Population Based Caner Registry - District

Cancer Incidence and Mortality in Colombo District : 2012 (First year Report of the Population Based Cancer Registry)

National Cancer Control Programme Ministry of Health and Indigenous Medical Services 555/5 Public Health Complex Elvitigala Mawatha, , Colombo 05 Sri Lanka

Population Based Caner Registry -Colombo District

1st Publication – Cancer Incidence and Mortality in Colombo District, Sri Lanka: 2012 (First year Report of the Population Based Cancer Registry)

Published date – 22st May 2020

Compiled by

Sri Lanka Cancer Registry Strategic Information Management (SIM) Unit National Cancer Control Programme

Published by

National Cancer Control Programme Ministry of Health and Indigenous Medical Services 555/5 Public Health Complex Elvitigala Mawatha, Narahenpita, Colombo 05 Sri Lanka

Contact no +94 112368627, Fax +94 112368627 Email- [email protected] Web – www.nccp.health.gov.lk

National Cancer Control Programme

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Population Based Caner Registry -Colombo District

Acknowledgement

Ministry of Health Officials Secretary – Ministry of Health and Indigenous Medical Services Additional Secretary (Public Health Services) Additional Secretary (Medical Services) Director General of Health Services Deputy Director General (NCD) Deputy Director Generals (MS I, MSII, PHS I,PHS II, LS, DS,ET &R) Directors- Medical Services, Tertiary Care Services, Laboratory Services, Dental Services, Planning, Heath Information, Private Health Sector Development Legal Officer – Ministry of Health Members of the National Advisory Committee on Prevention and Control of Cancers Members of the Technical Advisory Committee on Cancer Registration and Research

Administrators of the Hospitals Deputy Director General - National Hospital Sri Lanka Director, National Hospital - Kandy Director- Apeksha Hospital Directors of Teaching, Provincial General, District General Hospitals Medical Superintendents of Base Hospitals Medical Directors of Armed Services and Police

Professional Colleges and Associations College of Oncologists College of Pathologists College of Haematologists College of Surgeons iii

Population Based Caner Registry -Colombo District

College of Oral and Maxillo_facial Surgeons College of Obstetricians and Gynaecologists College of Radiologists College of Community Physicians College of Medical Administrators Sri Lanka Medical Association Association of Oral Medicine and Oral Pathology

Private Sector Members of the Private Health Sector Regulatory Council Directors of Private Hospitals

Consultants and Hospital staff Consultants- Oncologists, Oncosurgeons, Gynaeoncologists, Histopathologists, Haematologists, Oral Pathologists, OMF Surgeons, General Surgery and sub specialties Medical officers in Oncology, Pathology, Dental Surgeons in OMF Units Medical Officers – Public Health, Planning, NCD, Health Informatics in hospitals Chief Nursing Officers in hospitals with cancer treatment units Nursing Sisters and Nursing Officers in- Charge of Oncology Clinics Officers in charge of Medical Record Departments in Government and Private hospitals Medical Laboratory Technologists at Pathology Laboratories Development Officers at Pathology Laboratories

Universities Professors of Pathology /Haematology / Oral Pathology Senior Lecturers at the Faculties of Medicine and Dentistry

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Population Based Caner Registry -Colombo District

Department of Census and Statistics Registrar General Department District Secretariat – Colombo Divisional Secretariat Offices- Colombo district Divisional Death Registrars of Colombo district

Cancer Care Association – Sri Lanka

World Health Organization WHO Country Office – Sri Lanka WHO SEARO Office – New Delhi, India

International Organizations for Cancer Registry International Agency for Research on Cancer (IARC), Lyon, France

 Dr. Freddie Bray - Head, Section of Cancer Surveillance  Mr. Leslie Mery - Global Programme Manager, Section of Cancer Surveillance IARC Regional Hub, Centre for Cancer Epidemiology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai, India  Dr. Rajesh Dixit – Professor of Epidemiology  Dr. Atul Budukh – Assistant Professor of Epidemiology International Association for Cancer Registries (IACR) WIA Cancer Institute, Adyar, Chennai, India

 Prof. R.Swaminathan- Head, Department of Epidemiology, Bio statistics and Cancer Registry

National Cancer Control Programme – Sri Lanka Past Directors, Deputy Directors and Staff of National Cancer Control Programme Current Director, Deputy Director and Staff of National Cancer Control Programme

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Population Based Caner Registry -Colombo District

Table of Content

Contents Page List of Tables ...... viii List of Figures ...... ix List of Abbreviations ...... xi Executive Summary ...... 1 Background ...... 1 Methodology ...... 1 Main Findings ...... 2 Conclusions and recommendations ...... 3 1. Introduction ...... 4 1.1 History of Cancer Registration in Sri Lanka ...... 4 1.2 Reasons for selecting Colombo district for commencing Population Based Cancer Registry ...... 7 1.3 Important assumptions when establishing PBCR ...... 7 1.4 Objectives of commencing Population Based Cancer Registry of Colombo district ...... 8 2. Methodology ...... 9 2.1 The Process of establishing Population Based Cancer Registry of Colombo district ...... 9 2.2 Profile of Colombo District ...... 11 2.2.1 Population covered by the Population based cancer registry ...... 12 2.3. Major activities of cancer registration ...... 14 2.3.1 Data collection ...... 14 2.3.2 Data coding ...... 16 2.3.3 Data entry, duplicate checking and verification of data ...... 16 2.3.4 Data analysis ...... 16 2.3.5 Report writing and dissemination ...... 17 3. Results ...... 18 3.1 Cancer incidence in Colombo district ...... 18 3.1.1 Leading cancer sites ...... 21 Age specific incidence rates of leading cancer sites in Colombo district - 2012 ...... 29 1. Lip, tongue and mouth cancer (C00 – C06) ...... 29 2. Oesophagus cancer (C15) ...... 29 3. Stomach cancer (C16) ...... 30 vi

Population Based Caner Registry -Colombo District

4. Colo- rectal cancer (C18-C20) ...... 30 5. Liver cancer (C22) ...... 31 6. Larynx cancer (C32) ...... 31 7. Trachea, bronchus and lung cancer ( C33-C34) ...... 32 8. Breast cancer (C50) ...... 32 9. Cervix uteri cancer (C 53) ...... 33 10. Uterus cancer (C54-C55) ...... 33 11. Ovary cancer (C 56) ...... 34 12. Prostate cancer (C61) ...... 34 13. Bladder cancer (C 67) ...... 35 14. Brain and nervous system cancer (C70-C72)...... 35 15. Thyroid cancer (C73) ...... 36 16. Lymphoma (C81-C85, C96) ...... 36 17. Leukaemia (C91-C95)...... 37 18. Other and unspecified sites (C26, C48, C76 and C80) ...... 37 3.2 Mortality of Cancers ...... 40 3.2.1 Leading sites (ICD 10) of cancer mortality ...... 43 3.2.2 Age specific death rates of leading cancer sites in Colombo district - 2012...... 46 3.2.3 Comparison of age standardized cancer death rates of leading cancers of ‘Population based cancer registry of Colombo district’ with the ‘National Cause of Death Data of Sri Lanka’ ...... 52 3.3 Incidence and Mortality of leading cancers – 2012 ...... 54 3.4 Quality Control ...... 56 Standard Registry Tables ...... 59 Other tables ...... 59 References ...... 83 Appendix - Statistical Terminology ...... 85

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List of Tables Table 1: Distribution of population according to sector in Colombo district and entire Sri Lanka-2012 ... 13 Table 2: Cancer incidence in Colombo districts s- 2012 ...... 18 Table 3: Cancer incidence of Colombo district by age group and sex – 2012 ...... 20 Table 4: Leading sites of cancer incidence of Colombo district by sex – 2012 ...... 21 Table 5: Distribution of cancer related deaths reported by Divisional Death Registrars of Colombo district in year 2012...... 40 Table 6: Distribution of no. of deaths, cancer related crude death rate and age standardized death rate among the residents of Colombo district in the year 2012 ...... 40 Table 7: Cancer related deaths of Colombo district by age group and sex - 2012 ...... 41 Table 8: Leading sites of cancer mortality of Colombo district – male and female 2012 ...... 43 Table 9: Mean values of data quality indicators for comparison of cancer registries in Central, East and South Asia- Male ...... 56 Table 10: Mean values of data quality indicators for comparison of cancer registries in Central, East and South Asia - Female ...... 57 Table 11: Distribution of ICD -10 and other specific sites by Sex Colombo District 2012 ...... 58 Table 12: Number of incidence cancers by five-year age group and site (ICD 10) : 2012 – Males Colombo district ...... 60 Table 13: Number of incidence cancers by five-year age group and site (ICD 10) : 2012 – Females Colombo district...... 61 Table 14: Age specific incidence rate, Crude incidence rate (CR), Age standardized incidence rate (ASR) per 100,000 population and ...... 62 Table 15: Age specific incidence rate, Crude incidence rate (CR), Age standardized incidence rate (ASR) per 100,000 population and ...... 63 Table 16: Distribution of cancer cases based on method of diagnosis – Male, Colombo district-2012 ..... 64 Table 17: Distribution of cancer cases based on method of diagnosis – Female, Colombo district-2012 .. 66 Table 18: Number of Cancer deaths by five year age group and ICD 10 site in Colombo district - Male 2012 ...... 69 Table 19: Number of Cancer deaths by five year age group and ICD 10 site in Colombo district- Female 2012 ...... 72 Table 20: Age specific rate, Crude rate (R), Age standardized mortality rate (ASR) per 100,000 population of Colombo district – Male 2012 ...... 75 Table 21: Age specific rate, Crude rate (CR), Age standardized mortality rate (ASR) per 100,000 population of Colombo district– Female 2012 ...... 78 Table 22: Distribution of reporting of cancer related deaths by divisional death registrar of ...... 81

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List of Figures Figure 1:Population Pyramid of Colombo district Colombo district – 2012 ...... 13 Figure 2: Cancer incidence rates, Colombo districts – 2012 ...... 18 Figure 3: Comparison of crude incidence rates of Colombo PBCR, National Cancer Registry (including Colombo district) and National Cancer Registry (without Colombo district) - 2012 ...... 19 Figure 4:Age specific cancer incidence rates of Colombo district – 2012 ...... 19 Figure 5: Proportion of incidence of leading cancers in the Colombo district– Male 2012 ...... 22 Figure 6: Proportion of incidence of leading cancers in the Colombo district– Female 2012 ...... 22 Figure 7: Crude incidence of leading cancers in the Colombo district– Male 2012 ...... 23 Figure 8: Crude incidence of leading cancers in the Colombo district– Female 2012 ...... 23 Figure 9: Leading cancers of 00 - 14 years age group in the Colombo district – Male 2012 ...... 24 Figure 10: Leading cancers of 00 - 14 years age group in the Colombo district – Female 2012 ...... 24 Figure 11: Leading cancers of 15 - 34 years age group in the Colombo district – Male 2012 ...... 25 Figure 12: Leading cancers of 15 - 34 years age group in the Colombo district – Female 2012 ...... 25 Figure 13: Leading cancers of 35 - 49 years age group in the Colombo district – Male 2012 ...... 26 Figure 14: Leading cancers of 35 - 49 years age group in the Colombo district – Female 2012 ...... 26 Figure 15: Leading cancers of 50 - 64 years age group in the Colombo district – Male 2012 ...... 27 Figure 16: Leading cancers of 50 - 64 years age group in the Colombo district – Female 2012 ...... 27 Figure 17: Leading cancers of 65 years and above age group in the Colombo district – Male 2012 ...... 28 Figure 18: Leading cancers of 65 years and above age group in the Colombo district – Female 2012 ...... 28 Figure 19: Age specific incidence rate of Lip tongue & mouth cancer in Colombo district – 2012 ...... 29 Figure 20: Age specific incidence rate of Oesophagus cancer in Colombo district – 2012 ...... 29 Figure 21: Age specific incidence rate of Stomach cancer in Colombo district – 2012 ...... 30 igure 22: Age specific incidence rate of Colo-rectal cancer in Colombo district - 2012 ...... 30 Figure 23: Age specific incidence rate of Liver cancer in Colombo district – 2012 ...... 31 Figure 24: Age specific incidence rate of Larynx cancer in Colombo district – 2012...... 31 Figure 25: Age specific rate of Trachea, bronchus and lung cancer in Colombo district -2012 ...... 32 Figure 26: Age specific incidence rate of breast cancer in Colombo district - 2012 ...... 32 Figure 27; Age specific incidence rate of Cervix cancer in Colombo district - 2012 ...... 33 Figure 28: Age specific incidence rate of Uterus cancer in Colombo district - 2012 ...... 33 Figure 29: Age specific incidence rate of Ovary cancer in Colombo district - 2012 ...... 34 Figure 30: Age specific incidence rate of Prostate cancer in Colombo district - 2012 ...... 34 Figure 31: Age specific incidence rate of Bladder cancer in Colombo district – 2012 ...... 35 Figure 32: Age specific incidence rate of Brain and nervous system cancer in Colombo district - ...... 35 Figure 33: Age specific incidence rate of Thyroid cancer in Colombo district – 2012 ...... 36 Figure 34: Age specific incidence rate of Lymphoma in Colombo district - 2012 ...... 36 Figure 35: Age specific incidence rate of Leukaemia in Colombo district – 2012 ...... 37 Figure 36: Age specific incidence rate of other and unspecified cancer sites in Colombo district – ...... 37 Figure 37; Age standardized incidence rates of leading cancers among males in year 2012 – ...... 38 Figure 38: Age standardized incidence rates of leading cancers among Females in year 2012 – ...... 39

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Population Based Caner Registry -Colombo District

Figure 39: Cancer related crude death rates of Colombo district with national rates based on cause specific death data of Department of Census and Statistics ...... 40 Figure 40: Distribution age specific death rates among males and females - 2012 Colombo district vs cause specific death data of Department of Census & Statistics covering whole country...... 42 Figure 41: Proportion of leading cancer deaths, Male – 2012 ...... 44 Figure 42: Proportion of leading cancer deaths, Female - 2012 ...... 44 Figure 43: Crude death rate of leading cancer related deaths in the Colombo district– Male ...... 45 Figure 44: Crude death rate of leading cancer related deaths in the Colombo district– Female ...... 45 Figure 45: Age specific death rate of Lip tongue and mouth cancer in Colombo district – 2012 ...... 46 Figure 46: Age specific death rate of Oesophagus cancer in Colombo district - 2012 ...... 46 Figure 47: Age specific death rate of stomach cancer in Colombo district - 2012 ...... 47 Figure 48: Age specific death rate of colo -rectal cancer in Colombo district – 2012 ...... 47 Figure 49: Age specific death rate of liver cancer in Colombo district - 2012 ...... 48 Figure 50: Age specific death rate of trachea, bronchus and lung cancer in Colombo district - 2012 ...... 48 Figure 51: Age specific death rate of breast in Colombo district – 2012 ...... 49 Figure 52: Age specific death rates of common gynecological cancers in Colombo district - 2012 ...... 49 Figure 53: Age specific death rate of prostate cancer in Colombo district - 2012 ...... 50 Figure 54: Age specific death rate of lymphoma in Colombo district - 2012 ...... 50 Figure 55: Age specific death rate of leukaemia in Colombo district – 2012 ...... 51 Figure 56: Age standardized death rates of leading cancers among males in year 2012 – PBCR Colombo district vs National Cause of Death Data ...... 52 Figure 57: Age standardized death rates of leading cancers among females in year 2012 – PBCR Colombo district vs National Cause Specific Death Data ...... 53 Figure 58: Age standardized incidence rates and death rates of leading cancers in Colombo district - Males 2012 ...... 54 Figure 59: Age standardized incidence rates and death rates of leading cancers in Colombo district – Females 2012 ...... 55

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Population Based Caner Registry -Colombo District

List of Abbreviations

ASR Age Standardized Rate CR Crude Rate ICD -10 International Classification of Diseases – 10th Edition ICD 0-3 International Classification of Diseases for Oncology – 3rd Version

IACR International Association of Cancer Registries IARC International Agency for Research on Cancer NCCP National Cancer Control Programme PBCR Population Based Cancer Registry WHO World Health Organization

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Population Based Caner Registry -Colombo District

Executive Summary

Background The administrative district of Colombo district in the Western province was selected as the geographic area for the first population-based cancer registry (PBCR) in Sri Lanka. The actual population of Colombo district in year 2012 according to the national census was 2,324,349 (11.4% of total Sri Lankan Population). There were 1,140,472 (49.1%) males and 1,183,877(50.9%) females. About 77.6% of the population of Colombo district is living in urbanized areas. The Colombo district is further divided to 13 divisional secretariat areas. The leading hospitals including National Cancer Institute, (government main cancer treatment centre in the country), and National Hospital of Sri Lanka, several teaching hospitals, Private cancer treatment centres and main pathology laboratories are located in this district.

Methodology The methodology for commencing PBCR in Colombo district was developed over the years with the guidance of local and international experts in cancer registration. Administrative clearance was obtained from the National Advisory Committee on Cancer Prevention and Control and it was later endorsed by the National Policy and Strategic Framework on Cancer Control and Prevention published in 2015. Ethical clearance and concurrence of all stakeholders were obtained.

Since the PBCR was designed on top of the existing National Cancer Registry of Sri Lanka which collects details of newly identified patients with cancers through cancer treatment centres (using National Cancer Surveillance Form – H-1256), pathology laboratories (using Cancer return form 1 – H 1290) and Oral Maxillo Facial Units (using Annual Notification Form of Oral Cancer – H 1294), those sources were searched through CanReg 5 database to identify patients with cancer permanently residing in Colombo district.

In addition to above sources, additional cancer incidence and/or mortality data were collected from following sources, (i) From medical records department of other tertiary and secondary care hospitals in Colombo district and suburb through Cancer return form -2 (H-1291) quarterly and

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Population Based Caner Registry -Colombo District

(ii) from the offices of Divisional death registrars of Colombo district through Cancer return form -3.

All the data were checked and coded by the cancer registry staff and were entered to the CanReg 5 database. Duplicate checking was conducted during the data entry and data verification stages including the consistency checking. The population data of Colombo district was obtained from the national census conducted in year 2012.

Main Findings In the year 2012, PBCR Colombo district has registered 1366 male patients (47.2%) and 1530 (52.8%) female patients with cancer from the residents staying in district of Colombo for more than one year. The crude incidence rate for males and females were 119.8 per 100,000 population and 129.2 per 100,000 populations respectively. The crude incidence rates were higher than the crude incidence rates for the whole country generated from National Cancer Registry. The cumulative risk of developing cancer between the age group of 0-74 for males and females were 13.5% and 11.9% respectively. It means that among males one in eight males and one in eight females have a risk of developing cancer during their life time. The highest age specific incidence rate of cancer was observed in the age group of 70-74 years among both males (883.3 per 100,000) and females (593.4 per 100,000) respectively.

Trachea, bronchus and lung cancer (n=154, ASR=11.7/100,000), Colon and rectum cancer (n=127, ASR=9.8/100,000) and Prostate cancer (n=119, ASR = 9.3/100,000) were the highest incident cancers among males. Breast cancer (n=454, ASR =29.8/100,000), Ovary cancer (n=120, ASR=8.2/100,000), Thyroid (n=102, ASR = 7.3 /100,000) were the highest incident cancers among females. Out of male leading cancers relatively higher age standardized incidence rates were reported among males for Lung cancer, Colo-rectal cancer, Prostate cancer, Liver cancer and lower age standardized incidence rates were reported for Lip, tongue and mouth cancer, Oesophagus cancer and Larynx cancer in the Colombo district in comparison to the similar age standardized rates reported in the whole country through the National cancer registry. Out of female leading cancers relatively higher age standardized incidence rates were reported

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Population Based Caner Registry -Colombo District

for breast cancer, ovary cancer, uterine cancer, Lung cancer, liver cancer and lower age standardized incidence rates were reported for Thyroid cancer, Cervix cancer, Oesophagus cancer and Lip, tongue and mouth cancer in the Colombo district.

In the year 2012, PBCR has registered 1525 cancer related deaths and out of that 46.4 % (n=707) were among the residents of Colombo district. Cancer related crude death rate among males and females were 33.5 and 27.5 per 100,000 respectively. The age specific death rate of cancer was observed in the age group of 70-74 years among both males (292.9 per 100,000) and females (191 per 100,000). Since cancer related death reporting was commenced in year 2012 for PBCR Colombo and under reported, cancer related age standardized death rates of Colombo district were relatively lower when compared with the death rates of national cause of death data of year 2012 published by the Department of Census and Statistics

Conclusions and recommendations The cancer incidence rates of Colombo district were higher than the national incidence rates due to the fact that incidence data were obtained from multiple sources. However, the cancer mortality rates were lower than the national rates due to incomplete coverage in the year of commencement of PBCR in 2012. The extensive process of methodology of population-based cancer registry is generating most valid cancer incidence and mortality data. Therefore, expediting the process of generating reports of PBCR for year 2013- 2019 is essential. Also need to address to the deficiencies identified to generate comparable, valid, timely and complete cancer incidence and mortality data in subsequent years.

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Population Based Caner Registry -Colombo District

1. Introduction

1.1 History of Cancer Registration in Sri Lanka The National Cancer Control Programme (NCCP), Sri Lanka was established in 1980 according to a recommendation of World Health Organization (WHO) following a detailed survey of morbidity and mortality of cancers in Sri Lanka in the year 1979. Even before the establishing of NCCP, frequency data of newly reported cancers to the cancer units were published as a supplementary to Quarterly Epidemiological Report published by the Epidemiological Unit of Ministry of Health.

The formal process of cancer registration in Sri Lanka to generate ‘National Cancer Registry’ was commenced with the active data collection of hospital-based cancer incidence data of year 1985. For the publication of first ‘National Cancer Incidence Data’ details of newly detected patients with cancers were collected from three cancer treatment centres namely National Cancer Institute Maharagama, Teaching Hospitals Kandy and Karapitiya. Over the years, numbers of data collection points were increased with the expansion of cancer treatment network. (Cancer Incidence Data Sri Lanka 2012) In the year 2000/2001, NCCP in collaboration with the Department of Pathology, Faculty of Medicine, pathology-based cancer registration was commenced as a parallel surveillance system. It was expected about 40 pathology laboratories would send monthly returns to NCCP at the beginning. (Perera N ,2001)

In year 2004 and 2005, a detailed external review of cancer registration in Sri Lanka was conducted by Dr. R. Sankaranarayanan of International Agency for Research on Cancer (IARC) of World Health Organization (WHO) and Dr. Maxwell Parkin, President of the International Association of Cancer Registries (IACR) respectively. (Parkin M, 2005) The key recommendations of the review were accepted and were implemented in subsequent years as shown in following table.

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Population Based Caner Registry -Colombo District

Table (i): Key recommendations and implementation status of External Review on Cancer Registration in Sri Lanka

Recommendation Implementation

‘The registration system as it currently exists The ‘National Cancer Registry’ was further provides the basis for a ‘National Cancer strengthened over the years as shown in table Registry’ and should be continued, since it (ii) should provide information on perhaps 85%- 90% of cancer cases countrywide’

‘The data from the cancer registry and From year 2008 onwards, data on newly pathology register should be entered into the diagnosed cancers at the pathology same database using the CANREG system of laboratories were incorporated to the national IARC’ cancer registry.

In addition, from year 2006 onwards newly detected cancers from Oral Maxilla Facial Units throughout the country were also incorporated to the national cancer registry.

‘Á population-based cancer registry (PBCR) Methodology of commencing population- should be developed for Colombo district. based cancer registry Colombo district was The current data collection methods should be developed over the years with the technical augmented by a programme of routine visits guidance of International Agency for to all hospitals within Colombo district and Research on Cancer (IARC), WHO IARC obtaining a list of deaths from cancer from the Regional Hub for Cancer Registration, Registrar General’s office. Patient Mumbai India and other development information from these additional sources is partners. entered into the same database as for the ‘National Cancer Registry’

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Population Based Caner Registry -Colombo District

In addition to the recommendations of the IARC experts in 2004 / 2005, again in 2008 the first ever Comprehensive Review of Cancer Control Programme named ‘imPACT’ review was conducted by the Programme for Action for Cancer Therapy (PACT) of International Atomic Energy Authority (IAEA) and WHO highlighted the importance of commencement of PBCR in Colombo district.

Meantime, the ‘National Cancer Registry’ was further strengthened and continued over the years as shown in table (ii) since it would provide 85%-90% of cancer incidence of the country. As described by the international experts on cancer registration, it would provide the foundation for development of one or more regional population-based cancer registries.

Table (ii) Evolution of National Cancer Registry - Sri Lanka

Year of Data generating centres Publication cancer Cancer Pathology OMF Medical Death Total no. Volume Year incidence Treatment laboratories Units Record Registrars centres published data Centres Rooms 1985 3 _ _ _ _ 3 I 1990 1986 3 _ _ _ _ 3 II 1991 1987 3 _ _ _ _ 3 III 1993 1990 3 _ _ _ _ 3 IV 1996 1995 3 _ _ _ _ 3 V 2002 2000 4 _ _ _ _ 4 VI 2006 2001-2005 5 _ _ _ _ 5 VII 2009 2006 6 _ 4 _ _ 10 VIII 2012 2007 6 _ 4 _ _ 10 IX 2013 2008 7 16 17 _ _ 40 X 2014 2009 9 15 17 _ _ 41 XI 2015 2010 9 13 17 _ _ 39 XII 2016 2011 9 13 12 - - 34 XIII 2018 2012 9 37 12 36 36 130 XiV 2020

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Population Based Caner Registry -Colombo District

1.2 Reasons for selecting Colombo district for commencing Population Based Cancer Registry

Criteria Compliance to criteria Presence of clear definition of catchment Colombo administrative district population

Availability of reliable population The national census was conducted in year denominators from the census and other 2012 statistical offices

Availability of comprehensive cancer care National Cancer Institute is located in the facilities within the catchment area district. Also, all the private sector dedicated cancer units are located in the district

Easy access to case finding sources such as National Cancer Control Programme (NCCP) hospitals, pathology labs and other sources of which is the focal point of PBCR is also clinical data, death certificate information located within the same district. NCCP within the catchment area and in the coordinates with all the stake holders. surrounding areas.

1.3 Important assumptions when establishing PBCR

(i) Patient with cancer almost always may have a contact with a health care facility for diagnosis and treatment of cancers if adequate healthcare facilities are available at the specific geographic area

(ii) Cooperation from health care teams and health systems are obtained for the smooth functioning of population-based cancer registry

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Population Based Caner Registry -Colombo District

1.4 Objectives of commencing Population Based Cancer Registry of Colombo district 1. To obtain precise cancer incidence and mortality rates in a selected geographic area and describe the accurate cancer pattern in the selected area.

Provide cancer trends by demographic characteristics

GIS mapping of cancer incidence

2. To provide data for epidemiological research including descriptive and analytical studies (Starting point / end point) 3. To monitor and assess the effectiveness of cancer prevention, early detection and treatment programmes 4. To provide data for cancer incidence in Five Continents (CI 5) for international comparisons

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Population Based Caner Registry -Colombo District

2. Methodology

2.1 The Process of establishing Population Based Cancer Registry of Colombo district The approval was obtained from the National Advisory Committee on Prevention and Control Cancers which was chaired by the Secretary of Health to commence PBCR Colombo. Also, it was recommended to be included as a major activity into the first ever National Policy and Strategic Framework on Prevention and Control of Cancers in Sri Lanka.

The methodology to commence PBCR Colombo was developed through stakeholder consultations nationally and internationally. Some of the key interventions till commencing the PBCR Colombo in the year 2012 are listed below.

Obtaining ethical clearance

(i) Ethical clearance for the methodology of PBCR was obtained from the Ethical Review Committee of Faculty of Medicine, University of Colombo through EC-10-106 on 22.11.2010

Issuing administrative circulars

(i) Letter issued by the Secretary - Health on 31/05/2011 informing the commencement of PBCR to the administrators of hospitals in both government and private health sector

(ii) General circular no. 01- 22/2012 on Pathology Laboratory Based Cancer Surveillance in both government and private health sector

(iii) General circular no. 01-33/2012 on extending cancer surveillance to OMF units

(iii) Circular letter issued by the Secretary - Health on 20/09/2012 on ‘Surveillance of cancers in Sri Lanka – Provision of comprehensive cancer incidence data’ to all health care institutions to provide relevant information through the Medical Record Departments.

(iv) Circular letter issued by the Registrar General’s Department on 05/06/2012 regarding

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Population Based Caner Registry -Colombo District

collection of cancer related deaths through divisional death registrars.

Developing educational materials

(i) Booklet on Commencement of Population Based Cancer Registry in the Colombo district (Published in year 2012)

(ii) Booklet on Pathology Laboratory Based Cancer Surveillance (Published in year 2012)

Conducting training programmes and awareness sessions

(i) Training programmes were conducted for the officers in charge of Medical Record Departments and Divisional Death Registrars

(ii) Awareness programmes were conducted for the membership of College of Pathologists and Haematologists through their respective college councils

(iii) Awareness programmes were conducted at the academic sessions of professional colleges – Annual academic sessions of College of Pathologists and College of Gynaecologists, Young Community Physicians Forum on College of Community Physician, Monthly academic sessions Clinical Society etc.

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Population Based Caner Registry -Colombo District

2.2 Profile of Colombo District Colombo district is one of the three districts of Western province of Sri Lanka. It has an area of 675 sq km. It is surrounded on the north by Kelani River, from the south by Bolgoda River, and from the west by coast line and from the east by .

Colombo district is administratively divided into 13 Divisional Secretariat areas as shown in figure (i)

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Population Based Caner Registry -Colombo District

Map of Sri Lanka showing district margins Map of Colombo District showing Divisional Secretariat areas

Figure (i) Map showing Colombo district and its Divisional Secretariat areas

2.2.1 Population covered by the Population based cancer registry The population of Colombo district according to the national census conducted in year 2012 is 2,324,349 and it is an 11.4% of total population of Sri Lanka. There were 1,140,472 males and 1,183,877 females in the Colombo district as shown in table (iii).

Table (iii) Distribution of population according to sex in Colombo district and entire Sri Lanka- 2012

Male Female Total

Colombo district 1,140,472 (49.1%) 1,183,877 (50.9%) 2,324,349 (100%)

Entire Sri Lanka 9,856,634 (48.4%) 10,502,805(51.6%) 20,359,439 (100%

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Population Based Caner Registry -Colombo District

Figure 1: Population Pyramid of Colombo district – 2012

Colombo district is the most urbanized district in the country since 77.6% of the population were living in urbanized area and only 22.1% and 0.3% were from rural sector and estate sector as shown in table (1).

Table 1: Distribution of population according to sector in Colombo district and entire Sri Lanka- 2012

Urban Rural Estate Total

Colombo 1,802,904 (77.6%) 513,534 (22.1%) 7,911 (0.3%) 2,324,349 (100%) Entire Sri 3,704,470 (18.2%) 15,753,322 (77.4%) 901,647 (4.4%) 20,359,439 (100%) Lanka

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Population Based Caner Registry -Colombo District

2.3. Major activities of cancer registration The process of cancer registration includes following main activities. 1. Data collection (Abstraction of cancer incidence / mortality data) 2. Data coding 3. Data entry, duplicate checking and verification 4. Data analysis 5. Report writing and dissemination of information.

2.3.1 Data collection

2.3.1.1 Collection of cancer incidence data For the population-based cancer registry, cancer incidence data needed to be extracted from multiple sources at the points of diagnosis and treatment. Since the cancer incidence data were collected for the national cancer registry through the oncology clinics (from cancer incidence data of year 1985), pathology laboratories (from year 2008) and Oral and Maxillo Facial Surgery units (from year 2006), the same sources could be utilized to identify the residents of Colombo district for the PBCR.

In addition to the above-mentioned sources, details of cancer patients who have received in ward care from secondary /tertiary care hospitals without oncology units in Colombo districts and from hospitals adjacent to the Colombo district were collected though the newly developed Cancer Return Form -2.

This process facilitated the identification of as many as possible all the newly diagnosed cancer patients in the year 2012. The process is summarized in table (ii).

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Population Based Caner Registry -Colombo District

Table (iv): Summary details of extraction of cancer incidence data from multiple sources at the points of diagnosis / treatment or from the Medical Record Department

Setting Data abstraction Mode of data Frequency of form abstraction receiving data to NCCP Histopathology Cancer Return Form 1 Passive Monthly /Haematology /Oral (H 1290) {by an identified officer Pathology laboratory (MO/MLT/DO) of the laboratory under the (Point of diagnosis) supervision of the Consultant} Oncology clinics at National Cancer Active/Passive At least 6 months the cancer treatment Surveillance Form after the registration (by a Medical Officer / centres at the oncology clinic (H-1256) Nursing Officer/ Development Officer (Point of treatment) Oral & Maxillo Annual Notification Passive Annually Facial Surgery Unit Form of Oral Cancer {by an identified officer of Secondary (H-1294) (Dental Surgeon/ DO) /Tertiary care under the supervision of hospitals the Consultant}

(Point of treatment) Medical Record Cancer Return Form 2 Passive Quarterly Department of the (H 1291) (by the Officer in Secondary /Tertiary charge of Medical care hospitals Record Department)

2.3.1.2 Collection of cancer mortality data Since for the National Cancer Registry, cancer incidence data were extracted only once retrospectively from the clinic files without interviewing the patient, only few cancer deaths were documented routinely. Therefore, hospital mortality data of IMMR and Cause Specific mortality data published by the Census and Statistics Department is discussed with the National Registry without having individual level case matching with the cancer registration system.

15

Population Based Caner Registry -Colombo District

Therefore, when developing the methodology for PBCR, it was decided to generate a data flow from the Divisional Death Registrars covering entire Colombo district. This process was created in collaboration with Registrar General’s Department and District Secretariat of Colombo district. Cancer mortality data flow is summarized in table (v)

Table (v) Summary details of extraction of cancer mortality data from Divisional Death Registrars

Setting Data Abstraction Mode of data Frequency of Form abstraction receiving data to NCCP

Divisional Death Cancer Return Form Passive Monthly Registrars’ Offices 3 {by the Divisional death registrar}

2.3.2 Data coding The cancer registry staffs of National Cancer Control Programme coded the primary site (Topography) and histology (morphology) of each cancer according to the standards declared at the International Classification of Disease for Oncology 3rd edition (ICD-O 3).

2.3.3 Data entry, duplicate checking and verification of data Coded cancer incidence data were entered into the CanReg5 database by the trained data entry operators attached to the NCCP. The data entering activities were closely supervised by the registry staff and regular feedback was given to ensure optimum quality.

While entering and confirming the data to the CanReg5 data base, quality checks were carried out. In addition, Excel sheets and SPSS sheets were used to identify duplicates. The data sources up to the patient clinic files were rechecked in the instances where errors were noted

2.3.4 Data analysis Cancer registry staff of the National Cancer Control Programme analyzed population-based cancer registry data using Analysis Section of the CanReg 5 database, SPSS and MS Excel software. Cancer incidence data were analyzed using different software to verify the results.

16

Population Based Caner Registry -Colombo District

2.3.5 Report writing and dissemination Report was prepared according to the guidelines declared by the WHO IARC. The quality assurance process was also incorporated.

17

Population Based Caner Registry -Colombo District

3. Results

3.1 Cancer incidence in Colombo district

Table 2: Cancer incidence in Colombo districts s- 2012

Number % *CR **ASR Male 1,366 47.2 119.8 107.6 Female 1,530 52.8 129.2 102.3 Total 2,896 100 124.6 103.3

*CR- Crude cancer incidence rate per 100,000 populations **ASR- Age standardized cancer incidence rate per 100,000 population

140 129.2 124.6 119.8 120 107.6 102.3 103.3 100

80 Male Female 60 Total

40

20

0 CR ASR

*CR- Crude cancer incidence rate per 100,000 population **ASR- Age standardized cancer incidence rate per 100,000 population

Figure 2: Cancer incidence rates, Colombo districts – 2012

18

Population Based Caner Registry -Colombo District

119.8 Male 115.3 114.7

129.2 Female 112.1 Sex 109.9

124.6 Both Sexes 113.6 112.2

100 105 110 115 120 125 130 135 Crude incidence rate per 100,000 population

PBCR Colombo National Registry with Colombo National Registry without Colombo

Figure 3: Comparison of crude incidence rates of Colombo PBCR, National Cancer Registry (including Colombo district) and National Cancer Registry (without Colombo district) - 2012

Figure 4:Age specific cancer incidence rates of Colombo district – 2012

19

Population Based Caner Registry -Colombo District

Table 3: Cancer incidence of Colombo district by age group and sex – 2012

Male Female Total

Age group Cases Population *Ag. sp. Cases Population *Ag. Sp. Cases Population *Ag.Sp. In.rate In. rate In.rate 00-04 16 84185 19.0 14 82420 17.0 30 166605 18.0

05-09 5 87380 5.7 11 85513 12.9 16 172893 9.3

10-14 9 83683 10.8 2 80723 2.5 11 164406 6.7

15-19 11 90600 12.1 12 85247 14.1 23 175847 13.1

20-24 15 97525 15.4 12 96499 12.4 27 194024 13.9

25-29 17 93671 18.1 19 93012 20.4 36 186683 19.3

30-34 24 96735 24.8 35 94883 36.9 59 191618 30.8

35-39 28 85430 32.8 67 85736 78.1 95 171166 55.5

40-44 42 82775 50.7 95 82849 114.7 137 165624 82.7

45-49 73 73763 99.0 144 78179 184.2 217 151942 142.8

50-54 130 68502 189.8 175 75239 232.6 305 143741 212.2

55-59 175 58007 301.7 198 65849 300.7 373 123856 301.2

60-64 203 51218 396.3 213 59263 359.4 416 110481 376.5

65-69 233 36566 637.2 177 45105 392.4 410 81671 502.0

70-74 199 22530 883.3 174 29322 593.4 373 51852 719.4

75+ 179 27902 641.5 177 44038 401.9 356 71940 494.9 Unknown 7 5 12 Total 1366 1,140,472 119.8 1530 1183877 129.2 2896 2,324,349 124.6

*Ag. Sp. In.rate – Age specific incidence rate per 100,000 population

20

Population Based Caner Registry -Colombo District

3.1.1 Leading cancer sites

Table 4: Leading sites of cancer incidence of Colombo district by sex – 2012

Male Female ICD 10 code and site ICD 10 code and site Cases *CR **ASR Cases *CR **ASR

C33-C34 Trachea, bronchus 154 13.5 11.7 C50 Breast 454 38.3 29.8 and lung

C18-C20 Colon and rectum 127 11.1 9.8 C56 Ovary 120 10.1 8.2

C61 Prostate 119 10.4 9.3 C73 Thyroid 102 8.6 7.3

C00– C06 Lip, tongue and 116 10.2 8.9 C54-C55 Uterus 97 8.2 6.4 mouth

C26,C48, Other and 109 9.6 8.5 C18-C20 Colon and 88 7.4 5.6 C76,C80 unspecified rectum

C81-C85, Lymphoma 81 7.1 6.4 C53 Cervix uteri 85 7.2 5.5 C96

C15 Oesophagus 74 6.5 5.7 C26,C48, Other and 82 6.9 5.0 C76,C80 unspecified C91-95 Leukaemia 60 5.3 5.4 C33-C34 Trachea, 59 5.0 3.7 bronchus and lung C32 Larynx 58 5.1 4.5 C91-95 Leukaemia 58 4.9 4.6

C22 Liver 55 4.8 4.2 C81-C85, Lymphoma 48 4.1 3.4 C96 C00-D47 All sites 1366 119.8 107.6 C00-47 All sites 1530 129.2 102.3

*CR- Crude incidence rate per 100,000 populations, **ASR - Age standardized incidence rate per 100,000 populations

21

Population Based Caner Registry -Colombo District

Trachea, bronchus and lung 11% Other sites all Colon and 30% rectum 9%

Prostate 9%

Liver 4% Lip, tongue and mouth Larynx 9% 4% Leukaemia 4% Other and Oesophagus Lymphoma unspcified 6% 6% 8%

Figure 5: Proportion of incidence of leading cancers in the Colombo district– Male 2012

All other sites Breast 22% 30%

Lymphoma 3% Leukaemia 4%

Trachea, bronchus and lung 4% Ovary 8% Other and unspcified 5% Thyroid Cervix uteri Uterus 7% 5% Colon and rectum 6% 6%

Figure 6: Proportion of incidence of leading cancers in the Colombo district– Female 2012

22

Population Based Caner Registry -Colombo District

Trachea, bronchus and lung cancer ( C33-C34) 13.5

Colo rectal cancer (C18-C20) 11.1

Prostate cancer (C61) 10.4

Lip, tongue and mouth cancer (C00 – C06) 10.2

Other and unspecified sites (C26,C48,C76,C80) 9.6

Lymphoma (C81-C85, C96) 7.1 ICD ICD 10site Oesophagus cancer (C15) 6.5

Leukaemia (C90-C95) 5.3

Larynx cancer (C32) 5.1

Liver cancer (C22) 4.8

0 5 10 15 Crude incidence rate per 100,000 population Figure 7: Crude incidence of leading cancers in Colombo district– Male 2012

Breast cancer (C50) 38.3

Ovary cancer (C 56) 10.1

Thyroid cancer ( C73) 8.6

Uterus cancer (C54-C55) 8.2

Colo rectal cancer (C18-C20) 7.4

Cervix cancer (C53) 7.2 ICD ICD 10site Other and unspecified sites 6.9 (C26,C48,C76,C80) Trachea, bronchus and lung cancer ( 5 C33-C34)

Leukaemia (C90-C95) 4.9

Lymphoma (C81-C85, C96) 4.1

0 10 20 30 40 50 Crude incidence rate per 100,000 population Figure 8: Crude incidence of leading cancers in Colombo district– Female 2012

23

Population Based Caner Registry -Colombo District

Leading cancers according to age group

00-14 year - Male 30 cases

Leukaemia 40.0

Brain, nervous system 20.0

Eye 13.3 Site

Kidney 6.7

Lymphoma 3.3

0.0 10.0 20.0 30.0 40.0 50.0 Percentage

Figure 9: Leading cancers of 00 - 14 years age group in Colombo district – Male 2012

00-14 years - Female 27 cases

Leukaemia 40.7

Brain, nervous system 11.1

Liver 11.1 Site

Lymphoma 7.4

Kidney 7.4

0.0 10.0 20.0 30.0 40.0 50.0 Percentage

Figure 10: Leading cancers of 00 - 14 years age group in the Colombo district – Female 2012

24

Population Based Caner Registry -Colombo District

15-34 years - Male 67 cases

Leukaemia 16.4

Lymphoma 14.9

Other and unspcified 7.5 Site

Thyroid 7.5

Other thoracic organs 7.5

0.0 5.0 10.0 15.0 20.0 Percentage Figure 11: Leading cancers of 15 - 34 years age group in Colombo district – Male 2012

15-34 years Female 78 cases

Thyroid 34.6

Breast 14.1

Leukaemia 10.3 Site

Lymphoma 9.0

Ovary 6.4

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Percentage Figure 12: Leading cancers of 15 - 34 years age group in Colombo district – Female 2012

25

Population Based Caner Registry -Colombo District

35-49 years - Male 143 cases

Lymphoma 9.8

Colon and rectum 9.8

Trachea, bronchus 8.4 Site and lung

Lip, tongue and 7.7 mouth

Oesophagus 6.3

0.0 2.0 4.0 6.0 8.0 10.0 12.0 Percentage Figure 13: Leading cancers of 35 - 49 years age group in Colombo district – Male 2012

35-49 years - Female 306 cases

Breast 36.3

Thyroid 14.4

Ovary 12.1 Site

Colon and rectum 6.2

Cervix uteri 5.2

0.0 10.0 20.0 30.0 40.0 Percentage Figure 14: Leading cancers of 35 - 49 years age group in Colombo district – Female 2012

26

Population Based Caner Registry -Colombo District

50-64 years - Male 508 cases

Trachea, bronchus 14.5 and lung

Colon and rectum 11.0

Lip, tongue and 10.8 Site mouth

Other and unspcified 8.3

Oesophagus 5.7

0.0 5.0 10.0 15.0 20.0 Percentage Figure 15: Leading cancers of 50 - 64 years age group in Colombo district – Male 2012

50-64 years - Female 586 cases

Breast 35.3

Ovary 7.7

Cervix uteri 6.7 Site

Uterus 6.5

Colon and 4.6 rectum

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Percentage

Figure 16: Leading cancers of 50 - 64 years age group in Colombo district – Female 2012

27

Population Based Caner Registry -Colombo District

65 years and above - Male 611 cases

Prostate 15.1

Trachea, bronchus and 10.3

lung

Colon and rectum 8.8 Site

Other and unspcified 8.8

Lip, tongue and mouth 7.7

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 Percentage Figure 17: Leading cancers of 65 years and above age group in Colombo district – Male 2012

65 years and above - Female 528 cases

Breast 23.5

Other and unspcified 9.3

Uterus 8.5 Site

Colon and rectum 7.4

Ovary 6.1

0.0 5.0 10.0 15.0 20.0 25.0 Percentage

Figure 18: Leading cancers of 65 years and above age group in Colombo district – Female 2012

28

Population Based Caner Registry -Colombo District

Age specific incidence rates of leading cancer sites in Colombo district - 2012

1. Lip, tongue and mouth cancer (C00 – C06)

Figure 19: Age specific incidence rate of Lip tongue and mouth cancer in Colombo district – 2012

2. Oesophagus cancer (C15)

Figure 20: Age specific incidence rate of Oesophagus cancer in Colombo district – 2012

29

Population Based Caner Registry -Colombo District

3. Stomach cancer (C16)

Figure 21: Age specific incidence rate of Stomach cancer in Colombo district – 2012

4. Colo- rectal cancer (C18-C20)

Figure 22: Age specific incidence rate of Colo-rectal cancer in Colombo district - 2012

30

Population Based Caner Registry -Colombo District

5. Liver cancer (C22)

Figure 23: Age specific incidence rate of Liver cancer in Colombo district – 2012

6. Larynx cancer (C32)

Figure 24: Age specific incidence rate of Larynx cancer in Colombo district – 2012

31

Population Based Caner Registry -Colombo District

7. Trachea, bronchus and lung cancer ( C33-C34)

Figure 25: Age specific rate of Trachea, bronchus and lung cancer in Colombo district -2012

8. Breast cancer (C50)

Figure 26: Age specific incidence rate of breast cancer in Colombo district - 2012

32

Population Based Caner Registry -Colombo District

9. Cervix uteri cancer (C 53)

Figure 27; Age specific incidence rate of Cervix cancer in Colombo district - 2012

10. Uterus cancer (C54-C55)

Figure 28: Age specific incidence rate of Uterus cancer in Colombo district - 2012

33

Population Based Caner Registry -Colombo District

11. Ovary cancer (C 56)

Figure 29: Age specific incidence rate of Ovary cancer in Colombo district - 2012

12. Prostate cancer (C61)

Figure 30: Age specific incidence rate of Prostate cancer in Colombo district - 2012

34

Population Based Caner Registry -Colombo District

13. Bladder cancer (C 67)

Figure 31: Age specific incidence rate of Bladder cancer in Colombo district – 2012

14. Brain and nervous system cancer (C70-C72)

Figure 32: Age specific incidence rate of Brain and nervous system cancer in Colombo district - 2012

35

Population Based Caner Registry -Colombo District

15. Thyroid cancer (C73)

Figure 33: Age specific incidence rate of Thyroid cancer in Colombo district – 2012

16. Lymphoma (C81-C85, C96)

Figure 34: Age specific incidence rate of Lymphoma in Colombo district - 2012

36

Population Based Caner Registry -Colombo District

17. Leukaemia (C91-C95)

Figure 35: Age specific incidence rate of Leukaemia in Colombo district – 2012

18. Other and unspecified sites (C26, C48, C76 and C80)

Figure 36: Age specific incidence rate of other and unspecified cancer sites in Colombo district – 2012

37

Population Based Caner Registry -Colombo District

Comparison of age standardized cancer incidence rates of leading cancers of ‘Population based cancer registry of Colombo district’ with the ‘National Cancer Registry of Sri Lanka’

Age standardized incidence rates of leading cancers of both sexes for the year 2012 of the ‘Population based cancer registry of Colombo district was compared with the National cancer registry of Sri Lanka’ which generated the national age standardized incidence rates for each cancer for year 2012.

Out of male leading cancers relatively higher age standardized incidence rates were reported for Lung cancer, Colo rectal cancer, Prostate cancer, Liver cancer and lower age standardized incidence rates were reported for Lip, tongue and mouth cancer, Oesophagus cancer and Larynx cancer in the Colombo district in comparison to the age standardized rates reported in the whole country through the National cancer registry. as shown in figure (37)

11.7 Trachea, bronchus & lung cancer ( C33-C34) 10 9.8 Colo rectal cancer (C18-C20) 8.1 9.3 Prostate cancer (C61) 6.4 8.9 Lip, tongue & mouth cancer (C00 – C06) 16.6 8.5 Other & unspecified sites (C26,C48,C76,C80) 7.9 Lymphoma (C81-C85, C96) 6.4 5.3 5.7 Oesophagus cancer (C15) 7.8 5.4

Leukaemia (C90-C95) 4.8 ICD ICD site 10 4.5 Larynx cancer (C32) 5.1 4.2 Liver cancer (C22) 2.2 4.1 Bladder cancer (C 67) 3.8 3.7 Stomach cancer (C16) 3.3 2.2 Brain & nervous system (C70-C72) 1.9 2.2 Thyroid cancer ( C73) 2.2

0 5 10 15 20 Age standardized incidence rate per 100,000 population PBCR Colombo National Cancer Registry

Figure 37: Age standardized incidence rates of leading cancers among male in year - 2012 PBCR Colombo district vs National Cancer Registry

38

Population Based Caner Registry -Colombo District

Out of female leading cancers relatively higher age standardized incidence rates were reported for breast cancer, ovary cancer, uterine cancer, Lung cancer & liver cancer and lower age standardized incidence rates were reported for Thyroid cancer, Cervix cancer, Oesophagus cancer and Lip, tongue & mouth cancer in the Colombo district as shown in figure (38 )

29.8 Breast cancer (C50) 24.3 8.2 Ovary cancer (C 56) 6.9 7.3 Thyroid cancer ( C73) 9.1 6.4 Uterus cancer (C54-C55) 4.4 5.6 Colo rectal cancer (C18-C20) 5.5 Cervix cancer (C53) 5.5 7.2 5 Other & unspecified sites (C26,C48,C76,C80) 4.3 4.6

Leukaemia (C90-C95) 3.6 ICD ICD 10site 3.7 Trachea, bronchus & lung cancer ( C33-C34) 2.5 3.4 Lymphoma (C81-C85, C96) 3.2 2.6 Oesophagus cancer (C15) 5.6 1.9 Lip, Tongue & Mouth Cancer 3.6 1.9 Liver cancer (C22) 0.8 1.7 Stomach cancer 1.2

0 10 20 30 40 Age standardized incidence rate per 100,000 population

PBCR Colombo National Cancer Registry

Figure 38: Age standardized incidence rates of leading cancers among Female in year 2012 – PBCR Colombo district vs National Cancer Registry, Sri Lanka

39

Population Based Caner Registry -Colombo District

3.2 Mortality of Cancers

Table 5: Distribution of cancer related deaths reported by Divisional Death Registrars of Colombo district in year 2012

Resident district of the deceased person No. %

Colombo 707 46.4%

Another district other than Colombo 787 51.6%

District not known 31 2.0%

Total 1525 100.0%

Table 6: Distribution of no. of deaths, cancer related crude death rate and age standardized death rate among the residents of Colombo district in the year 2012

Number % CR ASR Male 382 54% 33.5 30.0 Female 325 46% 27.5 20.1 Total 707 100 30.4 24.5

*CR- Cancer related crude death rate per 100,000 population, **ASR – Cancer related age standardized death rate per 100,000 populations

33.5 Male 70.1

27.5 Female

54 Sex

30.4 Both sexes 61.8

0 10 20 30 40 50 60 70 80

Crude cancer related death rate per 100,000 population PBCR Colombo National cause specic mortality data

Figure 39: Cancer related crude death rates of Colombo district with national rates based on National cause of death data of Department of Census and Statistics

40

Population Based Caner Registry -Colombo District

Table 7: Cancer related deaths of Colombo district by age group and sex - 2012

Male Female Total Age group Cases Population Ag.Sp Cases Population Ag.Sp. Cases Population Ag.Sp .Rate Rate .Rate 00-04 2 84185 2.4 1 82420 1.2 3 166605 1.8 05-09 1 87380 1.1 0 85513 0.0 1 172893 0.6 10-14 1 83683 1.2 1 80723 1.2 2 164406 1.2 15-19 6 90600 6.6 0 85247 0.0 6 175847 3.4 20-24 5 97525 5.1 2 96499 2.1 7 194024 3.6 25-29 3 93671 3.2 3 93012 3.2 6 186683 3.2 30-34 3 96735 3.1 1 94883 1.1 4 191618 2.1 35-39 3 85430 3.5 7 85736 8.2 10 171166 5.8 40-44 7 82775 8.5 8 82849 9.7 15 165624 9.1 45-49 17 73763 23.0 18 78179 23.0 35 151942 23.0 50-54 23 68502 33.6 25 75239 33.2 48 143741 33.4 55-59 38 58007 65.5 40 65849 60.7 78 123856 63.0 60-64 60 51218 117.1 42 59263 70.9 102 110481 92.3 65-69 69 36566 188.7 41 45105 90.9 110 81671 134.7 70-74 66 22530 292.9 56 29322 191.0 122 51852 235.3 75+ 76 27902 272.4 76 44038 172.6 152 71940 211.3 Unknown 2 4 6 Total 382 1,140,472 33.5 325 1,183,877 27.5 707 2,324,349 30.4 Ag. Sp. Rate – Age specific death rate per 100,000 populations

41

Population Based Caner Registry -Colombo District

700.0

600.0

500.0

400.0

300.0

Agespecific death rate per 100,000 200.0

100.0

0.0

75+

05-09 20-24 35-39 00-04 10-14 15-19 25-29 30-34 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Age group

Colombo - Male Sri Lanka - Male Colombo - Female Sri Lanka - Female

Figure 40: Distribution age specific death rates among male and female - 2012 Colombo district vs National cause of death data of Department of Census and Statistics covering whole country.

42

Population Based Caner Registry -Colombo District

3.2.1 Leading sites (ICD 10) of cancer mortality

Table 8: Leading sites of cancer mortality of Colombo district – male and female 2012

Male Female ICD 10 code and site ICD 10 code and site Deaths CR ASR Deaths CR ASR

C33- Trachea, 62 5.4 4.8 C50 Breast 75 6.3 4.7 C34 bronchus and lung C26, Other and 53 4.6 4.2 C26, Other and 49 4.1 2.9 C48, unspecified C48, unspecified C76, C76, C80 C80 C00- Lip, tongue 29 2.5 2.2 C56 Ovary 24 2.0 1.6 C06 and mouth C18- Colon and 29 2.5 2.3 C33- Trachea, 20 1.7 1.2 C20 rectum C34 bronchus and lung C91- Leukaemia 25 2.2 2.1 C91- Leukaemia 16 1.4 1.2 C95 C95 C22 Liver 23 2.0 1.8 C22 Liver 14 1.2 0.9

C61 Prostate 22 1.9 1.7 C15 Oesophagus 13 1.1 0.8

C81- Lymphoma 21 1.8 1.7 C54- Uterus 13 1.1 0.9 C85, C55 C96 C15 Oesophagus 20 1.8 1.6 C18- Colon and 12 1.0 0.6 C20 rectum C16 Stomach 17 1.5 1.3 C16 Stomach 11 0.9 0.6

C00- All sites 382 33.5 30.0 C00- All sites 325 27.5 20.1 D48 D48 CR- Crude death rate per 100,000 population, ASR - Age standardized death rate per 100,000 population

43

Population Based Caner Registry -Colombo District

Trachea, bronchus and lung All other sites 16% 21%

Other and Stomach unspecified 4% 14%

Oesophagus 5% Lymphoma 5% Lip, oral cavity Prostate and mouth 6% Colon and 8% Liver Leukaemia rectum 6% 7% 8%

Figure 41: Proportion of leading cancer deaths, Male – 2012

All other sites, Breast, 23% 24%

Stomach, 3%

Colon and rectum, 4% Other and Uterus, 4% unspecified, 15% Oesophagus, 4% Ovary, 8% Liver, 4% Leukaemia, 5% Trachea, bronchus and lung, 6%

Figure 42: Proportion of leading cancer deaths, Female - 2012

44

Population Based Caner Registry -Colombo District

Trachea, bronchus and lung (C33-C34) 5.4

Other and unspecified (C26, C48, C76, C80) 4.6

Colon and rectum (C18-C20) 2.5

Lip, tongue and mouth (C00-C06) 2.5

Leukaemia (C91-C95) 2.2

Liver (C22) 2

ICD 10site Prostate (C61) 1.9

Oesophagus (C15) 1.8

Lymphoma (C81-85, C96) 1.8

Stomach (C16) 1.5

0 2 4 6

Crude death rate per 100,000 population

Figure 43: Crude death rate of leading cancer related deaths in the Colombo district– Male 2012

Breast (C50) 6.3

Other and unspecified (C26, 48,… 4.1

Ovary(C 56) 2

Trachea, bronchus and lung… 1.7

Leukaemia (C91-C95) 1.4

Liver (C22) 1.2 ICD ICD 10site Uterus (C54-C55) 1.1

Oesophagus (C15) 1.1

Colon and rectum (C18-C20) 1

Stomach (C16) 0.9

0 2 4 6 8 Crude death rate per 100,000 population

Figure 44: Crude death rate of leading cancer related deaths in the Colombo district– Female 2012

45

Population Based Caner Registry -Colombo District

3.2.2 Age specific death rates of leading cancer sites in Colombo district - 2012

1. Lip, tongue and mouth cancer (C00 – C06)

20.0 18.0 16.0

14.0 12.0 10.0

8.0 population 6.0 4.0 2.0

Age specific deathrate per 100,000 0.0

75+

10-14 00-04 05-09 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Age group Male Female Figure 45: Age specific death rate of Lip tongue and mouth cancer in Colombo district – 2012

2. Oesophagus cancer (C15)

20.0 18.0 16.0

14.0 12.0 10.0

population 8.0 6.0 4.0

2.0 Age specific death rateper 100,000

0.0

75+

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Age group Male Female

Figure 46: Age specific death rate of Oesophagus cancer in Colombo district - 2012

46

Population Based Caner Registry -Colombo District

3. Stomach cancer (C16)

16.0 14.0 12.0

10.0 8.0

6.0 population 4.0 2.0

Age specific deathrate per 100,000 0.0

75+

00-04 70-74 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 Age group Male Female

Figure 47: Age specific death rate of stomach cancer in Colombo district - 2012

4. Colo -rectal cancer (C18-C20)

35.0

30.0

25.0

20.0

15.0 population 10.0

5.0

Age specific death rate per death Ageper rate specific 100,000 0.0

75+

60-64 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 65-69 70-74 Age group Male Female

Figure 48: Age specific death rate of colo -rectal cancer in Colombo district – 2012

47

Population Based Caner Registry -Colombo District

5. Liver cancer (C22)

35.0

30.0

25.0

20.0

15.0

10.0

5.0

0.0

75+

Age specific death rate per death Ageper rate specific population 100,000

20-24 00-04 05-09 10-14 15-19 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

Age group Male Female

Figure 49: Age specific death rate of liver cancer in Colombo district - 2012

6. Trachea, bronchus and lung cancer (C33-C34)

60.0

50.0

40.0

30.0

population 20.0

10.0

Age specific deathrate per 100,000 0.0

75+

65-69 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 70-74

Age group Male Female

Figure 50: Age specific death rate of trachea, bronchus and lung cancer in Colombo district - 2012

48

Population Based Caner Registry -Colombo District

7. Breast cancer (C50)

40.0 35.0 30.0

25.0

20.0 15.0

population 10.0 5.0

0.0

Age specific deathrate per 100,000

75+

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

Age group Male Female Figure 51: Age specific death rate of breast in Colombo district – 2012

8. Common gynaecological cancers (Cervix-C53, Uterus C54-C55, Ovary C56)

18.0 16.0 14.0

12.0 10.0 8.0

population 6.0 4.0 2.0

Age specific deathrate per 100,000 0.0

75+

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Age group

Cervix Uterus Ovary Figure 52: Age specific death rates of common gynecological cancers in Colombo district – 2012

49

Population Based Caner Registry -Colombo District

9. Prostate cancer (C61)

50.0 45.0 40.0

35.0 30.0 25.0

population 20.0 15.0 10.0

5.0 Age specific deathrate per 100,000

0.0

75+

00-04 25-29 50-54 05-09 10-14 15-19 20-24 30-34 35-39 40-44 45-49 55-59 60-64 65-69 70-74

Age group

Figure 53: Age specific death rate of prostate cancer in Colombo district - 2012

10. Lymphoma (C81-C85, C96)

20.0 18.0 16.0

14.0 12.0 10.0 8.0 6.0 population 4.0 2.0

0.0

Age specific deathrate per 100,000

75+

00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 Age group Male Female

Figure 54: Age specific death rate of lymphoma in Colombo district - 2012

50

Population Based Caner Registry -Colombo District

11. Leukaemia (C91-C95)

18.0 16.0 14.0 12.0 10.0 8.0 population 6.0 4.0 2.0

Age specific deathrate per 100,000 0.0

75+

55-59 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 60-64 65-69 70-74 Age group Male Female Figure 55: Age specific death rate of leukaemia in Colombo district – 2012

51

Population Based Caner Registry -Colombo District

3.2.3 Comparison of age standardized cancer death rates of leading cancers of ‘Population based cancer registry of Colombo district’ with the ‘National Cause of Death Data of Sri Lanka’

Trachea, bronchus & lung cancer ( C33- 4.8 C34) 7.4 Lip,oral cavity and pharynx cancer (C00- 3.8 C14) 7.5 2.3 Colon,rectum and anus cancer (C18-C21) 1.8 2.1

Leukaemia (C91-C95) 3.0

1.8 Liver cancer (C22) 4.3 1.7

Prostate cancer (C61) 1.5 ICD ICD 10Site 1.6 Oesophagus cancer (C15) 3.7 1.4 Non-Hodgkin lymphoma C82-C85 1.4 1.3 Stomach cancer (C16) 2.7 0.7 Brain & nervous system cancer (C70-C72) 2.5

0.0 2.0 4.0 6.0 8.0 Age standardized death rate per 100,000 population

PBCR Colombo National Cause of Death Data

Figure 56: Age standardized death rates of leading cancers among male in year 2012 – PBCR Colombo district vs National Cause of Death Data

52

Population Based Caner Registry -Colombo District

4.7 Breast cancer (C50) 4.8 1.6 Ovary cancer (C 56) 1.5 Trachea, bronchus and lung cancer ( C33- 1.2 C34) 2.6 1.2

Leukaemia (C91-C95) 2.2

0.9 Uterus cancer (C54-C55) 2.1 0.9

Liver cancer (C22) 2.1 ICD ICD 10sites 0.8 Oesophagus cancer (C15) 1.9 Lip,oral cavity and pharynx cancer (C00- 0.8 C14) 2.0 0.6 Stomach cancer (C16) 1.9 0.5 Brain & nervous system (C70 - C72) 2.0

0.0 1.0 2.0 3.0 4.0 5.0 6.0

Age standardized death rate per 100,000 population

PBCR Colombo National Cause of Death Data

Figure 57: Age standardized death rates of leading cancers among female in year 2012 – PBCR Colombo district vs National Cause of Death Data

53

Population Based Caner Registry -Colombo District

3.3 Incidence and Mortality of leading cancers – 2012

11.7 Trachea, bronchus & lung cancer ( C33-C34) 4.8 9.8 Colo rectal cancer (C18-C20) 2.3 9.3 Prostate cancer (C61) 1.7 8.9 Lip, tongue & mouth cancer (C00 – C06) 2.2 8.5 Other & unspecified sites (C26,C48,C76,C80) 4.2 6.4

Lymphoma (C81-C85, C96) 1.7

5.7 Oesophagus cancer (C15) 1.6 5.4

Leukaemia (C90-C95) 2.1 ICD ICD site 10 4.5 Larynx cancer (C32) 0.5 4.2 Liver cancer (C22) 1.8 4.1 Bladder cancer (C 67) 0.5 3.7 Stomach cancer (C16) 1.3 2.2 Brain & nervous system (C70-C72) 0.7 2.2 Thyroid cancer ( C73) 0.2

0 5 10 15 Age standardized rate per 100,000 population Incidence Mortality

Figure 58: Age standardized incidence rates and death rates of leading cancers in Colombo district – Male - 2012

54

Population Based Caner Registry -Colombo District

29.8 Breast cancer (C50) 4.7 8.2 Ovary cancer (C 56) 1.6 7.3 Thyroid cancer ( C73) 0.1 6.4 Uterus cancer (C54-C55) 0.9 5.6 Colo rectal cancer (C18-C20) 0.6 Cervix cancer (C53) 5.5

0.4 5 Other and unspecified sites (C26,C48,C76,C80) 2.9 4.6

Leukaemia (C90-C95) 1.2 ICD 10site 3.7 Trachea, bronchus and lung cancer ( C33-C34) 1.2 3.4 Lymphoma (C81-C85, C96) 0.7 2.6 Oesophagus cancer (C15) 0.8 1.9 Lip, tongue and mouth cancer 0.4 1.9 Liver cancer (C22) 0.9 1.7 Stomach cancer 0.6 0 10 20 30 40 Age statandardized rate per 100,000 population

Incidence Mortality

Figure 59: Age standardized incidence rates and death rates of leading cancers in Colombo district – Female - 2012

55

Population Based Caner Registry -Colombo District

3.4 Quality Control

Table 9: Comparison of mean values of data quality indicators for cancer registries in Central, East and South Asia with PBCR Colombo – Male 2012

MV% M:I% ASR ICD -10 code and site Mean Colombo Mean Colombo Mean Colombo C00-C14 Oral Cavity & Pharynx 88.9 88.1 37.0 22.9 17.0 16.1 C 15 Oesophagus 78.5 82.4 86.6 27.0 3.6 5.7 C16 Stomach 74.1 78.7 60.3 36.2 13.9 3.7 C18-21 Large bowel 86.4 83.2 42.9 22.1 18.8 10.1 C22 Liver 29.2 49.1 86.7 45.5 16.5 4.2 C25 Pancreas 44.7 37.5 85.2 56.3 2.9 1.3 C32 Larynx 90.5 94.8 43.1 12.1 4.8 4.5 C33-C34 Trachea, Bronchus & 68.2 75.3 81.0 40.3 36.4 11.7 Lung C43 Melanoma of Skin 92.8 100.0 28.0 0 0.6 0.3 C50 Breast 76.8 90.9 44.4 9.1 0.6 0.8 C53 Cervix uteri ------C54-C55 Corpus Uteri & Uterus ------unspecified C56 Ovary ------C61 Prostate 83.1 77.3 27.6 18.5 11.5 9.4 C62 Testis 84.8 90.0 8.8 20.0 0.9 0.8 C64-C66 Kidney, Renal pelvis & 78.3 90.9 35.0 22.7 3.0 1.8 Ureter C67 Bladder 89.9 86.5 32.0 13.5 5.4 4.1 C70-C72 Brain, Central Nervous 70.7 80.0 62.0 32.0 2.4 2.2 System C73 Thyroid 88.9 96.5 11.2 6.9 1.6 2.2 C81-88,90 Lymphoma 90.4 95.0 38.7 30.9 8.3 6.4 C91-C95 Leukaemia 91.0 96.6 45.1 41.7 5.6 5.4 C76-C80 Unspecified 62.6 53.2 58.5 44.0 9.0 8.5 C00-C96 All sites (Excluding non- 73.4 80.4 56.5 28.1 171.7 106.4 excluding melanoma skin) C44

56

Population Based Caner Registry -Colombo District

Table 10: Comparison of mean values of data quality indicators for cancer registries in Central, East and South Asia with PBCR Colombo – Female 2012

MV% M:I% ASR ICD -10 Code and site Mean Colombo Mean Colombo Mean Colombo

C00-C14 Oral Cavity & Pharynx 86.0 86.2 29.4 20.7 9.3 3.8 C 15 Oesophagus 77.3 78.0 66.2 31.7 2.0 2.6 C16 Stomach 73.1 63.0 57.6 40.7 7.4 1.7 C18-21 Large bowel 86.4 83.5 44.2 13.2 14.0 7.7 C22 Liver 28.5 30.8 95.1 57.7 5.0 1.9 C25 Pancreas 45.6 45.5 82.8 72.7 2.2 0.7 C32 Larynx 83.9 83.3 40.7 0.0 0.7 0.4 C33-C34 Trachea, Bronchus & Lung 69.1 71.2 78.5 33.9 10.3 3.7 C43 Melanoma of Skin 93.3 100.0 36.7 0 0.3 0.3 C50 Breast 91.0 84.3 23.4 16.5 40.2 29.8 C53 Cervix uteri 89.5 90.6 30.0 8.2 15.7 5.5 C54-C55 Corpus Uteri & Uterus 85.2 84.5 17.1 13.4 6.6 6.4 unspecified. C56 Ovary 82.5 86.7 37.1 20.0 8.0 8.2 C61 Prostate ------C62 Testis ------C64-C66 Kidney, Renal pelvis & 73.8 88.8 37.5 11.1 1.5 1.3 Ureter C67 Bladder 86.2 82.4 34.0 29.4 1.3 1.1 C70-C72 Brain, Central Nervous 66.6 50.0 64.0 36.4 1.8 1.6 System C73 Thyroid 92.4 96.1 8.6 1.0 5.1 7.3 C81-88,90 Lymphoma 89.2 95.8 41.3 33.3 5.3 3.4 C91-C95 Leukaemia 89.6 93.1 54.1 27.6 4.4 4.6 C76-C80 Unspecified 60.8 52.4 55.0 52.4 6.4 5.2

C00-C96 All sides (excluding non- 82.0 74.4 42.1 21.2 156.6 102.1 excluding C44 melanoma skin)

57

Population Based Caner Registry -Colombo District

The percentage of ‘Other and unspecified sites’, including primary site unknown is related to the quality of diagnostic information and quality of documentation of the medical records.

Table 11: Distribution of ICD -10 and other specific sites by Sex Colombo District 2012

ICD – 10 Male Female

No. % No. %

C26 5 0.3% 7 0.4%

C48 3 0.2% 2 0.1%

C76 11 0.8% 13 0.8%

C80 90 6.6% 60 3.9%

Total 109/1366 7.9% 82/1530 5.4%

58

Population Based Caner Registry -Colombo District

Standard Registry Tables (i) Number of incidence cancers by five-year age group and site (ICD 10): 2012 – Males Colombo district (ii) Number of incidence cancers by five-year age group and site (ICD 10): 2012 – Females Colombo district (iii) Age specific incidence rate, Crude incidence rate (CR), Age standardized incidence rate(ASR) per 100,000 population & Cumulative risk by five-year age group and site (ICD 10) : 2012 – Males Colombo district (iv) Age specific incidence rate, Crude incidence rate (CR), Age standardized incidence rate(ASR) per 100,000 population and Cumulative risk by five-year age group and site (ICD 10) : 2012 – Females Colombo district (v) Number and proportion of cancers by site (ICD 10) and method of diagnosis: 2012 – Males Colombo district (vi)Number and proportion of cancers by site (ICD 10) and method of diagnosis: 2012 – Females Colombo district (vii)Number of cancer deaths by five year group and site (ICD 10): 2012 – Males Colombo district (viii)Number of cancer deaths by five year group and site (ICD 10): 2012 – Females Colombo district (ix) Cancer related Crude death rate (CR), Age standardized death rate(ASR) per 100,000 population by five-year age group and site (ICD 10) : 2012 – Males Colombo district (x) Cancer related Crude death rate (CR), Age standardized death rate(ASR) per 100,000 population by five-year age group and site (ICD 10) : 2012 – Females Colombo district

Other tables 1. Distribution of reporting of cancer related deaths by divisional death registrar of Colombo district and resident district of the deceased person: 2012

59

Population Based Caner Registry -Colombo District

Table 12: Number of incidence cancers by five-year age group and site (ICD 10) : 2012 – Male Colombo district

60

Population Based Caner Registry -Colombo District

Table 13: Number of incidence cancers by five-year age group and site (ICD 10) : 2012 – Female Colombo district

61

Population Based Caner Registry -Colombo District

Table 14: Age specific incidence rate, Crude incidence rate (CR), Age standardized incidence rate (ASR) per 100,000 population and Cumulative risk by five-year age group and site (ICD 10): – Male, Colombo district- 2012

62

Population Based Caner Registry -Colombo District

Table 15: Age specific incidence rate, Crude incidence rate (CR), Age standardized incidence rate (ASR) per 100,000 population and Cumulative risk by five-by age group and site (ICD 10): – Female, Colombo district- 2012

63

Population Based Caner Registry -Colombo District

Table 16: Distribution of cancer cases based on method of diagnosis – Male, Colombo district-2012

Site of Cancer (ICD 10) Death certificate Clinical Biochemical Cytology Histology of Histology of Unkown Total only Investigations /immunological /Haematology metastases Primary only test No. % No. % No. % No. % No. % No. % No. % No. C00-C06/ Lip, tongue and 5 4.3% 1 0.9% 1 0.9% 2 1.7% 101 87.1% 6 5.2% 116 mouth C07-C08/ Salivary gland 8 88.9% 1 11.1% 9 C09/ Tonsil 19 95.0% 1 5.0% 20 C10/ Other oropharynx 1 5.9% 1 5.9% 15 88.2% 17 C11/ Nasopharynx 4 80.0% 1 20.0% 5 C12-C13/ Hypopharynx 24 92.3% 2 7.7% 26 C14/ Pharynx unspecified 7 41.2% 1 5.9% 8 47.1% 1 5.9% 17 C15/ Oesophagus 4 5.4% 1 1.4% 61 82.4% 8 10.8% 74 C16/ Stomach 8 17.0% 37 78.7% 2 4.3% 47 C17/ Small intestine 1 100.0% 1 C18-C20/ Colon and 9 7.1% 105 82.7% 13 10.2% 127 rectum C21/ Anus 4 100.0% 4 C22/ Liver 20 36.4% 4 7.3% 27 49.1% 4 7.3% 55 C23-C24/ Gallbladder etc. 2 20.0% 1 10.0% 5 50.0% 2 20.0% 10 C25/ Pancreas 5 31.3% 1 6.3% 6 37.5% 4 25.0% 16 C30-C31/ Nose, sinuses,etc. 4 100.0% 4 C32/ Larynx 1 1.7% 55 94.8% 2 3.4% 58 C33-34/ Trachea, bronchus 24 15.6% 3 1.9% 17 11.0% 6 3.9% 93 60.4% 11 7.1% 154 and lung C37-C38/ Other thoracic 7 77.8% 2 22.2% 9 organs C40-C41/ Bone 5 83.3% 1 16.7% 6 C43/ Melanoma of skin 4 100.0% 4 C44/ Other skin 14 87.5% 2 12.5% 16

64

Population Based Caner Registry -Colombo District

Site of Cancer (ICD 10) Death certificate Clinical Biochemical Cytology Histology of Histology of Unkown Total only Investigations /immunological /Haematology metastases Primary only test C47 and C47/ Soft tissue 1 7.7% 1 7.7% 10 76.9% 1 7.7% 13 C50/ Breast 10 90.9% 1 9.1% 11 C60/ Penis 1 9.1% 10 90.9% 11 C61/ Prostate 11 9.2% 3 2.50% 2 1.7% 90 75.6% 13 10.9% 119 C62/ Testis 1 10.0% 9 90.0% 10 C63/ Other male genital 1 100.0% 1 organ C64/ Kidney 1 4.5% 20 90.9% 1 4.5% 22 C67/ Bladder 3 5.8% 1 1.9% 45 86.5% 3 5.8% 52 C68/ Other urinary organs 1 100.0% 1 C69/ Eye 4 100.0% 4 C70-C72/ Brain, nervous 5 20.0% 1 4.0% 19 76.0% 25 system C73/ Thyroid 1 3.4% 1 3.4% 26 89.7% 1 3.4% 29 C74/ Adrenal gland 1 100.0% 1 C81- C85 and C96/ 4 4.9% 7 8.6% 1 1.2% 69 85.2% 81 Lymphoma C90/ Multiple myeloma 3 15.0% 7 35.0% 8 40.0% 2 10.0% 20 C91-C95/ Leukaemia 2 3.3% 35 58.3% 23 38.3% 60 D45 and D47/ 1 100.0% 1 Myeloproliferative disorders D46/ Myelodysplastic 1 100.0% 1 syndrome C26, C48, C76,C80/ Other 38 34.9% 5 4.6% 3 2.8% 47 43.1% 8 7.3% 8 7.3% 109 and unspcified All sites 155 11.3% 16 1.2% 3 0.20% 78 5.7% 61 4.5% 960 70.3% 93 6.8% 1366 All sites excuding C44 155 11.5% 16 1.2% 3 0.20% 78 5.8% 61 4.5% 946 70.1% 91 6.7% 1350

65

Population Based Caner Registry -Colombo District

Table 17: Distribution of cancer cases based on method of diagnosis – Female, Colombo district-2012

Site of Cancer (ICD Death Clinical Biochemical Cytology Histology of Histology of Unkown 10) certificate only Investigations /immunological /Haematology metastases Primary Total only test No. % No. % No. % No. % No. % No. % No. % Total C00-C06/ Lip, 3 9.7% 27 87.1% 1 3.2% 31 tongue and mouth C07-C08/ Salivary 2 20.0% 8 80.0% 10 gland C09/ Tonsil 4 100.0% 0 4 C11/ Nasopharynx 4 100.0% 4 C12-C13/ 2 100.0% 2 Hypopharynx C14/ Pharynx 3 42.9% 3 42.9% 1 14.3% 7 unspecified C15/ Oesophagus 6 14.6% 32 78.0% 3 7.3% 41 C16/ Stomach 10 37.0% 17 63.0% 27 C17/ Small intestine 1 100.0% 1 C18-C20/ Colon and 6 6.8% 73 83.0% 9 10.2% 88 rectum C21/ Anus 3 100.0% 3 C22/ Liver 12 46.2% 2 7.7% 1 3.8% 7 26.9% 4 15.4% 26 C23-C24/ 5 29.4% 11 64.7% 1 5.9% 17 Gallbladder etc. C25/ Pancreas 3 27.3% 2 18.2% 1 9.1% 4 36.4% 1 9.1% 11 C30-C31/ Nose, 1 100.0% 1 sinuses,etc. C32/ Larynx 5 83.3% 1 16.7% 6 C33-34/ Trachea, 13 22.0% 1 1.7% 6 10.2% 2 3.4% 34 57.6% 3 5.1% 59 bronchus and lung C37-C38/ Other 2 66.7% 1 33.3% 3 thoracic organs C40-C41/ Bone 5 100.0% 5 C43/ Melanoma of 4 100.0% 4 skin

66

Population Based Caner Registry -Colombo District

Site of Cancer (ICD Death Clinical Biochemical Cytology Histology of Histology of Unkown 10) certificate only Investigations /immunological /Haematology metastases Primary Total only test No. % No. % No. % No. % No. % No. % No. % Total C44/ Other skin 4 100.0% 4 C45/ Mesothelioma 1 100.0% 0 1 C47 and C47/ Soft 1 5.9% 16 94.1% 17 tissue C50/ Breast 31 6.8% 7 1.5% 2 .4% 374 82.4% 40 8.8% 454 C51/ Vulva 6 100.0% 6 C52/ Vagina 3 100.0% 3 C53/ Cervix uteri 2 2.4% 77 90.6% 6 7.1% 85 C54-C55/ Uterus 10 10.3% 1 1.0% 81 83.5% 5 5.2% 97 C56/ Ovary 5 4.2% 1 .8% 5 4.2% 99 82.5% 10 8.3% 120 C57/ Other female 6 100.0% 6 genital organ C58/ Placenta 3 100.0% 3 C64/ Kidney 1 5.6% 15 83.3% 2 11.1% 18 C67/ Bladder 1 5.9% 14 82.4% 2 11.8% 17 C68/ Other urinary 1 100.0% 1 organs C69/ Eye 1 100.0% 1 C70-C72/ Brain, 6 27.3% 1 4.5% 11 50.0% 4 18.2% 22 nervous system C73/ Thyroid 2 2.0% 1 1.0% 95 93.1% 4 3.9% 102 C74/ Adrenal gland 1 33.3% 2 66.7% 3 C75/ Other 2 100.0% 2 endocrine gland C81- C85 and C96/ 2 4.2% 4 8.3% 42 87.5% 48 Lymphoma C90/ Multiple 2 7.1% 19 67.9% 1 3.6% 6 21.4% 28 myeloma C91-C95/ 4 6.9% 30 51.7% 24 41.4% 58 Leukaemia D46/ 2 100.0% 2 Myelodysplastic syndrome

67

Population Based Caner Registry -Colombo District

Site of Cancer (ICD Death Clinical Biochemical Cytology Histology of Histology of Unkown 10) certificate only Investigations /immunological /Haematology metastases Primary Total only test No. % No. % No. % No. % No. % No. % No. % Total C26, C48, C76,C80/ 31 37.8% 4 4.9% 1 1.2% 31 37.8% 11 13.4% 4 4.9% 82 Other and unspcified Total 156 10.2% 12 .8% 74 4.8% 46 3.0% 1140 74.5% 102 6.7% 1530 All sites excuding 156 10.2% 12 0.8% 74 4.8% 46 3.0% 1136 74.4% 102 6.7% 1526 C44

68

Population Based Caner Registry -Colombo District

Table 18: Number of Cancer deaths by five year age group and ICD 10 site in Colombo district - Male 2012

ICD 10 Age group

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

- (%)

75+

Total

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70

AGE AGE UNK C00 Lip 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C01-02 Tongue 0 0 0 0 0 0 0 0 0 0 0 0 3 2 4 1 0 10 2.6 C03-06 Mouth 1 0 0 0 0 1 0 0 0 1 1 1 0 7 2 2 3 19 5.0 C07-08 Salivary gland 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0.3 C09 Tonsil 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 2 0.5 C10 Other oropharynx 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 3 0.8 C11 Nasopharynx 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 2 0.5 C12-13 Hypopharynx 0 0 0 0 0 0 0 0 0 0 0 1 2 0 0 0 1 4 1.0 C14 Pharynx 0 0 0 0 0 0 0 0 0 0 1 0 0 1 2 1 4 9 2.4 unspecified C15 Oesophagus 0 0 0 0 0 0 0 0 0 0 0 2 1 5 5 4 3 20 5.2 C16 Stomach 0 0 0 0 0 0 1 0 1 0 0 0 5 1 5 1 3 17 4.5 C17 Small intestine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C18 Colon 0 0 0 0 0 0 0 0 0 0 0 1 1 3 3 2 2 12 3.1 C19-20 Rectum 0 0 0 0 0 0 0 0 0 1 2 0 2 4 0 5 3 17 4.5 C21 Anus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 C22 Liver 0 0 0 0 0 0 0 0 1 1 0 0 1 2 6 4 8 23 6.0 C23-24 Gallbladder etc. 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 2 2 6 1.6 C25 Pancreas 0 0 0 0 0 1 0 0 0 0 0 0 0 2 0 4 2 9 2.4 C30-31 Nose, sinuses etc. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

C32 Larynx 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 2 7 1.8

69

Population Based Caner Registry -Colombo District

ICD 10 Age group

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

- (%)

75+

Total

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70

AGE AGE UNK C33-34 Trachea, bronchus 1 0 0 0 0 0 0 0 0 1 3 6 9 12 10 11 9 62 16.2 and lung

C37-38 Other thoracic 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 organ C40-41 Bone 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 2 0.5 C43 Melanoma of skin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C44 Other skin 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 2 0.5 C45 Mesothelioma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C47,C49 Connective and 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0.3 soft tissue

C50 Breast 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0.3 C60 Penis 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 3 0.8 C61 Prostate 0 0 0 0 0 0 0 0 0 0 0 0 3 1 1 5 12 22 5.8 C62 Testis 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 2 0.5 C63 Other male genital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 organs C64 Kidney 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 5 1.3 C65 Renal Pelvis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 C66 Ureter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 C67 Bladder 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 1 2 7 1.8 C68 Other urinary 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0.3 organs C69 Eye 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 C70-72 Brain, Nervous 0 1 0 0 1 0 0 0 0 0 0 0 0 2 1 2 1 8 2.1 system C73 Thyroid 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 0.5 C74 Adrenal gland 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0

70

Population Based Caner Registry -Colombo District

ICD 10 Age group

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

- (%)

75+

Total

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70

AGE AGE UNK C75 Other endocrine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 C81 Hodgkin disease 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 3 0.8 C82- Non Hodgkin 0 0 0 0 0 0 2 0 0 0 2 2 1 1 3 4 3 18 4.7 C85 and lymphoma C96 C90 Multiple myeloma 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 1 0 4 1.0

C91 Lymphoid 0 0 1 0 2 1 0 0 0 1 0 0 0 0 3 0 1 9 2.4 leukaemia C92 Myeloid 0 0 0 0 1 0 0 0 0 1 3 0 0 2 2 1 1 11 2.9 leukaemia C95 Leukaemia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 2 5 1.3 unspecified C26, Other and 0 0 0 1 0 1 0 3 0 0 3 5 4 6 12 10 8 53 13.9 C48, unspecified C76 and C80 D45,D47 Myeloproliferative 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 disorders

D46 Myelodysplastic 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 syndromes

Total 2 2 1 1 6 5 3 3 3 7 17 23 38 60 69 66 76 382 100

71

Population Based Caner Registry -Colombo District

Table 19: Number of Cancer deaths by five year age group and ICD 10 site in Colombo district- Female 2012

ICD 10 code and site Age group

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

- (%)

75+

Total

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70 Notkn C00 Lip 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C01-02 Tongue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 3 0.9 C03-06 Mouth 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 1 0 4 1.2 C07-08 Salivary gland 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C09 Tonsil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C10 Other oropharynx 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C11 Nasopharynx 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0.3 C12-13 Hypopharynx 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0.3 C14 Pharynx unspecified 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 1 1 4 1.2 C15 Oesophagus 0 0 0 0 0 0 0 0 0 0 1 0 1 2 3 2 4 13 4.0 C16 Stomach 0 0 0 0 0 0 0 0 0 0 0 1 3 0 2 1 4 11 3.4 C17 Small intestine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C18 Colon 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 3 0.9 C19-20 Rectum 2 0 0 0 0 1 0 0 0 0 1 0 0 0 1 1 3 9 2.8 C21 Anus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C22 Liver 0 0 0 0 0 0 0 0 0 0 0 2 2 2 1 4 3 14 4.3 C23-24 Gallbladder etc. 0 0 0 0 0 0 0 0 0 0 1 2 1 0 0 0 4 8 2.5 C25 Pancreas 0 0 0 0 0 0 0 0 0 1 0 0 3 0 0 4 0 8 2.5 C30-31 Nose, sinuses etc. 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0.3 C32 Larynx 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

72

Population Based Caner Registry -Colombo District

ICD 10 code and site Age group

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

- (%)

75+

Total

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70 Notkn C33-34 Trachea, bronchus and 0 0 0 0 0 0 0 0 0 0 1 1 1 4 4 3 6 20 lung 6.2 C37-38 Other thoracic organ 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 2 0.6 C40-41 Bone 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C43 Melanoma of skin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C44 Other skin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C45 Mesothelioma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C47-49 Connective and soft tissue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0.3 C50 Breast 1 0 0 0 0 0 0 0 0 5 8 7 11 11 6 11 15 75 23.1 C51 Vulva 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0.3 C52 Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0.6 C53 Cervix uteri 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 2 7 2.2 C54 Corpus uteri 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 2 0.6 C55 Uterus unspecified 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 5 1 11 3.4 C56 Ovary 0 0 0 0 0 0 0 0 0 1 2 4 5 4 3 3 2 24 7.4 C57 Other female genital organs 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0.3 C58 Placenta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C64 Kidney 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 2 0.6 C65 Renal pelvis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C66 Ureter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C67 Bladder 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 0 2 5 1.5 C68 Other urinary organs 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0.3

73

Population Based Caner Registry -Colombo District

ICD 10 code and site Age group

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

- (%)

75+

Total

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70 Notkn C69 Eye 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C70-72 Brain, Nervous system 0 0 0 0 0 0 0 0 1 0 0 2 0 1 1 1 2 8 2.5 C73 Thyroid 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0.3 C74 Adrenal gland 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C75 Other endocrine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 gland 0 C81 Hodgkin disease 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 2 0.6 C82-85, C96 Non Hodgkin lymphoma 0 0 0 0 0 0 0 1 1 0 0 0 4 1 0 1 1 9 2.8 C90 Multiple myeloma 0 0 0 0 0 0 0 0 1 0 0 0 0 2 1 0 1 5 1.5 C91 Lymphoid leukaemia 0 0 0 0 0 0 2 0 1 0 0 0 0 0 0 0 1 4 1.2 C92-94 Myeloid leukaemia 0 1 0 1 0 0 0 0 2 0 0 0 0 1 1 2 1 9 2.8 C95 Leukaemia unspecified 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 3 0.9 C26, C48, Other and C76,C80 unspecified 1 0 0 0 0 0 0 0 0 0 3 2 4 3 8 11 17 49 15.1 D45,D47 Myelo Proliferative 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 disorders 0 D46 Myelo Dysplastic Syndromes 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0.3 0 Total 4 1 0 1 0 2 3 1 7 8 18 25 40 42 41 56 76 325 100.0

74

Population Based Caner Registry -Colombo District

Table 20: Age specific rate, Crude rate (R), Age standardized mortality rate (ASR) per 100,000 population of Colombo district – Male 2012

Age group

ICD10 and Site

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

CR

75+

ASR

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70

C00 Lip 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 C01-02 Tongue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5.2 3.9 10.9 4.4 0.0 0.9 0.8 C03-06 Mouth 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 1.2 1.4 1.5 0.0 13.7 5.5 8.9 10.8 1.7 1.4 C07-08 Salivary 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.7 0.0 0.0 0.1 0.1 gland C09 Tonsil 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 0.0 0.0 0.0 0.0 2.0 0.0 0.0 0.0 0.2 0.1 C10 Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.0 2.7 0.0 3.6 0.3 0.2 oropharynx C11 Nasopharynx 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.4 1.5 0.0 0.0 0.0 0.0 0.0 0.2 0.2 C12-13 Hypopharynx 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 3.4 0.0 0.0 0.0 3.6 0.4 0.3 C14 Pharynx 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 0.0 2.0 5.5 4.4 14.3 0.8 0.7 unspecified C15 Oesophagus 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.9 1.7 9.8 13.7 17.8 10.8 1.8 1.6 C16 Stomach 0.0 0.0 0.0 0.0 0.0 1.1 0.0 1.2 0.0 0.0 0.0 8.6 2.0 13.7 4.4 10.8 1.5 1.3 C17 Small 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Intestine C18 Colon 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 1.7 5.9 8.2 8.9 7.2 1.1 0.9 C19-20 Rectum 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 2.7 0.0 3.4 7.8 0.0 22.2 10.8 1.5 1.3 C21 Anus 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C22 Liver 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 1.2 0.0 0.0 1.7 3.9 16.4 17.8 28.7 2.0 1.8 C23-24 Gallbladder 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 1.7 0.0 0.0 8.9 7.2 0.5 0.5 etc. C25 Pancreas 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.9 0.0 17.8 7.2 0.8 0.7 C30-31 Nose, sinuses 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 etc. C32 Larynx 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.4 0.0 1.7 2.0 2.7 4.4 7.2 0.6 0.5 C33-34 Trachea, 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 4.1 8.8 15.5 23.4 27.3 48.8 32.3 5.4 4.8 bronchus and

75

Population Based Caner Registry -Colombo District

Age group

ICD10 and Site

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

CR

75+

ASR

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70

lung

C37-38 Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 thoracic organ C40-41 Bone 0.0 0.0 0.0 1.1 0.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 0.0 0.0 0.0 0.0 0.2 0.2 C43 Melanoma of 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 skin C44 Other skin 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 2.0 0.0 0.0 0.0 0.2 0.1 C45 Mesothelioma 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C47,C49 Connective 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 and soft tissue C50 Breast 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.7 0.0 0.0 0.1 0.1 C60 Penis 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 2.0 0.0 0.0 3.6 0.3 0.2 C61 Prostate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5.2 2.0 2.7 22.2 43.0 1.9 1.7 C62 Testis 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 0.0 2.7 0.0 0.0 0.2 0.2 C63 Other male 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 genital organs C64 Kidney 1.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 0.0 0.0 0.0 2.0 2.7 4.4 0.0 0.4 0.5 C65 Renal Pelvis 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C66 Ureter 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C67 Bladder 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 5.9 0.0 4.4 7.2 0.6 0.5 C68 Other urinary 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.7 0.0 0.0 0.1 0.1 organs C69 Eye 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C70-72 Brain, 1.2 0.0 0.0 1.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.9 2.7 8.9 3.6 0.7 0.7 Nervous system C73 Thyroid 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.4 3.6 0.2 0.2

76

Population Based Caner Registry -Colombo District

Age group

ICD10 and Site

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

CR

75+

ASR

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70

C74 Adrenal gland 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C75 Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 endocrine C81 Hodgkin 0.0 0.0 0.0 1.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 0.0 0.0 0.0 3.6 0.3 0.2 disease C82- Non Hodgkin 0.0 0.0 0.0 0.0 0.0 2.1 0.0 0.0 0.0 2.7 2.9 1.7 2.0 8.2 17.8 10.8 1.6 1.4 C85 and lymphoma C96 C90 Multiple 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 0.0 5.5 4.4 0.0 0.4 0.3 myeloma C91 Lymphoid 0.0 1.1 0.0 2.2 1.0 0.0 0.0 0.0 1.2 0.0 0.0 0.0 0.0 8.2 0.0 3.6 0.8 0.8 leukaemia C92-94 Myeloid 0.0 0.0 0.0 1.1 0.0 0.0 0.0 0.0 1.2 4.1 0.0 0.0 3.9 5.5 4.4 3.6 1.0 0.9 leukaemia C95 Leukaemia 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.7 8.9 7.2 0.4 0.4 unspecified C26, Other and 0.0 0.0 1.2 0.0 1.0 0.0 3.1 0.0 0.0 4.1 7.3 6.9 11.7 32.8 44.4 28.7 4.6 4.2 C48, unspecified C76, C80 D45,D47 Myelo 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0 0.0 Proliferative Disorders D46 Myelo 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Dysplastic Syndromes Total 2.4 1.1 1.2 6.6 5.1 3.2 3.1 3.5 8.5 23.0 33.6 65.5 117.1 188.7 292.9 272.4 33.5 30.0

77

Population Based Caner Registry -Colombo District

Table 21: Age specific rate, Crude rate (CR), Age standardized mortality rate (ASR) per 100,000 population of Colombo district– Female 2012

Age group

ICD 10 code and site

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

CR

75+

ASR

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70

C00 Lip 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C01-02 Tongue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.2 3.4 2.3 0.3 0.2 C03-06 Mouth 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 4.4 3.4 0.0 0.3 0.3 C07-08 Salivary gland 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C09 Tonsil 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C10 Other oropharynx 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C11 Nasopharynx 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 0.0 0.0 0.0 0.1 0.1 C12-13 Hypopharynx 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 0.0 0.0 0.0 0.1 0.1 C14 Pharynx unspecified 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.4 0.0 3.4 2.3 0.3 0.2

C15 Oesophagus 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.3 0.0 1.5 3.4 6.7 6.8 9.1 1.1 0.8 C16 Stomach 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.3 4.6 0.0 4.4 3.4 9.1 0.9 0.6 C17 Small intestine 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C18 Colon 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 2.2 3.4 0.0 0.3 0.2 C19-20 Rectum 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 0.0 1.3 0.0 0.0 0.0 2.2 3.4 6.8 0.8 0.4 C21 Anus 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C22 Liver 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.7 3.0 3.4 2.2 13.6 6.8 1.2 0.9 C23-24 Gallbladder etc. 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.3 2.7 1.5 0.0 0.0 0.0 9.1 0.7 0.5 C25 Pancreas 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 0.0 0.0 4.6 0.0 0.0 13.6 0.0 0.7 0.5 C30-31 Nose, sinuses etc. 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 0.0 0.0 0.0 0.1 0.1 C32 Larynx 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C33-34 Trachea, bronchus and lung 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.3 1.3 1.5 6.7 8.9 10.2 13.6 1.7 1.2

78

Population Based Caner Registry -Colombo District

Age group

ICD 10 code and site

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

CR

75+

ASR

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70

C37-38 Other thoracic organ 0.0 0.0 0.0 0.0 0.0 1.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.3 0.2 0.1

C40-41 Bone 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C43 Melanoma of skin 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C44 Other skin 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C45 Mesothelioma 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C47-49 Connective and soft tissue 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.3 0.1 0.0

C50 Breast 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 6.0 10.2 9.3 16.7 18.6 13.3 37.5 34.1 6.3 4.7 C51 Vulva 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.2 0.0 0.0 0.1 0.1 C52 Vagina 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.5 0.2 0.1 C53 Cervix uteri 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.3 1.5 1.7 2.2 3.4 4.5 0.6 0.4 C54 Corpus uteri 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 2.2 0.0 0.0 0.2 0.1 C55 Uterus unspecified 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 0.0 1.3 1.3 0.0 1.7 2.2 17.1 2.3 0.9 0.7 C56 Ovary 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 2.6 5.3 7.6 6.7 6.7 10.2 4.5 2.0 1.6 C57 Other female genital organs 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.5 0.0 0.0 0.0 0.0 0.1 0.1

C58 Placenta 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C64 Kidney 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.2 0.1 C65 Renal pelvis 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C66 Ureter 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C67 Bladder 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.4 2.2 0.0 4.5 0.4 0.3 C68 Other urinary organs 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 0.0 0.0 0.0 0.1 0.1

C69 Eye 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C70-72 Brain, Nervous system 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 0.0 0.0 2.7 0.0 1.7 2.2 3.4 4.5 0.7 0.5

79

Population Based Caner Registry -Colombo District

Age group

ICD 10 code and site

04 09 14 19 24 29 34 39 44 49 54 59 64 69 74

------

CR

75+

ASR

00 05 10 15 20 25 30 35 40 45 50 55 60 65 70

C73 Thyroid 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.7 0.0 0.0 0.0 0.1 0.1 C74 Adrenal gland 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 C75 Other endocrine gland 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

C81 Hodgkin disease 0.0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 1.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.2 C82-85, Non Hodgkin lymphoma 0.0 0.0 0.0 0.0 0.0 0.0 1.1 1.2 0.0 0.0 0.0 6.1 1.7 0.0 3.4 2.3 0.8 0.6 C96 C90 Multiple myeloma 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.2 0.0 0.0 0.0 0.0 3.4 2.2 0.0 2.3 0.4 0.3 C91 Lymphoid leukaemia 0.0 0.0 0.0 0.0 0.0 2.2 0.0 1.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.3 0.3 0.3

C92-94 Myeloid leukaemia 1.2 0.0 1.2 0.0 0.0 0.0 0.0 2.3 0.0 0.0 0.0 0.0 1.7 2.2 6.8 2.3 0.8 0.7 C95 Leukaemia unspecified 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 6.8 2.3 0.3 0.2

C26, Other and unspecified 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.8 2.7 6.1 5.1 17.7 37.5 38.6 4.1 2.9 C48, C76, C80 D45,D47 Myelo Proliferative 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 disordes

D46 Myelodysplastic 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.2 0.0 0.0 0.1 0.1 syndromes Total 1.2 0.0 1.2 0.0 2.1 3.2 1.1 8.2 9.7 23.0 33.2 60.7 70.9 90.9 191.0 172.6 27.5 20.1

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Table 22: Distribution of reporting of cancer related deaths by divisional death registrar of Colombo district and resident district of the deceased person: 2012 Resident district of the deceased person Divisional Death Registrar Division Colombo Other Not Total district known 1 Dam Street-(Medical) 2 Dam Street-Aluthkade 5 0 0 5 3 Dam Street- 2 0 0 2 4 Dam Street-New Bazar 9 0 0 9 5 Dam Street- (Medical)(Sinhala) 6 Dam Street-Kotahena(Medical)(Tamil) 7 Dam Street-(Medical) 8 Dam Street-(Medical) 16 16 0 32 9 -Dehiwala/(Medical) 39 20 1 60 10 -Kaluaggala(Hewagam Korale) 4 2 0 6 11 Hanwella-Avissawella Town(Hewagam 14 2 0 16 Korale)(Medical) 12 Hanwella-Kosgama (Hewagam Korale) 11 1 1 13 13 Hanwella-Hanwella(Hewagam Korale) 14 3 0 17 14 -(Hewagam Korale) 11 1 0 12 15 Homagama-(Hewagam Korale) 21 3 0 24 16 Homagama-(Salpiti Korale) 1 0 0 1 17 Homagama-Mattegoda(Salpiti Korale) 18 Homagama-Salpiti Korale(salpiti Korale/Kiriwattuduwa) 19 Homagama-Mattegoda(Salpiti Korale/Hewagam 6 1 0 7 Korale/Athurugiriya) 20 Kaduwela-(Hewagam Korale) 14 0 1 15 21 Kaduwela-Ranala(Hewagam Korale) 12 1 0 13 22 -Mampe(Salpiti Korale) 13 0 0 13 23 Kesbewa-(Colombo) 17 0 0 17 24 Kesbewa-Pepiliyana(Salpiti Korale) 1 0 0 1 25 Kesbewa-Thumbowila 26 Kesbewa-Kesbewa(Salpiti Korale) 14 0 0 14 27 -Mulleriyawa(Hewagam Korale) 15 5 0 20 28 Kolonnawa-Kolonnawa(Medical) 4 0 0 4

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Resident district of the deceased person Divisional Death Registrar Division Colombo Other Not Total district known 29 Kolonnawa-Lower Ambatale(Colombo) 7 1 0 8 30 Maharagama-Maharagama North(Colombo) 288 669 25 982 31 Maharagama-Maharagama South(Colombo) 12 0 0 12 32 Maharagama-Jayawardenepura South(Medical) 1 1 0 2 33 -Moratuwa Town South(Medical) 11 0 0 11 34 Moratuwa-Moratuwa Town North(Medical) 14 0 0 14 35 -Padukka(Hewagam Korale-Muslim) 36 Padukka-Padukka(Hewagam Korale) 37 Padukka-Waga(Hewagam Korale) 6 2 0 8 38 Rathmalana-Rathmalana(Medical) 18 0 0 18 39 Rathmalana-Attidiya(Colombo Division/Attidiya) 6 0 0 6 40 Sri Jayawardenepura Kotte-Kote North(Medical) 8 1 0 9 41 Thimbirigasyaya-(Medical) 2 0 0 2 42 Thimbirigasyaya-Kirulapone(Sinhala) 54 29 1 84 43 Thimbirigasyaya-Kirulapone(Tamil) 44 Thimbirigasyaya-(Medical) 8 0 0 8 45 Thimbirigasyaya-Wellawatta(Medical) 8 0 0 8 46 Thimbirigasyaya-De Zoysa Hospitsl for Women(Medical) 47 Thimbirigasyaya-General Hospita(Medical) 21 29 2 52 48 Thimbirigasyaya-(Medical) 49 Thimbirigasyaya Total 707 787 31 1525 (46.4%) (51.6%) (2%) (100%)

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References Annual Health Bulletin – 2012, Medical Statistics Unit, Ministry of Health, Sri Lanka. [Online] Available at: http://www.health.gov.lk/moh_final/english/public/elfinder/files/publications/AHB/A nnual%20Health%20Bulletin%20-%202012.pdf [27 April 2020]

Bray, F., Znaor, A., Cueva, P., Korir, A., Swaminathan, R., Ullrich, A., Wang, S., Parkin, D., Bray, F. (2020). Planning and Developing Population-Based Cancer Registration In Low- And Middle-Income Settings. [Online] Available at: https://publications.iarc.fr/Book-And-Report-Series/Iarc-Technical- Publications/Planning-And-Developing-Population-Based-Cancer-Registration-In- Low--And-Middle-Income-Settings-2014 [27 April 2020]

Commencement of Population Based Cancer Registry in the Colombo District, National Cancer Control Programme, Ministry of Health. January 2012

Cancer Incidence and Mortality in Sangur District, Punjab State, India : 2014 Tata Memorial Centre, Mumbai, India.

Cancer Registry, National Cancer Control Programme (2018), Cancer Incidence Data, Sri Lanka, 2011. [Online] Available at: https://www.nccp.health.gov.lk/en [27 April 2020]

Department of Census and Statistics, [Online] Available at: http://www.statistics.gov.lk/PopHouSat/VitalStatistics/Tables.asp?Year=2012 [27 April 2020]

Fritz, A., Percy. C., Shanmugaratnam, A., Sobin, K., Parkin, L., & Whelan, D 2009. International Classification of Diseases of Oncology, 3rd edn, WHO, Geneva

Glossary of statistical terms; http://www-dep.iarc.fr/WHOdb/glossary.htm [27 April 2020]

ICD 10-10th revision, Fifth edition 2016, World Health Organization [Online] Available at: https://www.who.int/classifications/icd/icdonlineversions/en/ [27 April 2020]

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Integrated Missions of PACT (imPACT) - Joint Interagency Report for a National Cancer Control Programme submitted to the Ministry of Healthcare and Nutrition of Sri Lanka, June 2008.

Parkin, D., 2005. Cancer Information Systems: Sri Lanka. Report of WHO consultation, Nov - Dec 2005. Oxford University, UK.

Pathology Laboratory Based Cancer Surveillance, National Cancer Control Programme, Ministry of Health January 2012

Perera, N., 2016. Using pathology reports as a data source for strengthening cancer surveillance. Journal of Diagnostic Pathology, 11(1), pp.1–4. [Online] Available at: https://jdp.sljol.info/articles/abstract/10.4038/jdp.v11i1.7688/ [27 April 2020]

Population Tables, Census of Population and Housing- 2012 Sri Lanka Department of Census and Statistics

Standard Operating Procedures for Cancer Registration in Sri Lanka National Cancer Control Programme, Ministry of Health, Nutrition and Indigenous Medicine. February 2019

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Appendix - Statistical Terminology Population at risk The population at risk includes all individuals susceptible to a specific cancer. It is defined on the basis of demographic variables, such as place of residence, sex, age group. Years of risk duration is counted in person-years.

Incidence Incidence quantifies the number of new cases that develop in a population of individuals at risk during a specified time interval. Usually it is given as 100,000 population per year.

Mortality Mortality is the number of deaths occurring in a given period in a specified population. It can be expressed as an absolute number of deaths per year or as a rate of 100,000 persons per year.

Crude rate Data on incidence or mortality are often presented as rates. For a specific tumour and population, a crude rate is calculated simply by dividing the number of cancer deaths observed during a given time period by the corresponding number of person years in the population at risk. For cancer, the result is usually expressed as an annual rate per 100,000 persons at risk. . Crude incidence rate = Total number of cases in the year X 100,000 Total mid-year population at risk

Crude death rate = Total number of deaths in the year X 100,000 Total mid-year population at risk

Age-specific rate This rate is calculated simply by dividing the number of new cancers or cancer deaths observed in a given age category during a given time period by the corresponding number of person years in the population at risk in the same age category and time period. The result is

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usually expressed as an annual rate per 100,000 person-years. In this publication. five- year age categories are used.

Age-specific incidence Number of cases in the five-year age group X 100,000 rate Population at risk in the corresponding age group

Age-specific death rate Number of deaths in the five-year age group X 100,000 Population at risk in the corresponding age group

ASR (Age standardized rate) An age-standardized rate (ASR) is a summary measure of the rate that a population would have if it had a standard age structure. Standardization is necessary when comparing several populations that differ with respect to age because age has a powerful influence on the risk of dying from cancer. The ASR is a weighted mean of the age-specific rates; the weights are taken from population distribution of the standard population. The most frequently used standard population is the World Standard Population. The calculated mortality rate is then called age-standardized mortality rate (world). The world standard population used within the application is as proposed by Segi (1960) and modified by Doll and al. (1966). The ASR is also expressed per 100,000. Age distribution of the world standard population Age group Population 0-4 12000 5-9 10000 10-14 9000 15-19 9000 20-24 8000 25-29 8000 30-34 6000 35-39 6000 40-44 6000 45-49 6000 50-54 5000 55-59 4000 60-64 4000 65-69 3000 70-74 2000 75-79 1000 80-84 500 85+ 500 Total 100000

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Life time risk (Cumulative Risk) Cumulative incidence/mortality is the probability or risk of individuals getting/dying from the disease within a specified age interval within a time period.

(The cumulative risk is the risk which an individual would have of developing the cancer under study, during a certain age span if no other causes of death were in operation.)

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