cancer incidence in peninsular malaysia 2003

Edited by:

Dr Gerard Lim Chin ChyeDr Sanjay Rampal

Dato’ Dr Halimah Yahaya

National Cancer Registry

Cancer Incidence inPeninsular Malaysia

2003-2005

NATIONAL CANCER REGISTRY ACKNOWLEDGESGRANTS FROM:

Ministry of Health, MalaysiaAND SUPPORT FROM:

Majl is Kanser NasionalNat ional Cancer Counci l

Design &

Printing by : Konsep N

iaga (+603) 2148 6413

Cancer Incidence inPeninsular Malaysia,

2003-2005

The Third Report of theNational Cancer Registry,

Malaysia

Edited by

Gerard Lim Chin Chye

Sanjay Rampal

Halimah Yahaya

National Cancer Registry

Ministry of Health Malaysia

January 2008 © National Cancer Registry, Malaysia

Published by: National Cancer Registry

This report is copyrighted. However it may be freely reproduced without the permission of NCR. Acknowledgment would be appreciated and the suggested citation is:

The National Cancer Registry report is also published electronically on: Jabatan Kesihatan Awam, MOH : http://www.cancer.gov.myMAKNA : http://www.makna.org.myCollege of Radiology, Academy of Medicine : http://www.radiologymalaysia.orgCollege of Pathology, Academy of Medicine : http://www.acadmed.org.myMalaysian Oncological Society : http://www.malaysiaoncology.org

GCC Lim, S Rampal, Y Halimah (Eds). Cancer Incidence in Peninsular Malaysia,2003 - 2005. National Cancer Registry. Kuala Lumpur 2008.

2003-2005

iCONTENTS

TABLE OF CONTENTS Page

CONTENTS i

CONTENTS i

ABBREVIATIONS xiii

FOREWORD BY THE MINISTER OF HEALTH, MALAYSIA 1

FOREWORD BY THE DIRECTOR GENERAL OF HEALTH, MALAYSIA 2

ACKNOWLEDGEMENTS 3

NATIONAL CANCER REGISTRY PARTICIPATING CENTRES 4

ADVISORY COMMITTEE 8EXPERT PANEL 9

NATIONAL CANCER REGISTRY UNIT 14

EXECUTIVE SUMMARY 15

1.0 NATIONAL CANCER REGISTRY 19

1.1 Background 19

1.2 Objectives 19

1.3 Operations of the National Cancer Registry 19

1.4 Sponsors Of The NCR 20

2.0 MALAYSIA AND ITS POPULATION 21

2.1 Geography 21

2.2 Population Of Peninsular Malaysia 22

2.3 Infrastructure 23 2.4 Socioeconomic Status 23

2.5 Health Status and Facilities 24

3.0 METHODS 25

3.1 Evaluation of the Quality of NCR Data 32

4.0 CANCER INCIDENCE IN MALAYSIA 2003-2005 38

4.1 Overall Cancer Incidence 38

4.2 Cancer Incidence by Site 40

4.3 Cancer Incidence by Site, Ethnicity and Sex 43

4.4 Cancer Incidence by Site, Age and Sex 45

5.0 SELECTED CANCER SITES 2003-2005 61

5.1 TONGUE (ICDO: C01-C02) 61 5.2 SALIVARY GLAND (ICDO: C07-C08) 64

5.3 MOUTH (ICDO: C03-C06) 67

5.4 NASOPHARYNX (ICDO: C11) 71

5.5 OESOPHAGUS (ICDO: C15) 77

5.6 STOMACH (ICDO: C16) 80

5.7 LARGE BOWEL (ICDO: C18-C21) 83

5.8 LIVER (ICDO: C22) 87

5.9 GALLBLADDER (ICDO: C23-C24) 90

2003-2005

ii CONTENTS

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5.10 PANCREAS (ICDO: C25) 93

5.11 NOSE and SINUSES (ICDO: C30-C31) 99

5.12 LARYNX (ICDO: C32) 103

5.13 LUNG (ICDO: C33-C34) 106

5.14 BONE (ICDO: C40-C41) 111

5.15 OTHER SKIN 117

5.16 MELANOMA 120 5.17 FEMALE BREAST (ICDO: C50) 125

5.18 CERVIX UTERI (ICDO: C53) 131

5.19 CORPUS UTERI (ICDO: C54) 134

5.20 OVARY (ICDO: C56-C57) 137

5.21 PROSTATE (ICDO: C61) 143

5.22 BLADDER (ICDO: C67) 145

5.23 KIDNEY and OTHER URINARY ORGANS (ICDO: C64, C65, C66, C68) 148

5.24 BRAIN and OTHER NERVOUS SYSTEM (ICDO: C70-C72) 153

5.25 THYROID (ICDO: C73) 156

5.26 LYMPHOMA 161

5.26.1 Hodgkin’s Lymphoma 164

5.26.2 Non Hodgkin’s Lymphoma 166 5.27 LEUKAEMIA 171

5.27.1 Lymphatic Leukaemia 174

5.27.2 Myeloid Leukaemia 176

REFERENCES 179

2003-2005

iiiCONTENTS

LIST OF TABLES Page

Table 2.2.1: Age, sex and ethnic distribution of the population of Peninsular Malaysia, 2004

23

Table 2.5.1: Perinatal, neonatal, infant and maternal mortality rate for Malaysia, 2004 24

Table 4.1.1: Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex, Malaysia 2003-2005

38

Table 4.1.2: Cancer Incidence per 100,000 population (CR) by age and sex, Peninsular Malaysia 2003-2005

38

Table 4.1.3: Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity and sex, Peninsular Malaysia 2003-2005

39

Table 4.1.4: Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

39

Table 4.2.1: Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by site and sex, Peninsular Malaysia 2003-2005

41

Table 5.1.1: Tongue Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

61

Table 5.1.2: Tongue Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

61

Table 5.1.3: Number of Tongue cases by subsite, Peninsular Malaysia 2003-2005 62

Table 5.1.4: Number (%) of Tongue cases by morphology, Peninsular Malaysia 2003-2005

62

Table 5.2.1: Salivary Gland Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

64

Table 5.2.2: Salivary Gland Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

64

Table 5.2.3: Number (%) of Salivary Gland cases by morphology, Peninsular Malaysia 2003-2005

65

Table 5.2.4: Number of Salivary Gland cases by subsite, Peninsular Malaysia 2003-2005

66

Table 5.3.1: Mouth Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

67

Table 5.3.2: Mouth Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity and sex, Peninsular Malaysia 2003-2005

67

Table 5.3.3: Number of Mouth cases by subsite, Peninsular Malaysia 2003-2005 68

Table 5.3.4: Number (%) of Mouth cases by morphology, Peninsular Malaysia 2003-2005

69

Table 2.4.1: Malaysia: Percentage Distribution of Employed Persons by Occupation 23

2003-2005

iv CONTENTS

LIST OF TABLES Page

Table 5.4.1: Nasopharynx Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

71

Table 5.4.2: Nasopharynx Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

71

Table 5.5.1: Oesophagus Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

77

Table 5.5.2: Oesophagus Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

77

Table 5.5.3: Number of Oesophagus cases by subsite, Peninsular Malaysia 2003-2005 78

Table 5.5.4: Number (%) of Oesophagus cases by morphology, Peninsular Malaysia 2003-2005

78

Table 5.6.1: Stomach Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

80

Table 5.6.2: Stomach Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

80

Table 5.6.3: Number of Stomach cases by subsite, Peninsular Malaysia 2003-2005 81Table 5.6.4: Number (%) of Stomach cases by morphology, Peninsular Malaysia 2003-

200581

Table 5.7.1: Large Bowel Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

83

Table 5.7.2: Large Bowel Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

83

Table 5.7.3: Number of Large Bowel cases by subsite, Peninsular Malaysia 2003-2005 84

Table 5.7.4: Number (%) of Large Bowel cases by morphology, Peninsular Malaysia 2003-2005

85

Table 5.8.1: Liver Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

87

Table 5.8.2: Liver Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

87

Table 5.8.3: Number (%) of Liver cases by morphology, Peninsular Malaysia 2003-2005

88

Table 5.9.1: Gallbladder Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

90

Table 5.9.2: Gallbladder Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

90

Table 5.9.3: Number of Gallbladder cases by subsite, Peninsular Malaysia 2003-2005 91

Table 5.9.4: Number (%) of Gallbladder cases by morphology, Peninsular Malaysia 2003-2005

91

Table 5.10.1: Pancreas Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

93

2003-2005

vCONTENTS

v

LIST OF TABLES Page

Table 5.10.2: Pancreas Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

93

Table 5.10.3: Number of Pancreas cases by subsite, Peninsular Malaysia 2003-2005 94

Table 5.10.4: Number (%) of Pancreas cases by morphology, Peninsular Malaysia 2003-2005

94

Table 5.11.1: Nose and Sinuses Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

99

Table 5.11.2: Nose and Sinuses Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

99

Table 5.11.3: Number of Nose and Sinuses cases by subsite, Peninsular Malaysia 2003-2005

100

Table 5.11.4: Number (%) of Nose and Sinuses cases by morphology, Peninsular Malaysia 2003-2005

101

Table 5.12.1: Larynx Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

103

Table 5.12.2: Larynx Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

103

Table 5.12.3: Number of Larynx cases by subsite, Peninsular Malaysia 2003-2005 104

Table 5.12.4: Number (%) of Larynx cases by morphology, Peninsular Malaysia 2003-2005

104

Table 5.13.1: Lung Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

106

Table 5.13.2: Lung Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

106

Table 5.13.3: Number of Lung cases by subsite, Peninsular Malaysia 2003-2005 107

Table 5.13.4: Number (%) of Lung cases by morphology, Peninsular Malaysia 2003-2005

107

Table 5.14.1: Bone Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

111

Table 5.14.2: Bone Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

111

Table 5.14.3: Number of Bone cases by subsite, Peninsular Malaysia 2003-2005 112

Table 5.14.4: Number (%) of Bone cases by morphology, Peninsular Malaysia 2003-2005

113

Table 5.15.1: Other Skin Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

117

Table 5.15.2: Other Skin Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

117

Table 5.15.3: Number of Other Skin cases by subsite, Peninsular Malaysia 2003-2005 118

Table 5.15.4: Ten most common of Other Skin cases by morphology, Peninsular Malaysia 2003-2005

118

v

LIST OF TABLES Page

Table 5.10.2: Pancreas Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

93

Table 5.10.3: Number of Pancreas cases by subsite, Peninsular Malaysia 2003-2005 94

Table 5.10.4: Number (%) of Pancreas cases by morphology, Peninsular Malaysia 2003-2005

94

Table 5.11.1: Nose and Sinuses Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

99

Table 5.11.2: Nose and Sinuses Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

99

Table 5.11.3: Number of Nose and Sinuses cases by subsite, Peninsular Malaysia 2003-2005

100

Table 5.11.4: Number (%) of Nose and Sinuses cases by morphology, Peninsular Malaysia 2003-2005

101

Table 5.12.1: Larynx Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

103

Table 5.12.2: Larynx Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

103

Table 5.12.3: Number of Larynx cases by subsite, Peninsular Malaysia 2003-2005 104

Table 5.12.4: Number (%) of Larynx cases by morphology, Peninsular Malaysia 2003-2005

104

Table 5.13.1: Lung Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

106

Table 5.13.2: Lung Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

106

Table 5.13.3: Number of Lung cases by subsite, Peninsular Malaysia 2003-2005 107

Table 5.13.4: Number (%) of Lung cases by morphology, Peninsular Malaysia 2003-2005

107

Table 5.14.1: Bone Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

111

Table 5.14.2: Bone Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

111

Table 5.14.3: Number of Bone cases by subsite, Peninsular Malaysia 2003-2005 112

Table 5.14.4: Number (%) of Bone cases by morphology, Peninsular Malaysia 2003-2005

113

Table 5.15.1: Other Skin Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

117

Table 5.15.2: Other Skin Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

117

Table 5.15.3: Number of Other Skin cases by subsite, Peninsular Malaysia 2003-2005 118

Table 5.15.4: Ten most common of Other Skin cases by morphology, Peninsular Malaysia 2003-2005

118

2003-2005

v� CONTENTS

vi

LIST OF TABLES Page

Table 5.16.1: Melanoma Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

120

Table 5.16.2: Melanoma Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

120

Table 5.16.3: Number of Melanoma cases by subsite, Peninsular Malaysia 2003-2005 121

Table 5.17.1: Female Breast Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

125

Table 5.17.2: Female Breast Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

125

Table 5.17.3: Number (%) of Female Breast cases by morphology, Peninsular Malaysia 2003-2005

126

Table 5.18.1: Cervix Uteri Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

131

Table 5.18.2: Cervix Uteri Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

131

Table 5.18.3: Number (%) of Cervix Uteri cases by morphology (WHO), Peninsular Malaysia 2003-2005

132

Table 5.19.1: Corpus Uteri Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

134

Table 5.19.2: Corpus Uteri Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

134

Table 5.19.3: Number (%) of Corpus Uteri cases by morphology (WHO), Peninsular Malaysia 2003-2005

135

Table 5.20.1: Ovary Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

137

Table 5.20.2: Ovary Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

137

Table 5.20.3: Number (%) of Ovary cases by morphology (WHO), Peninsular Malaysia 2003-2005

139

Table 5.21.1: Prostate Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

143

Table 5.21.2: Prostate Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

143

Table 5.21.3: Number (%) of Prostate cases by morphology, Peninsular Malaysia 2003-2005

144

Table 5.22.1: Bladder Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

145

Table 5.22.2: Bladder Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

145

vi

LIST OF TABLES Page

Table 5.16.1: Melanoma Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

120

Table 5.16.2: Melanoma Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

120

Table 5.16.3: Number of Melanoma cases by subsite, Peninsular Malaysia 2003-2005 121

Table 5.17.1: Female Breast Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

125

Table 5.17.2: Female Breast Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

125

Table 5.17.3: Number (%) of Female Breast cases by morphology, Peninsular Malaysia 2003-2005

126

Table 5.18.1: Cervix Uteri Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

131

Table 5.18.2: Cervix Uteri Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

131

Table 5.18.3: Number (%) of Cervix Uteri cases by morphology (WHO), Peninsular Malaysia 2003-2005

132

Table 5.19.1: Corpus Uteri Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

134

Table 5.19.2: Corpus Uteri Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

134

Table 5.19.3: Number (%) of Corpus Uteri cases by morphology (WHO), Peninsular Malaysia 2003-2005

135

Table 5.20.1: Ovary Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

137

Table 5.20.2: Ovary Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

137

Table 5.20.3: Number (%) of Ovary cases by morphology (WHO), Peninsular Malaysia 2003-2005

139

Table 5.21.1: Prostate Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by ethnicity, Peninsular Malaysia 2003-2005

143

Table 5.21.2: Prostate Age specific Cancer Incidence per 100,000 population, by ethnicity, Peninsular Malaysia 2003-2005

143

Table 5.21.3: Number (%) of Prostate cases by morphology, Peninsular Malaysia 2003-2005

144

Table 5.22.1: Bladder Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

145

Table 5.22.2: Bladder Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

145

2003-2005

v��CONTENTS

vii

LIST OF TABLES Page

Table 5.22.3: Number (%) of Bladder cases by morphology, Peninsular Malaysia 2003-2005

146

Table 5.23.1: Kidney and Other Urinary Organs Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

148

Table 5.23.2: Kidney and Other Urinary Organs Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

148

Table 5.23.3: Number of Kidney and Other Urinary Organs cases by subsite, Peninsular Malaysia 2003-2005

149

Table 5.23.4: Number (%) of Kidney and Other Urinary Organs cases by morphology, Peninsular Malaysia 2003-2005

149

Table 5.24.1: Brain and Other Nervous System Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

153

Table 5.24.2: Brain and Other Nervous System Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

153

Table 5.24.3: Number of Brain and Other Nervous System cases by subsite, Peninsular Malaysia 2003-2005

154

Table 5.24.4: Number (%) of Brain and Other Nervous System cases by morphology, Peninsular Malaysia 2003-2005

154

Table 5.25.1: Thyroid Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

156

Table 5.25.2: Thyroid Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

156

Table 5.25.3: Number (%) of Thyroid cases by morphology, Peninsular Malaysia 2003-2005

157

Table 5.26.1: Lymphoma Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

161

Table 5.26.2: Lymphoma Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

161

Table 5.26.3: Number of Lymphoma cases by subsite, Peninsular Malaysia 2003-2005 162

Table 5.26.4: Number (%) of Lymphoma cases by morphology, Peninsular Malaysia 2003-2005

163

Table 5.26.1.1: Hodgkin Lymphoma Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

164

Table 5.26.1.2: Hodgkin Lymphoma Age specific Cancer Incidence per 100,000 population (CR) by sex, Peninsular Malaysia 2003-2005

164

Table 5.26.2.1: Non Hodgkin Lymphoma Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

166

Table 5.26.2.2: Non Hodgkin Lymphoma Age specific Cancer Incidence per 100,000 population (CR) by sex, Peninsular Malaysia 2003-2005

166

vii

LIST OF TABLES Page

Table 5.22.3: Number (%) of Bladder cases by morphology, Peninsular Malaysia 2003-2005

146

Table 5.23.1: Kidney and Other Urinary Organs Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

148

Table 5.23.2: Kidney and Other Urinary Organs Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

148

Table 5.23.3: Number of Kidney and Other Urinary Organs cases by subsite, Peninsular Malaysia 2003-2005

149

Table 5.23.4: Number (%) of Kidney and Other Urinary Organs cases by morphology, Peninsular Malaysia 2003-2005

149

Table 5.24.1: Brain and Other Nervous System Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

153

Table 5.24.2: Brain and Other Nervous System Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

153

Table 5.24.3: Number of Brain and Other Nervous System cases by subsite, Peninsular Malaysia 2003-2005

154

Table 5.24.4: Number (%) of Brain and Other Nervous System cases by morphology, Peninsular Malaysia 2003-2005

154

Table 5.25.1: Thyroid Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

156

Table 5.25.2: Thyroid Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

156

Table 5.25.3: Number (%) of Thyroid cases by morphology, Peninsular Malaysia 2003-2005

157

Table 5.26.1: Lymphoma Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

161

Table 5.26.2: Lymphoma Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

161

Table 5.26.3: Number of Lymphoma cases by subsite, Peninsular Malaysia 2003-2005 162

Table 5.26.4: Number (%) of Lymphoma cases by morphology, Peninsular Malaysia 2003-2005

163

Table 5.26.1.1: Hodgkin Lymphoma Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

164

Table 5.26.1.2: Hodgkin Lymphoma Age specific Cancer Incidence per 100,000 population (CR) by sex, Peninsular Malaysia 2003-2005

164

Table 5.26.2.1: Non Hodgkin Lymphoma Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

166

Table 5.26.2.2: Non Hodgkin Lymphoma Age specific Cancer Incidence per 100,000 population (CR) by sex, Peninsular Malaysia 2003-2005

166

2003-2005

v�� CONTENTS

viii

LIST OF TABLES Page

Table 5.27.1: Leukaemia Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

171

Table 5.27.2: Leukaemia Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

171

Table 5.27.1.1: Lymphatic Leukaemia Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

174

Table 5.27.1.2: Lymphatic Leukaemia Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

174

Table 5.27.2.1: Myeloid Leukaemia Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

176

Table 5.27.2.2: Myeloid Leukaemia Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

176

viii

LIST OF TABLES Page

Table 5.27.1: Leukaemia Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

171

Table 5.27.2: Leukaemia Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

171

Table 5.27.1.1: Lymphatic Leukaemia Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

174

Table 5.27.1.2: Lymphatic Leukaemia Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

174

Table 5.27.2.1: Myeloid Leukaemia Cancer Incidence per 100,000 population (CR) and Age-standardized incidence (ASR), by sex and ethnicity, Peninsular Malaysia 2003-2005

176

Table 5.27.2.2: Myeloid Leukaemia Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

176

2003-2005

ixCONTENTS

LIST OF FIGURES Page

Figure 2.2.1: Age and sex distribution of the population of Peninsular Malaysia 2004 22

Figure 2.2.2: Ethnicity in Peninsular Malaysia, 2004 22

Figure 2.5.1: Most common causes of death in Malaysia government hospitals, 2003-2005

24

Figure 3.1: Flow Chart for Overall Operations of the NCR 25

Figure 3.2: Flow Chart for Receiving data 27

Figure 3.3: Flow Chart for Data Management Process 28Figure 4.2: Ten most frequent cancers, Peninsular Malaysia 2003-2005 40

Figure 4.2.1(a): Ten most frequent cancers in males, Peninsular Malaysia 2003-2005 40

Figure 4.2.1(b): Ten most frequent cancers in females, Peninsular Malaysia 2003-2005 40

Figure 4.3.1(a): Ten most frequent cancers in males by ethnic groups, Peninsular Malaysia 2003-2005

43

Figure 4.3.1(b): Ten most frequent cancers in females by ethnic groups, Peninsular Malaysia 2003-2005

44

Figure 4.4.1(a): Ten most frequent cancers in males by age groups, Peninsular Malaysia 2003-2005

45

Figure 4.4.1(b): Ten most frequent cancers in females by age groups, Peninsular Malaysia 2003-2005

46

Figure 5.1.1: Tongue Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

62

Figure 5.1.2: Tongue International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

63

Figure 5.2.1: Salivary Gland Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

65

Figure 5.2.2: Salivary Gland International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

66

Figure 5.3.1: Mouth Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

68

Figure 5.3.2: Mouth International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

70

Figure 5.4.1: Nasopharynx Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

72

Figure 5.4.2: Nasopharynx International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

73

Figure 5.5.1: Oesophagus Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

78

Figure 5.5.2: Oesophagus International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

79

Figure 5.6.1: Stomach Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

81

Figure 5.6.2: Stomach International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

82

Figure 5.7.1: Large Bowel Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

84

2003-2005

x CONTENTS


Figure 5.7.2: Large Bowel International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

86

Figure 5.8.1: Liver Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

88

Figure 5.8.2: Liver International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

89

Figure 5.9.1: Gallbladder Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

91

Figure 5.9.2: Gallbladder International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

92

Figure 5.10.1: Pancreas Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

94

Figure 5.10.2: Pancreas International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

95

Figure 5.11.1: Nose and Sinuses Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

100

Figure 5.11.2: Nose and Sinuses International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

102

Figure 5.12.1: Larynx Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

104

Figure 5.12.2: Larynx International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

105

Figure 5.13.1: Lung Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

107

Figure 5.13.2: Lung International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

108

Figure 5.14.1: Bone Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

112

Figure 5.14.2: Bone International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

114

Figure 5.15.1: Other Skin Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

118

Figure 5.15.2: Other Skin International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

119

Figure 5.16.1: Melanoma Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

121

Figure 5.16.2: Melanoma International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

122

Figure 5.17.1: Female Breast Age specific Cancer Incidence per 100,000 population, Peninsular Malaysia 2003-2005

127

Figure 5.17.2: Female Breast International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

127

Figure 5.18.1: Cervix Uteri Age specific Cancer Incidence per 100,000 population, Peninsular Malaysia 2003-2005

132

Figure 5.18.2: Cervix Uteri International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

133

2003-2005

x�CONTENTS

xi


Figure 5.19.1: Corpus Uteri Age specific Cancer Incidence per 100,000 population, Peninsular Malaysia 2003-2005

135

Figure 5.19.2: Corpus Uteri International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

136

Figure 5.20.1: Ovary Age specific Cancer Incidence per 100,000 population, Peninsular Malaysia 2003-2005

138

Figure 5.20.2: Ovary International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

138

Figure 5.21.1: Prostate Age specific Cancer Incidence per 100,000 population, Peninsular Malaysia 2003-2005

144

Figure 5.21.2: Prostate International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

144

Figure 5.22.1: Bladder Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

146

Figure 5.22.2: Bladder International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

147

Figure 5.23.1: Kidney and Other Urinary Organs Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

150

Figure 5.23.2: Kidney and Other Urinary Organs Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

150

Figure 5.24.1: Brain and Other Nervous System Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

155

Figure 5.24.2: Brain and Other Nervous System International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

155

Figure 5.25.1: Thyroid Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

157

Figure 5.25.2: Thyroid International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

158

Figure 5.26.1: Lymphoma Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

162

Figure 5.26.1.1: Hodgkin Lymphoma Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

164

Figure 5.26.1.2: Hodgkin Lymphoma International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

165

Figure 5.26.2.1: Non Hodgkin Lymphoma Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

166

Figure 5.26.2.2: Non Hodgkin Lymphoma International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

167

Figure: 5.27.1 Leukaemia Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

172

Figure: 5.27.2 Leukaemia International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

173

xi


Figure 5.19.1: Corpus Uteri Age specific Cancer Incidence per 100,000 population, Peninsular Malaysia 2003-2005

135

Figure 5.19.2: Corpus Uteri International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

136

Figure 5.20.1: Ovary Age specific Cancer Incidence per 100,000 population, Peninsular Malaysia 2003-2005

138

Figure 5.20.2: Ovary International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

138

Figure 5.21.1: Prostate Age specific Cancer Incidence per 100,000 population, Peninsular Malaysia 2003-2005

144

Figure 5.21.2: Prostate International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

144

Figure 5.22.1: Bladder Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

146

Figure 5.22.2: Bladder International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

147

Figure 5.23.1: Kidney and Other Urinary Organs Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

150

Figure 5.23.2: Kidney and Other Urinary Organs Age specific Cancer Incidence per 100,000 population, by ethnicity and sex, Peninsular Malaysia 2003-2005

150

Figure 5.24.1: Brain and Other Nervous System Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

155

Figure 5.24.2: Brain and Other Nervous System International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

155

Figure 5.25.1: Thyroid Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

157

Figure 5.25.2: Thyroid International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

158

Figure 5.26.1: Lymphoma Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

162

Figure 5.26.1.1: Hodgkin Lymphoma Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

164

Figure 5.26.1.2: Hodgkin Lymphoma International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

165

Figure 5.26.2.1: Non Hodgkin Lymphoma Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

166

Figure 5.26.2.2: Non Hodgkin Lymphoma International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

167

Figure: 5.27.1 Leukaemia Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

172

Figure: 5.27.2 Leukaemia International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

173

2003-2005

x�� CONTENTS

xii


Figure 5.27.1.1: Lymphatic Leukaemia Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

175

Figure: 2.27.1.2: Lymphoid Leukaemia International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

175

Figure 5.27.2.1: Myeloid Leukaemia Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

177

Figure: 2.27.2.2: Myeloid Leukaemia International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

178

xii


Figure 5.27.1.1: Lymphatic Leukaemia Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

175

Figure: 2.27.1.2: Lymphoid Leukaemia International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

175

Figure 5.27.2.1: Myeloid Leukaemia Age specific Cancer Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

177

Figure: 2.27.2.2: Myeloid Leukaemia International comparisons – Age-standardized Incidence per 100,000 population by sex, Peninsular Malaysia 2003-2005

178

2003-2005

x��ABBREVIATIONS

xiii

Abbreviations

ASR Age-standardized Incidence Rate

CR Crude Incidence Rate

CRC Clinical Research Centre

CRU Cancer Registry Unit

CumR Cumulative Risk

HMIS Hospital Management Information System

IACR International Association of Cancer Registry

IARC International Agency for Cancer Research

IC Identification Card

ICD International Classification of Disease, WHO

ICD -10 International Classification of Diseases 10th Edition

ICD-O International Classification of Disease for Oncology, WHO

MOH Ministry of Health, Malaysia

NCR National Cancer Registry

QC Quality Control

SDP Source Data Provider or Producer

SOP Standard Operating Procedure

USA United States of America

WHO World Health Organization

NSCLC Non Small Cell Lung Carcinoma

xiii

Abbreviations

ASR Age-standardized Incidence Rate

CR Crude Incidence Rate

CRC Clinical Research Centre

CRU Cancer Registry Unit

CumR Cumulative Risk

HMIS Hospital Management Information System

IACR International Association of Cancer Registry

IARC International Agency for Cancer Research

IC Identification Card

ICD International Classification of Disease, WHO

ICD -10 International Classification of Diseases 10th Edition

ICD-O International Classification of Disease for Oncology, WHO

MOH Ministry of Health, Malaysia

NCR National Cancer Registry

QC Quality Control

SDP Source Data Provider or Producer

SOP Standard Operating Procedure

USA United States of America

WHO World Health Organization

NSCLC Non Small Cell Lung Carcinoma

2003-2005

x�v

2003-2005

1FOREWORD BY THE MINISTER OF HEALTH, MALAYSIA

2003-2005

2 FOREWORD BY THE DIRECTOR GENERAL OF HEALTH, MALAYSIA

2003-2005

�ACKNOWLEDGEMENTS

2003-2005

� NATIONAL CANCER REGISTRY PARTICIPATING CENTRES

2003-2005

�NATIONAL CANCER REGISTRY PARTICIPATING CENTRES

2003-2005

� NATIONAL CANCER REGISTRY PARTICIPATING CENTRES

2003-2005

�NATIONAL CANCER REGISTRY PARTICIPATING CENTRES

2003-2005

� ADVISORY COMMITTEE

2003-2005

�EXPERT PANEL

2003-2005

�0 EXPERT PANEL

2003-2005

��EXPERT PANEL

2003-2005

�� EXPERT PANEL

2003-2005

��EXPERT PANEL

2003-2005

�� NATIONAL CANCER REGISTRY UNIT

2003-2005

��EXECUTIVE SUMMARY

TheThirdReportoftheNCRdescribesthemorbidityburdenofcancerfrom1stJanuary2003to31stDecember2005.Thisreportismainlyadescriptivereportofthedatacollectedfortheaboveperiodtogetherwithadetailedanalysisoftopographyandmorphology,interpretationandcomparisonofthesaiddata.In 2003, 2004 and 2005, NCRreceived 42,963, 48,549 and 46,048 notifications respectively fromvarious hospitals, laboratories and clinics, both public and private, making a total of 137,560notifications. This report includes 75,735 incident cases from the whole of Malaysia with 67,792incidentcasesreportedfromPeninsularMalaysia.This report has the advantage of a large source population that produces precise incidenceestimates.Asummaryofthedataforthewholecountry(PeninsularandEastMalaysia)ispresentedinTable4.1.1.However,thedetailedanalysis ispresentedforPeninsularMalaysia.Welimitedthepresentation of the detailed analyses, as the ascertainment rate for Peninsular is more confidentlydetermined. The information derived from this report is representative of the cancer burden toMalaysianslivinginPeninsularMalaysia.In this report, comparisons between groups within and outside the country were based on AgeSpecificRatesinordertoovercomethepossibleextraneouseffectofdifferencesinagecompositionofthevariousgroups.Femalebreast cancer ispresentedon itsownas in previous reportswhilenoting thatmalebreastcancer contributeda further257cases.The figures forbonecancer, livercancerandbrain cancerwerecomparabletointernationalfigures,thusreflectingthequalityoftheexpertinput,asmetastasestothesesiteswereconsciouslyexcludedfrombeingreportedasprimarytumoursfromthesesites.Themaincontributorsof thedata, theSourceDataProviders (SDP)has increasedover theyears.ThetotalnumberofactiveSDPsincreasedfrom141in2002to193in2005.However,somecancersmay still be underreported even though the numbers of SDPs had been increased to includeradiologists,chestphysicians,surgeons,gastroenterologists.A totalof 67,792newcancers caseswerediagnosedamongMalaysians inPeninsularMalaysia intheyears20032005,comprising29,596males (43.7%)and38,196 females (56.3%).Theannualcruderateformaleswas100.2per100,000populationand132.1per100,000forfemales;whereasthe age standardized incidence rate for all cancers was 136.9 per 100,000 males, and 156.4 per100,000females.In comparison with the second NCR report for 2003, the figures for this report were similar. Forinstance,ethnicvariationsweresimilartotheNCRSecondReport2003.Overall,thisreportshowedthattheChinesepopulationhadthehighestCRof174.1per100,000malesand218.1per100,000females. This was followed by the Indians who had CR of 89.6 per 100,000 males and 150.7 per100,000 females. The Malays had relatively lower CR of 60.2 per 100,000 males and 82.6 per100,000females.A similar ethnic variation was seen in the Penang Cancer Registry Report 1999 2003. In thePenangReport,theChinesehadaCRof169.2per100,000malesand217.7per100,000females;followedbytheIndianswithaCRof85.7per100,000malesand147.2per100,000females;withtheMalayshavingaCRof60.6per100,000malesand79.0per100,000females.In this report, the cumulative lifetime risk forMalaysians in Peninsular Malaysiadeveloping cancerwas14.8%formalesand15.9%forfemales.Thistranslatestoanestimatedriskof1in7males,and1in6femalesdevelopingcancerintheirlifetime.

2003-2005

�� EXECUTIVE SUMMARY

16

In this third report, cancers from the colon and rectum are grouped together as coming from onecancer site. This is to standardize the report for comparison to other national and internationalreports.Themostfrequentcancer inMalaysianswasbreastcancer(18.0%)followedby largebowelcancer(11.9%)andlungcancer(7.4%).ThetenmostfrequentcancersinmalesandfemalesarepresentedinFigures4.2.1(a)and4.2.1(b)andtheaccompanyingtables.Amongst males, large bowel cancer (14.5%; ASR20.9)was the most frequent cancer followed bycancersof the lung (12.2%;ASR18.1),nasopharynx (7.8%;ASR9.2),prostate (7.3%;ASR12.0),leukaemia (6.5%;ASR7.0)and lymphoma (6.2%;ASR7.7). In females, themost frequent cancerwas breast cancer (31.3%; ASR 47.4), followed by cancers of the cervix uteri (10.6%; ASR 16.1),largebowel(9.9%;ASR16.8),ovary(4.3%;ASR6.4), leukaemia(3.7%;ASR5.2)and lung(3.6%;ASR6.2).Generally, the incidence of cancers was reported more in males than females in most countries.However themale to female (M:F) sex ratio in this reportwas1: 1.3.A similar trendwasnoted inearlierNCRreports.Consistentwithotherregionalregistries,therewaspredominanceoffemalestomalesincancersofthethyroidasseenbyaM:Fratioof1:3.ThevariationofthetenmostfrequentcancerincidencebysexandmajorethnicgroupsisshowninFigure 4.3.1(a) and 4.3.1(b) and the accompanying tables. Overall, this report showed that theChinesehadsignificantlyhigherASRper100,000populationof182.9(males)and201.5(females),comparedwith the Indians (ASRof134.4 inmalesand186.3 in females)and theMalays (ASRof89.6 in males and 106.4 in females). The following estimates of cancers are presented as aproportiontothetotalsubgroupandasanASRper100,000populationforcomparisonpuposes.AmongstMalaymales,largebowelcancer(12.6%;ASR12.3)wasthemostcommoncancerfollowedby leukaemia (11.2%; ASR 7.2), lung cancer (11.1%; ASR 11.2), lymphoma (9.0%; ASR 7.4) andprostatecancer(6.6%;ASR7.7).Large bowel cancer was also the leading cause of cancer in Chinese males (16.9%; ASR 31.5)followedbycancersofthelung(14.2%;ASR26.8),nasopharynx(10.7%;ASR17.0),prostate(7.8%;ASR15.8)andstomach(5.9%;ASR11.3).In Indian males, the most frequent cancers were large bowel (11.5%; ASR 15.7), prostate (8.7%;ASR14.8),stomach(8.0%;ASR11.9),lung(7.0%;ASR9.9)andlymphoma(6.4%;ASR6.9)The most frequent cancers for Malay females are cancers of the breast (33.6%; ASR 34.9), largebowel(8.2%;ASR9.7),cervixuteri(8.1%;ASR8.7),Leukaemia(6.0%;ASR5.3)andovary(5.0%;ASR5.2).In theChinese females, themost frequentcancerswerecancersof thebreast (30.3%;ASR59.9),largebowel(12.8%;ASR26.2),cervixuteri(11.8%;ASR23.2),lung(5.1%;ASR10.6)andstomach(3.8%;ASR7.7).AmongsttheIndianfemalesbreastcancer(31.2%;ASR54.2)wasfollowedbycancersofthecervixuteri(8.8%;ASR16.4),mouth(6.5%;ASR14.5),largebowel(6.3%;ASR12.9)andcorpusuteri(4.0%;ASR8.0).

2003-2005

��EXECUTIVE SUMMARY

For most tumour sites, Chinese had the highest ASR except for the following cancers: lymphoma(ASR highest in Malay males and females); lymphatic leukemia (ASR highest in Malay and Indianmales,andMalayfemales);myeloidleukemia(ASRhighest inMalaymales,Indianfemales); larynx(highestinIndianmalesandfemales);mouth(highestinIndianmalesandfemales);tongue(highestin Indianmalesand females);oesophagus (highest in Indianmalesand females);bone (highest inIndianfemales);corpusuteri(highestinIndianfemales);brainandnervoussystem(highestinIndianfemales),thyroid(highestinMalaymales).In tumour sites not mentioned in the previous paragraph, Malays had the lowest ASR among themajorethnicgroups.Forstomachcancer,Malaymalesand femaleshadan incidencemuch lowerthantheothermajorethnicgroups.Inthemouth,Chinesehadthe lowestamongfemales,althoughamongmalestheMalayshadthelowestASR.InNasopharyngealcancer,IndianmalesandfemaleshadthelowestASR.Theother surprising finding in this reportwas thehigh ranking of leukemiaamongstMalay Males.However,thiswasconsistentwiththeKelantanCancerRegistryReport19992003wherebyleukemiawas the third most frequent cancer among all Males, and second highest among Malay Males.Bycontrast, in the Penang Cancer Registry 19992003, leukemia featured eighth among males andeighthamongfemales.An unexpected finding is that prostate cancer was the secondmost common cancer in Indianmales.ProstatecancerrankedfourthamongmalecancersinMalaysia.Interestingly,theagespecificincidencerateinChinese(ASR15.8)andIndians(ASR14.8)inMalaysiawerehigherthanthoseinTaiwan(ASR11.9),HongKong(ASR8.6)andMumbai(ASR7.4).ThisfindingforMalaysianIndianmales could be due to chance variation in a smaller sample compared to the other major ethnicgroups.However, inSingapore Indians, thenumbersof cases reported for lungandprostatewerevery close (68and65 respectively),with the ASR for these twoorgansbeing 10.0and9.9 in thispopulation inSingapore.TheASRforprostatecancer inMalaysianIndians(14.8per100,000)washigher than that reported for Indians in the Singapore Cancer Registry and various other IndianCancerRegistries.ThevariationincancerincidencebyageandsexispresentedinFigures4.4.1(a)and4.4.1(b)andindetailintheaccompanyingtable.ThefollowingestimatesofcancersarepresentedasaproportiontothetotalsubgroupandasCRper100,000populationforcomparison.Themostfrequentcancersinmalechildrenchildren(014years)wereleukaemias(47.6%,CR7.7),braincancers (11.2%,CR1.8), lymphomas(9.5%,CR1.5),cancerofkidneys(3.9%,;CR0.6)andthebones(3.7%;CR0.6).Similarly, in female children aged 014 years, the most frequent cancers are leukemia(45.4%; CR5.8),brain(13.3%;CR1.7),lymphoma(6.2%,CR0.8),bones(4.3%;CR0.5)andkidneys(3.6%;CR0.5).In the age group of young male adults (1549 years old), the common cancers were nasopharynx(15.9%;CR7.7), largebowel (10.7%,CR5.2), lymphomas (9.6%;CR4.7), leukaemias (9.2%;CR4.4)andlung(6.6%;CR3.2).Inwomenaged1549years,thecommoncancerswerebreast(39.1%;CR37.8),cervixuteri(13.5%;CR13.1),largebowel(5.4%;CR5.3),ovary(5.2%;CR5.1)andthyroid(4.9%;CR4.7).In older subjects (50 69 years), cancers of the large bowel (16.6%; CR 63.4), lung (15.4%; CR58.7), prostate (7.2%; CR 27.3), nasopharynx (7.1%; CR 27.2) and lymphoma (5.3%; CR 20.0)predominatedinmen.Whereasthemostfrequentcancerinwomenaged5069werebreast(31.9%,CR149.3), largebowel(11.1%;CR52.0),cervixuteri (10.1%;CR47.1), lung(4.5%;CR20.9)andcorpusuteri(4.5%;CR20.9).

2003-2005

�� EXECUTIVE SUMMARY

18

Intheoldestgroup(aged≥70years),themostcommoncancersinmenwerelargebowel(17.4%:CR177.2),prostate(16.5%:CR167.7), lung(14.6%:CR147.6),stomach(7.3%:CR74.4)andbladder(5.3%: CR 54.3). While in women aged ≥ 70 years, the most frequent cancers were large bowel(20.0%;CR133.7),breast (15.7%;CR105.1), cervixuteri (6.9%;CR46.2), lung (6.6%;CR44.2),stomach(6.3%;CR42.5).

2003-2005

��NATIONAL CANCER REGISTRY

TheMalaysianNationalCancerRegistry(NCR)isaservicesupportedbyMinistryofHealth,Malaysia(MOH)tocollectinformationaboutcancerincidenceinMalaysia.Thisinformationisvitalinplanningandevaluationofcancerservicesbythegovernementalagencies,NonGovernementalOrganizations(NGO),privateprovidersandtheindustry.InNovember2001,theHonorableMinisterofHealthMalaysiadirectedtheClinicalResearchCentre(CRC) to establishaNationalCancerRegistry (NCR).Following thisdirective, theNCR’sSponsorGroupwasformed.ThemembershipcomprisedofOncologist,Pathologist,Haematologist,PaediatricOncologist,HeadoftheCancerResearchCentreintheInstituteofMedicalResearch,DirectoroftheDiseaseControlDivisionand theDirectorof theMedicalDevelopmentDivision. InApril 2002, theNCR obtained approval from the Director General of Health to setup its operations and wassubsequentlyawardedaMedicalResearchGrantgrantinJune2002bytheDeputyDirectorGeneralofHealth(Research&TechSupport).Administratively, the NCR began as one of the seven clinical registries under the umbrella of theClinicalResearchCentre,MinistryofHealth. In2005,astheregistry ‘matured’ theadministrationofthe registry was handed over to the Department of Radiotherapy and Oncology, Hospital KualaLumpur. In response to the call by the Director General of Health for a single Cancer Registry inMalaysia,theDivisionofPublicHealth(DPH)hastakenoverthemanagementoftheNCRfrom2007onwards.This is timelyas theDPH is in themidstofexpanding itscancer registrationsystematanationallevel.Itishopedthatwithasinglemanagementsystem,theregionalregistriesalongwiththenational registry would be able to produce national data more effectively and efficiently. This willprovidethemuchneededimpetusforfurtherdevelopmentofcancerprogrammesandinitiatives.TheobjectivesofNationalCancerRegistryareto:1. Determine the disease burden attributable to cancer by quantifying the magnitude of cancer morbidityandmortality,anditsgeographicandtemporaltrendsinMalaysia.2. Identify subgroups in the population at high risk of cancer to whom cancer prevention effort shouldbetargeted.3. Stimulate and facilitate epidemiological research on cancer with respect to cancer etiology, diagnosisandprognosis.4. Evaluatecancertreatment,controlandpreventionprogramme.TheNCRreceiveddatavoluntarilyoncancerincidencemainlyfromindividualdoctorswhoprovidedcancer diagnostic services or who cared for cancer patients. Information on cancer incidence wasalsoextractedusingthetheMinistryofHealth’sHospitalInformationSystem.

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20

ThedaytodayoperationsoftheNCRcanbecategorizedastwoessentialcomponents:a. These are the daytoday administration, site and data management operationsofaRegistry.Itentailsgeneraladministrationoftheregistry,initiatingandmaintaining siteparticipationintheregistry,dataacquisition,datastorage,dataprocessing(datatransmittal, review,coding,cleaning,query, reconciling, transferringandarchiving),dataqualityassurance, andperiodicsitemonitoringandretraining.b. Anelectronicdatabaseserverwasusedtostorethedataand a database application was used to automate most of the work processes involved in data management. Thedatabasemanagement system required routineadministration,maintenance andcontinuingdevelopmentandenhancementtomeetthedynamicneedsofthisregistry.Oncology,HaematologyandPathologyservices,MOH

DivisionofDiseaseControl,PublicHealthDepartment,MOH

MedicalDevelopmentDivision,MOH

CancerResearchCentre,InstituteforMedicalResearch,MOH

ClinicalResearchCentre,HospitalKualaLumpur,MOH

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��MALAYSIA AND ITS POPULATION

MalaysiaislocatedintheSouthEastAsianregionandcoversanareaof329,961km2.ItsharesitsborderswithSingapore,Thailand,IndonesiaandBrunei.TheSouthChinaSeaseparatesWestandEast Malaysia; West Malaysia being a peninsular region of the Asian Continent whereas EastMalaysia is located on the Island of Borneo. There are a total of 13 states and three FederalTerritoriesasfollows:

PeninsularMalaysia NorthernRegion:Perlis,Kedah,Penang,Perak EastCoastRegion:Kelantan,Terengganu,Pahang CentralRegion:Selangor,FederalTerritoryofKualaLumpurandFederalTerritoryof

Putrajaya SouthernRegion:NegeriSembilan,Malacca,Johor

EastMalaysia Sarawak Sabah FederalTerritoryofLabuan

Malaysia enjoys an equatorial climate. It is hot and humid throughout the year with an averagetemperatureof27oCandanannualrainfallthatexceeds2000mm.Therainyseasonsareinfluencedbythemonsoontradewinds.

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�� MALAYSIA AND ITS POPULATION

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TheagedistributionofMalysia isdynamicover the years and the country currently experiences ahighbirthratewithadeclineofthedeathrates.Theagepyramidstillhasalargebasebuttheelderlyproportion is increasing. The age and sex distribution of the population of Peninsular Malaysia isshowninFigure2.2.1.Malaysiaisamultiethniccountry,withtheMalaysbeingthemajorityfollowedbytheChinese,Indians,IndigenousgroupsandOrangAsli.AgraphicalrepresentationoftheethnicdistributioninPeninsularMalaysiaisshowninFigure2.2.2.

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��MALAYSIA AND ITS POPULATION

Thisreportcoversincidentcancercasesfrom2003to2005.Thustheage,sexandethnicdistributionin 2004 can be used to represent the average age, sex and ethnic distribution of the study base(averagedistributionofthedenominatorusedforincidentratecalculation).ThetotalpopulationofPeninsularMalaysiain2004was19.5millionwhichconsistedof9.84million(50.5%)malesand9.64million(49.5%)females.Therewere12.0million(61.5%)Malays,5.2million(26.7%)Chineseand1.8million(9.2%)Indians.

04 799,100 753,300 231,900 214,800 93,000 89,600 1,158,700 1,089,500 12,00059 743,100 700,000 240,200 221,100 91,800 88,500 1,105,000 1,037,900 10,000

1014 707,300 669,600 227,000 207,300 8,600 82,900 1,044,400 983,600 9,0001519 658,600 637,600 228,900 213,700 87,400 83,300 996,500 957,500 9,0002024 566,500 559,000 216,700 206,300 81,700 79,800 886,300 866,400 8,0002529 433,800 442,000 205,400 197,100 73,600 75,400 737,900 736,000 8,0003034 384,100 396,200 200,600 194,600 69,600 72,000 676,400 682,100 6,0003539 376,900 387,400 200,400 196,700 67,300 68,900 659,200 668,200 6,0004044 339,400 346,100 192,500 187,500 62,300 63,800 604,300 608,800 6,0004549 300,600 299,700 182,100 173,400 56,900 58,100 548,800 539,200 6,0005054 243,700 240,800 158,700 148,600 45,300 46,300 454,200 441,500 5,0005559 171,400 167,600 124,500 113,300 28,700 29,200 329,000 314,300 4,0006064 124,000 125,500 96,400 89,900 19,500 20,900 242,900 239,300 4,0006569 88,000 99,800 68,800 70,800 13,500 17,000 172,400 189,700 3,0007074 55,500 67,100 44,200 49,800 8,100 10,800 109,200 129,200 2,000

75+ 63,500 79,900 41,800 63,400 8,900 10,200 116,300 155,300 2,000

Infrastructure such as roads, public transportation and telecommunication in Malaysia are welldeveloped.Thereisgoodcoverageforelectricityandwatercoverage.ThemainoccupationsinMalaysiaof2004areshownin Legislators,seniorofficialsandmanagers 8.6%Professionals 5.6%Techniciansandassociateprofessionals 12.1%Clericalworkers 9.3%Serviceworkersandshopandmarketsalesworkers 14.8%Skilledagriculturalandfisheryworkers 13.2%Craftandrelatedtradeworkers 11.7%Plantandmachineoperatorsandassemblers 14.1%Elementaryoccupations 10.7%

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�� MALAYSIA AND ITS POPULATION

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Since independence, the health status of Malaysia has been enhanced by improved socioeconomicalstatus,healthinfrastructureandservices.Thefollowingstatisticsarepresentedfor2004unlessstatedotherwiseasitrepresentsanaverageofthe20032005period.Lifeexpectancyatbirthwas70.4yearsand76.2yearsinMalaysianmalesandfemalesrespectively.InfantMortalityRatewas5.9per1000livebirthswhereasMaternalMortalityRatewas0.3per1000livebirths (Table2.5.1).Thedoctor topopulation ratiowas1:1402and therewere119governmenthospitals, 6 nonMOH government hospitals, 218 private hospitals, 859 MOH health clinics, 1924MOH rural clinics, 93 MOH maternal and child health clinics, 165 mobile clinics and 1969 dentalclinics.Governmenthospitalsandprivatehospitalsprovided28,966and10,542bedsrespectively.

Perinatalmortalityrate* 6.8Maternalmortalityrate* 0.3Infantmortalityrate* 5.9Neonatalmortalityrate* 3.8*Per1000livebirths

WithMalaysiansenjoyingbetterhealthstatuscurrentlycomparedwiththeirpredecessors,itwasthennosurprise thatmalignantneoplasmrankedamong its top five causesofdeath in theyears20032005.

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��METHODS

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125FEMALE BREAST

* Editorial Note: Singapore estimates in the above write-up are based on Singapore Cancer Registry ReportNo. 6, Trends In Cancer Incidence in Singapore 1968-2002 (Reference 10); whereas Singapore estimates for Figure 5.17.2 are based on Cancer Incidence in Five Continents (Reference 4).

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179REFERENCES

REFERENCES

1) First Report of the National Cancer Registry. Cancer Incidence in Malaysia 2002. Lim,GCC and Halimah, Y. National Cancer Registry. Kuala Lumpur 2003.

2) 2nd Report of the National Cancer Registry. Cancer Incidence in Malaysia 2003. Lim,GCC and Halimah, Y. National Cancer Registry. Kuala Lumpur 2004.

3) International Classification of Diseases for Oncology 3rd edition. Fritz. A., Percy. C., Jack. A., Shanmugaratnam, K., Sobin, L., Parkin, D. M. and Whelan, S. World Health Organization, Geneva, 2000.

4) Cancer Incidence in Five Continents Volumes I to VIII. Parkin, D.M., Whelan, S.L., Ferlay, J. and Storm, H. IARC CancerBase No 7, Lyon, 2005.

5) Malaysia, Year Book of Statistics 2006. Department of Statistics, Malaysia, 2006.

6) Health Facts 2002. Planning and Development Division (Information and Documentation System Unit), Ministry of Health Malaysia, 2004.




10)

11) Penang Cancer Report 1999-2003. Bina Rai, S., Devaraj, T., Aishah, K., Rokiah, M. and Nor Asikin, A.K. Penang Cancer Registry, 2005.

12) Kelantan Cancer Registry Report 1999-2003. Fauziah, M.N., Hamizah, M.S., Norazmi, A., and Lila, P.M.M. Kelantan Cancer Registry, 2006.

13) Epidemiology of Cancer in Sarawak 1996-2000. Ooi, CH., Kiyu, A., Yao, SK., Helli, B., Mastulu, W. and Assan, J. Sarawak Cancer Registry, Sarawak Health Department, Sarawak. 2005.

Trends In Cancer Incidence in Singapore 1968-2002. A Seow, W P Koh, K S Chia,L M Shi, H P Lee, K Shanmugaratnam (editors). Singapore Cancer Registry ReportNo. 6. Singapore Cancer Registry, 2004.

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cancer incidence in peninsular malaysia 2003

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