective public education and ‍encouragement of women for breast self-examination and participation in screening campaigns. ‍     

中国女性乳腺癌的发病和死亡现况——全国32个肿瘤登记点2003-2007年资料分析报告

目的:描述2003-2007年中国女性乳腺癌的发病和死亡情况.方法:从经审核合格的全国32个肿瘤登记点收集2003-2007年女性乳腺癌发病、死亡和相应的人口数据,对数据进行汇总和描述分析.结果:2003-2007年全国32个肿瘤登记点女性乳腺癌合计发病率为41.64/10万,居女性癌症发病的第1位;合计死亡率为9.63/10万,居女性癌症死因的第6位.女性乳腺癌在全国城市地区的发病率和死亡率均高于农村地区,城市地区发病率是农村地区的3.04倍,城市地区死亡率是农村地区的1.92倍.肿瘤登记点合计女性乳腺癌发病率在GLOBOCAN 2008统计的184个国家中排位第110位,死亡率排位第172位.结论:女性乳腺癌已经成为中国女性最常见的癌症之一,中国城市女性乳腺癌的发病率和死亡率水平显著高于农村,但中国女性乳腺癌的发病率和死亡率在世界范围仍处于中低水平.     

Knowledge of Cancer in West Bengal - a Pilot Survey

A pilot survey was conducted based on 900 respondents of the population of West Bengal to assess their level of ‍awareness regarding cancer with the aim of estimating associations between response variables (knowledge about ‍cancer) and predictor variables (age, sex, level of education). The data of the pilot survey revealed that 98% of the ‍respondents had heard of the disease ‘Cancer’ . Unfortunately only 35% of the respondents were aware of the 7- ‍danger signals (i.e. the primary symptoms of cancer) as defined by the World Health Organisation (WHO). None of ‍the respondents knew all 7-primary symptoms of cancer and the majority (about 88%) knew only one or two (mainly ‍tumour lumps and ulcers). Only 44.67% were aware of the major risk factors (like smoking and tobacco chewing). ‍The percentage of the respondents believing that most cancers are curable in early stages was 58%. Some of the ‍respondents (21%) expressed the vague idea that cancer is a infectious disease which is creating a problem of isolation ‍from the family/society with some unfortunate cancer patients. Over 11% of the respondents suggested that a ‍cancer diagnosis should be kept secret from neighbours due to some social stigma like problems with daughters’ ‍marriage. Only 8% had experienced any cancer awareness programme conducted by any organisation, only 37% ‍had listened to any cancer awareness programme conducted by the All India Radio, only 36% had seen any cancer ‍awareness programme conducted by Doordarsan/ private Television channels, only 34% had read cancer awareness ‍articles in the newspapers/magazines and only 13% had seen posters/hoardings regarding cancer awareness. The ‍results thus revealed a huge lack regarding cancer awareness in the region. Most of the respondents (68%) expressed ‍a wish for starting cancer awareness programmes. From the Pilot Survey it has been found that the average Knowledge ‍Index of the respondents is 58+ 1.7 irrespective of the socio-economic and personal status. On testing of associations, ‍there was no statistically significant association of the Knowledge Index with the domicile status (rural or urban), ‍sex, occupation and religion of the respondents. However, statistically significant links were evident with the level of ‍education (p=0.00001), social participation (p=0.00004) and income (p=0.00013) of the respondents.     

Women and Tobacco Use: Discrepancy in the Knowledge,Belief and Behavior towards Tobacco Consumption among Urban and Rural Women in Chhattisgarh,Central India

Background: Tobacco consumption has become pandemic, and is estimated to have killed 100 million peoplein the 20th century worldwide. Some 700,000 out of 5.4 million deaths due to tobacco use were from India. Theera of global modernization has led to an increase in the involvement of women in tobacco consumption in thelow income and middle-income countries. Tobacco consumption by females is known to have grave consequences.Objectives: To assess: (1) the tobacco use among urban and rural women; (2) the discrepancy in the knowledge,belief and behavior towards tobacco consumption among urban and rural women in Durg-Bhilai Metropolitan,Chhattisgarh, Central India. Materials and Methods: The study population consisted of 2,000 18-25 year oldyoung women from Durg-Bhilai Metropolitan, Chhattisgarh, Central India, from both urban and rural areas.Data were collected using a pretested, anonymous, extensive face to face interview by a female investigator toassess the tobacco use among women and the discrepancy in the knowledge, belief and behavior towards tobaccoconsumption among urban and rural individuals. Results: The prevalence of tobacco use was found to be 47.2%.Tobacco consumption among rural women was 54.4% and in urban women was 40%. The majority of the womenfrom urban areas (62.8%) were smokers whilst rural women (77.4%) showed preponderance toward smokelesstobacco use. Urban women had a better knowledge and attitude towards harms from tobacco and its use thanthe rural women. Women in rural areas had higher odds (1.335) of developing tobacco habit than the urbanwomen. Conclusions: Increased tobacco use by women poses very severe hazards to their health, maternal andchild health, and their family health and economic well-being. Due to the remarkably complex Indian pictureof female tobacco use, an immediate and compulsory implementation of tobacco control policies laid down byt he WHO FCTC is the need of the hour.     

Women’s Knowledge,Attitudes, and Practices about Breast Cancer in a Rural District of Central India

Background: Breast cancer accounted for almost 25% of all cancers in women globally in 2012. Althoughbreast cancer is the most prevalent cancer in India, there is no organised national breast cancer screeningprogramme. Local studies on the burden of breast cancer are essential to develop effective context-specificstrategies for an early detection breast cancer programme, considering the cultural and ethnic heterogeneityin India. This study examined the knowledge, attitudes, and practices about breast cancer in rural women inCentral India. Materials and Methods: This community-based cross sectional study was conducted in Wardhadistrict, located in Maharashtra state in Central India in 2013. The sample included 1000 women (609 rural,391 urban) aged 13-50 years, selected as representative from each of the eight development blocks in the district,using stratified cluster sampling. Trained social workers interviewed women and collected demographic andsocio-economic data. The instrument also assessed respondents’ knowledge about breast cancer and its symptoms,risks, methods of screening, diagnosis and treatment, as well as their attitudes towards breast cancer and selfreportedpractices of breast cancer screening. Chi-square and t-test were applied to assess differences in the levelsof knowledge, attitude, and practice (the outcome variables) between urban and rural respondents. Multivariablelinear regression was conducted to analyse the relationship between socio-demographic factors and the outcomevariables. Results: While about two-thirds of rural and urban women were aware of breast cancer, less than7% in rural and urban areas had heard about breast self-examination. Knowledge about breast cancer, itssymptoms, risk factors, diagnostic modalities, and treatment was similarly poor in both rural and urban women.Urban women demonstrated more positive attitudes towards breast cancer screening practices than their ruralcounterparts. Better knowledge of breast cancer symptoms, risk factors, diagnosis, and treatment correlatedsignificantly with older age, higher levels of education, and being office workers or in business. Conclusions:Women in rural Central India have poor knowledge about breast cancer, its symptoms and risk factors. Breastself-examination is hardly practiced, though the willingness to learn is high. Positive attitudes towards screeningprovide an opportunity to promote breast self-examination.     

Regional Cancer Center,Trivandrum, Kerala,India: a Green Park for Epidemiological Studies

Kerala a Southern State of the Indian Union has achieved ‍many strides in health care and has an infant mortality of 14 ‍and life expectancy of 72 years for women and 70 years for ‍men. Communicable diseases are largely under control and ‍chronic diseases like cancer, cardiovascular diseases etc are ‍on the increase. The literacy rate is 90% compared to a ‍National average of 50%.1 ‍Trivandrum, the capital city of Kerala State has an ‍International Air port and has scenic surroundings including ‍the attractive Kovalam beach and Ponmudi Hill resorts. The ‍backwater trips are an experience of being one with the nature.     

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.     

Cancer Occurrence in Semnan Province,Iran: Results of a Population-Based Cancer Registry

Introduction: suitable information of different cancers in special geographic areas can help define medical ‍programs for treatment and screening of high-risk groups. ‍Aims and Methods: The provincial health authority reported a high mortality rate from upper GI cancer in the ‍center of Iran. A comprehensive search was undertaken to survey and register all cases of cancer during a 5-year ‍(1998-2002) period among the indigenous population of Semnan Province. Diagnosis of cancer was based on ‍histopathology, clinical or radiological findings, and death certificates. ‍Results: A total of 1732 patients with cancers (mean age 59.41%+19.08% years) were found during the study. Of ‍these, 936(54.86%) were in males. Crude rates were 124.8/100’000 and 112.1/100,000 for males and females, ‍respectively. Age-standardized ratios (ASRs) for all cancers in males and females were 156/100’000 and 136/100,000 ‍person-year, respectively. Gastric cancer was the most common tumor with an incidence rate of 19.7 per 100,000 ‍people (ASR=27.5). In upper gastrointestinal cancers, gastric cancer was the most common (47.17%), followed by ‍colon malignancies (8.1%, 9.5 per 100,000 populations), esophagus (6.8%, 7.9 per 100,000 populations), liver (2.4%, ‍and 2.8 per 100,000 populations). In women, breast, uterine and ovary, stomach and skin were the most common ‍cancers. In the child population the most common tumors were of the brain, acute lymphocytic leukemia, and bone. ‍Conclusion: Gastric cancer alone constitutes one-sixth of all cancers in Semnan, with the highest ASR incidence ‍rate reported from Iran up to now.     

Decrease in the Esophageal Cancer Incidence Rate in Mountainous but Not Level Parts of Cixian County,China, Over 29 Years

Background: Cixian county has one of the highest incidence rates of esophageal cancer (EC) in China, as well as ‍the world. In 1974, the Cixian population-based cancer registry system was established, so that there is now information ‍on esophageal cancer cases over almost 30 years. Methods: Data from Cixian Cancer Registry were checked and ‍analyzed using SPSS 11.5. Results: From 1974 to 2002, a total of 18,471 new esophageal cancer cases were registered ‍in Cixian, 11,068 in males and 7,403 in females. The age standardized incidence rate (ASR) for males was 208.77 per ‍100,000, while for females it was 120.47 per 100,000. There was a clear trend for decrease overall in the incidence ‍rate of esophageal cancer over the 29 years (X2=19.94, P<0.001). As to the geographic distribution, the incidence rate ‍in mountainous and hilly areas showed a significant decline (X2 = 195.00 and X2 = 46.08, respectivbely, both P<0.001). ‍Data for esophageal cancer incidence in level land areas in contrast were relatively steadily, with increase in recent ‍years. Conclusion: Esophageal cancer has decreased in Cixian county during the last 29 years, but this is due to ‍change in mountainous and hilly areas. Compared to other regions in the world, Cixian county still has a very high ‍incidence of ECs.