ESMO SUMMIT MIDDLE EAST 2018

Transcription

1 ESMO SUMMIT MIDDLE EAST 2018 Head and Neck Cancer in the Middle East Name Dr. Pankaj Chaturvedi 6-7 April 2018, Dubai, UAE

2 CONFLICT OF INTEREST DISCLOSURE None.

3 MIDDLE EAST Total population: 218 million Geographic Influences: Europe above Asia by the side Africa below Past and Present Cultural influences: USA UK Rest of the world

4 CANCER IN THE MIDDLE EAST Incidence 555,318 Head and Neck - 8 th most common Middle Eastern and Northern Africa (MENA) Not so common in ME parts

5 Oral and Oropharyngeal cancers in ME region: Highest seen in Egypt, Iran, Turkey Due to increase in population >65 year Population growth rate, Expats

6 CRITICAL ANALYSIS OF PUBLICATIONS Total-1,773

7 DISEASE BURDEN - INCIDENCE

8 DISEASE BURDEN - MORTALITY

9 SITE AND STAGE OF PRESENTATION IN ARAB WORLD

10 COMMON H & N CANCERS Country Most common Other common Bahrain Thyroid (2.4) and Lip, oral cavity (2.2) Larynx (1.9) Iran Thyroid (2.7) and larynx (2.2) Lip, oral cavity (2.0) Iraq Larynx (5.5) Lip, oral cavity (2.3) and Thyroid (2.0) Israel Thyroid (11.5) Lip, oral cavity (2.2) and Larynx (2.2) Jordan Thyroid (4.5) and Larynx (3.4) Lip, oral cavity (1.7) and Nasopharynx (1.1) Kuwait Thyroid (3.4) Lip, oral cavity (1.5) and Larynx (1.5) Lebanon Thyroid (4.4) and Larynx (3.6) Lip, oral cavity (2.0) Oman Thyroid (2.5) Lip, oral cavity (1.8) and Larynx (1.0) Qatar Thyroid (2.3) and Lip, oral cavity (2.1) Larynx (1.9) Saudi Arabia Thyroid (4.1) Lip, oral cavity (2.0) and Nasopharynx (1.4) Syria* Larynx (4.6) and Thyroid (3.3) Lip, oral cavity (2.0) UAE Thyroid (2.4) and Lip, oral cavity (2.1) Larynx (1.9) Yemen Thyroid (2.3), Lip, oral cavity (2.2) and Larynx (2.2) Nasopharynx (1.5) Lip, oral cavity Nasopharynx Thyroid Larynx

11 AGE DISTRIBUTION Country Salivary gland Mouth Tongue Pharynx Larynx Thyroid Registry year Bahrain Iran Israel Jordan Oman Qatar Saudi Arabia Surprisingly high incidence in younger age groups!!! Oral cancer and Thyroid - Oman and Yemen Pharynx - Saudi Arabia and Jordan Salivary gland - Qatar

12 ETIOLOGIC AGENTS Tobacco Alcohol Shadowed by social and religious barriers Infection by oncogenic HPV Genetic susceptibility Sun exposure Environmental Occupational Dietary factors

13 TOBACCO USE SPECIFIC TO THE MIDDLE EAST Smoked: Cigarettes Cigar and pipes Alternative tobacco products: Water pipe smoking or Hookah Midwakh/Dokha (Arabic for dizzy ) Kreteks (clove cigarettes) E-cigarettes or vapes

14 Smokeless tobacco Region Use Lesion Qat (Catha Edulis) Yemen Leaves and shoots chewed Oral cavity, oropharynx, larynx, esophageal and gastric; submucous fibrosis like Shammah Saudi Arabia, Yemen powdered tobacco leaves + carbonated lime + ash + flavorings Nass Iran, Iraq Tobacco + ash + cotton or sesame oil + gum Naswar Air cured, sun dried tobacco + lime + Indigo + cardamom or menthol Paan and paan masala Dry snuff UAE, Qatar Saudi Arabia (Jazan), Yemen Betel leaf + areca nut + lime + tobacco (sometimes); many variations Tobacco (sp. Nicotiana rustica) + soda bicarbonate; used as 10 gm saffa Buccal mucosa, lower vestibule; Typical leukoplakia with mucosal burn Floor of mouth, lower lip vestibule Oral cavity, tongue base, oropharynx, larynx Lower gingival sulcus, tongue base, oropharynx

15 TOBACCO USAGE Country Child smoking (10-14 yo) Adult smoking (15yo +) Child smokeless (10-14 yo) Adult smokeless (15 yo +) Bahrain Iran Iraq Israel and Palestinian Territory Jordan (only female) Kuwait Lebanon Oman Qatar Saudi Arabia Syria United Arab Emirates Yemen Deaths caused by tobacco

16 ALCOHOL Country Status Bahrain Iran Prohibited Iraq > 21 years Israel and Palestinian Territory > 18 years Jordan > 18 years Kuwait Prohibited Lebanon > 21 years Oman > 21 years Qatar Saudi Arabia Prohibited Syria No age United Arab Emirates Allowed (except Sharjah) Yemen Prohibited Global Information System on Alcohol and Health (GISAH) - WHO Bahrain Israel Lebanon Qatar UAE

17 Heavy Consumption > 50g / day Western spirits Araq Lebanese wines Châteaux Musar, Ksara Syrian beer Al Sharq (Aleppo) Barada (Damascus)

18 HPV IN THE MIDDLE EAST Incidence varies from 0-65% Most common types 16, 18, 31, 33 Highest incidence seen in Egyptian series followed by Turkish series Studied retrospectively with high number of oral cavity cases Country Site n HPVs +% HPV types Egypt HN 64 (30 HN, 34 SG) and 18 Iran HN 175 (20 NPC, 20 OC, 41 PM, 94 TG) and 18 Israel OC 23 (23 OC) Pakistan OC, OPC 318 (262 PM, 56 OC and OPC) and 18 Syria HN In preparation 43 16, 18, 31, 33 and 35 Turkey LN 157 (21 LN, 47 LN, 89 LN and HP) ,18, 31 and 33 Yemen OC 18 (18 OC) 20 - Saudi Arabia* HN - 30

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20 EFFECT OF IMMIGRANT POPULATION Saudi Arabia has a large expatriate community particularly people of Southeast Asian origin, in which social habits such as areca nut chewing are common. Subsequently, these factors will contribute to an increased incidence of oral cancer in Saudi Arabia in future years.

21 OUTBOUND MEDICAL TOURISM Oman send 5,000 patients/year to India and UK Qatar sends 500 patients/year to India Libya and Syria outbound is all dried up due to political instability, usually send to Jordan UAE sends 8,500 patients/year to USA, Germany, Thailand, Singapore Jordan inbound tourism expected to reduce by 25% Lebanon inbound for reconstructive procedures UAE has setup largest clinic ties with USA and UK Cultural and religious differences are some of the main attentions to consider when dealing with Arab patients.

22 WHAT GOVERNMENTS ARE DOING TO REDUCE OUTBOUND MEDICAL TOURISM

23 GOVERNMENT AND PRIVATE HEALTH POLICIES Country National tobacco control policy Complete smoke free law Tobacco related expense in mil. USD$ (mil. local exchange) Enforce bans Tax raises (% to excise) Bahrain Yes (2007) No (yes only café) 116 $ (44 BHD) 7/ Fully National health insurance support Iran Yes (2005) Yes 745 $ (24,846,407 IRR) 7/ Almost fully Iraq Yes (2008) No (yes only café) 3,321 $ (3,954,546 IQD) 5/ Almost nothing Israel - No 2,680 $ (9,391 ILS) 1/ Fully Jordan Yes (2004) No 711 $ (505 JOD) 7/ Partially Kuwait Yes (2006) No 76 $ (23 KWD) 7/7 0 Partially Lebanon Yes (2005) Yes 473 $ (718,082 LBP) 7/ Partially Oman Yes (2005) No 122 $ (47 OMR) 7/7 0 Almost nothing Qatar Yes (2004) No 220 $ (801 QAR) 7/7 0 Almost fully Saudi Arabia Yes (2005) Yes (No in café) 1,211 $ (4,545 SAR) 7/ Fully Syria Yes (2004) Yes 54 $ (28,264 SYP) 7/7 40 No UAE Yes (2005) Yes 284 $ (1,044 AED) 7/7 0 Partially Yemen Yes (2007) Yes (no only café) 178 $ (44,446 YER) 7/ No

24 FUTURE DIRECTIONS Projected values (As per IARC projections) 30.48% incidence increase 34.36% mortality increase Suggestions: Better infrastructure for treatments and research and academics. Increase education and awareness among people in the region More tailored strategies by governments for early detection Control on these less popularized, traditional means of tobacco usage (Waterpipe)

25 THANK YOU Any questions?