Trends in Breast Cancer Incidence in Iraq During the Period 2000-2019

Background: Breast cancer is the most common cancer among women around the world. Objective: This study aims to explore the time trends in the incidence of breast cancer in Iraq in twenty years period (2000 to 2019) to assist health officials and decision-makers in planning and organizing programs to controlling breast cancer growth and enhance women’s health. Methods: Breast cancer data from 2000 to 2019 were obtained from the Iraqi Cancer Registry’s yearly book series (Ministry of Health). The United Nations Population Division provides annual population estimates by 5-year age groups and gender. Joinpoint regression analysis was used to calculate and assess age-specific and age-standardized incidence rates. Results: A total of 72,022 breast cancer cases were identified among women in Iraq between 2000 and 2019. The average age-standardized incidence rate (ASIRs) was 37.883/100,000. Breast cancer ASIR Iraq exhibited a significantly rising trend during the study period, with an average annual percentage change (AAPC) of +3.192%. Furthermore, a significant increase in breast cancer incidence for the age group 40–49 (AAPC = +2.162%), 50–59 (AAPC=+3.210%), 60–69 (AAPC=+5.551%), and age 70 and over (AAPC=+7.943%) were observed. When compared to other countries in the world, Iraq had a moderate rate of breast cancer ASIR. Conclusions: In summary, our finding revealed an increase in the incidence rates of breast cancer among Iraqi women from 2000 to 2019. Further research is needed to explore risk factors including levels of overweight, dietary changes, physical inactivity, obesity, smoking, high marriage age, and low birth rates to prevent and control breast cancer.     

Female Breast Cancer Incidence and Mortality in Mexico, 2000-2010

The objective of this study was to investigate the recent incidence and mortality trends for breast cancer inMexican females. Data between 2000 and 2010 from the Department of Epidemiology of the Ministry of Health,and International Agency for Research on Cancer (IARC) were analyzed. Age-standardized rates (ASRs) andannual percent changes (APCs) were calculated. The absolute incidence and mortality rates of breast cancerincreased: 3,726 and 4,615 in 2000 to 8,545 and 4,966 in 2010, respectively. Incidence increased over time in allage groups tested, the 60-64 age group had the highest ASR (57.4 per 100,000 women in 2010), while the 20-44age group had the lowest ASR (12.3 in 2010). The results show that incidence of breast cancer has increased inMexico during last one decade, especially among older women, while the downturn observed in mortality mainlyreflects improved survival as a result of earlier diagnosis and better cancer treatment.     

Cancer Incidence Rates in the Kurdistan Region/Iraq from 2007-2009

Cancer is a disease of gradual increase in incidence overall the world. Kurdistan Region in Iraq has beenexposed to several carcinogenic hazards. There are few reports about the increased risk of cancer in different citiesin Iraq. These reports did not cover Kurdistan region. The aim of this paper was to study cancer incidence and toidentify possible risks of cancer in this region. Cancer registries from 9 hospitals in three cities of Kurdistan wereused as a source of data. Information on these cases was subjected to careful verification regarding repetition,place of residence and other possible errors. Overall registered cases in 2007, 2008 and 2009 were 1444, 2081,2356 respectively. 49% of registered cases were males and 51% were female. The Age Standardized Rate ofcancer was 89.83/100 000 among male and 83.93/100 000 among female. The results showed major variationin incidence rates of different types of cancer in the three governorates of Kurdistan. Furthermore, there wasevidence of increased risks of cancer in Kurdistan Region in Iraq. Hematological malignancies were the mostcommon cancer among male (21.13% of all cancer in males) and second most common in female (18.8% of allcancer in female), only exceeded by breast cancer. To reach sound conclusions about extent and determinantsof cancer in Kurdistan, enormous multi-spectrum efforts are now needed.     

Incidence of Childhood Leukemia in Iraq, 2000-2019

Background: Leukemia is a major concern for children worldwide. Around 30% of malignancies in children (ages 0–14) are caused by leukemia. Objective: This study aims to explore the time trends in the incidence of childhood leukemia (aged 0-14 years) in Iraq between 2000 and 2019. Methods: Poisson regression with a log link function was used to analyze the long-term trends of incidence related to childhood leukemia cancer based on published data from the Iraqi cancer registry between 2000 and 2019. Annual estimates of the population, by 5-year age groups and by gender obtained from the United Nations, population Division. Results: A total of 8,570 cases of leukemia children in Iraq between 2000 and 2019 were recorded, the boys to girl ratio were 1.32 to 1. The most diagnosed type of leukemia was Acute lymphoblastic leukemia, accounting for about 33.56%, followed by Leukemia Not specify (NOS) (17.3%) with a relatively equal proportion of stated instances between boys and girls in these subsets. The age-standardized incidence rates, aged 0-14 years, from 2000-2019 were 3.45/100,000 for both genders. The Joinpoint regression ASRs analysis of childhood leukemia from 2000-2019 among 0 –14 age group for both genders indicate that there was an overall significant increasing trend at 1.23% per year, while no one joinpoint was identified during the entire study period. Among boys, there was an overall insignificant increasing trend at 0.77% per year. Among girls, there was an overall significant increasing trend at 1.93% per year, while one joinpoint was identified during the entire study period.  Conclusions: The overall (both genders) incidence rate of childhood leukemia has been increasing significantly in Iraq. The test for trends was insignificant among boys, while it was significant among girls. The increasing trend of leukemia requires further epidemiological studies to describe incidence by geography in Iraq.     

Cancer Incidence Trends in Thailand , 1989-2000

Through 2004, five cancer registries in Thailand have collected data for more than ten years. Three-year cancerincidence in Thailand covering the years 1989-1997 has been regularly reported in three volumes of ‘Cancer inThailand’. Since the data for the last decade of the 20th century have been collected, the trends in incidence of somecancer sites were analyzed. Data sources were registry data from Chiang Mai, Lampang, Khon Kaen, Bangkok, andSongkhla, which are representative of the four major geographic regions of Thailand. The data drawn in 2002covered the years 1989 to 1997 for Bangkok, the other four registries drew data from 1989 to 2000. The populationdenominators were estimated from the two censuses in 1990 and 2000. Only cancers of the liver, lung, colon-rectum,female breast, uterine cervix, and all cancer sites were analyzed since cancers of these sites may have major publichealth impacts. Age-specific incidence rates of different 5-year age groups were projected through the period 2007-2009 using a linear regression model if the rates were increasing, and a log-linear model to prevent prediction of anegative rate if the rates were decreasing. During the past decade, colorectal and breast cancers showed a statisticalsignificant increasing trend, while the trend was generally stable for cancer of other sites. The number of new cancercases of all sites is expected to be approximately 125,000 by the year 2008, compared with 81,000 in 1999. However,the accuracy of projections depends very much on the quality of the cancer registries’ data. The Bangkok registrysignificantly improved case ascertainment in recent years, while the Chiang Mai registry had a consistent drop inincidence of cancer at many sites. In-depth investigation of some cancer sites and age period cohort modeling arerequired for better understanding of cancer trends in Thailand.     

Trend Analysis of Lung Cancer Incidence Rates in Ninawa Province,Iraq, from 2000 to 2010 - Decrease and Recent Stability

Background: Lung cancer is the most frequent malignancy of men worldwide. In Ninawa in Iraq, lung cancerranks first among cancers diagnosed in men. Since no prior studies have been conducted on incidence trendsin our population the present investigation of rates during 2000-2010 was therefore performed. Materials andMethods: Registy data for lung cancer cases were collected from the Directorate of Health in Ninawa-MosulContinuing Medical Education Center. We restricted our analyses to men categorized according to the age groupsof 0- 39, 40-49, 50-59, 60-69 and 70+ years. The significance of incidence rate trends during 2000-2010 was testedusing Poisson regression. Age-standardized rates (ASR), and age-specific rates per 100,000 population werecalculated. Results: A total of 1,206 incident lung cancer were registered among males, accounting for 15.5%of all male cancers registered during 2000-2010. It ranked first throughout the period. Median age at diagnosiswas 69 (mean 66.8± 11.0) years. The incidence rate of all male lung cancers in Ninawa (all ages) decreased from26.4 per 100,000 in 2000 to 12.7 in 2010 (APC=-6.55%, p<.0001). The incidences in age groups 40-49, 50-59,60-69 and 70+ decreased in earlier years and recently appeared (2007-2010) stable. The incidence in age group(0-39) remained stable between 2000-2010. Squamous cell carcinoma (SCC)was the most common type of lungcancer, while adenocarcinoma was relatively rare. Conclusions: With the data from Directorate of Health inNinawa during the period 2000-2010, lung cancer is the most common cancer but generally declining. Amongall age groups, the recent incidence of lung cancer remained stable. The SCC predominance suggests change intobacco habits as an important factor in the trends observed.     

Trends in Incidence of Childhood Leukemia,Khon Kaen,Thailand, 1985-2002

Background: The Khon Kaen Cancer Registry (KKCR), providing both hospital and population-based ‍registration, was established in 1984 in the Faculty of Medicine, Khon Kaen University. Leukemia is the most ‍common cancer among Thai children in Thailand, including both curable and preventable types, but no assessment ‍of trends has hitherto been performed. Objective: To perform a statistical assessment of the incidence trend of ‍childhood leukemia in Khon Kaen, Thailand, between 1985 and 2002. Methods: Population-based cases of childhood ‍leukemia registered between 1985 and 2002 were retrieved from the KKCR and cases with an ICD-O diagnosis ‍(coding C42) in children under 15 were selected. Incidence trends were calculated using the Generalized Linear ‍Model method (GLM), which generates incidence-rate-based logarithms. Results: Of the 277 cases of leukemia, ‍boys were affected two times more frequently than girls and half of the cases were 0-4 years of age. Most diagnoses ‍were histologically- or cytologically-proven and the most common type (affecting two-thirds, 65.7%) was acute ‍lymphoblastic leukemia (ALL). The overall, age-standardized rate (ASR) for leukemia was 31.9 per million (95%CI: ‍28.1 to 35.7); 40.3 per million (95%CI: 34.2 to 46.4) in boys and 27.0 (95%CI: 21.8 to 32.2) in girls. Incidence has ‍been increasing by 2.4% per year in boys (95% CI: -0.5 to 5.3) and 4.1% per year in girls (95% CI: 1.1 to 7.2). ‍Conclusions: This incidence-rate-based logarithm indicates that childhood leukemia has been increasing, suggesting ‍further epidemiological research on causes and possible prevention is needed.     

Influence of Mammographic Screening on Breast Cancer Incidence Trends in South Australia

Purpose: To examine breast cancer (BC) incidence trends in relation to mammographic screening and riskfactor prevalence in South Australia (SA). Materials and Methods:Trends in annual BC incidence rates werecalculated using direct standardisation and compared with projected incidence derived from Poisson regressionanalysis of pre-screening rates. Annual percentage change and change time points were estimated using Joinpointsoftware. Biennial mammography screening participation rates were calculated using data from BreastScreenSA. Trends in overweight/obesity, alcohol use and hormone replacement therapy (HRT) use were examined using1991-2009 Health Omnibus Survey data. Trends in total fertility were examined using data from the AustralianBureau of Statistics. Results: BC incidence increased around the time BreastScreen commenced and thenstabilised in the mid-1990s. However rates have remained higher than projected, even though the proportionand age distribution of first time screening attendees stabilised around 1998. A decrease in BC incidence wasobserved among women aged 50-59yrs from the late-1990’s but not among older women. Obesity and alcoholuse have increased steadily in all age groups, while HRT use declined sharply from the late-1990s. Conclusions:BC incidence has remained higher than projected since mammography screening began. The sustained elevationis likely to be due to lead time effects, though over-diagnosis cannot be excluded. Declining HRT use has alsoimpacted incidence trends. Implications: Studies using individual level data, which can account for changes inrisk factor prevalence and lead time effects, are required to evaluate ‘over-diagnosis’ due to screening.     

Trends of Breast Cancer Incidence in Iran During 2004-2008: A Bayesian Space-time Model

Background: Breast cancer is the most frequently diagnosed cancer in women and estimating its relativerisks and trends of incidence at the area-level is helpful for health policy makers. However, traditional methodsof estimation which do not take spatial heterogeneity into account suffer from drawbacks and their results maybe misleading, as the estimated maps of incidence vary dramatically in neighboring areas. Spatial methods havebeen proposed to overcome drawbacks of traditional methods by including spatial sources of variation in themodel to produce smoother maps. Materials and Methods: In this study we analyzed the breast cancer data inIran during 2004-2008. We used a method proposed to cover spatial and temporal effects simultaneously andtheir interactions to study trends of breast cancer incidence in Iran. Results: The results agree with previousstudies but provide new information about two main issues regarding the trend of breast cancer in provinces ofIran. First, this model discovered provinces with high relative risks of breast cancer during the 5 years of thestudy. Second, new information was provided with respect to overall trend trends o. East-Azerbaijan, Golestan,North-Khorasan, and Khorasan-Razavi had the highest increases in rates of breast cancer incidence whilst Tehran,Isfahan, and Yazd had the highest incidence rates during 2004-2008. Conclusions: Using spatial methods canprovide more accurate and detailed information about the incidence or prevalence of a disease. These modelscan specify provinces with different health priorities in terms of needs for therapy and drugs or demands forefficient education, screening, and preventive policy into action.     

Breast Cancer in Surat Thani,a Province in Southern Thailand: Analysis of 2004-2012 Incidence and Future Trends

Background: With the recent epidemiologic transition in Thailand, featuring decreasing incidences ofinfectious diseases along with increasing rates of chronic conditions, cancer is becoming a serious problem forthe country. Breast cancer has the highest incidence rates among females, not only in the southern regions, butthroughout Thailand. Surat Thani is a province in the upper part of Southern Thailand. A study was neededto identify the current burden, and the future trends of breast cancer. Materials and Methods: Here we usedcancer incidence data from the Surat Thani Cancer Registry to characterize the incidences of breast cancer.Joinpoint analysis was used to investigate the incidences in the province from 2004 to 2012 and to project futuretrends from 2013 to 2030. Results: Age-standardized incidence rates (world) of breast cancer in the upper partsof Southern Thailand increased from 35.1 to 59.2 cases per 100,000 female population, which is equivalent toan annual percentage change of 4.5-4.8%. Linear drift effects played a role in shaping the increase of incidence.Joinpoint projection suggested that incidence rates would continue to increase in the future with incidence forwomen aged 50 and above, at a higher rate than for women below the age of 50. Conclusions: The current earlydetection measures increase detection rates of early disease. Preparation of a budget for treatment facilities andhuman resources, both in surgical and medical oncology, is essential.     

Trends in Breast Cancer Epidemiology in Chelyabinsk Region, 2006-2015

Breast cancer among women occupies a leading position in the profile of cancer incidence in most parts of the world. The present study of the incidence and prevalence of breast cancer was carried out using data from the Chelyabinsk population cancer registry for 2006-2015. A stable growth trend in the incidence over time was noted overall, as well as major differences in the figures for women of different ethnicities (Russian, Tatar, Bashkir), by far the highest incidences being observed for Russian women. Urban rates were generally higher than in rural sites and a shift towards older age at presentation was seen between 2006 and 2015. At the same time a slight decrease in mortality was noted, from 42.4% to 33.5% relative to incidence, with a decrease in the proportion of stage IV cancers. This might have been related to increasing use of mammography screening.The data have obvious connotations for primary prevention and particularly for measures adopted for secondary prevention in detection of the disease in its early stages, facilitating reduction in associated mortality. Improvement in screening rates is thus a high priority for more effective management of breast cancer in the region.     

Time Trends of Ovarian Cancer Incidence in China

The aim of this study was to examine the trend of ovary cancer incidence from 1999 to 2010 in China andpredict the burden up to 2020. Crude incidence, age specific incidence and age-adjusted incidence rates werecalculated. Joinpoint regression was performed to obtain estimated annual percentages and Bayesian age-periodcohortmodeling was used to predict the incidence rate until the year 2020. In China, the crude rate of ovarycancer was 7.91/100,000 and the age-adjusted rate was 5.35/100,000 overall during period 1999-2010. The ratesin urban regions were higher than in rural regions. A significant rising trend during 1999-2006 was followedby a drop during 2006-2010 in age-adjusted rates for urban females. In contrast, constant rise was observed inrural women. The decrease in ovary cancer of urban areas tended to be restricted to women aged 50 years andyounger. In contrast, increases of ovary cancer in rural areas appeared in virtually all age groups. Although theage-adjusted incidence rate for ovary cancer was predicted to be reduced after year 2011, the crude rate waslikely to be relative stable up to 2020. The burden of ovary cancer in China will continue to be relative stabledue to the aging population.     

Poor Knowledge and Practice Towards Breast Cancer among Women in Baghdad City,Iraq

Background: Breast cancer is one of the most common cancers among females worldwide. The aim of thisstudy was to assess the knowledge and practice about breast cancer and its related factors among women inBaghdad city, Iraq. Materials and Methods: A cross-sectional study was conducted among 508 women aged18 to 55 years from four non-governmental organizations (NGO) in Baghdad city, Iraq. A self-administeredquestionnaire on breast cancer knowledge and practice was distributed to participants during weekly activityof the NGO. Results: A total of 61.2% of the respondents had poor knowledge, only 30.3% performed breastself-examination (BSE) and 41.8% said that they did not know the technique to perform BSE. Associationsbetween knowledge and marital status and age were significant. For practice, working status, education, ageand family income were significant. After controlling for cofounders, the most important contributing factorsfor poor knowledge among respondents were marital status and not performing BSE, with adjusted odds ratioof 1.6 and 1.8 respectively. Conclusions: Breast cancer knowledge and practice of BSE are poor among womenin Baghdad city, Iraq. More promotion regarding breast cancer signs and symptoms and also how to performBSE should be conducted using media such as television and internet as these constituted the main sources ofinformation for most women in our study.     

Temporal Trends and Future Prediction of Breast Cancer Incidence Across Age Groups in Trivandrum,South India

Background: Increasing breast cancer (BC) incidence rates have been reported from India; causal factors for this increased incidence are not understood and diagnosis is mostly in advanced stages. Trivandrum exhibits the highest BC incidence rates in India. This study aimed to estimate trends in incidence by age from 2005- 2014, to predict rates through 2020 and to assess the stage at diagnosis of BC in Trivandrum. Materials and Methods: BC cases were obtained from the Population Based Cancer Registry, Trivandrum. Distribution of stage at diagnosis and incidence rates of BC [Age-specific (ASpR), crude (CR) and age-standardized (ASR)] are described and employed with a joinpoint regression model to estimate average annual percent changes (AAPC) and a Bayesian model to estimate predictive rates. Results: BC accounts for 31% (2681/8737) of all female cancers in Trivandrum. Thirty-five percent (944/2681) are 60 years and overall CR is 80 (ASR: 57) for 2019- 20. Conclusions: BC, mostly diagnosed in advanced stages, is rising rapidly in South India with large increases likely in the future; particularly among post-menopausal women. This increase might be due to aging and/or changes in lifestyle factors. Reasons for the increased incidence and late stage diagnosis need to be studied.     

Cancer Incidence in the Kurdistan Region of Iraq: Results of a Seven-Year Cancer Registration in Erbil and Duhok Governorates

Introduction: There are limited published data regarding the recent incidence trends of cancer in Iraqi Kurdistan. Methods: The present study assessed the epidemiological estimates of cancer incidence, as well providing a projection of future cancer trends in the upcoming decade by analysing the population-based cancer registry between 2013 and 2019, in both the Erbil and Duhok governorates. A retrospective analysis was performed on data retrieved from the Medical Statistics Department at the Ministry of Health, Kurdistan Regional Government (KRG). Results: The total number of female cancer patients was higher in both governorates, and the total incidence of patients with cancer increased by over 2x between 2013 and 2019 in Erbil and Duhok, from 73 to 174 patients/100,000 individuals for women, and 36 to 85 patients/100,000 individuals for men. Analysis indicated that the percentage of patients with cancer is projected to increase by >2x in the current decade, from 3,457 cases to 4,547 and 4,449 cases in the Erbil governorate; and from 1,365 to 2,633 and 2,737 cases in 2028 based on LSTM and bi-LTSM analysis in the Duhok governorate. Lung cancer (LC) and female breast cancer (BC) were the most prominent types of cancers diagnosed since 2013 in both the Erbil and Duhok governorates. Conclusion: The striking pattern of trends for both present and future cancer incidence rates require urgent solutions and comprehensive efforts to control risk factors that promote the increasing incidence of cancer in these two KRG governorates.