Magnitude of Liver Cancer in Egypt - NCI

Magnitude of Liver Cancerin EgyptInas ElattarProfessor of BiostatisticsDepartment of Biostatistics & EpidemiologyNCI EgyptOctober 2003

Outline• World Statistics: Globocan 2000, IARC• Statistics for Egypt:• Gharbiah Population-based CancerRegistry, 1999• National Cancer Registry Center• National Cancer Institute (NCI)• Risk Factors for Liver Cancer

World• Liver cancer is the 5 th most frequent cancer sitefor males after lung, prostate, stomach andcolorectal cancer.• It constitutes 7.5% of all cancer types• For females, it is the 8 th most common,accounting for 3.5% of all cancer types

World Estimated New Cancer Cases,Crude and Age-adjusted IncidenceRates by Gender, Globocan 2000GenderNumber ofnew casesCrudeincidencerateAge-adjustedincidencerateMales398,36413.115.0Females165,9725.55.5Incidence rates/100,000

World Estimated Cancer Deaths, Crudeand Age-adjusted Death Rates byGender, Globocan 2000GenderNumber ofdeathsCrudedeath rateAge-adjusteddeath rateMales383,59312.614.4Females164,9615.55.46Death rates/100,000

World Age-adjusted Incidence Rates byGender, Globocan 2000MalesFemalesWorldMore developedcountriesLess developedcountries15.08.717.45.52.96.8Incidence rates/100,000

World Age-adjusted Death Rates byGender, Globocan 2000MalesFemalesWorldMore developedcountriesLess developedcountries14.48.116.95.53.06.6Incidence rates/100,000

Countries with Highest Age-adjustedIncidence Rates, Globocan 2000Mongolia98.9Korea48.8Rwanda40.1Thailand36.9Hong Kong36.5China35.2Mali34.6Guinea33.2Congo32.3Japan29.20 20 40 60 80 100 120Age-adjusted incidence rate/100,000

Frequency in Arab World (Males)Egypt (2nd)13.0%Saudi Arabia(2nd)8.6%Qatar (3rd)7.5%Kuwait (5th)7.0%UAE (6th)6.2%Oman (6th)4.9%USA1.1%Japan(Osaka)15.5%0.0% 5.0% 10.0% 15.0% 20.0%Percent of all cancer cases

Egypt, Gharbiah Population-based CancerRegistry, 1999• Gharbiah is Egypt’s s first Population-based CancerRegistry• Liver cancer is the 2nd most frequent cancer sitefor males after bladder. It constitutes 13% of allcancers• For females, it is the 4th after breast, NHL andleukemia. It constitutes 4.1% of all cancers

Estimated New Cancer Cases, Crude andAge-adjusted Incidence Rates by Gender forEgypt, Gharbiah 1999GenderNumber ofnew casesCrudeincidencerateAge-adjustedincidencerateMales22513.021.4Females694.16.0Incidence rates/100,000

Most Common Sites in Males, Gharbiah,Egypt, 1999Bladder15.4Liver13NHLLung8.210.9Leukemia5.4ColorectalProstateBrainLarynxStomachPancreasBonesKidney3.93.32.72.72.52.41.91.80 5 10 15 20Percent of cases

Most Common Sites in Females, Gharbiah,Egypt, 1999BreastNHLLeukemiaLiverColorectalOvaryBladderBonesBrainLungThyroidSoft tissuePancreasCervix4.94.13.73.73.4332.42.221.81.8837.60 5 10 15 20 25 30 35 40Percent of cases

National Cancer Registry Center• In August 2000, the Minister of Health and Populationlaunched the National Cancer Registry Project• The Nasser Institute Hospital in Cairo has been designatedas the Center for the National Cancer Registry Project• The National Cancer Registry Center has a network ofregional cancer registries, namely Aswan, Menia, Sohag,Damanhour, Domiatt, , Tanta, Nasser, and El Salam

Ten Most Common Cancer Sites Based on 18,420Cancer Cases Registered at the Central CancerRegistry (1/1/99-31/6/01)Breast21.1Lymph nodesBladder9.99.9Liver8.1ColorectalBloodLungBrainOvaryBones3.73.43.22.82.22.10 5 10 15 20 25Percent of cases

Frequency of Liver CancerCentral Cancer Registry (1/1/99-31/6/01)Domiatt(n=2045)11.3Menia(n=4135)10.2Damanhour(n=2563)10.2Aswan(n=1194)8.0Tanta(n=4039)5.8Sohag(n=2382)5.8Nasser(n=1372)5.6El Salam(n=690)4.30.0 2.0 4.0 6.0 8.0 10.0 12.0Percent of cases

Male to Female RatioCentral Cancer Registry (1/1/99-31/6/01)Nasser(n=1372)Damanhour(n=2563)Menia(n=4135)Tanta(n=4039)Sohag(n=2382)Domiatt(n=2045)Aswan(n=1194)El Salam(n=690)0.0 2.0 4.0 6.0 8.0M/F ratioRatio 1

19,568 New Cancer Cases by Systems,NCI 2001-20022002Lip, oral cavity &pharynx693Digestive system3056Respiratory system1242Bones & joints515Soft tissue845Skin509Breast3729Male genital305Female genital909Urinary system2357Eye & brainThyroid &other endocrine376513Lymphoma1718LeukemiaOthers121114460 500 1000 1500 2000 2500 3000 3500 4000Number of cases

3,056 (15.6%) New Cases of DigestiveSystem, , NCI 2001-200220022883162131641381Liver (45.3%)Rectum (12%)Colon (10.7%)Stomach (10.4%)Pancreas (9.4%)325369Esophagus (7%)Others (5.4%)

Most Common Sites in Males, NCI 2001-2002Bladder16.3Liver10.6Lymphoma10.6Leukemia6.8Lung5.4Soft tissue5.1Colorectal3.9Skin 3.2Bones 3.1Larynx 3Prostate 2.5Brain 2.2Pancreas 2Stomach 1.9Kidney 1.80 5 10 15 20Percent of cases

Most Common Sites in Females, NCI 2001-2002Breast36.5Lymphoma 6.3Leukemia 5.5Bladder 4.7Soft tissue 4.2Colorectal 3.8Ovary 3.7Liver 3.6Cervix 2.8Thyroid 2.2Bones 2.1Skin 2Brain 1.8Uterus 1.5Lung 1.40 10 20 30 40Percent of cases

Relative Frequency of Liver Cancer,NCI 1975-2002861975-97 2001-02Percent42 01975-85 1990 1995 2000Year

Trend of Registered HCC Mortality in Egypt,1981-1998 1998 (Mostafa(& El-Said, May 2002)25002339200019602125 20881777Number ofcases1500141115691000954745500538081 83 85 87 89 91 93 95 97 99Year

Trend of HCC Mortality in Egypt, 1981-19961996(Mostafa& El-Said, May 2002)5.04.54.0FemalesMales4.24.63.53.03.23.33.0Rate/100,0002.52.02.12.42.02.32.52.52.31.51.01.41.01.21.50.50.081 83 85 87 89 91 93 95 97Year

Egypt Mortality Statistics, Liver Cancer, 2001(The Cancer Database, 2001)MalesNumber ofcases2126% of allcancerdeaths17.3%Females107111.5%Total319714.8%

Egypt Mortality Statistics, 2001Most common sites (The Cancer Database, 2001)Liver (14.8%)3197Lymph&Leuk(11.6%)2497Brain (9.4%)2023Breast (9.3%)2006Bladder (8.7%)Lung&Bronchus(7.7%)16621869Colorectal (3.9)834Stomach (3.7%)797Pancreas (2.5%)550Prostate (2%)4250 500 1000 1500 2000 2500 3000 3500Number of cases

Risk Factors for Liver CancerCertain types of Viral Hepatitis:Chronic infection with hepatitis B virus (HBV)and hepatitis C virus (HCV) is an important livercancer riskLong –Term Exposure to Aflatoxin:This carcinogenic substance is produced intropical and subtropical regions by a fungus thatoften contaminates peanuts, wheat, soybeans,ground nuts, corn, and rice

Risk Factors for Liver Cancer (continued)Vinyl Chloride and Thorium Dioxide:These chemicals are risk factors forangiosarcoma of the liver and to a lesserdegree, will increase the risk of HCCBirth Control Pills:Oral contraceptives are a cause of benigntumors, hepatic adenomas. They may alsoincrease the risk of HCC

Risk Factors for Liver Cancer (continued)Anabolic steroids:Long-term use can slightly increase the risk ofHCCArsenic:Drinking water contaminated with arsenicincreases the risk of HCC in some parts of theworldSmoking:There is some evidence that smoking mayincrease the risk of liver cancer

Risk Factors of Liver Cancer AmongEgyptians• Egypt has the World’s s highest prevalence ofhepatitis C• HCV antibody positivity estimated by theEgyptian Ministry of Health (1999) to be 18.9%• Smoking is increasing among men• Pesticides are common in the environment

Conclusions• HCC is a recognized complication of hepatitis C.• There is no prospective studies which can provideaccurate estimates of the risk of HCC• There is a significant differences between gender• Frequency of liver cancer varied between thedifferent cancer centers, between 4% to 13% of allcancer cases.

Conclusions (continued)• Liver cancer is increasing in Egypt• There is significant increase in the age specificincidence rates starting at the age of 40 years• There is an approximately, fourfold increase inthe death rate from 1981• Liver cancer is the number one cause of deathfrom among all other cancer sites

References• Globocan 2000: Cancer Incidence, Mortality and PrevalenceWorldwide, Version 1.0. Lyon, IARCPress, , 2001• Highlight, The National Cancer Registry Newsletter, March 2002• The Cancer Database, Egypt 1985-2001: Edited by Omar H. ElHattab; ; Ministry of Health & Population; World Health Organization,2002• Cancer Profile in Gharbiah-Egypt,Gharbiah Population-basedCancer Registry• National Cancer Institute, 2001• Epidemiology, Prevention and Control Programs of Hepatitis C inEgypt: Mostafa K.Mohamed and El-Said A. Aoun, , WHO InformalConsultation with VHPB, Geneva Swittzerland, , 13-14 14 May 2002

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