Cancer in the North Africa

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1 Cancer in the North Africa Diaa Marzouk Prof Of Public Health Faculty of Medicine, Ain Sams University

2 Presentation Outline Cancer in North Africa Countries according to HDI Cancers in the Eastern Mediterranean Region &Arab Countries Risk Factors of Cancer in North Africa Prevention of Cancer in North Africa

3 Human Development Index of Countries (HDI) in North Africa The United Nations Development Program's Human Development Statistical Update released in 2008, divided the populations according to the Human Development Index (HDI) HDI has some drawbacks Population HDI Egypt Morocco Libya Tunisia Algeria MEDITERRANEAN ONCOLOGY SOCIETY,

4 The Mediterranean Oncology Society, 2008 correlated between the HDI and the Age Standardized Rates in the various populations by sex.

5 Male Cancer Age Standardized rates in Mediterranean Countries according to HDI MEDITERRANEAN ONCOLOGY SOCIETY,

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7 Female Cancer Age Standardized rates in Mediterranean Countries according to HDI MEDITERRANEAN ONCOLOGY SOCIETY,

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9 Cancer in Arab World Inas Elattar, National Cancer Institute, Egypt, 2005

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13 Globocan Database Created by the International Agency for Research on Cancer (IARC) in 2002 The age standardized incidence (ASRI) of all cancers in the Eastern Mediterranean Region is currently 3 to 4 times lower than in the industrialized countries Half of the cancers in the Region occur before age 55 which is years younger than in industrialized countries. but is expected to double in the next 15 years as risk factor exposure increases including population aging.

14 The mortality/incidence ratio is 70%, which is high (40% in America, 55% in Europe), indicating significantly lower survival rates from diagnosed cancer. The top five cancers in the Region when males and females are combined are breast, bladder, lung, oral and colon cancer (IARC) in 2002

15 Cancers in the Eastern Mediterranean Region World Health Organization 2009

16 Countries Rank order of incidence of Cancer in North Africa Egypt a Morocco b Tunisia Libya 1 st 2 nd 3 rd 4 th 5 th Breast NHL Bladder Liver Lung Rectum Thyroid Liver Colon Stomach Lung Breast Bladder Colon NHL Bladder Breast Lung Cervix Colon Source: GLOBACAN, IARC, 2002, a Gharbiah population-based cancer registry report b National cancer registry

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27 Cancer and Pollution While a widespread public belief strongly associates cancer and pollution, the burden of cancer due to environmental factors is less than 2% in developed countries They are particularly high levels of pollution, or in particular occupations where chemical exposure is high. Where such circumstances can be identified, specific measures can usually be taken to protect the at risk population.

28 Prevalence of Tobacco Smoking and Overweight / Obesity in the Eastern Mediterranean Region Prevalence of tobacco smoking a (%) Prevalence of BMI 25 b (%) Males > 15 yrs Females > 15 yrs Males Females Egypt a Morocco b Tunisia Libya

29 Cancer and Infections Infections are associated with a much greater fraction of the cancer burden in developing countries (26%) than in developed countries (8%) It is estimated that cancers due to infections represent 11% of the cancer burden in North Africa and 16% of the cancer burden in west Asia. This percentage may be higher in specific countries. In some countries or regions it may be as important as smoking or dietary factors, resulting in marked differences in the pattern of cancer, e.g. the high incidence of both bladder and liver cancer in Egypt. Control of the infection process also results in cancer control.

30 Cancer and Infections Human papillomaviruses (HPVs): HPV infection is the main cause of cervical cancer. Hepatitis B and hepatitis C viruses, develop after many years of infection Liver cancer Human T]cell leukaemia / lymphotropic virus (HTLV ]1): Human immunodeficiency virus (HIV): people are at greater risk of Kaposi sarcoma.

31 Cancer and Infections Epstein ]Barr virus (EBV): Infection with EBV has been linked to an increased risk of lymphoma. Helicobacter pylori: This bacterium can cause stomach ulcers and stomach cancer

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33 The National Cancer Registry Program of Egypt The Supreme Committee of the Program decided to start by population-based registration of incident cancer cases in 2008 and to explore the possibility of establishing a national cancer database through hospital based registries.

34 Gharbiah Registry, Egypt Governorate of Gharbiah already has a registry that was established 10 years ago and will be included is the national registry program in a subsequent phase. By the end of the current phase, Egypt will be covered by a network of population based registries that fairly represents the entire country. In Beheira, Damietta, Menia, Assiut, Sohag and Aswan Governorates

35 Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

36 The National Cancer Registry of Egypt: (NCRPE) Overview & Objectives It aims to develop a reliable source of information on cancer incidence in Egypt. It collects cancer incidence data from population-based cancer registries covering approximately 22 percent of Egypt population on patient demographics, primary tumor site, tumor morphology and stage at diagnosis, and follow-up for vital status.

37 Overview & Objectives (cont) NCRPE data will be available for researchers, clinicians, public health officials, legislators, policymakers, community groups, and the public. NCRPE staff work to guide all registries to achieve data content acceptable for pooling data and improving national estimates. Computer applications are developed to unify cancer registration systems and to analyze and disseminate population-based data.

38 Is cancer a problem in Egypt? A: Yes, but magnitude is unknown More than 50% of the new cancer cases in the world occur in developing countries Burden of the problem will increase: - Better Diagnosis - More exposure to Risk Factors -Increased Life Expectancy

39 Egyptian Population Pyramid / Distribution of Cancer among Population Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

40 Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

41 Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

42 Does Gharbiah represent Egypt? Compare by Human Development Index (HDI The Age Standardized Incidence rate is more or less similar to whole Egypt

43 The Gharbiah Population-based Cancer Registry GPCR Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

44 Does Gharbiah represent Egypt? Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

45 Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

46 Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

47 Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

48 Amal Samy Ibrahim, Prof of Epidemiology National Cancer Institute Cairo Univ

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50 Prevention Cancer prevention involves eliminating or minimizing exposure to known environmental causes of cancer. It is estimated that more than 50% of the cancers in the world are attributable to three factors: tobacco, infection and unhealthy lifestyle (diet, obesity and lack of physical exercise). The attributable fraction associated with these three factors differs between developing and developed countries.

51 Prevention These cancers can either be prevented (bladder and lung), or detected early (breast, oral and colon), although the methods used and cost benefit ratios will vary according to incidence and available resources. The striking predominance of breast cancer, ranked first in incidence even when males are included, suggests that this cancer should be given a particularly high priority in both regional and national cancer control plans.

52 Thank you for your Attention