Cancer incidence in southern Iran, 1998-2002: results of population-based cancer registry

Purpose: The main aim of this study was to obtain population-based cancer incidence data for the entire population of Fars province in Iran, and to compare these rates with those obtained from a previous study in the same population ten years previously. Methods: Data were collected on all patients in major cities of Fars province who were diagnosed with cancer between 1998 and 2002. The data were computerized using SPSS (Chicago, IL) software, version 13.0, and MS EXCEL (Microsoft, Redmond, WA) software with Persian fonts. The results are presented as incidence rates of cases by site, sex, age, crude rates, and age-standardized rates per 100,000 person-years (ASRs), using the direct method of standardization to the world population. Results: During the 5-year study period, 8359 new cancer cases were registered. Diagnosis of cancer was based on histopathological criteria in 86.7%, clinical or radiological criteria in 9.4% and death certificate only in 3.9% of cases. According to the calculated ASRs, the 5 most frequent cancers in women were breast (13 per 100,000), stomach (4.4 per 100,000), lung and bronchus (2.9 per 100,000), uterus (2.7 per 100,000), and colon and rectum (2.6 per 100,000); and in men, the 5 most frequent types were stomach (9.2 per 100,000), bladder (6.8 per 100,000), lung and bronchus (6.3 per 100,000), lymphocytic leukemia (4.1 per 100,000), and skin melanoma (3.8 per 100,000). The ASR for all cancers in men was 64.5 per 100,000, and that for women was 55.5 per 100,000. Conclusion: Considering the limitations of this study, our results should be taken as the minimum incidence rates of cancers in Fars province, southern Iran. Significant differences were observed between the two study periods. However, we most likely have underestimated the frequencies of some tumors.     

Epidemiology of pediatric primary malignant central nervous system tumors in Iran: A 10 year report of National Cancer Registry

BackgroundCNS tumors are the leading cause of cancer related deaths among children and adolescents. Nonetheless, the incidence of pediatric CNS tumors in developing countries is poorly understood. We aimed to provide epidemiologic features of primary malignant CNS tumors in Iranian children 0–19 years of age using National Cancer Registry (NCR) data bank.MethodsThe data recorded by NCR over a 10 year period (2000–2010) were reviewed.ResultsOf 1948 tumor cases, 93.3% were located in brain, 5.1% were found in the spinal cord & cauda equina, and 1.6% affected cranial nerves and other parts of the nervous system. The overall average annual age specific incidence rate was 1.43 per 100,000. Males were more likely to develop CNS tumors (1.65 per 100,000) compared to females (1.21 per 100,000, p < 0.01). Children under 5 years of age had the highest age specific incidence rate (1.86 per 100,000). Astrocytic tumors with the incidence rate of 0.61 per 100,000 were the most frequent specific histology followed by embryonal (0.38 per 100,000), and ependymal tumors (0.10 per 100,000). With regard to the histological distribution of tumors, some unique features including the high proportion of unspecified malignant neoplasms (7.6%) were noted.ConclusionThe overall incidence rate was markedly lower than western findings. Major differences were also observed in incidence rates of specific histologies. Although the discrepancies may be attributable to diversity in classification schemes and registration practices, a real ethnic and geographical variation in predisposition to development of pediatric CNS cancers is strongly suggested.     

Women cancers in India: Incidence,trends and their clinical extent from the National Cancer Registry Programme

BackgroundTo provide a comprehensive assessment of women cancer in India utilizing the systematically collected data on all cancers by the National Cancer Registry Programme (NCRP).MethodsThe study examined 10,2287 cancer cases among women cancers providing cancer burden for major anatomical sites. Aggregated data of 28 PBCRs and 58 HBCRs under NCRP for 2012–16 was analysed for incidence rates, trends, cumulative risk of developing cancer, stage at detection and treatments offered.ResultsStudy results have found region –wide variation of women cancers by indicating highest proportions in western followed by southern region of India. North-Eastern region had lowest proportion. It was observed that breast is highest ranking cancer in most registry areas of urban agglomerations of country while cancer cervix was leading site in registries of rural areas like Barshi (15.3) and Osmanabad &Beed (13.1). States of Mizoram (23.2) and Tripura (9.5) along with Pasighat, Cachar and Nagaland. Median age of occurrence for women for these anatomical sites ranged from 45 to 60 years of age. For cancer breast, cervix and ovary –most cases were detected with regional spread. These findings were different for cancer corpus uteri where registries have reported higher proportions (49.3 %) of localized stage at detection. Loco regional cancers had higher proportions of multimodality treatments.ConclusionStudy provides a foundation for assessing the status of women cancers in the country. Variations between geographies would guide appropriate support for action to strengthen efforts to improve cancer prevention and control in underserved areas of the country. This would facilitate advocacy for better investments and research on women cancers.     

Progress in cancer survival across last two decades: A nationwide study of over 1.2 million Polish patients diagnosed with the most common cancers

BackgroundThe purpose of this study was to estimate the high incidence cancers survival in Poland between 2000 and 2018, with the following aim to monitor the national polish cancer control program 2020–2030 effectiveness. We calculated survival in cancer of lung, breast, prostate, colon, rectum, ovarian, cervical cancers, and skin melanoma.MethodsData were obtained from the Polish Cancer Registry (PLCR). We estimated age-standardized 5-year net survival (NS) with the life table method and the Pohar-Perme estimator using the International Cancer Survival Standard weights. The corresponding 95% confidence intervals (95% CI) were estimated with log transformation.ResultsOverall, 1,288,944 high incidence cancer cases were included in the study (622,486 men and 666,458 women). In 2015–2018 age-standardized 5-year NS was 85.2% (95% CI = 84.6% to 85.8%) in prostate cancer, 80.0% (79.5% to 80.4%) breast cancer, 77.3%(76.4% to 78.1%) melanoma, 58.5% (57.5% to 59.5%) cervical cancer, 57.9% (57.3% to 58.5%) colon cancer, 52.1% (51.3% to 52.9%) rectal cancer, 43.3% (42.4% to 44.3%) ovarian cancer, and 17.8% (17.4% to 18.1%) for lung cancer. Between the 2000–2004 and 2015–2018 the highest increase in survival was noted for prostate cancer (14.6% points [pp]; from 70.6% to 85.2%) and the lowest for lung cancer (4.5 pp; from 13.3% to 17.8%).ConclusionCancer survivorship has been consistently improving during the last two decades. Notwithstanding these overall encouraging results, more extraordinary efforts are needed to close the cancer survival gap in Poland.     

Regional disparities in cancer survival in Iran: Insight from a National Surveillance of Cancer Survival in Iran (IRANCANSURV)

Background and objectivesWe aimed to investigate geographical disparity in cancer survival in 9 provincial population-based cancer registries in Iran from 2015 to 2016.Material and methodIn the current study, data from 90,862 adult patients (aged >15 years) diagnosed with cancer were retrieved from 9 population-based cancer registries across Iran. Five-year survival rates were estimated by applying relative survival approaches. We also applied the international cancer survival standard weights for age standardization. Finally, we calculated the excess hazard ratio (EHR) for each province adjusted for age, sex, and cancer sites to estimate the excess hazard ratio of mortality compared to the capital province (Tehran).ResultsThe largest gap in survival was observed in more curable cancer types, including melanoma (41.4%), ovary (32.3%), cervix (35.0%), prostate (26.7%), and rectum (21.4%), while the observed geographical disparity in lethal cancers such as lung, brain, stomach, and pancreas was less than 15%. Compared to Tehran, we found the highest excess hazard of death in Western Azerbaijan (EHR=1.60, 95% CI 1.51, 1.65), Kermanshah (EHR=1.52, 95% CI=1.44, 1.61), and Kerman (EHR=1.46, 95% CI=1.38, 1.53). The hazard ratio of death was almost identical in Isfahan (EHR=1.04, 95% CI=1.03, 1.06) and Tehran provinces.ConclusionProvinces with higher HDI had better survival rates. IRANCANSURV study showed regional disparities in cancer survival in Iran. Cancer patients in provinces with a higher Human Development Index (HDI) had a higher survival rate and lived longer compared to the patients in provinces with medium and low HDI regions.     

Cancer in adolescents and young adults: National incidence and characteristics in Japan

ObjectiveAdolescents and young adults (AYA) with cancer are confronted with unique challenges in areas of paramount concern within their age group, such as fertility, education, career, and delayed and long-term effects of treatment. However, the extent and depth of the problem has never been examined in the Japanese population. The aim of this study was to describe the status of cancer patients in the AYA population, using data from the hospital-based cancer registry (HBCR).Study designPatients included in the HBCR from January 2011 to December 2014 were included in this study to evaluate the incidence and cancer distribution trends among AYA. The total number and the proportion of AYA (15–39 years of age) stratified by sex, age, and cancer type were obtained. The incidence of age-specific cancer among AYA was also calculated.ResultsWe identified 30,394 male (35.1%) and 56,100 female (64.9%) cancer patients in the population, which collectively constituted about 3% of all invasive cancer cases. The incidence of cancer in AYA was estimated as 86.2 per 100,000 per year, and increased with age. The most affected population was women between 35 and 39 years of age (35%). Breast cancer was the most common type of cancer, followed by cervical, uterine, and thyroid cancers.ConclusionA substantial number of AYA are diagnosed with cancer every year. The distribution of cancer types in AYA was dependent on age and sex. These diversities in cancer types can inform researchers and policy makers to fine-tune their studies and policies.     

Population genetics of the people of Iran II. Genetic differentiation and population structure

The genetic structure of six populations of Iran (Turks, Kurds, Lurs, Zabolis, Baluchis and Zoroastrians) was examined using data on blood groups, serum proteins and cell enzymes. Our results show conclusively that there are genetic differences among the six populations and the analysis of superimposed R and S matrices defined Harpending & Jenkins (1973) show by that the dispersion of some of the alleles correspond to the dispersion of the populations. The F_ST estimates are not large enough to favour selection on any of the loci studied. The F_IT and F_IS estimates are positive and moderately high suggesting that the genetic differentiation to some extent is influenced by inbreeding.     

Population genetics of the peoples of Iran I. Genetic polymorphisms of blood groups,serum proteins and red cell enzymes

Genetic polymorphisms of six blood groups and seven biochemical genetic markers were investigated in six Iranian populations (Turks, Kurds, Lurs, Zabolis, Baluchis and Zoroastrians). Eight of the genetic systems (ABO, MNSs, Kidd, C3, AP, AK, PGM1 and EsD) showed conclusive heterogeneity among these populations. Comparison of gene frequencies with the few available samples of Iranian populations demonstrated an intra-ethnic and extensive overall genetic diversity in the Iranian plateau. A gradient of C3*F gene was also discernible within the geographical region of Iran which may reflect the relics of the historical movements of different racial groups in this region. The present genetic variation may reflect the differences in the structure of these populations, the analysis of which is further attempted in the accompanying paper.     

Racial/ethnic differences in the utilization of chemotherapy among stage I-III breast cancer patients,stratified by subtype: Findings from ten National Program of Cancer Registries states

BackgroundThe study aimed to examine racial/ethnic differences in chemotherapy utilization by breast cancer subtype.MethodsData on female non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic stage I-III breast cancer patients diagnosed in 2011 were obtained from a project to enhance population-based National Program of Cancer Registry data for Comparative Effectiveness Research. Hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) were used to classify subtypes: HR+/HER2-; HR+/HER2+; HR-/HER2-; and HR-/HER2 + . We used multivariable logistic regression models to examine the association of race/ethnicity with three outcomes: chemotherapy (yes, no), neo-adjuvant chemotherapy (yes, no), and delayed chemotherapy (yes, no). Covariates included patient demographics, tumor characteristics, Charlson Comorbidity Index, other cancer treatment, and participating states/areas.ResultsThe study included 25,535 patients (72.1% NHW, 13.7% NHB, and 14.2% Hispanics). NHB with HR+/HER2- (adjusted odds ratio [aOR] 1.22, 95% CI 1.04–1.42) and Hispanics with HR-/HER2- (aOR 1.62, 95% CI 1.15–2.28) were more likely to receive chemotherapy than their NHW counterparts. Both NHB and Hispanics were more likely to receive delayed chemotherapy than NHW, and the pattern was consistent across each subtype. No racial/ethnic differences were found in the receipt of neo-adjuvant chemotherapy.ConclusionsCompared to NHW with the same subtype, NHB with HR+/HER2- and Hispanics with HR-/HER2- have higher odds of using chemotherapy; however, they are more likely to receive delayed chemotherapy, regardless of subtype. Whether the increased chemotherapy use among NHB with HR+/HER2- indicates overtreatment needs further investigation. Interventions to improve the timely chemotherapy among NHB and Hispanics are warranted.     

Fallout from the Chernobyl accident and overall cancer incidence in Finland

Aim: We studied whether incidence of all cancer sites combined was associated with the radiation exposure due to fallout from the Chernobyl accident in Finland. An emphasis was on the first decade after the accident to assess the suggested “promotion effect”. Methods: The segment of Finnish population with a stable residence in the first post-Chernobyl year (2 million people) was studied. The analyses were based on a 250 m × 250 m grid squares covering all of Finland and all cancer cases except cancers of the breast, prostate and lung. Cancer incidence in four exposure areas (based on first-year dose due to external exposure <0.1 mSv, 0.1–1.3, 0.3–0.5, or ≥0.5 mSv) was compared before the Chernobyl accident (1981–1985) and after it (1988–2007) taking into account cancer incidence trends for a longer period prior to the accident (since 1966). Results: There were no systematic differences in the cancer incidence in relation to radiation exposure in any calendar period, or any subgroup by sex or age at accident. Conclusion: The current large and comprehensive cohort analysis of the relatively low levels of the Chernobyl fallout in Finland did not observe a cancer promotion effect.     

Cancer incidence in the Greater Poland region as compared to Europe

Greater Poland is a region with a high risk of cancer. In terms of age-standardised incidence rate, it is ranked 2nd for men and 3rd for women out of Poland’s 16 provinces. Incidence structure in the region of Greater Poland is similar to that in other West European countries. The most common cancers in men are lung, prostate and colorectal, in women: breast, colorectal and lung. In 2016, nearly every third cancer-related death in the region was caused by lung cancer. In women, it was cause no. one. The incidence of chronic diseases, including cancer, is expected to further grow in view of the global ageing of the population. This means that malignancies will remain to be a major challenge for public health care.in the Greater Poland region.     

Experts against precaution: analyzing the process of biosafety regulation in Iran

The process of preparing and enacting a biosafety law in Iran lasted more than a decade. This paper examines the process of biosafety policy-making in Iran in relation to the Cartagena Protocol on Biosafety (CPB) and to domestic Iranian factors. While some scholars argued that the CPB would be influential in developing countries, our findings indicate that it was not particularly important in Iranian biosafety legislation. This paper outlines the internal Iranian political processes, which initially envisaged a very precautionary approach, but which concluded with a biosafety law designed to promote the adoption of these technologies. Reference will be made to the changing influence of expert biotechnologists on policy-making. The dominance of domestic policy considerations, compared to CPB provisions, implies that signing the CPB does not imply that national regimes will converge on a common model, based on the text of the CPB.     

Spatial analysis of hepatocellular carcinoma and socioeconomic status in China from a Population-based Cancer Registry

Background: Little is known about geographic variations in liver cancer at high incident regions. We aimed to identify spatial variation of hepatocellular carcinoma (HCC) at a high-risk area in China and determine its association with socioeconomic status (SES). Methods: Based on 2299 liver cancer cases diagnosed in Haimen from 2003 to 2006, we calculated age–sex standardized incidence ratios (SIRs) and used two spatial scan statistics to determine the geographic variations in HCC. Bayesian hierarchical model was used to explore the association between HCC incidence and SES. Results: Age and sex SIRs for HCC varied from 0.54 to 1.97 for 24 townships. The eastern region of Haimen was identified to have a significantly increased risk of HCC. Fitting of a Bayesian hierarchical model linking per-capita fiscal revenue with SIRs of HCC indicated that the area with a lower revenue had a significantly higher incidence of HCC [β_log(revenue) = ?0.179, posterior 95% Bayesian credible interval (CI) = (?0.326, ?0.04)]. Conclusions: This study demonstrated substantial geographic variation in the incidence of HCC within a high-risk region, which was associated with SES. HCC control and intervention should focus on disadvantaged areas to reduce the HCC disparities.     

New cases of melanoma as documented in the National Cancer Registry

The authors briefly survey general aspects of crucial importance for the proper functioning of the National Cancer Registry, such as legislation, collected data, identification of patients, the completeness and validity of its content in relation to the results and conclusions of a comprehensive, national supervision performed after the Melanoma Consensus Conference. Compared to earlier national controlling attempts, the present supervision was highly successful: doctors of various hospitals did perform the detailed control of diagnosis in 95.81% of 1361 melanoma patients announced in 2001. They checked whether patients given the C43 BNO code had melanoma indeed, searched for those who received a different BNO code and identified those not announced for any reason to the Registry. After correction the Registry included 1117 new cases of melanoma in 2001. The authors state that the conclusions from this supervision may enhance the reliability not only of the data base of the Registry but that of the hospitals as well.     

Cancer incidence and spectrum among Uygurs in Hotan District in China

Cancer is the leading cause of death in China and a significant public health problem with increasing incidence and fatality rates. The Han nationality is the main ethnic group in China, and many reports on the epidemiology of cancers in Han nationality are published. However no studies report the cancer spectrum of Uygurs which are one of the minority nationalities in China. Hence, we present incidence and mortality numbers of different cancers for the Uygur patients for the period 2018–2020 in Hotan District where Uygur population accounts for 99 %. During the 3-year study period, 2509 new Uygur cancer cases were registered, comprising 774 men and 1735 women. Cervical cancer was the most common, followed by esophageal, breast, gastric and colorectal cancers. The most common cancers in women and men were cervical cancer and esophageal cancer, respectively. In conclusion, the cancer spectrum in Hotan is different from other regions of China and our research revealed the cancer incidence in Hotan, which could help us to take appropriate measures to reduce the incidence rate.     

A new Mylabris species from south-eastern Iran and a key to the Iranian species of the nominate subgenus (Coleoptera, Meloidae)

A new species of Mylabris of the nominate subgenus is described and figured. This species is apparently endemic to the south-eastern Iranian province of Kerman and seems to be phenetically very distinct from all other species of this subgenus, primarily because of the unique elytral pattern. A key to the species of the nominate subgenus distributed in Iran is also presented.     

Five-year relative survival and determinants of excess mortality in patients with head and neck and thyroid cancers: A population-based study from Golestan province,Northern Iran

BackgroundWe aimed to assess relative survival (RS) and determinants of excess mortality rate in patients with head and neck squamous cell carcinomas (HNSCC) and thyroid cancer in Golestan province, Northern Iran.MethodsWe recruited new primary HNSCC and thyroid cancer cases from Golestan, 2006–2016. Five-year age-standardized RS with their 95% confidence intervals (CIs) were calculated. The relationships between different variables with excess mortality rates were assessed by estimating adjusted excess hazard ratios (aEHRs) with their 95% CIs.ResultsOverall, 718 cases of HNSCC and 386 thyroid cancer cases were enrolled. Five-year age-standardized RS (95% CI) were 36% (31−41) and 61% (52−69) in HNSCC and thyroid cancer patients, respectively. There were significant relationship between excess mortality rates in HNSCC patients with metastasis (aEHR= 3.31; 95%CI: 2.26–4.84), treatment type (4.19; 2.54–6.91, for no treatment as compared to receiving both surgery and chemoradiotherapy), age (2.16; 1.57–2.96, for older age group) and smoking (2.00; 1.45–2.75, for smokers as compared to non-smokers). Determinant of the excess mortality in thyroid cancer patients included metastasis (19.65; 8.08–47.79), tumor morphology (12.27; 4.62–32.58, for anaplastic cancer as compared to papillary cancer), treatment type (8.95, 4.13–19.4, for no treatment as compared to receiving both surgery and iodine therapy) and age (2.31; 1.17–4.54, for older age group).ConclusionOur findings suggested low RS for thyroid cancer in our population, while the estimates for HNSCC were comparable with other population. Metastasis, treatment type and age were determinants of mortality both in thyroid and HNSCC patients.     

Mycetomas in Iran: a review article

Mycetomas are the subcutaneous and relatively rare chronic pustular infections. The etiologic agents of mycetomas are a group of saprophytic fungi and actinomycetes living in soil. We retrospectively discussed the overall prevalence of mycetomas and the prevalence of infective agents in Iran between 1972 and 2005. Seventy-six cases of mycetomas have been reported from various geographical locations in Iran during 33 years. Analysis of the records revealed that 84.5% were actinomycetoma and only 15.5% were eumycetoma. Disease mainly has been seen in foot, and the male to female ratio was 2:1. Mycetomas were abundant among farmers in rural areas of Iran. The commonest agents of mycetomas were Nocardia asteroids, Actinomadura madura (actinomycetoma) and Allesheria boydii (eumycetoma). The peak age of onset was between 31 and 51 years.     

Embryo Donation in Iran: An Ethical Review

Iran is the only Muslim country that has legislation on embryo donation, adopted in 2003. With an estimated 10–15% of couples in the country that are infertile, there are not any legal or religious barriers that prohibit an infertile couple from taking advantage of Assisted Reproductive Technologies (ARTs). Although all forms of ARTs available in Iran have been legitimized by religious authorities, there is a lack of legislation in all ARTs except embryo donation. By highlighting ethical issues in embryo donation, the paper presents a critical review of the Act of Embryo Donation in Iran. The paper argues that the Act does not provide enough safeguards for the future child and assurance for the safety of the donated embryos. It also does not restrict embryo donation to surplus embryos from infertile couples and is silent about the number of embryos that could be donated by each couple as well as the number of recipients for donated embryos by a couple. The Act is also silent about the issues of genetic linkage (nasab) and heritage which are challenging issues, especially in a conservative Islamic society. As a result, the future child may not inherit from their birth parents, as it is not required by the Act, or from the genetically related parents under the anonymity policy. Finally there is no standard national protocol or guidelines to evaluate the safety of the donated embryos. The paper concludes that despite its benefits, the Act lacks clarity, and it is subject to misunderstanding and confusion.     

Evaluation of Off-Hour Emergency Care in Acute Ischemic Stroke: Results from the China National Stroke Registry

Background and Purpose

The quality of after-hour emergency care of patients with acute ischemic stroke is debatable. We therefore, sought to analyze the performance measures, quality of care and clinical outcomes in these patients admitted during off-hours.

Methods

Our study included 4493 patients from a selected cohort of patients admitted to the hospitals with ischemic stroke in the China National Stroke Registry (CNSR) from September 2007 to August 2008. On-hour presentation was defined as arrival at the emergency department from the scene between 8AM and 5PM from Monday through Friday. Off-hours included the remainder of the on-hours and statutory holidays. The association between off-hour presentation and outcome was analyzed using multivariate logistic-regression models.

Results

Off-hour presentation was identified in 2672 (59.5%) patients with ischemic stroke. Comparison of patients admitted during off-hours with those admitted during on-hours revealed an unadjusted odds ratio of in-hospital mortality of 1.38 (95% confidence interval, 1.04–1.85), which declined to 1.34 (95% confidence interval, 0.93–1.93) after adjusting for patient characteristics (especially, pre-hospital delay). No difference in 30-day mortality, total death or dependence at three, six and 12 months between two groups was observed. No association between off-hour admission and quality of care was found.

Conclusions

In the CNSR database, compared with on-hour patients, off-hour patients with acute ischemic stroke admitted to the emergency departments from scene manifested a higher incidence of in-hospital mortality. However, the difference in incidence and quality of care between the groups disappeared after adjusting for pre-hospital delay and other variables.