Kingdom of Saudi Arabia Ministry of Health National Cancer Registry. Cancer Incidence Report Saudi Arabia

Transcription

1 Kingdom of Saudi Arabia Ministry of Health National Cancer Registry Cancer Incidence Report Saudi Arabia

2 Report prepared by: Haya S. AlEid, BDS, DFE, CTR Suad O. Arteh, MA Reviewed by: Shouki Bazarbashi, MD Edward B. De Vol, PhD Susan Young, CTR, CCHRA(C) Published by the Main Office, National Cancer Registry, under the Depository Number at King Fahad National Library, 80/22, date: /9/122H, ISSN: 1809, Riyadh May, 200.

3 ACKNOWLEDGEMENT The Board of Directors of the National Cancer Registry would like to acknowledge the many people who have facilitated the publication of this report. It is impossible to name every individual but those who have helped us in any way should feel proud of the project and this report. We take this opportunity to thank H.E. Professor Osama Shobokshi, the former Minister of Heath, for his support of the NCR. His inspiration and assistance encouraged the Board of Directors to continue in their endeavor. We also thank H.E. Dr. Qassim al Gasabi former Executive Deputy for the Ministry of Health, for his commitment and supervision. We are grateful for the continuing support of Dr. Anwar Al Jabarti, the Executive and Council for the Management at King Faisal Specialist Hospital & Research Center, in extending technical and administrative facilities to help maintain the NCR. We would also like to thank former members of the Board of Directors and administrative staff for their involvement and contributions to the continued development of the NCR: Dr. Peter Tallos, National Guard Hospitals, Riyadh Dr. Osama Koreich, Armed Forces Hospitals, Riyadh Dr. Salah Al Ghamdi, King Khalid University, Abha Dr. Assem Al Radi, King Abdulaziz Hospital & Oncology Center, Jeddah Dr. Abdulrahman Al Diab, Security Forces Hospital, Riyadh Brenda J. Lange, CTR, Administrative Director We wish to extend our thanks and appreciation to the laboratories, pathology and medical record departments in healthcare facilities throughout the Kingdom who have assisted the registry staff in the data collection process. Finally, we would like to thank Ms. Jinky B. Gomez for her assistance in formatting the final report and the registry team, in both the Regional and Main Offices, whose skill and dedication have made possible the data capture and analysis resulting in this report.

4 FOREWARD The Cancer Incidence Report is the fourth publication of the National Cancer Registry. The information in this report is a very important part of the infrastructure which is required in the efforts to reduce the burden of cancer. The registry data will assist researchers studying cancer and authorities involved in the planning of cancer services (epidemiological research, identification of risk factors for use in cancer control, development of screening and prevention programs, planning for diagnostic and treatment services.) The registry continues to be committed to quality data focusing on improving caseascertainment, patient and tumor linkage and editing processes through training and quality control procedures. Throughout the data collection and analysis process, every effort is made to ensure both patient and facility confidentiality. Some changes from the previous reports have been made in the presentation of the data although we have tried to maintain consistency to enable easy comparison of data over the years. Since it is our goal to present this report in a manner that will be easily understood by all, we welcome and, indeed, encourage feedback from readers for consideration in the preparation of future reports. Dr. Shouki Bazarbashi Chairman National Cancer Registry

5 INTRODUCTION This is the fourth report to be published in an effort designed to provide information on cancer incidence in Saudi Arabia. The first of its kind was the 199 Summary Report, the second and the third were the and Incidence Reports respectively, and this one covers cancer Incidence Report for the years It is the objective of the National Cancer Registry of Saudi Arabia to present the data on a period of twothree years now and in a more extended period of time in later years. Data on an extended period of time has advantages of presenting more stable incidence rates and timetrends studies. The structure of this report can be outlined as follows: Part I Materials and Methods This part of the report contains information about the background of the National Cancer Registry and methods used in collecting and analyzing the data. We present the basics of coding and classification of tumor topography, morphology and extent of disease at the time of diagnosis. Also we explain the software program we used to analyze the data. Part II Overview Part II contains figures and tables that show overall cancer incidence in Saudi Arabia for the years We present these figures and tables mainly by sex and in certain areas we have it analyzed by different age groups. There are pie and bar charts representing the age distribution of cancer incidence for the years among Saudis by sex and age groups. We present separate incidence and morphology tables for the most common types of cancers among adults and children. In addition, a bar chart depits the 10 most common types of cancer, by sex, in each of the 1 administrative regions of Saudi Arabia. Part III Incidence of SelectedSites In this part the incidences of selected cancer types among Saudis are outlined in order of relative frequency. A standardized layout presents data for all patients and both sexes where applicable. For each selected site we list the number and the percentage of all newly diagnosed cases for the years 1999 and 2000, the AgeStandardized Incidence Rate (ASR) per 100,000 population for each sex, and the specific cancer rank for both sexes. In addition, we provide (whenever available) international statistics for the specified cancer including the ranking of the cancer worldwide, estimated number of cases for , and areas of the world that have the highest ranking.

6 Part IV Cancer Incidence among nonsaudis In this part we have the incidence cases of cancer among nonsaudis. We present the most common types of cancer among them and the agespecific incidence rates. The age distribution of non Saudis is overrepresented in the 2 agegroup as a result of the nature of the expatriate population. For this reason we have opted to do the analysis separately. Part V Tables of Incidences Part V contains the following detailed tables for all newly diagnosed cancer types among Saudis and nonsaudis for For the years 1999 and 2000 we have separate tables for male and female agedistribution of cancer cases among Saudis agestandardized incidence rate for cancer cases among Saudis by age group (per 100,000 population) For the years 1999 and 2000 we have for each region agestandardized incidence rate and relative frequencies for all cancer cases among Saudis by site and sex For the years 1999 and 2000 we have separate tables for male and female agedistribution of cancer cases among nonsaudis crude incidence rates for cancer cases among nonsaudis by age group (per 100,000 population) Part VI Appendices Reporting hospitals list Includes hospital names in each administrative region. The objective is to receive feedback from hospitals in order to minimize underreporting. Addresss of the National Cancer Registry offices Cancer Registration Form The Data Request Form

7 TABLES OF CONTENTS ACKNOWLEDGEMENT... FOREWARD... INTRODUCTION... PART I Background on Saudi Arabia... 1 NATIONAL CANCER REGISTRY... 1 Definitions of Statistical Terms PART II Cancer in Saudi Arabia Reported Cancer Incidence Cases in Saudi Arabia, Distribution of Cancer Cases in Saudi Arabia by Nationality and Sex... 2 Ten Most Common Types of Cancer Among Saudis, (All Ages)... 2 Adult Cancers in Saudi Arabia, (above 1 years) Childhood Cancers in Saudi Arabia (1 years and under)... 2 Cancer in the 1 Administrative Regions of the Kingdom... International comparison of agestandardized incidence rates... 0 PART III Cancer Incidence for Specific Sites Female Breast (C0)... NonHodgkins Lymphoma (C82C8;C9)... Leukaemia (C91C9)... 9 Colorectal (C18C21)... 1 Liver (ICD10 C22)... Thyroid (C)... Brain, nervous system (C0C2)... 0 Lung (CC)... Hodgkin s Disease (C81)... Urinary Bladder (C)... 9 Skin (NonMelanoma) (C)... 2 Prostate Cancer (ICD10 C1)... Ovary (C)... Cervix Uteri (C) PART IV Cancer among the non Saudi Population PART V TABLES OF INCIDENCE... 8 PART VI APPENDIX A...11 APPENDIX B APPENDIX C APPENDIX D APPENDIX E APPENDIX F...122

8 FIGURES PART I Figure 11 Administrative Regions of Saudi Arabia... 1 Figure 12 Population Pyramid of Saudis by Sex and Age Groups, Figure 1 Population Pyramid of nonsaudis by Sex and Age Groups, Figure 1 Organizational Chart of the National Cancer Registry of Saudi Arabia... 1 PART II Fig. 21 Percentage Distribution of Cancer Incidence among Saudis by Age Group and Sex, Fig. 22 A Most Frequent Types of Cancer by Age and Sex among Saudis, Fig. 2 Ten Most Common Cancers for Saudis by Sex, Fig. 2 Average AgeSpecific Incidence Rates (AIR) for All Cancers among Saudis, Fig. 2Age Standardized Rate ( ASR) Regional Distribution of All Sites of Cancer among Saudis, Fig. 2 Ten Most Common Types of Cancer among Adult Saudis by Sex, Fig. 2 Ten Most Common Types of Cancer among Saudi Children by Sex, Fig. 281 Riyadh Region, (Percentage Distribution)... Fig. 282 Najran Region, (Percentage Distribution)... Fig. 28 Eastern Region, (Percentage Distribution)... Fig. 28 Makkah Region, (Percentage Distribution)... Fig. 28 Northern Region, (Percentage Distribution)... Fig. 28 Qassim Region, (Percentage Distribution)... Fig. 28 Jazan Region, (Percentage Distribution)... Fig. 288 Hail Region, (Percentage Distribution)... Fig. 289 Madinah Region, (Percentage Distribution)... 8 Fig Baha Region, (Percentage Distribution)... 8 Fig Tabuk Region, (Percentage Distribution)... 8 Fig Asir Region, (Percentage Distribution)... 9 Fig. 281 Jouf Region, (Percentage distribution)... 9 Fig. 29 Shows the 2000 ASR Estimation in Selected Countries among the Females and Male... 0 PART III Fig. 1 Average AgeSpecific Incidence Rate (AIR) for Female Breast Cancer in Saudi Arabia, Fig. 2 ASR Regional Distribution of Female Breast Cancer in Saudi Arabia, Fig. Stage Distribution of Female Breast Cancer in Saudi Arabia, Fig. Average AgeSpecific Incidence Rates (AIR) for NHL in Saudi Arabia, Fig. ASR Regional Distribution of NHL in Saudi Arabia, Fig. Stage Distribution of NHL in Saudi Arabia, Fig. Average AgeSpecific Incidence Rate (AIR) for Leukaemia in Saudi Arabia, Fig. 8 ASR Regional Distribution of Leukaemia in Saudi Arabia, Fig. 9 Average Age Specific Incidence rate (AIR) for Colorectal Cancer in Saudi Arabia, Fig. 10 ASR Regional Distribution of Colorectal Cancer in Saudi Arabia, Fig. 11 Stage Distribution of Colorectal Cancer, Fig. 12 Average AgeSpecific Incidence Rate (AIR) for Liver Cancer in Saudi Arabia, Fig. 1 ASR Regional Distribution of Liver Cancer in Saudi Arabia, Fig. 1 Stage Distribution of Liver Cancer in Saudi Arabia, Fig. 1 Average AgeSpecific Incidence Rate (AIR) for Thyroid Cancer in Saudi Arabia, Fig. 1 ASR Regional Distribution of Thyroid Cancer in Saudi Arabia, Fig. 1 Stage Distribution of Thyroid Cancer in Saudi Arabia, Fig. 18 Average AgeSpecific Incidence Rate (AIR) for Brain, CNS Cancer in Saudi Arabia,

9 Fig. 19 ASR Regional Distribution of Brain, CNS Cancer in Saudi Arabia, Fig. 20 Stage Distribution of Brain, CNS Cancer in Saudi Arabia, Fig. 21 Average AgeSpecific Incidence Rate (AIR) for Lung Cancer in Saudi Arabia, Fig. 22 ASR Regional Distribution of Lung Cancer in Saudi Arabia, Fig. 2 Stage Distribution of Lung Cancer in Saudi Arabia, Fig. 2 Average AgeSpecific Incidence Rate (AIR) for Hodgkin s Disease in Saudi Arabia, Fig. 2 ASR Regional Distribution of Hodgkin s Disease in Saudi Arabia, Fig. 2 Stage Distribution of Hodgkin s Disease in Saudi Arabia, Fig. 2 Average AgeSpecific Incidence Rate (AIR) for Urinary Bladder Cancer in Saudi Arabia, Fig. 28 ASR Regional Distribution of Urinary Bladder Cancer in Saudi Arabia, Fig. 29 Stage Distribution of Urinary Bladder Cancer in Saudi Arabia, Fig. 0 Average AgeSpecific Incidence Rates (AIR) for Skin Cancer in Saudi Arabia, Fig. 1 ASR Regional Distribution of Skin Cancer in Saudi Arabia, Fig. 2 Stage Distribution of Skin Cancer in Saudi Arabia, Fig. Average AgeSpecific Incidence Rate (AIR) for Prostate Cancer in Saudi Arabia, Fig. ASR Regional Distribution of Prostate Cancer in Saudi Arabia, Fig. Stage Distribution of Prostate Cancer in Saudi Arabia, Fig. Average AgeSpecific Incidence Rate (AIR) for Ovary Cancer in Saudi Arabia, Fig. ASR Regional Distribution of Ovary Cancer in Saudi Arabia, Fig. 8 Stage Distribution of Ovary Cancer in Saudi Arabia, Fig. 9 Average AgeSpecific Incidence Rate (AIR) for Cervix Uteri Cancer in Saudi Arabia, Fig. 0 ASR Regional Distribution of Cervix Uteri Cancer in Saudi Arabia, Fig. 1 Stage Distribution of Cervix Uteri Cancer in Saudi Arabia, PART IV Fig. 1 Ten Most Common Cancers among nonsaudis by Sex, Fig. 2 Average AgeSpecific Incidence Rate (AIR) for All Cancers among nonsaudis in Saudi Arabia,

10 TABLES PART II Table 21 Distribution of Cancer Cases in Saudi Arabia by Nationality and Sex, Table 22 Number of New Cases by Primary Site and Sex among Saudis, Table 2 Distribution of Adult s Cancers Cases in Saudi Arabia by Nationality and Sex, Table 2 Number and Proportion of Morphological Types for the Most... 0 Table 2 Distribution of Childhood Cancer Cases in Saudi Arabia by Nationality and Sex, Table 2 Number and Proportion of the Most Common Types of Childhood Cancer among Saudis, PART III Table 1 Histology of Female Breast Cancer in Saudi Arabia, Table 2 Comparison of ASR for Breast Cancer among Saudi Females with 2000 ASR Estimation in Selected Countries... Table Histology of NHL, Table Comparison of ASR for NHL among Saudis with 2000 ASR Estimation in Selected Countries 8 Table Histology of Leukemia, Table Comparison of ASR for Leukemia among Saudis with 2000 ASR Estimation in Selected Countries... 0 Table Histology of Colorectal Cancer, Table 8 Comparison of ASR for Colorectal among Saudis with 2000 ASR Estimation in Selected Countries... Table 9 Histology of Liver Cancer, Table 10 Comparison of ASR for Liver Cancer among Saudis with 2000 ASR Estimation in Selected Countries... Table 11 Histology of Thyroid Cancer, Table 12 Comparison of ASR for Thyroid Cancer among Saudis with 2000 ASR Estimation in Selected Countries... 9 Table 1 Histology of Brain, CNS Cancer, Table 1 Comparison of ASR for Brain, CNS Cancer among Saudis with 2000 ASR Estimation in Selected Countries... 2 Table 1 Histology of Lung Cancer, Table 1 Comparison of ASR for Lung Cancer among Saudis with 2000 ASR Estimation in Selected Countries... Table 1 Histology of Hodgkin s Disease, Table 18 Comparison of ASR for Hodgkin s Disease among Saudis with 2000 ASR Estimation in Selected Countries... 8 Table 19 Histology of Urinary Bladder Cancer, Table 20 Comparison of ASR for Urinary Bladder Cancer among Saudis with 2000 ASR Estimation in Selected Countries... 1 Table 21 Histology of Skin Cancer (NonMelanoma), Table 22 Histology of Prostate Cancer, Table 2 Comparison of ASR for Prostate Cancer among Saudis with 2000 ASR Estimation in Selected Countries... Table 2 Histology of Ovary Cancer, Table 2 Comparison of ASR for Ovary Cancer among Saudis with 2000 ASR Estimation in Selected 9 Table 2 Histology of Cervix Uteri, Table 2 Comparison of ASR for Cervix Uteri Cancer among Saudis with 2000 ASR Estimation in Selected Countries... 82

11 PART V Table 11 Age Distribution of Cancer Cases among Saudi Males, Table 12 Age Distribution of Cancer Cases among Saudi Females, Table 1 Incidence Rates for Cancer Cases among Saudi Males by Age Group (per 100,000), Table 1 Incidence Rates for Cancer Cases among Saudi Females by Age Group (per 100,000), Table 1 Age Distribution of Cancer Cases among Saudi Males, Table 1 Age Distribution of Cancer Cases among Saudi Females, Table 1 Incidence Rates for Cancer Cases among Saudi Males by Age Group (per 100,000), Table 18 Incidence Rates for Cancer Cases among Saudi Females by Age Group (per 100,000), Table 21 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Riyadh Region, Table 22 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Najran Region, Table 2 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Eastern Region, Table 2 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Makkah Region, Table 2 Age Standarized Rates and Relative Frequencies for All Cases among Saudis by Site and Sex, Northern Region, Table 2 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Qassim Region, Table 2 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Jazan Region, Table 28 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Hail Region, Table 29 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Madinah Region, Table 210 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Baha Region, Table 211 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Tabuk Region, Table 212 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Asir Region, Table 21 Age Standarized Rates and Relative Frequencies for All Cancer Cases among Saudis by Site and Sex, Jouf Region, Table 1 Age Distribution of Cancer Cases among nonsaudi Males, Table 2 Age Distribution of Cancer Cases among nonsaudi Females, Table Incidence Rates for Cancer Cases among nonsaudi Males by Age Group (per 100,000), Table Incidence Rates for Cancer Cases among nonsaudi Females by Age Group (per 100,000), Table Age Distribution of Cancer Cases among nonsaudi Males, Table Age Distribution of Cancer Cases among nonsaudi Females, Table Incidence Rates for Cancer Cases among nonsaudi Males by Age Group (per 100,000), Table 8 Incidence Rates for Cancer Cases among nonsaudi Females by Age Group (per 100,000),

12 PART I MATERIALS AND METHODS 12

13 Background on Saudi Arabia Saudi Arabia is a vast country extending over fourfifths of the Arabian Peninsula. It stretches from the Arabian Gulf in the east to the Red Sea in the west. It is approximately 2,19,00* square kilometers in area. It is divided into 1 administrative regions (Figure 11). Figure 11 Administrative Regions of Saudi Arabia The estimated Saudi National population for year 2000 was 1,88,80**. Of these,800,01 were males and,88, were females. The estimated nonsaudi population in 2000 was,28,09; of these,1,91 were males and 1,,1 females. Figures 12 and 1 shows the Saudi and nonsaudi population pyramids by sex and agegroup. * Source: Demographic and Health Indicators for Countries of the East Meditranian, WHO, Regional Office for the EM, 1999 ** Source: Central Department for Statistics (CDS). Ministry of Planning. 1

14 8,12,028 12,9 28, 0,01 11,8 21, 8,2,810 0,2 0,0 20,80 119, ,901 20,8 29, Figure 1 Population Pyramid of nonsaudis by Sex and Age Groups, 2000,82 8,9,02 10,91 1, 29,0,1 108, 20,82 20,91 1,989 11, ,82 19, 29,0 229,0,1,91 Male Female 1,,1 1

15 National Cancer Registry The National Cancer Registry of Saudi Arabia is a populationbased registry developed in It was established under the jurisdiction of the Ministry of Health (MOH) by the Order of His Excellency the Minister of Health. The NCR commenced reporting cancer cases from 01 January 199. Objectives: The primary goal of the NCR is to define the populationbased incidence of cancer in Saudi Arabia. Programs for early detection and cancer screening, as well as cancer research projects are planned for future consideration. Organizational Structure: A Board of Directors was appointed to include representatives from the MOH, King Faisal Specialist Hospital and Research Center (KFSH&RC), and the Medical Services Departments of the Ministry of Defense and Aviation, Ministry of Interior, the National Guard, King Saud University, King Faisal University, King Abdulaziz University and King Khalid University. The Board is charged with the responsibility of overseeing the NCR s establishment, defining demographic and cancerrelated data to be collected, approving research requests, and reporting findings, as well as disseminating information collected while ensuring the confidentiality of all data reported to the NCR. The NCR Main Office, including administrative and technical staff, is located on the premises of the KFSH&RC in Riyadh. Additionally, five regional branches and three hospitalbased offices were set up to ensure comprehensive data collection from all over the Kingdom Figure 1. Central Region: King Khalid University Hospital in Riyadh, covering Riyadh, Qassim, and Hail Health Regions. Eastern Region: King Fahad Hospital of the University, Khobar, covering Dammam, Al Ahsa, and Hafr AlBatin Health Regions. Western Region: King Abdulaziz Hospital and Cancer Center, Jeddah, covering Jeddah, Makkah, Taif and Qunfudah Health Regions. Southern Region: King Khalid University, Abha, covering Asir, Baha, Najran, Jazan and Bisha Health Regions. Madinah/Northern: King Fahad Hospital, Madinah, covering Madinah, Tabuk, Jouf and Northern Health Regions. Offices at the Medical Services Division or Oncology Department of the following establishments: Ministry of Defense and Aviation, Armed Forces Hospital, Riyadh National Guard, King Fahad Hospital, Riyadh covering KFNGH & KKNGH. Ministry of Interior, Security Forces Hospital, Riyadh. 1

16 Each of these branches and offices are under the supervision of a member of the Board of Directors who is responsible for the daily management of that office and for ensuring the accuracy of information reported to the NCR. In addition to tumor registrars and secretarial staff, each office is provided with the necessary computer facilities, printers, and other office equipment. Functions of the NCR Main office include: compilation of data collected from all the regions and offices merging of all cases to ensure that each case is counted only once verification of diagnosis conducting quality control review of all abstracts submitted preparation of regular reports for dissemination of information to the medical community, government establishment, international organizations and the media. training of staff. Ministry of Health Saudi Arabia National Cancer Registry Main Office King Faisal Specialist Hospital & Research Centre (Riyadh) Central Region (Riyadh, Qassim & Hail) Eastern Region (Dammam, Ahsa & H. Al Batin) Western Region (Jeddah, Makkah, Taif & Gunfudah) Southern Region (Asir, Baha, Jazan, Najran & Bisha) Madinah Region (Madinah, Tabuk, Jouf & Northern Region) Armed Forces Hospitals (Riyadh & Jeddah) National Guard Hospitals (Riyadh & Jeddah) Security Forces (Riyadh) Figure 1 Organizational Chart of the National Cancer Registry of Saudi Arabia 1

17 Format The format of the current report is similar to the previous reports; however the first part has been extended by adding a section for childhood and adult cancer and morphology of the most common types of childhood and adult cancer. We also report the ten most common cancers for each region and present a comparative bar chart in which we compare age standardized rate (ASR) of cancer incidence among Saudis with other countries. Data management A ministerial decree has categorized cancer as a mandatory notifiable disease. This ensures the opportunity for comprehensive data collection. The NCR strives for full access to cancer data from all MOH, governmental and private hospitals, as well as clinics and laboratories throughout the Kingdom. Cancer data are abstracted from patients medical records based on clinical and/or histopathological diagnosis, by NCRtrained cancer registrars. The data abstract (see appendix E) includes the patient s personal identification (name, ID Number, sex, age), demographic information (address, telephone number, nationality), and tumor details (diagnosis date, primary site, histology, behavior, grade, stage, basis of diagnosis). The primary site (topography) and histology (morphology) of the malignancies are identified and coded according to the International Classification of Diseases for Oncology, 2nd Edition (ICDO2), published by the World Health Organization (WHO), Every effort is made to accurately code patient and tumor information, to ensure that all data can be reviewed, matched, and merged, as appropriate, so that each malignancy is counted only once for statistical analysis. The computer software program used for data entry and incidence tables output is CanReg.21, developed by the International Agency for Research on Cancer, (IARC) Lyon, France. The second part of the report includes the overall cancer incidence in Saudi Arabia and the relevant epidemiological and clinicpathological details for the 1 most common cancers among Saudi nationals for the years of 1999 and A standardized layout is used to present data for all patients and both sexes where applicable. For each cancer site the first paragraph includes the number and the percentage of all newly diagnosed cases for the years 1999 and 2000, the agestandardized incidence rate for each sex (ASR) (per 100,000 population), and the specific cancer rank in comparison to all cancers for both sexes. The second paragraph contains useful international statistics for the specified cancer. It includes the ranking of the cancer worldwide, the estimated number of cases for , and the high incidence areas of the world. The relevant source of this information is World Health Organization. GLOBOCAN 2000: Cancer Incidence Mortality and Prevalence Worldwide. International Agency for research on Cancer (IARC), Lyon,

18 The relevant data incorporate details for all patients presented over the years 1999 and For each cancer there are four figures a line chart, a bar chart, a pie chart and a table outlined as follows: 1. Arithmetic line graphs represent the change in average agespecific incidence rate (AIR) for all age groups at fiveyear intervals. The graphs are plotted by sex, where applicable. 2. Bar charts show regional distribution of ASR for particular cancer across the administrative regions and are given separately for males and females.. Tables list the percentages of the most common histology subtypes for each cancer.. Pie charts show the distribution of the clinical stages of each cancer such as insitu, localized, regional, distant metastasis and unknown.. Tables show comparison of agestandardized incidence rate (ASR) for each cancer type in Saudi Arabia with 2000 ASR estimation in selected countries In reviewing the data and its collection and analysis, two qualifying statements can be made: a. The number of patients presenting with malignant disease from the Riyadh region exceeds the anticipated number per population. The reason for this is that Riyadh has many referral centers providing patients from outside the region with cancerrelated care. Many of these patients fail to provide their permanent address, and instead, provide a temporary Riyadh address. It is anticipated that this situation will be resolved as soon as computerization of identification documents is completed. b. As previously noted, the software used in analyzing this report, CanReg Ver..21, did not enroll insitu cases in the incidence tables. These cases were added to the total cancer cases in the overview. Notification The data used for this report was extracted in January 200. Additional cases diagnosed in 1999 and 2000 may be added later in subsequent incidence reports, which means an increase of the total cases for those two year, which has not been included in the analysis. 18

19 Definitions of Statistical Terms ICD10 The World Health Organization s International Classification of Diseases, tenth edition. ICD02 The World Health Organization s International Classification of Diseases for Oncology, 2nd Edition. Metastasis It is the distant spread of cancer from its original site to other organs of the body, including lymph nodes, skeletal and or visceral organs. Incidence Rate It is defined as the rate at which new event occur in a population. It is calculated as the number of new cases of disease arising in a population over a defined time period, divided by the population at risk of developing that disease. Crude Incidence Rate The crude incidence rate for a cancer site is the total number of cases registered as a proportion of the total population. It denotes the approximate number of cases occurring in each 100,000 individuals. All rates are thus, expressed as per 100,000 population. Cancer rates vary greatly with age and the crude rate is strongly influenced by the demographic structure of the population. Hence, if the population structure changes over time the crude rate over that period may be artificially altered. It is not appropriate to compare crude rates across geographical areas of cancer registries with different population age structures. Therefore, in order to assess time trends in registration data or compare incidence across geographical areas or between registries it is necessary to first standardize the rates with respect to age. Prevalence This reflects the total number of patients with a disease in a specified population at a specified time, including both new and old cases. Relative Frequency This statistic is defined as the number of specific cancer cases registered relative to the total number of all cancer. It is expressed as a percentage. Rank This measure reflects the importance of a specific cancer site relative to other sites, in terms of the number of registrations. Ranking illustrates the most and least frequent cancer sites in a population according to their frequency. Average AgeSpecific Incidence Rate (AIR) The number of cancer cases occurring during a specific period in a population of a specific age and sex group, divided by the number of midyear population of that age and sex group. 19

20 AgeStandardized Rate (ASR) The Agestandardized rate is a summary measure of a rate that a population would have if it had a standard age structure. Standardization is necessary when comparing several populations that differ with respect to age structure. The most frequently used standard population is the World Standard Population (see below). The calculated incidence is known as the World Standardized Incidence Rate. The rate is expressed per 100,000 populations. The World Standard Population Age Class Population Age Class Population ,000 10,000 9,000 8,000 8,000,000,000,000, Total,000,000,000,000,000 2,000 1, ,000 The World Standard Population (Doll et al., 19) 20

21 PART II OVERVIEW OF CANCER 21

22 Cancer in Saudi Arabia The total number of cancer cases reported among Saudis during the years were Fifty two percent (20,2) of the cases were reported among men and 8% (18) among women. In Saudi Arabia, taking into consideration the population structure and the fact that cancer is primarily a disease of the old, the pattern of cancer has some unique characteristics. During this period, 9% of the cases in men and % of the cases in women were found in the above9 agegroup. This agegroup accounts for only.2% of the Saudi population. This signifies that a large proportion of cancer cases in women occur in younger agegroup. If we look at the agegroup between 0 year, we will find that 22% of the cases in women and 12% of the cases in men were found in this group. It can be safely said that Saudi women are affected in early ages more than men and this can be attributed to breast and thyroid cancer (figure 21). 2.2 % Male Female Age Groups Fig. 21 Percentage Distribution of Cancer Incidence among Saudis by Age Group and Sex, Liver NonHodgkin Lymphoma Leukaemia Lung All Ages Breast Thyroid Leukaemia NonHodgkin Lymphoma Colorectal.2 2. Colorectal Prostate Ovary Urinary Bladder Liver Brain, Nervous System Brain, Nervous System Stomach Cervix Uteri Hodgkin s Disease Skin Other Sites Other Sites Male (202) Female (18)* Fig. 22A Most Frequent Types of Cancer by Age and Sex among Saudis, * One case of unknown age shows only in total as it could not be added to any age group. 22

23 Leukaemia Years 1.2 Leukaemia Brain, Nervous System 8..2 Brain, Nervous System Hodgkin s Disease NonHodgkin Lymphoma Hodgkin s Disease NonHodgkin Lymphoma Connective Tissue. 2. Kidney Bone Connective Tissue Eye Bone Kidney Eye Liver Ovary Testes Thyroid Other Sites.8. Other Sites Male (2201) Female (1) Leukaemia Hodgkin s Disease NonHodgkin Lymphoma Bone Brain, Nervous System Thyroid Connective Tissue Testis Nasopharynx Colorectal Other Sites 1 29 Years Thyroid Breast Leukaemia Hodgkin s Disease NonHodgkin Lymphoma Ovary Bone Brain, Nervous System Connective Tissue Nasopharynx Other Sites Male (112) Female (201) 0 Years NonHodgkin s Lymphoma Breast Leukaemia. 10. Thyroid Colorectal.1.1 Colorectal Nasopharynx 2..0 Cervix Uteri Thyroid Leukaemia Hodgkin s Disease NonHodgkin Lymphoma Brain, Nervous System Ovary Urinary Bladder Nasopharynx Lung Brain, Nervous System Skin Kidney Other Sites Other Sites Male (20) Female (128) Fig. 22B Most Frequent Types of Cancer by Age and Sex among Saudis,

24 Liver 9 Years. 1.0 Breast NonHodgkin Lymphoma.. Colorectal Colorectal Lung Thyroid NonHodgkin Lymphoma Urinary Bladder Liver Nasopharynx Ovary Leukaemia Cervix Uteri Stomach Corpus Uteri Skin Brain, Nervous System Leukaemia Stomach Other Sites Other Sites Male (1) Female (18) 0 Years Liver 8..1 Breast Lung.9. Colorectal Prostate NonHodgkin Lymphoma NonHodgkin Lymphoma. 2. Liver Urinary Bladder Thyroid Colorectal Skin Stomach. 1. Ovary Skin Oesophagus Oesophagus Stomach Leukaemia Corpus Uteri Other Sites Other Sites Male (02) Female (1) Prostate Liver Urinary Bladder Lung + Years Breast NonHodgkin Lymphoma Colorectal Skin NonHodgkin Lymphoma. 1.9 Liver Stomach. 1.8 Stomach Skin.1 1. Oesophagus Colorectal.0 1. Lung Oesophagus. 1.2 Ovary Leukaemia Other Sites Male (8) Female (18) Cervix Uteri Other Sites Fig. 22C Most Frequent Types of Cancer by Age and Sex among Saudis, * 2

25 Reported Cancer Incidence Cases in Saudi Arabia, Between January 1999 and December 2000, the total number of cancer cases reported to the NCR was 1,8. Overall, cancer was more predominant in men than in women. Cancers affected,1 (1.%) males and,20 (8.%) females, with a male to female ratio of 10:100. Eleven thousand three hundred eighty three (11,8) cases were reported among Saudis,,22 among nonsaudis and 21 are of unknown nationality. Histological and/or cytological diagnosis of malignancy was confirmed in 9.% of the cases. Onesixth percent of the cases were confirmed clinically,.2% radiologically, and 0.% were diagnosed by other methods. The method of diagnosis was unknown for 0.% of the cases. Distribution of Cancer Cases in Saudi Arabia by Nationality and Sex Out of 1,8 cancer cases reported, there were 21 cases of unknown nationality reported to the NCR for 1999 and Since these cases can be included in neither the Saudi category nor in the nonsaudis category, they were excluded from the overall analysis. There were also 8 insitu cases reported during 1999 and 2000 (Table 21). The current software program, CanReg.21, does not include insitu cases in the statistical analysis. The total number of cases excluded from the analysis was 299. Saudis NonSaudis Unknown Nationality Behavior Male Female Total Male Female Total Male Female Total Total Invasive Insitu Total Table 21 Distribution of Cancer Cases in Saudi Arabia by Nationality and Sex, Based on the above, 1, cases were analyzed of which 11,0 (.8%) were Saudis and,22 (22.2%) were nonsaudis. Among the Saudis,,1 (0.%) were male and,1 (9. %) were female. The male to female ratio was 102:100. The crude incidence rate (CIR) of all cancers among the Saudi population was.2/100,000 (./100,000 among males and.8/ 100,000 among females). The overall agestandardized incidence rate (ASR) for all Saudis with a world standard population reference was 2./100,000 (1./100,000 in males and./100,000 in females). For all sites, the agespecific incidence rate (AIR) increased with age for both males and females. After the age of years, the increase was twofold for males compared to females. The mean age at diagnosis was 2 years for men and years for women. The geographic regions with the highest ASR were Riyadh region at 109./100,000, Eastern region at 80./100,000, Najran region at 0./100,000, Qassim region at 0./100,000, and Makkah and Madinah regions at 8./100,000 2

26 ICD(10) PRIMARY SITE Males Females All All sites C00 Lip C01C02 Tongue 1 10 C0C08 Salivary gland C0C0 Mouth C09C10 Oropharynx 11 C11 Nasopharynx C12C1 Hypopharynx 10 2 C1 Pharynx unspec C1 Oesophagus C1 Stomach C1 Small intestine C18 Colon C19C21 Rectum C22 Liver C2C2 Gallbladder etc C2 Pancreas C0C1 Nose, sinuses etc C2 Larynx CC Bronchus, lung 100 CC8 Other thoracic organs 22 1 C0C1 Bone C;C9 Connective tissue C Mesothelioma 8 1 C Kaposi's sarcoma C Melanoma of skin 18 1 C Other skin C0 Male breast C0 Female breast C Uterus unspec. 1 1 C Cervix uteri 1 1 C8 Placenta C Corpus uteri C Ovary etc C1C2;C Other female genital 2 2 C1 Prostate 0 0 C2 Testis 0 0 C0 Penis 2 2 C Other male genital C Bladder CC;C8 Kidney etc C9 Eye 9 9 C0C2 Brain, nervous system C Thyroid CC Other endocrine 21 2 C81 Hodgkin's disease 20 1 C82C8;C9 NonHodgkin lymphoma C88;C90 Multiple myeloma C91 Lymphoid leukaemia C92 Myeloid leukaemia C9 Monocytic leukaemia 9 C9 Other leukaemia 1 C9 Leukaemia unspec Other & unspecified Table 22 Number of New Cases by Primary Site and Sex among Saudis,

27 Ten Most Common Types of Cancer Among Saudis, (All Ages) During , 9.% of all cancers among Saudis occurred before the age of 1, and 20.% occurred after the age of years. For the total Saudi population the ten most common cancers were as follows: CANCER NO. OF CASES PERCENTAGE (%) Female breast NonHodgkin s lymphoma (NHL) Leukaemia Colorectal Liver Thyroid Brain, nervous system (CNS) Lung Hodgkin s disease Bladder Male NHL 28 (9.2%) Liver 12 (9%) Leukaemia 9 (8.%) Colorectal 89 (.8%) Lung (.2%) Prostate 0 (.%) Bladder 01 (.%) Brain &CNS 20 (.%) Hodgkin s 20 (.%) Skin 22 (%) Total = 1 Female Breast 11 (20.%) Thyroid 9 (9.%) Leukaemia 82 (.9%) Colorectal (.%) NHL (.%) Ovary 20 (.%) Brain & CNS 18 (.%) Liver 18 (.%) Hodgkin s 1 (.1%) Cervix uteri 1 (%) Total = 1 Fig. 2 Ten Most Common Cancers for Saudis by Sex,

28 00 male female 0 00 Rate per 100, Age groups Fig. 2 Average AgeSpecific Incidence Rates (AIR) for All Cancers among Saudis, Riyadh Male Riyadh Female 108. Easterm 81. Easterm 9.1 Najran.2 Qassim.2 Makkah.2 Madinah. Qasim.2 Makkah 0. Madinah 2. Northern 8.8 Hail 9. Najran.1 Jouf 9.1 Hail 8. Northern. Tabuk 2. Tabuk 2. Jouf. Jazan 1 Jazan Asir 28.8 Asir 29. Baha 2. Baha ASR (PER 100,000) ASR (PER 100,000) Fig. 2Age Standardized Rate ( ASR) Regional Distribution of All Sites of Cancer among Saudis,

29 Adult Cancers in Saudi Arabia, (above 1 years) Between January 1999 and December 2000, the total number of adult cancer cases reported to the NCR was 1,. Overall, cancer was more predominant in males than in females. Cancer affected,89 (0.9%) males and,0(9.1%) females, with a ratio of 10:100. Of all cases, there were 10,20 Saudis,,0 nonsaudis and 22 of unknown nationality. As explained above, cases with unknown nationality in this case 210 cases and insitu cases (8) were excluded from the analysis. Table 2 illustrates the distribution of adult cancer cases by nationality and sex. Saudis NonSaudis Unknown Nationality Behavior Male Female Total Male Female Total Male Female Total Total Invasive Insitu Total Table 2 Distribution of Adult s Cancers Cases in Saudi Arabia by Nationality and Sex, As shown in table 2, the total number of cases analyzed was 1,18 including 10,12 (%) Saudis and,0 (2%) nonsaudis. Among Saudis,,08 (0.1%) cases were male and,0 (9.9%) were female. The male to female ratio was 100.:100. For all sites, the agespecific incidence rate (AIR) increased with age for both males and females. The mean age at diagnosis was 8 years in males and 1 years in females. During the , adult cancers accounted for 89.% of all cancers among Saudis. Thirty point nine percent (0.9%) of these cases occurred after the age of 0 years. For the total adult Saudi population the ten most common cancers were as follows: CANCER NO. OF CASES PERCENTAGE (%) Female breast NonHodgkin s lymphoma (NHL) Colorectal Thyroid Liver Leukaemia Lung Bladder Skin (nonmelanoma) Stomach

30 Male Liver 00 (9.8%) NHL 81 (9.%) Colorectal 89 (.%) Lung (%) Prostate 0 (%) Bladder 01 (.9%) Leukaemia 280 (.%) Skin 220 (.%) Stomach 210 (.1%) Nasopharynx 18 (.%) Total = 08 Female Breast 11 (22.8%) Thyroid (10.%) ColoRectal 0 (.1%) NHL 19 (.%) Leukaemia 199 (%) Ovary 191 (.8%) Liver 18 (.%) Cervix uteri 1 (.%) Skin 19 (2.9%) Corpus uteri 11 (2.8%) Total = 0 Fig. 2 Ten Most Common Types of Cancer among Adult Saudis by Sex, Primary Site Morphology Males Females %* No. No. %* Female breast cancer NHL Colorectal Thyroid Liver Infiltrating duct carcinoma Carcinoma, NOS Lobular carcinoma, NOS Infiltrating duct and lobular carcinoma Medullary carcinoma, NOS Paget s disease and Infiltrating duct carcinoma All other Malignant lymphoma large cell, diffuse NOS Malignant lymphoma, NOS Malignant lymphoma, nonhodgkin s, NOS Malignant lymphoma, small lymphocytic, NOS Malignant lymphoma, mixed small and large cell, diffuse Malignant lymphoma, follicular, NOS All other Adenocarcinoma, NOS Mucinous adenocarcinoma Carcinoma, NOS Signet ring cell carcinoma Adenocarcinoma in villous adenoma All other Papillary carcinoma, NOS Papillary and follicular carcinoma Follicular adenocarcinoma, NOS Medullary carcinoma, NOS All other Hepatocellular carcinoma, NOS Malignant tumor, NOS Cholangiocarcinoma Adenocarcinoma, NOS All other

31 Primary Site Leukaemia Lung Acute myeloid leukaemia Acute lymphoblastic leukaemia, NOS Chronic myeloid leukaemia Chronic lymphoblastic leukaemia All other Squamous cell carcinoma, NOS Adenocarcinoma, NOS Carcinoma, NOS Small cell carcinoma, NOS All other Urinary bladder Papillary transitional cell carcinoma Transitional cell carcinoma, NOS Squamous cell carcinoma, NOS Adenocarcinoma, NOS All other Skin Basal cell carcinoma (nonmelanoma) Squamous cell carcinoma Dermatofibrosarcoma Squamous cell carcinoma, keratinizing, NOS Basosquamous carcinoma All other Stomach Ovary Nasopharynx Morphology Adenocarcinoma, NOS Signet ring cell carcinoma Adenocarcinoma, intestinal type Carcinoma, NOS All other Papillary serous cystadenocarcinoma Adenocarcinoma, NOS Endometrioid carcinoma Serous surface papillary carcinoma All other Carcinoma, undifferentiated, NOS Carcinoma, NOS Squamous cell carcinoma, large cell, nonkeratinizing Squamous cell carcinoma, NOS All other Males No %* Females No %* Cervix uteri Squamous cell carcinoma, NOS Squamous cell ca, nonkeratinizing, NOS Adenocarcinoma, NOS Squamous cell, keratinizing, NOS All other Corpus uteri Prostate Adenocarcinoma, NOS Endometrioid carcinoma Endometrial stromal sarcoma Mullerian mixed tumor All other Adenocarcinoma, NOS Carcinoma, NOS All other * Relative percentage of morphology type within primary site Table 2 Number and Proportion of Morphological Types for the Most Common Types of Cancer among Saudi Adults,

32 Childhood Cancers in Saudi Arabia (1 years and under) The total of cases reported among children (01 years as defined by the WHO) between January 1999 and December 2000 was 1,9. This represented 9. % of the total number of cancers in Saudi Arabia. The total reported incidence shows that cancer was more predominant in males than in females. Seven hundred fifty eight (8) (.%) cases were reported among males and (.%) among females, with a male to female ratio of 119:100. Of all the cases reported, there were 1,1 Saudis, 19 nonsaudis and 21 of unknown nationality. Childhood cancer is very important not only because of the age of occurrence, but also because more than % of the Saudi population is under 1 years of age. In addition to this, recent years have shown a breakthrough for the cure of many childhood cancers. Childhood cancers accounted for 10.% of all cancers among Saudis. As explained earlier, 21cases of unknown nationality were excluded from the statistical analysis. Table 2 demonstrates the distribution of childhood cancer cases by nationality and sex. Saudis NonSaudis Unknown Nationality Behavior Male Female Total Male Female Total Male Female Total Total Invasive Insitu Total Table 2 Distribution of Childhood Cancer Cases in Saudi Arabia by Nationality and Sex, Based on the above, the total number of cases analysed was 1,9 including 1,1 (8.8%) Saudis and 19(1.2%) nonsaudis. Among Saudis, 2 (.%) were male and 0(.%) were female. The male to female ratio was 11: 100. The leading cancer among the Saudi children was leukaemia, which accounted for 2.%, followed by Brain (CNS) and Hodgkin s disease. The following is a listing of the ten most common types of cancer among Saudi children in order of relative frequency. Figure 2 shows the top ten sites by sex and frequency, and table 2 shows the number and proportion of the morphological types for the most common types of cancer. CANCER NO. OF CASES PERCENTAGE (%) Leukaemia Brain, nervous system Hodgkin s disease NonHodgkin lymphoma Bone Connective tissue Kidney Eye Liver Ovary

33 Male Leukaemia 199 (1.8%) Brain, nervous system 101 (1.1%) Hodgkin s (12.1%) NHL (.%) Bone 9 (.2%) Connective tissue (.%) Kidney 0 (.8%) Eye 28 (.%) Liver 12 (1.9%) Testes 10 (1.%) Female Leukaemia 18 (.%) Brain, nervous system 9 (1.%) Hodgkin s 1 (9.%) NHL (.%) Bone (%) Eye 2 (.8%) Kidney 0 (.%) Connective tissue 29 (.%) Ovary 1 (2.%) Liver & Thyroid (1.1%) each Total = 2 Total = 0 Fig. 2 Ten Most Common Types of Cancer among Saudi Children by Sex,