national cancer registry past, present and future

National Cancer RegistryPast, Present and FuturePresented by:Ali Shamseddine, MD.Professor, Head Hematology Oncology AUBVP /NCR

History of Cancer RegistrationThe first systematic collection of information on cancer was in 1728 in the general census of cancer in London.The first reliable cancer statistics appeared in mortality figures for the city of Verona in 1842.The International Association of Cancer Registries (IACR) was formed in 1966.

Population-based cancer registries world-wide

Cancer registry (CR)Aim: Systematic collection, storage, analysis, interpretation, and reporting of data on subjects with cancer

Types:Hospital-based CRPopulation-based CR

Hospital-based CRRecord information on new cancer patients seen in a particular hospital

Objective: To contribute to patient care by providing readily accessible information on the subjects with cancer, the treatment they received & the results

Population-based CRSeek to collect data on all new cases occurring in a well defined population.Objective:-Produce statistics on the occurrence of cancer in a defined population (Incidence, prevalence, CFR)-Provide a framework for assessing and controlling the impact of cancer in the community

The Lebanese National Cancer Registry The Past (before 1998)

The idea of establishing a National Cancer Registry started in the 1970 Other registries in the Arab world at that time: Kuwait, Egypt, IraqMeanwhile efforts started to establish hospital-based cancer registries

National Based StudiesThe only national-based study was that of Abou Daoud in 1966.Pathology Reports of 8 Medical Institutions in Lebanon (1year from 01/08/1964-31/07/1965):Sample Size: 1,950 cases (1,507 Lebanese, 443 Non-Lebanese)Results: Males: Skin (17.0%), Bladder (9.1%), Lung (7.1%), Larynx (5.7%)Females: Breast (16.4%), Cervix and Uterine (14.1%), Skin (10.7%)Cancer Incidence Rates: 74.9 per 100,000 for males75.6 per 100,000 for femalesAdjusted Crude Incidence Rates:102.8 per 100,000 for males104.1 per 100,000 for femalesAbou Daoud KT; Cancer; 19: 1293-1300, 1966.

Lebanese Hospital-based CRAUBMC1970: Founded (Drs. Kamal Bikhazi and Elizabeth Morton)1971: Dr. Philip Salem appointed as first AUBMC tumor registry head.1983: Reactivated (Dr. Ghaleb Saab)

1984: HDF (Drs. Najib Taleb and Edgard Gedeon)

Hospital Based Studies

Mir Amin Meeting, 1994--- special committee was set up to create a NCR under the auspices of MOPHThis committee met for about 5 years without any practical results.

The Lebanese National Cancer Registry

The Present (1998-2008)

1998 : The establishment of the LCEG2001: The Italian Cooperation signed an agreement with the Ministry of Public Health (MOPH) of Lebanon to fund in 2002 activities leading to a National Cancer Registry in Lebanon. Report 2002: The report 2002 was supported by the NCDP and MOPHReport 2003: Funded and supported by LSMO and the Italian Cooperation under the umbrella of MOPH.2005: NCR oversight committee.2008: Reports 2003(Revised) and 2004,collection of 2005,2006 and 2007 data.

Overview

The Lebanese Cancer Epidemiology Group (LCEG)Founded in 1998A network of all hospitals with oncology specialists and all pathology laboratories.To study cancer caseload and to estimate incidence rates at the national level.All cases diagnosed in the year 1993, and for each 5-year interval thereafter, are registered.

The Lebanese Cancer Epidemiology GroupFifteen Hospitals: American University of Beirut-Medical Center Hotel-Dieu de France University HospitalSt George University HospitalHammoud HospitalHopital LibanaisHopital Notred-Same des Secours Khoury General HospitalMakassed HoapitalMiddle-East HospiatlRizk HospitalSacre-Coeur HospitalSt Geaorge HospitalSahel HospitalZahraa HospitalBarbir Hospital

Pathology Laboratories:Dr. Albert AounDr. Fady AssiDr. Akram El-AhadabDr. Mouin Soussi

Cancer incidence in postwar Lebanon: The first population-based estimates, 1993 and 1998. Shamseddine et al. Annals of Epidemiology, 2004 (1998 data)

The Lebanese Cancer Epidemiology Group

Findings were based on 2856 and 4388 incident cases reported and registered in Lebanon in the year 1998 and 1993 respectively.Crude and age-standardized rates (ASRs) per 100,000 population were calculated and results were contrasted with estimates from developed and developing countries in the region.Crude Incidence Rates (1993-1998)

The ten leading sites of cancer cases, Lebanon, 1993 and 1998

1993

1998

Male (n=1469)

Female (n=1387)

Male (n=2296)

Female (n=2092)

Bladder (18.6%)

Lung (15.0%)

Prostate (9.7%)

Colo-rectal (8.7%)

Larynx (7.0%)

Stomach (4.6%)

Non-Hodgkins (3.8%)

Brain & nervous sytem (3.7%)

Oro-pharyngeal (3.4%)

Kidney & urinary tract (3.3%)

Breast (38.6%)

Colo-rectal (6.8%)

Corpus uteri (6.6%)

Ovary (4.8%)

Cervix uteri (4.6%)

Stomach (4.5%)

Lung (3.2%)

Bladder (3.1%)

Brain & nervous system (2.8%)

Non-Hodgkins (2.5%)

Bladder (18.5%)

Prostate (14.2%)*

Lung (14.1%)

Colo-rectal (8.0%)

Stomach (5.1%)

Larynx (4.8%)


Kidney & urinary tract (2.7%)

Non-Hodgkins (2.7%)

Oro-pharyngeal (2.6%)

Breast (33.4%)

Colo-rectal (8.7%)

Corpus uteri (4.8%)

Ovary (4.3%)

Bladder (4.3%)

Lung (4.3%)

Cervix uteri (4.2%)


Stomach (3.6%)

Thyroid (3.3%)

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Crude incidence and age-specific incidence Males

Table 3

TABLE III- AGE STANDARDIZED INCIDENCE RATES DIRECTLY ADJUSTED TO THE WORLD STANDARD POPULATION PER 100,000 FOR SELECTED CANCER SITES IN LEBANON COMPARED TO

SELECTED POPULATIONS FROM DEVELOPING AND DEVELOPED COUNTRIES

LebanonAlgeria1Brazil 1Kuwait 1Israel1France 1UK 1USA, SEER1

MalesPercentFemalesPercent(1990-1993)(1982-1986)(1988-1989, 1992-1993)(1988-1992)(1983-1987)(1988-1990)(1988-1992)

Site19931998change19931998changeMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemaleMaleFemale

Oro-pharyngeal3.03.413.31.51.66.7______________

Esophagus0.91.011.10.10.6500.01.20.36.31.51.72.51.71.116.31.27.63.54.51.2

Stomach4.66.439.14.34.0-7.014.43.542.016.04.14.8136.212.24.916.16.37.53.1

Colon5.16.119.62.86.7139.30.40.64.53.93.54.824.919.930.218.819.315.628.120.8

Rectum4.14.10.03.23.59.42.62.32.84.73.91.914.411.419.08.914.68.114.38.7

Liver1.42.578.61.51.66.75.12.20.70.57.33.53.21.613.12.12.01.03.01.2

Gall bladder0.91.344.41.01.220.03.610.21.73.11.91.41.52.42.22.71.21.21.41.7

Pancreas1.11.754.51.11.318.21.80.75.52.24.83.57.25.76.93.87.45.37.75.7

Larynx7.56.5-13.30.80.912.55.70.28.70.52.50.94.70.711.60.64.50.86.31.4

Lung15.718.719.12.85.182.128.12.928.67.220.39.227.09.267.47.262.422.861.333.8

Bone1.83.172.21.62.131.32.00.72.61.50.70.81.41.01.20.81.00.71.00.8

Connective tissue2.52.916.01.52.780.00.40.41.920.80.92.82.21.91.71.91.52.41.7

Melanoma of skin0.41.1175.00.30.433.30.10.11.40.90.40.39.59.86.67.84.66.613.110.2

Breast0.61.066.736.238.97.50.39.50.830.20.032.81.277.41.378.80.568.80.790.7

Cervix uteri___4.24.32.4_13.9_64.8_7.6_5.3_10.0_12.5_7.5

Corpus uteri___6.06.11.7_1.2_1.9_2.4_10.8_16.1_8.6_18.2

Ovary___4.25.326.2_1.2_4.5_4.7_11.6_12.3_12.4_11.9

Prostate9.718.792.8___1.8_17.9_6.5_23.9_48.1_28.0_100.8_

Testis & male genitalia2.11.9-9.5_____1.3__________

Bladder19.223.522.43.04.343.31.80.13.01.27.02.525.15.323.14.020.35.724.06.2

Kidney & urinary tract3.63.72.81.01.880.00.40.32.31.52.11.910.45.416.17.36.93.310.85.5

Brain & nervous system3.55.557.12.54.684.01.60.63.41.83.72.95.84.25.14.06.34.57.35.1

Thyroid1.21.850.02.13.566.70.30.70.31.22.06.12.77.71.32.60.71.72.56.4

Hodgkins disease2.61.6-38.51.31.30.02.21.42.51.04.02.02.92.82.71.89.61.83.42.7

Non Hodgkins lymphoma3.63.2-11.12.22.513.66.32.74.22.15.57.112.610.412.18.33.46.316.310.1

All sites100.7128.527.690.8113.124.6107.167.4183.5177.5103.9125.8235.7239.3394.0229.3261.1225.5370.9280.9

1Abstracted from Parkin et al., 1997: Algeria (p. 72), Brazil (p. 100), Kuwait (p. 416), Israel (p. 364), France (p. 476), UK (p. 696), USA SEER (p. 316).

Tables 1 &2

TABLE I- PERCENT DISTRIBUTION OF CANCER CASES BY SITE, CRUDE AND AGE-SPECIFIC INCIDENCE RATES PER 100,000, AND MEAN AGE AT DIAGNOSIS SD (STANDARD DEVIATION)

AMONG MALES, LEBANON, 1993 and 1998

19931998

Site (ICD-O code)n%CrudeAge-specific incidence ratesAgen%CrudeAge-specific incidence ratesAge

rate0-1415-2425-3435-4445-5455-6465-7475+MeanSDrate0-1415-2425-3435-4445-5455-6465-7475+MeanSD

Oro-pharyngeal1503.43.00.40.31.34.25.88.77.023.559.815.4602.63.0001.12.86.113.314.121.660.814.2

Esophagus (150)120.80.8_____4.89.8_65.105.2170.70.9_0.3_1.11.54.43.83.157.216.2

Stomach (151)684.64.0__0.41.81415.518.230.360.812.71165.15.8_0.61.11.112.121.337.255.663.113.8

Colon (153)714.84.7_1.02.13.69.115.519.650.559.317.21114.85.7_1.20.85.09.813.329.580.362.417.5

Rectum (154)573.93.7_0.3_3.65.813.521.040.463.413.7723.13.7_0.31.52.27.69.830.818.560.715.3

Liver (155)181.21.2___1.82.56.85.63.457.211.5492.12.2__0.41.76.111.512.83.158.610.7

Gall bladder (156)141.00.9___1.2_1.98.410.166.214.3221.01.2___0.61.53.55.124.768.913.0

Pancreas (157)151.01.0__0.40.6_9.74.2_58.810.6271.21.5__0.4_1.57.110.318.565.512.4

Larynx (161)1037.06.7_0.30.42.411.539.644.723.561.310.51104.85.7___2.214.427.537.227.861.609.8

Lung (162)22015.013.90.20.7_8.531.362.8102.047.160.711.132414.116.80.20.31.98.327.281.611895.862.211.9

Bone(170)271.81.70.71.60.4_3.35.85.610.146.725.2562.43.00.83.30.83.94.56.29.515.544.422.8

Connective tissue (171)392.72.40.41.01.33.01.68.712.610.152.420.2572.52.80.81.81.53.33.05.312.815.548.722.4

Melanoma of skin1*50.30.30.20.3_1.20.8___32.016.6180.81.0_0.3_1.10.86.23.86.258.215.9

Breast (174-5)90.60.5___1.23.3_1.4_48.609.1140.60.8___0.63.83.53.8_56.409.8

Prostate (185)*1429.79.1____4.129.083.8134.670.208.632714.217.60.20.3_0.67.657.7152.7271.969.710.5

Testis & male genitalia (186-7)342.32.1_3.62.91.84.14.8_3.437.018.8391.72.00.41.55.42.2_2.72.66.236.219.8

Bladder (188)*27318.617.2_0.70.83.630.574.4132.7131.263.911.842518.521.40.20.30.89.429.576.3157.8244.165.612.1

Kidney & urinary tract (189)493.33.21.1__1.27.410.623.713.556.119.7622.73.40.40.30.82.24.516.921.812.457.616.6

Brain & nervous system (191-2)553.73.41.51.03.36.02.510.69.83.441.620.8903.95.11.81.84.65.615.111.512.86.243.319.3

Thyroid (193)191.31.0__0.80.64.93.92.8_51.411.5321.41.70.21.51.51.72.34.47.73.146.820.7

Hodgkins disease1402.72.61.82.33.332.55.81.43.433.320.3321.41.60.42.71.12.22.30.95.1_35.420.1

Non-Hodgkins1563.83.41.51.61.73.67.47.714.03.444.222.2612.72.90.80.9_3.95.311.514.16.251.519.6

All other sites1936.350.71.31.74.810.713.523.716.850.820.61757.68.22.00.93.83.912.927.525.749.453.521.3

All sites*1469100.091.79.216.121.358163.1354.5554.5558.458.117.32296100.0117.98.718.428.466.0180.1427.6735.2998.160.217.1

1Oro-pharyngeal (ICD-O codes 140-149); Skin melanoma (ICD-O code 173, histology 87203); Hodgkins lymphoma (ICD-O code 196, histology 96503-96673); Non- Hodgkins lymphoma (ICD-O code 196, histology: 96703-96673,

95900-96333, 96403-96423, 96903-96983, 97003-97093, 97103-97233, 97503); All other sites (ICD-O codes 152, 158-9, 160, 163-5, 190,194-5, 199).

* A significant difference in crude incidence rates between the years 1993 and 1998 (p-value

Table 3






Oro-pharyngeal3.03.413.31.51.66.7______________

Esophagus0.91.011.10.10.6500.01.20.36.31.51.72.51.71.116.31.27.63.54.51.2

Stomach4.66.439.14.34.0-7.014.43.542.016.04.14.8136.212.24.916.16.37.53.1

Colon5.16.119.62.86.7139.30.40.64.53.93.54.824.919.930.218.819.315.628.120.8

Rectum4.14.10.03.23.59.42.62.32.84.73.91.914.411.419.08.914.68.114.38.7

Liver1.42.578.61.51.66.75.12.20.70.57.33.53.21.613.12.12.01.03.01.2

Gall bladder0.91.344.41.01.220.03.610.21.73.11.91.41.52.42.22.71.21.21.41.7

Pancreas1.11.754.51.11.318.21.80.75.52.24.83.57.25.76.93.87.45.37.75.7

Larynx7.56.5-13.30.80.912.55.70.28.70.52.50.94.70.711.60.64.50.86.31.4

Lung15.718.719.12.85.182.128.12.928.67.220.39.227.09.267.47.262.422.861.333.8

Bone1.83.172.21.62.131.32.00.72.61.50.70.81.41.01.20.81.00.71.00.8


Melanoma of skin0.41.1175.00.30.433.30.10.11.40.90.40.39.59.86.67.84.66.613.110.2

Breast0.61.066.736.238.97.50.39.50.830.20.032.81.277.41.378.80.568.80.790.7

Cervix uteri___4.24.32.4_13.9_64.8_7.6_5.3_10.0_12.5_7.5

Corpus uteri___6.06.11.7_1.2_1.9_2.4_10.8_16.1_8.6_18.2

Ovary___4.25.326.2_1.2_4.5_4.7_11.6_12.3_12.4_11.9

Prostate9.718.792.8___1.8_17.9_6.5_23.9_48.1_28.0_100.8_


Bladder19.223.522.43.04.343.31.80.13.01.27.02.525.15.323.14.020.35.724.06.2



Thyroid1.21.850.02.13.566.70.30.70.31.22.06.12.77.71.32.60.71.72.56.4



All sites100.7128.527.690.8113.124.6107.167.4183.5177.5103.9125.8235.7239.3394.0229.3261.1225.5370.9280.9


Sheet1

Males 1998

Site (ICD-O code)n%CrudeAge-specific incidence ratesAge

rate0-1415-2425-3435-4445-5455-6465-7475+MeanSD

Oro-pharyngeal1602.63.0001.12.86.113.314.121.660.814.2

Esophagus (150)170.70.9_0.3_1.11.54.43.83.157.216.2

Stomach (151)1165.15.8_0.61.11.112.121.337.255.663.113.8

Colon (153)1114.85.7_1.20.85.09.813.329.580.362.417.5

Rectum (154)723.13.7_0.31.52.27.69.830.818.560.715.3

Liver (155)492.12.2__0.41.76.111.512.83.158.610.7

Gall bladder (156)221.01.2___0.61.53.55.124.768.913.0

Pancreas (157)271.21.5__0.4_1.57.110.318.565.512.4

Larynx (161)1104.85.7___2.214.427.537.227.861.609.8

Lung (162)32414.116.80.20.31.98.327.281.611895.862.211.9

Bone(170)562.43.00.83.30.83.94.56.29.515.544.422.8

Connective tissue (171)572.52.80.81.81.53.33.05.312.815.548.722.4

Melanoma of skin1*180.81.0_0.3_1.10.86.23.86.258.215.9

Breast (174-5)140.60.8___0.63.83.53.8_56.409.8

Prostate (185)*32714.217.60.20.3_0.67.657.7152.7271.969.710.5

Testis & male genitalia (186-7)391.72.00.41.55.42.2_2.72.66.236.219.8

Bladder (188)*42518.521.40.20.30.89.429.576.3157.8244.165.612.1

Kidney & urinary tract (189)622.73.40.40.30.82.24.516.921.812.457.616.6

Brain & nervous system (191-2)903.95.11.81.84.65.615.111.512.86.243.319.3

Thyroid (193)321.41.70.21.51.51.72.34.47.73.146.820.7

Hodgkins disease1321.41.60.42.71.12.22.30.95.1_35.420.1

Non-Hodgkins1612.72.90.80.9_3.95.311.514.16.251.519.6

All other sites11757.68.22.00.93.83.912.927.525.749.453.521.3

All sites*2296100.0117.98.718.428.466.0180.1427.6735.2998.160.217.1

Tables 1 &2



19931998



Oro-pharyngeal1503.43.00.40.31.34.25.88.77.023.559.815.4602.63.0001.12.86.113.314.121.660.814.2

Esophagus (150)120.80.8_____4.89.8_65.105.2170.70.9_0.3_1.11.54.43.83.157.216.2

Stomach (151)684.64.0__0.41.81415.518.230.360.812.71165.15.8_0.61.11.112.121.337.255.663.113.8

Colon (153)714.84.7_1.02.13.69.115.519.650.559.317.21114.85.7_1.20.85.09.813.329.580.362.417.5

Rectum (154)573.93.7_0.3_3.65.813.521.040.463.413.7723.13.7_0.31.52.27.69.830.818.560.715.3

Liver (155)181.21.2___1.82.56.85.63.457.211.5492.12.2__0.41.76.111.512.83.158.610.7

Gall bladder (156)141.00.9___1.2_1.98.410.166.214.3221.01.2___0.61.53.55.124.768.913.0

Pancreas (157)151.01.0__0.40.6_9.74.2_58.810.6271.21.5__0.4_1.57.110.318.565.512.4

Larynx (161)1037.06.7_0.30.42.411.539.644.723.561.310.51104.85.7___2.214.427.537.227.861.609.8

Lung (162)22015.013.90.20.7_8.531.362.8102.047.160.711.132414.116.80.20.31.98.327.281.611895.862.211.9

Bone(170)271.81.70.71.60.4_3.35.85.610.146.725.2562.43.00.83.30.83.94.56.29.515.544.422.8


Melanoma of skin1*50.30.30.20.3_1.20.8___32.016.6180.81.0_0.3_1.10.86.23.86.258.215.9

Breast (174-5)90.60.5___1.23.3_1.4_48.609.1140.60.8___0.63.83.53.8_56.409.8

Prostate (185)*1429.79.1____4.129.083.8134.670.208.632714.217.60.20.3_0.67.657.7152.7271.969.710.5


Bladder (188)*27318.617.2_0.70.83.630.574.4132.7131.263.911.842518.521.40.20.30.89.429.576.3157.8244.165.612.1



Thyroid (193)191.31.0__0.80.64.93.92.8_51.411.5321.41.70.21.51.51.72.34.47.73.146.820.7


Non-Hodgkins1563.83.41.51.61.73.67.47.714.03.444.222.2612.72.90.80.9_3.95.311.514.16.251.519.6

All other sites1936.350.71.31.74.810.713.523.716.850.820.61757.68.22.00.93.83.912.927.525.749.453.521.3

All sites*1469100.091.79.216.121.358163.1354.5554.5558.458.117.32296100.0117.98.718.428.466.0180.1427.6735.2998.160.217.1




Table 3






Oro-pharyngeal3.03.413.31.51.66.7______________

Esophagus0.91.011.10.10.6500.01.20.36.31.51.72.51.71.116.31.27.63.54.51.2

Stomach4.66.439.14.34.0-7.014.43.542.016.04.14.8136.212.24.916.16.37.53.1

Colon5.16.119.62.86.7139.30.40.64.53.93.54.824.919.930.218.819.315.628.120.8

Rectum4.14.10.03.23.59.42.62.32.84.73.91.914.411.419.08.914.68.114.38.7

Liver1.42.578.61.51.66.75.12.20.70.57.33.53.21.613.12.12.01.03.01.2

Gall bladder0.91.344.41.01.220.03.610.21.73.11.91.41.52.42.22.71.21.21.41.7

Pancreas1.11.754.51.11.318.21.80.75.52.24.83.57.25.76.93.87.45.37.75.7

Larynx7.56.5-13.30.80.912.55.70.28.70.52.50.94.70.711.60.64.50.86.31.4

Lung15.718.719.12.85.182.128.12.928.67.220.39.227.09.267.47.262.422.861.333.8

Bone1.83.172.21.62.131.32.00.72.61.50.70.81.41.01.20.81.00.71.00.8


Melanoma of skin0.41.1175.00.30.433.30.10.11.40.90.40.39.59.86.67.84.66.613.110.2

Breast0.61.066.736.238.97.50.39.50.830.20.032.81.277.41.378.80.568.80.790.7

Cervix uteri___4.24.32.4_13.9_64.8_7.6_5.3_10.0_12.5_7.5

Corpus uteri___6.06.11.7_1.2_1.9_2.4_10.8_16.1_8.6_18.2

Ovary___4.25.326.2_1.2_4.5_4.7_11.6_12.3_12.4_11.9

Prostate9.718.792.8___1.8_17.9_6.5_23.9_48.1_28.0_100.8_


Bladder19.223.522.43.04.343.31.80.13.01.27.02.525.15.323.14.020.35.724.06.2



Thyroid1.21.850.02.13.566.70.30.70.31.22.06.12.77.71.32.60.71.72.56.4



All sites100.7128.527.690.8113.124.6107.167.4183.5177.5103.9125.8235.7239.3394.0229.3261.1225.5370.9280.9


Sheet1

Males 1998

Site (ICD-O code)n%CrudeAge-specific incidence ratesAge

rate0-1415-2425-3435-4445-5455-6465-7475+MeanSD

Oro-pharyngeal1602.63.0001.12.86.113.314.121.660.814.2

Esophagus (150)170.70.9_0.3_1.11.54.43.83.157.216.2

Stomach (151)1165.15.8_0.61.11.112.121.337.255.663.113.8

Colon (153)1114.85.7_1.20.85.09.813.329.580.362.417.5

Rectum (154)723.13.7_0.31.52.27.69.830.818.560.715.3

Liver (155)492.12.2__0.41.76.111.512.83.158.610.7

Gall bladder (156)221.01.2___0.61.53.55.124.768.913.0

Pancreas (157)271.21.5__0.4_1.57.110.318.565.512.4

Larynx (161)1104.85.7___2.214.427.537.227.861.609.8

Lung (162)32414.116.80.20.31.98.327.281.611895.862.211.9

Bone(170)562.43.00.83.30.83.94.56.29.515.544.422.8


Melanoma of skin1*180.81.0_0.3_1.10.86.23.86.258.215.9

Breast (174-5)140.60.8___0.63.83.53.8_56.409.8

Prostate (185)*32714.217.60.20.3_0.67.657.7152.7271.969.710.5

Testis & male genitalia (186-7)391.72.00.41.55.42.2_2.72.66.236.219.8

Bladder (188)*42518.521.40.20.30.89.429.576.3157.8244.165.612.1

Kidney & urinary tract (189)622.73.40.40.30.82.24.516.921.812.457.616.6

Brain & nervous system (191-2)903.95.11.81.84.65.615.111.512.86.243.319.3

Thyroid (193)321.41.70.21.51.51.72.34.47.73.146.820.7

Hodgkins disease1321.41.60.42.71.12.22.30.95.1_35.420.1

Non-Hodgkins1612.72.90.80.9_3.95.311.514.16.251.519.6

All other sites11757.68.22.00.93.83.912.927.525.749.453.521.3

All sites*2296100.0117.98.718.428.466.0180.1427.6735.2998.160.217.1

Sheet2

Site (ICD-O code)Females 1998

n%CrudeAge-specific incidence ratesAge

rate0-1415-2425-3435-4445-5455-6465-7475+MeanSD

Oro-pharyngeal1321.51.50.20.61.00.54.34.27.72.757.116.2

Esophagus (150)120.60.6___1.0_1.75.25.563.713.4

Stomach (151)763.63.7__1.01.07.214.423.230.162.413.5

Colon (153)*1225.86.3__1.74.412.314.443.860.262.614.3

Rectum (154)592.83.30.2_1.01.93.613.521.924.660.815.2

Liver (155)351.71.50.2__1.01.47.69.010.961.616.7

Gall bladder (156)221.11.1____2.94.27.78.262.710.5

Pancreas (157)251.21.2___0.52.94.211.62.762.810.1

Larynx (161)140.70.8__0.3_2.94.22.62.757.611.5

Lung (162)*894.34.8_0.30.73.97.218.634.824.660.713.5

Bone(170)401.92.10.41.62.42.92.95.15.2_40.218.4


Melanoma of skin190.40.4_0.3_0.5_2.5_2.751.820.0

Breast (174-5)69833.435.3__10.765.6127.6100.8114.784.852.812.8

Cervix uteri (180)874.24.1__2.811.210.88.512.95.548.812.9

Corpus uteri (181-2)1004.85.6__1.43.410.821.238.732.861.212.4

Ovary (183)904.34.80.20.92.44.913.719.516.810.953.215.5

Bladder (188)914.34.10.4_0.71.96.515.220.643.862.217.4

Kidney & urinary tract (189)301.41.60.4_0.31.53.67.66.45.553.918.3

Brain & nervous system (191-2)*844.04.52.11.35.92.97.912.711.65.541.920.3

Thyroid (193)693.33.30.41.32.85.38.77.69.05.545.916.9

Hodgkins disease1311.51.50.41.93.11.51.40.8_2.731.516.2

Non-Hodgkins1502.42.4_0.61.03.92.95.119.32.754.016.2

All other sites11738.38.21.31.91.02.915.125.443.852.057.219.2

All sites*2092100.0105.36.914.242.4124.4265.3324.3475.6440.554.416.1

Tables 1 &2



19931998



Oro-pharyngeal1503.43.00.40.31.34.25.88.77.023.559.815.4602.63.0001.12.86.113.314.121.660.814.2

Esophagus (150)120.80.8_____4.89.8_65.105.2170.70.9_0.3_1.11.54.43.83.157.216.2

Stomach (151)684.64.0__0.41.81415.518.230.360.812.71165.15.8_0.61.11.112.121.337.255.663.113.8

Colon (153)714.84.7_1.02.13.69.115.519.650.559.317.21114.85.7_1.20.85.09.813.329.580.362.417.5

Rectum (154)573.93.7_0.3_3.65.813.521.040.463.413.7723.13.7_0.31.52.27.69.830.818.560.715.3

Liver (155)181.21.2___1.82.56.85.63.457.211.5492.12.2__0.41.76.111.512.83.158.610.7

Gall bladder (156)141.00.9___1.2_1.98.410.166.214.3221.01.2___0.61.53.55.124.768.913.0

Pancreas (157)151.01.0__0.40.6_9.74.2_58.810.6271.21.5__0.4_1.57.110.318.565.512.4

Larynx (161)1037.06.7_0.30.42.411.539.644.723.561.310.51104.85.7___2.214.427.537.227.861.609.8

Lung (162)22015.013.90.20.7_8.531.362.8102.047.160.711.132414.116.80.20.31.98.327.281.611895.862.211.9

Bone(170)271.81.70.71.60.4_3.35.85.610.146.725.2562.43.00.83.30.83.94.56.29.515.544.422.8


Melanoma of skin1*50.30.30.20.3_1.20.8___32.016.6180.81.0_0.3_1.10.86.23.86.258.215.9

Breast (174-5)90.60.5___1.23.3_1.4_48.609.1140.60.8___0.63.83.53.8_56.409.8

Prostate (185)*1429.79.1____4.129.083.8134.670.208.632714.217.60.20.3_0.67.657.7152.7271.969.710.5


Bladder (188)*27318.617.2_0.70.83.630.574.4132.7131.263.911.842518.521.40.20.30.89.429.576.3157.8244.165.612.1



Thyroid (193)191.31.0__0.80.64.93.92.8_51.411.5321.41.70.21.51.51.72.34.47.73.146.820.7


Non-Hodgkins1563.83.41.51.61.73.67.47.714.03.444.222.2612.72.90.80.9_3.95.311.514.16.251.519.6

All other sites1936.350.71.31.74.810.713.523.716.850.820.61757.68.22.00.93.83.912.927.525.749.453.521.3

All sites*1469100.091.79.216.121.358163.1354.5554.5558.458.117.32296100.0117.98.718.428.466.0180.1427.6735.2998.160.217.1




Cancer incidence 1993 and 1998 Possible causes for the increase in crude incidence ratesImprovement in detection rateReporting and data gathering of various cancers due to the marked rise in the number of diagnostic facilitiesAfter 1991, a proliferation in the number health-care institutions as well as a significant upsurge in modern diagnostic technologies, equipment and services:MRIs (n = 12)CT Scans (n = 54)Colonoscopy and gastroscopies (over 30 suites) mammograms, cytology and pathology labs. Ammar W et al. Leb Med J 1998;46:149-155. Soweid A et al Gastrointest Endosc 2001;54:279-281.

During the past decade alone, the number of oncology specialists in the country has risen from 20 to around 80 physicians (Lebanese Cancer Society).Several risk factor awareness campaigns and screening programs became part of national public policies with wide advertisement and coverage.

Cancer incidence 1993 and 1998Breast CancerBreast cancer was the most frequent malignancy in females in Lebanon (Over one third of all female cancers).

Same rates observed in all earlier hospital-based studies in the country. Azar HA. Cancer in Lebanon and the near east. Cancer January-February 1962;15:66-74. Ghosn M et al. The cancer registry at the Hotel Dieu de France Hospital. Leb Med J 1992;40:4-10. El-Saghir NS et al. Cancer in Lebanon: analysis of 10220 cases from the American University of Beirut Medical Center. Leb Med J 1998;46:4-10.

ASR (38.9 per 100,000, 1998)Lower than that observed for the US (90.7), UK (68.8), France (78.8) or Israel (77.4)Much higher than other developing countries of the region such as Algeria

Breast CancerThe age pattern at diagnosis is typical of that in low-risk countries

Increase in the rate up to the 5th decade, around menopause, and a decrease thereafter. Rodriguez-Cuevas Et al. Breast carcinoma presents a decade earlier in Mexican women than in women in the United States or European countries. Cancer 2001;91:863-868

Median age at diagnosis was 52 years (range 22-92)

Around 43% of cases presenting before the age 50 compared to median age of 63 years for developed countries such as the US. Bosch X. Early development of breast cancer in Mexican women. The Lancet Oncology 2001;2:194

Public Health ImplicationsBreast Cancer In Lebanon; causes for the rise:Screening programs are widely adopted by most academic and health centersChanges in certain reproductive factors:Mean age at marriage of women has increased from 23.2 years in 1970 to 27.5 in 1996 Total fertility rate has steadily declined from 4.4 to 2.5United Nations. Health and reproduction. In: The female and male in Lebanon: a statistical profile. The Lebanese Republic, 2000 pp.57-65

Should we screen for breast cancer among younger age groups (below 40 years) and what type of screening should we adopt?Screening of high-risk groups (MRI).Unification of the screening programs and training of the radiology technicians.

Tobacco Associated CancersBladder CancerLung Cancer

Public Health Implications Bladder CancerIncidence rates in Lebanon are high, in particular among males.Incidence rates parallel those observed in developed countries such France, the USA, UK and Israel.Rates have always been this high in national and hospital based studies in the country.Abou-Daoud KT. Morbidity from cancer in Lebanon. Cancer 1966;19:1293-300. Azar HA. Cancer in Lebanon and the near east. Cancer January-February 1962;15:66-74. Ghosn M et al. The cancer registry at the Hotel Dieu de France Hospital. Leb Med J 1992;40:4-10. El-Saghir NS et al. Cancer in Lebanon: analysis of 10220 cases from the American University of Beirut Medical Center. Leb Med J 1998;46:4-10.Tobacco smoking was identified as a major risk factor for bladder cancer.Abou- Daoud KT. Cancer of the bladder and cigarette smoking, coffee and alcohol drinking in Lebanon. Leb Med J 1980;3:251-257.

Bladder CancerInternationally, a stronger relationship between smoking and bladder cancer is reported in women than in men. Brennan P et al. The contribution of cigarette smoking to bladder cancer in women pooled European data. Cancer Causes Control 2001;12:411-7A small proportion of bladder cancer can be attributed to coffee drinking especially in nonsmokers. Sala M et al. Coffee consumption and bladder cancer in non-smokers: a pooled analysis of case-control studies in European countries. Cancer Causes Control 2001;11:925-31Other causative agents: Bilharsia (Egypt, Iraq) Exposures to paint components, polycyclic aromatic hydrocarbons, diesel exhausts, and aromatic amines Zeegers Mpet al. Occupational risk factors for male bladder cancer: results from a population based case cohort study in the Netherlands. Occcup Envoron Med 2001;58:590-6

Public Health Implications Bladder CancerRole of HPV in bladder cancer!! Two of the HPVs (16 and 18) are known to be high risk for the incidence of bladder cancer. The association between bladder cancer and HPVs was found to be ranging between 2.5-81%. Soulitzis N et al. p53 Codon 72 Polymorphism and its Association with Bladder Cancer. Cancer Letters, 2002. Lopez-Batran A et al. Human Papillomavirus and Bladder Cancer. Biomed and Pharmacother, 1997.The role of HPV among Bladder Cancer should be investigated. Should we design a retrospective cohort study on bladder cancer patients?

Public Health ImplicationsLung CancerLung cancer has long been closely linked to tobacco smoking. Doll R, Peto R. The cause of cancer. Oxford: Oxford University Press, 1981

In countries with prolonged smoking history, about 90% of cases of lung cancer in men are related to tobacco. Parkin DM. Global cancer statistics in the year 2000. The Lancet Oncology 2001;2:533-542

In various countries, national trends in lung cancer incidence and mortality reflect the maturity of the smoking epidemic. Gilliland FD, Samet JM. Lung cancer. Cancer Surv 1994;19-20:175-95

Lebanon may have reached this maturity in men, the trend in women is certainly still increasing.Smoking prevalence rates among men have long been in the range of 50-60%. Khogali M et al. Dar el fatwa, Aisha Bakar, CVD Project. Spring-Summer 1999In women, smoking prevalence have considerably increased:1960s: 28% Abou- Daoud KT. Cancer of the bladder and cigarette smoking, coffee and alcohol drinking in Lebanon. Leb Med J 1980;3:251-2571992: 35% Nuwayhid I et al. In: Deeb M, ed. Beirut: a health profile 1984-1994. Beirut, AUB, 1997 1999: 47% & 57% Khogali M et al. Dar el fatwa, Aisha Bakar, CVD Project. Spring-Summer 1999. Chidiac C. The profile of the Lebanese smoker: prevalence, characteristics and risk factors. USJ 1998 (unpublished paper)

Public Health ImplicationsLung Cancer

Lung cancer rate among women doubled during recent years and this can be expected to continue its rise as smoking is increasingly seen in successive birth cohorts with prevalence rates:30-39 years: 54%Over 60 years: 16% Nuwayhid I et al. Morbidity, mortality and risk factors. In: Deeb M, ed. Beirut: a health profile 1984-1994. Beirut, AUB, 1997

Public Health ImplicationsLung Cancer

Primary PreventionLung CancerEffective anti-smoking programmes should be implemented to prevent future rise. School children and women should be particularly targeted.Distribution channels should include mass media, MOPH institutions, Ministry of Social Affairs institutions, schools, NGOs and places of work.

Public Health Implications Prostate CancerSignificant increase in the crude incidence of prostate cancer from 1993 to 1998 (9.1 and 17.6 per 100,000 respectively).

The second most common type of malignancy in men.

Surveillance and detection bias

National awareness campaigns promoting screening for prostate cancer in 1994

Age specific incidence ratesMales 1993

Chart3

00.2000

0.70.701.30.3

0.8002.10.4

3.68.507.32.4

30.531.34.114.811.5

74.462.8292939.6

132.710283.840.544.7

131.247.1134.690.823.5

Badder

Lung

Prostate

Colo-rectal

Larynx

Age-specific incidence rates/100,000

FIGURE 2a- Age-specific incidence rates for bladder, lung, prostate, colo-rectal and larynx in Males, 1993

Table 3






Oro-pharyngeal3.03.413.31.51.66.7______________

Esophagus0.91.011.10.10.6500.01.20.36.31.51.72.51.71.116.31.27.63.54.51.2

Stomach4.66.439.14.34.0-7.014.43.542.016.04.14.8136.212.24.916.16.37.53.1

Colon5.16.119.62.86.7139.30.40.64.53.93.54.824.919.930.218.819.315.628.120.8

Rectum4.14.10.03.23.59.42.62.32.84.73.91.914.411.419.08.914.68.114.38.7

Liver1.42.578.61.51.66.75.12.20.70.57.33.53.21.613.12.12.01.03.01.2

Gall bladder0.91.344.41.01.220.03.610.21.73.11.91.41.52.42.22.71.21.21.41.7

Pancreas1.11.754.51.11.318.21.80.75.52.24.83.57.25.76.93.87.45.37.75.7

Larynx7.56.5-13.30.80.912.55.70.28.70.52.50.94.70.711.60.64.50.86.31.4

Lung15.718.719.12.85.182.128.12.928.67.220.39.227.09.267.47.262.422.861.333.8

Bone1.83.172.21.62.131.32.00.72.61.50.70.81.41.01.20.81.00.71.00.8


Melanoma of skin0.41.1175.00.30.433.30.10.11.40.90.40.39.59.86.67.84.66.613.110.2

Breast0.61.066.736.238.97.50.39.50.830.20.032.81.277.41.378.80.568.80.790.7

Cervix uteri___4.24.32.4_13.9_64.8_7.6_5.3_10.0_12.5_7.5

Corpus uteri___6.06.11.7_1.2_1.9_2.4_10.8_16.1_8.6_18.2

Ovary___4.25.326.2_1.2_4.5_4.7_11.6_12.3_12.4_11.9

Prostate9.718.792.8___1.8_17.9_6.5_23.9_48.1_28.0_100.8_


Bladder19.223.522.43.04.343.31.80.13.01.27.02.525.15.323.14.020.35.724.06.2



Thyroid1.21.850.02.13.566.70.30.70.31.22.06.12.77.71.32.60.71.72.56.4



All sites100.7128.527.690.8113.124.6107.167.4183.5177.5103.9125.8235.7239.3394.0229.3261.1225.5370.9280.9


Tables 1 &2



19931998



Oro-pharyngeal1503.43.00.40.31.34.25.88.77.023.559.815.4602.63.0001.12.86.113.314.121.660.814.2

Esophagus (150)120.80.8_____4.89.8_65.105.2170.70.9_0.3_1.11.54.43.83.157.216.2

Stomach (151)684.64.0__0.41.81415.518.230.360.812.71165.15.8_0.61.11.112.121.337.255.663.113.8

Colon (153)714.84.7_1.02.13.69.115.519.650.559.317.21114.85.7_1.20.85.09.813.329.580.362.417.5

Rectum (154)573.93.7_0.3_3.65.813.521.040.463.413.7723.13.7_0.31.52.27.69.830.818.560.715.3

Liver (155)181.21.2___1.82.56.85.63.457.211.5492.12.2__0.41.76.111.512.83.158.610.7

Gall bladder (156)141.00.9___1.2_1.98.410.166.214.3221.01.2___0.61.53.55.124.768.913.0

Pancreas (157)151.01.0__0.40.6_9.74.2_58.810.6271.21.5__0.4_1.57.110.318.565.512.4

Larynx (161)1037.06.7_0.30.42.411.539.644.723.561.310.51104.85.7___2.214.427.537.227.861.609.8

Lung (162)22015.013.90.20.7_8.531.362.8102.047.160.711.132414.116.80.20.31.98.327.281.611895.862.211.9

Bone(170)271.81.70.71.60.4_3.35.85.610.146.725.2562.43.00.83.30.83.94.56.29.515.544.422.8


Melanoma of skin1*50.30.30.20.3_1.20.8___32.016.6180.81.0_0.3_1.10.86.23.86.258.215.9

Breast (174-5)90.60.5___1.23.3_1.4_48.609.1140.60.8___0.63.83.53.8_56.409.8

Prostate (185)*1429.79.1____4.129.083.8134.670.208.632714.217.60.20.3_0.67.657.7152.7271.969.710.5


Bladder (188)*27318.617.2_0.70.83.630.574.4132.7131.263.911.842518.521.40.20.30.89.429.576.3157.8244.165.612.1



Thyroid (193)191.31.0__0.80.64.93.92.8_51.411.5321.41.70.21.51.51.72.34.47.73.146.820.7


Non-Hodgkins1563.83.41.51.61.73.67.47.714.03.444.222.2612.72.90.80.9_3.95.311.514.16.251.519.6

All other sites1936.350.71.31.74.810.713.523.716.850.820.61757.68.22.00.93.83.912.927.525.749.453.521.3

All sites*1469100.091.79.216.121.358163.1354.5554.5558.458.117.32296100.0117.98.718.428.466.0180.1427.6735.2998.160.217.1




Distribution of the 5 most common Male cancers diagnosed and or treated at AUBMC during 1983-2000 (N=4220)

Chart1

8636194430

7937254436

8431263622

8242144722

6318133337

8637133922

283517299

5544243321

5629193425

5031214423

7041304234

8030343627

8222373921

8123442548

7725553746

7824784738

8326995536

7023984538

Broncho-Pul.

Larynx

Prostate

Bladder

Non-Hodgkin

males + females-all reg

Distribution of cancer sites in patients (Males vs. Females) diagnosed/treated at AUBMC

during the period 1983 - 2000 (N= 16258)

Sex

Males (n=7419)Females (n=7334)Total (N= 14753)

SiteFreq.%Freq.%Freq.%

Breast400.5%265836.2%269818.3%

Broncho-Pulmonary128517.3%2703.7%155510.5%

Leukemia6478.7%4175.7%10647.2%

Lymph Nodes5507.4%3374.6%8876.0%

Bladder7029.5%941.3%7965.4%

Brain4385.9%3494.8%7875.3%

Prostate6578.9%20.0%6594.5%

Larynx5497.4%771.0%6264.2%

Cervix Uteri00.0%6098.3%6094.1%

Colon2583.5%2183.0%4763.2%

Stomach2453.3%1812.5%4262.9%

Soft Tissue2203.0%1972.7%4172.8%

Unknown Primary2413.2%1672.3%4082.8%

Recto-Sigmoid2012.7%1642.2%3652.5%

Corpus Uteri00.0%2974.0%2972.0%

Ovary00.0%2773.8%2771.9%

Bone1291.7%1191.6%2481.7%

Kidney & Urinary Tract1562.1%921.3%2481.7%

Thyroid891.2%1492.0%2381.6%

Pancreas1021.4%640.9%1661.1%

Testis & Male Genitalia1532.1%00.0%1531.0%

Vulvo-Vagina00.0%1261.7%1260.9%

Extrahepatic Duct520.7%650.9%1170.8%

Mediastinum650.9%480.7%1130.8%

Nasopharynx700.9%350.5%1050.7%

Oral Cavity510.7%330.4%840.6%

Esophagus590.8%200.3%790.5%

Tongue510.7%280.4%790.5%

Liver580.8%160.2%740.5%

Eye & Orbit390.5%270.4%660.4%

Salivary Glands350.5%270.4%620.4%

Spinal Cord330.4%260.4%590.4%

Lip460.6%120.2%580.4%

Retroperitoneum310.4%200.3%510.3%

Tonsils310.4%200.3%510.3%

Nasal & Sinuses250.3%230.3%480.3%

Small Intestine320.4%140.2%460.3%

Oro-Hypopharynx280.4%110.1%390.3%

Pleura260.4%130.2%390.3%

Endocrine System70.1%170.2%240.2%

Peritoneum80.1%100.1%180.1%

Pituitary100.1%40.1%140.1%

Unspecified00.0%10.0%10.0%

TOTAL7419100.0%7334100.0%14753100.0%

males VS females-all reg

Distribution of Cancer Sites at Males & Females diagnosed and or treated at AUBMC

during 1983 - 2000 (N= 15016*)

Males (n= 7571)Females (n= 7445)

SiteFreq.%SiteFreq.%

Broncho-Pulmonary129017.0%Breast266235.8%

Bladder7099.4%Cervix Uteri6138.2%

Prostate6668.8%Non-Hodgkin4025.4%

Larynx5547.3%Colon & Recto-Sigmoid3795.1%

Non-Hodgkin5357.1%Brain3374.5%

Leukemia4896.5%Leukemia2994.0%

Colon & Recto-Sigmoid4586.0%Corpus Uteri2964.0%

Brain4295.7%Ovary2723.7%

Hodgkin2643.5%Broncho-Pulmonary2703.6%

Unknown Primary2353.1%Soft Tissue1802.4%

Stomach2222.9%Unknown Primary1632.2%

Soft Tissue1902.5%Stomach1522.0%

Kidney & Urinary Tract1562.1%Thyroid1472.0%

Testis & Male Genitalia1471.9%Hodgkin1431.9%

Myeloma1191.6%Vulvo-Vagina1261.7%

Bone1081.4%Bone1001.3%

Pancreas1021.3%Bladder941.3%

Thyroid881.2%Kidney & Urinary Tract911.2%

Nasopharynx670.9%Myeloma791.1%

Esophagus600.8%Larynx771.0%

Lymph Nodes560.7%Extrahepatic Duct650.9%

Liver520.7%Pancreas640.9%

Extrahepatic Duct520.7%Lymph Nodes510.7%

Melanoma Skin520.7%Melanoma Skin440.6%

Tongue490.6%Oral Cavity320.4%

Lip460.6%Tongue270.4%

Oral Cavity450.6%Eye & Orbit270.4%

Mediastinum400.5%Salivary Glands260.3%

Breast390.5%Nasopharynx250.3%

Eye & Orbit350.5%Spinal Cord230.3%

Salivary Glands330.4%Mediastinum220.3%

Spinal Cord270.4%Nasal & Sinuses200.3%

Oro-Hypopharynx240.3%Esophagus200.3%

Pleura230.3%Retroperitoneum160.2%

Retroperitoneum210.3%Liver160.2%

Small Intestine200.3%Endocrine System150.2%

Nasal & Sinuses180.2%Lip110.1%

Other Lymphoreticular Neop.150.2%Peritoneum110.1%

Tonsils130.2%Small Intestine100.1%

Pituitary110.1%Pleura100.1%

Endocrine System70.1%Oro-Hypopharynx90.1%

Peritoneum50.1%Other Lymphoreticular Neop.80.1%

Tonsils60.1%

Pituitary40.1%

Unspecified10.0%

TOTAL**:7571100.0%TOTAL***:7445100.0%

*: Exludes 1322 basal and squamous cell skin cancers and in situ carcinomas except urinary bladder

**: Exludes 828 basal and squamous cell skin cancers and in situ carcinomas except urinary bladder

***: Exludes 494 basal and squamous cell skin cancers and in situ carcinomas except urinary bladder

males VS females-all reg

0

0

0

0

0

%

Distribution of the first 5 Cancer Sites at Males diagnosed/treated in AUBMC(n=7571)

Non-Hodgkin7.1%

Prostate8.8%

Bladder9.4%

Broncho-Pulmonary17%

Larynx7.3%

first 10 males+females-all reg

0

0

0

0

0

%

Distribution of the first 10 Cancer Sites in Females diagnosed/treated at AUBMC(n= 7445)

Brain4.5%

Colon & Recto-Sigmoid5.1%

Non-Hodgkin5.4%

Cervix Uteri8.2%

Breast35.8%

males-first 5+years

Distribution of Cancer Sites at Males & Females diagnosed and or treated at AUBMC

during 1983 - 2000 (N= 15016*)

Males (n= 7571)Females (n= 7445)

SiteFreq.%SiteFreq.%

Broncho-Pulmonary129017.0%Breast266235.8%

Bladder7099.4%Cervix Uteri6138.2%

Prostate6668.8%Non-Hodgkin4025.4%

Larynx5547.3%Colon & Recto-Sigmoid3795.1%

Non-Hodgkin5357.1%Brain3374.5%

Leukemia4896.5%Leukemia2994.0%

Colon & Recto-Sigmoid4586.0%Corpus Uteri2964.0%

Brain4295.7%Ovary2723.7%

Hodgkin2643.5%Broncho-Pulmonary2703.6%

Unknown Primary2353.1%Soft Tissue1802.4%

*: Exludes 1322 basal and squamous cell skin cancers and in situ carcinomas except urinary bladder

**: Exludes 828 basal and squamous cell skin cancers and in situ carcinomas except urinary bladder

***: Exludes 494 basal and squamous cell skin cancers and in situ carcinomas except urinary bladder

males-first 5+years

0.170387003

0.0936468102

0.0879672434

0.0731739532

0.0706643772

%

Distribution of the first 5 Cancer Sites at Males diagnosed/treated in AUBMC(n=7571)

Non-Hodgkin7.1%

Prostate8.8%

Bladder9.4%

Broncho-Pulmonary17%

Larynx7.3%

Females-first 5+years

0.3575554063

0.082337139

0.0539959704

0.0509066488

0.0452652787

%

Distribution of the first 10 Cancer Sites in Females diagnosed/treated at AUBMC(n= 7445)

Brain4.5%

Colon & Recto-Sigmoid5.1%

Non-Hodgkin5.4%

Cervix Uteri8.2%

Breast35.8%

first 10 MALES +other countries

Line chart presenting the ditribution of the five most common Male cancers

diagnosed and or treated at AUBMC during 1983 - 2000 (n= 3754)

YearBroncho-Pul.LarynxProstateBladderNon-HodgkinTotal

Y19838636194430129

Y19847937254436142

Y19858431263622115

Y19868242144722125

Y19876318133337101

Y19888637133922111

Y198928351729990

Y19905544243321122

Y19915629193425107

Y19925031214423119

Y19937041304234147

Y19948030343627127

Y19958222373921119

Y19968123442548140

Y19977725553746163

Y19987824784738187

Y19998326995536216

Y20007023984538204

TOTAL12905546667095352464

first 10 MALES +other countries

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00000

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00000

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00000

00000

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00000

Larynx

Broncho-Pul.

Prostate

Bladder

Non-Hodgkin


frst 10 FEMALES +othr contries

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

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Broncho-Pul.

Larynx

Prostate

Bladder

Non-Hodgkin


Males-leb+canada

Bar Diagram presenting the ditribution of the five most common Female cancers

diagnosed and or treated at AUBMC during 1983 - 2000 (n= 4393)

YearBreastCervix UteriColon & Recto-SigmoidNon-HodgkinBrainTotal

19831434142415200

198414157182821265

198516046191623264

198612545192014223

19879442182016190

198813333201124221

198910022161012160

19901473716117218

199114650261915256

19921422717914209

199314834291412237

199417849242212285

199516134191415243

199616133222413253

199714425182719233

199815829322531275

199918623225038319

200019523305836342

TOTAL26626133794023374393

Males-leb+canada

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00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

00000

Breast

Cervix Uteri

Colon & Recto-Sigmoid

Non-Hodgkin

Brain

Distribution of the 5 most common Female cancers diagnosed and or treated at AUBMC during 1983-2000 (n=4609)

Females-leb+canada

The ranking of the ten most common cancers for Males in Lebanon and other selected countries

Lebanon (1)Kuwait (2)Algeria (3)France (4)China (5)USA (6)Brazil (7)Israel (8)

Broncho-PulmonaryLungLungLungLiverProstateLungLung

Skin (+)LymphomaStomachProstateStomachLung & bronchusUnknow PrimaryUnknown Primary

BladderLiverUknown PrimaryColonLungColon & rectumProstateBladder

ProstateLeukemiaNasopharynxBladderEsophagusUrinary BladderStomachLymphoma

Leukemia (#)Unkown PrimaryLeukemiaRectumPancreasNon-Hodgkin's LymphomaEsophagusProstate

Lymph NodesBladderLymphomaEsophagusRectumMelanoma of the SkinBladderStomach

LarynxProstateLiverUnknow PrimaryBladderOral CavityColonLeukemia

BrainStomachLarynxHypopharynxLeukemiaKidneyLarynxBrain & NS (*)

ColonEsophagusBladderKidneyLymphomaLeukemiaLymphomaColon

StomachPancreasGallbladderStomachBrain & NS (*)PancreasRectumNose & Sinuses

NOTE:

(1) Lebanon: AUBMC Tumor Reg. (1983-2000)(+) Exludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder

(2) Kuwait: National Reg. (1983-1987)(*) NS: Nervous System

(3) Algeria: Satif Wilaya Reg. (1986-1989)(#) Leukemia: includes Lymphocytic, Granulocytic and other Leukemias

(4) France: Sas-Rhin Reg. (1983-1987)

(5) China: Qidong City Reg. (1983-1987)

(6) USA: American Cancer Society (1999)

(7) Brazil: Goiania (1988-1989)

(8) Israel: Non-Jews (1982-1986)

Males in Leb,AUBMC, USA-93+98-

The ranking of the ten most common cancers for Females in Lebanon and other selected countries

Lebanon (1)Kuwait (2)Algeria (3)France (4)China (5)USA (6)Brazil (7)Israel (8)

BreastBreastCervix UteriBreastLiverBreastBreastBreast

Cervix UteriUnknown PrimaryGallbladderColonStomachLung & BronchusCervix UteriUnkown Primary

Skin*ThyroidBreastCorpus UteriLungColon & RectumUnknown PrimaryColon

Leukemia (#)LungLiverOvaryBreastUterine corpusLungLymphoma

BrainCervix UteriStomachCervix UteriRectumOvaryColonLeukemia

Lymph NodesLeukemiaUnkown PrimaryRectumEsophagusNon-Hodgkin's LymphomaStomachLung

Corpus UteriLymphomaLeukemiaUnknown PrimaryPancreasMelanoma of the skinOvaryGallbladder

OvaryOvaryLymphomaStomachCervix UteriUrinary bladderRectumStomach

Broncho-PulmonaryColonNasopharynxLymphomaLeukemiaPancreasCorpus UteriRectum

ColonPancreasLungMelanoma of SkinBrain & NS (*)ThyroidLymphomaCorpus Uteri

NOTE:

(1) Lebanon: AUBMC Tumor Reg. (1983-2000)(+) Exludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder

(2) Kuwait: National Reg. (1983-1987)(*) NS: Nervous System

(3) Algeria: Satif Wilaya Reg. (1986-1989)(#) Leukemia: includes Lymphocytic, Granulocytic and other Leukemias

(4) France: Sas-Rhin Reg. (1983-1987)

(5) China: Qidong City Reg. (1983-1987)


(7) Brazil: Goiania (1988-1989)

(8) Israel: Non-Jews (1982-1986)

Males in Leb,AUBMC, USA-93-

The ranking of the ten most common cancers for Males in Lebanon and Canada

during 2000

Lebanon (N=410 out of 537)Canada (N= 55450 out of 67900)

SiteFreq.SiteFreq

Prostate89Prostate16900

Broncho-Pulmonary64Lung12200

Skin*59Colorectal9200

Brain42Bladder3600

Bladder38Non-Hodgkin's Lymphoma3300

Leukemia35Kidney2400

Lymph Nodes26Oral2200

Colon25Leukemia1950

Larynx18Melanoma1950

Stomach14Stomach1750

TOTAL:410TOTAL:55450


0

0

0

0

0

0

0

0

0

0

Canada (N= 55450 out of 67900) Freq

Percentage Distribution of the first ten Cancer Cases in Males registred in the "National Cancer Institute of Canada" (N=55450 out of 67900)


0

0

0

0

0

0

0

0

0

0

Lebanon (N=410 out of 537) Freq.

Percentage Distribution of the first ten Cancer Cases in Males diagnosed or treated at AUBMC during 2000 (N= 410 out of 537)

Females in Leb,AUBMC,USA-93+98-

The ranking of the ten most common cancers for Females in Lebanon and Canada

during 2000

Lebanon (N=410 out of 537)Canada (N=50850 out of 64300)

SiteFreq.SiteFreq

Breast185Breast19200

Brain36Lung8400

Leukemia34Colorectal7900

Skin*28Body of Uterus3500

Lymph Nodes26Non-Hodgkin's Lymphoma2700

Colon24Ovary2500

Broncho-Pulmonary20Melanoma1950

Soft Tissue19Thyroid1600

Cervix Uteri19Pancreas1600

Corpus Uteri19Leukemia1500

TOTAL:410TOTAL:50850

Females in Leb,AUBMC,USA-93+98-

0

0

0

0

0

0

0

0

0

0

Lebanon (N=410 out of 537) Freq.

Percentage Distribution of the first ten Cancer Cases in Females diagnosed or treated at AUBMC during 2000 (N=537) (N=410 out of 537) Freq.

Females in Leb,AUBMC,USA-93-

0

0

0

0

0

0

0

0

0

0

Canada (N=50850 out of 64300) Freq

Percentage Distribution of the first ten Cancer Cases in Females registred in the "National Cancer Institute of Canada" (N=50850 out of 64300)

Females in Leb,AUBMC,USA-98-

The ranking of the ten most common cancer Males Patients in

Lebanon (93+98) , AUBMC (93+98) & USA(99)

Lebanon (1993+1998)AUBMC (1993+1998)USA (1999)EC (1990)

BladderBroncho-PulmonaryProstateLung (21.9%)

Broncho-PulmonaryProstateLung & bronchusColon & rectum (15.9%)

ProstateLeukemiaColon & rectumProstate (7.1%)

Non-HodgkinBladderUrinary BladderStomach (4.7%)

LarynxLarynxNon-Hodgkin's LymphomaBladder (4.7%)

ColonLymph NodesMelanoma of the SkinMouth & Pharynx (3.2%)

StomachBrainOral CavityLarynx (2.2%)

Recto-SigmoidSoft TissueKidneyKidney (2.1%)

Kidney & Urinary TractColonLeukemiaPancreas (2.1%)

BrainStomachPancreasLeukemia (2.0%)

(1) Lebanese Hosp. (Except Sacre Coeur Hosp. + Private Pathology Labs) (1993 & 1998)

(2) AUBMC Tumor Registry (1993 & 1998)


males at AUBMC 93+98


Lebanon (93) , AUBMC (93) & USA(99)

Lebanon (1993)AUBMC (1993)USA (1999)

BladderBroncho-PulmonaryProstate

Broncho-PulmonaryBladderLung & bronchus

ProstateLarynxColon & rectum

Non-HodgkinLymph NodesUrinary Bladder

LarynxProstateNon-Hodgkin's Lymphoma

ColonLeukemiaMelanoma of the Skin

StomachBrainOral Cavity

Recto-SigmoidRecto-SigmoidKidney

Kidney & Urinary TractColonLeukemia

HodgkinUnknown PrimaryPancreas

(1) Lebanese Hosp. (Except Sacre Coeur Hosp. + Private Pathology Labs) (1993)

(2) AUBMC Tumor Registry (1993)


males in LEBANON 93+98




BladderBroncho-PulmonaryProstate

ProstateProstateLung & bronchus

Broncho-PulmonaryLeukemiaColon & rectum

Non-HodgkinBladderUrinary Bladder

LarynxBrainNon-Hodgkin's Lymphoma

ColonSoft TissueMelanoma of the Skin

StomachLarynxOral Cavity

Recto-SigmoidStomachKidney

LeukemiaLymph NodesLeukemia

BrainColonPancreas

(1) Lebanese Hosp. (Except Sacre Coeur Hosp. + Private Pathology Labs) (1998)

(2) AUBMC Tumor Registry (1998)


Females in LEBANON 93+98

The ranking of the ten most common cancer Females Patients in

Lebanon (93+98) , AUBMC (93+98) & USA(99)

Lebanon (1993+1998)AUBMC (1993+1998)USA (1999)

BreastBreastBreast

Corpus UteriCervix UteriLung & bronchus

Non-HodgkinBrainColon & rectum

ColonLeukemiaUterine corpus

OvaryOvaryOvary

Cervix-UteriColonNon-Hodgkin's lymphoma

BladderCorpus UteriMelanoma of the skin

Broncho-PulmonaryBroncho-PulmonaryUrinary bladder

StomachSoft TissuePancreas

Recto-SigmoidStomachThyroid

(1) Lebanese Hosp. (Except Sacre Coeur Hosp. + Private Pathology Labs) (1993+1998)

(2) AUBMC Tumor Registry (1993+1998)


Females at AUBMC 93+98

The ranking of the ten most common cancer Females Patients in



BreastBreastBreast

Corpus UteriCervix UteriLung & bronchus

OvaryCorpus UteriColon & rectum

Non-HodgkinStomachUterine corpus

Cervix UteriRecto-SigmoidOvary

Recto-SigmoidLymph NodesNon-Hodgkin's l

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