Cancer Incidence Report Saudi Arabia 2009

Home , Baljurashi, Buraidah, Samtah, Udhailiyah

Kingdom of Saudi Arabia Ministry of Health Saudi Cancer Registry Saudi Arabia 2009

December 2012

ISSN: 1658-0559 Cancer Incidence Report www.scr.org.sa

Kingdom of Saudi Arabia Ministry of Health Saudi Cancer Registry

Cancer Incidence Report Saudi Arabia 2009

P01a.indd 1 16/01/2013 12:45:31 PM Report prepared by: Haya S. Al-Eid, BDS, DFE, CTR Angelica D. Garcia, Secretary

Reviewed by: Shouki Bazarbashi, MD Ali Al-Zahrani, MD, PhD

P01a.indd 2 16/01/2013 12:45:31 PM Foreword Acknowledgment

The 2009 cancer incidence report represents the The Saudi Cancer Registry is a program funded by twelfth publication for the cancer registry since The Ministry of Health and its main office located at its establishment in 1992. As stated earlier, our King Faisal Specialist Hospital and Research Center. Mission is to provide comprehensive cancer data This publication is a part of our efforts to make about incidence of cancer in the Kingdom of Saudi cancer data available to oncologists, researchers, Arabia. Our data undergo extensive quality control strategic health planners, community care providers, performed continuously, which includes IARC edit and administrators. checks through our CanReg-4 program and through visual review of abstracted cases. The production of this report reflects the efforts of our valuable cancer registrars, main office staff This report shows an increase in cancer incidence and members of the board of directors. Special rate and number of cases. This increase is likely warm thanks to our registrar who maintain patients’ a combination of better case ascertainment and confidentiality and travel to every part of the true increase in cancer incidence. Regardless of kingdom to collect the cancer cases from different the possible cause, we believe quality control is an and numerous health facilities. important issue in our data. For this we are planning an external review of our data and procedures in Special thanks to the support provided by the the coming few weeks. This should strengthen our Ministry of Health represented by his Excellency the results and create a solid ground for research on Minister of Health Dr. Abdullah Al Rabeeah and the the difference of cancer incidence between Saudi deputy Minister of Health Dr. Mansour Al Hawasi. Arabia and neighboring countries. The Oncology center at King Faisal Specialist Unfortunately, we continue to have difficulty with Hospital and Research Center will be moving in some institution allowing our registrars to collect 2014 to the new King Abdullah Center for Cancer the data. For this we are using all channels possible and Liver Diseases (KACCLD). The hospital to solve these issues and do hope it will not affect leadership represented by his Excellency Dr. Qasem our results in the future. Al Qasabi, has been of our major support in the past and we do hope that this support will continue with We have finished a 10 year color coding of our the move to the new KACCLD. reports, so that each year is represented in different color. Starting 2010, we will repeat the colors for Many pharmaceutical companies spare no effort to each year for easy identification. Also we are re- support us and we feel in debt to them for their doing our website to a much user friendly site and generous support. hope to be able to attract more researchers to look into our data for better scientific results.

In this report, we have maintained the same standard format as in the previous reports especially the section of the collective data variables since the start of the Saudi Cancer Registry in January 1994 beside the Arabic summary of cancer statistics.

Shouki Bazarbashi, MD Chairman

P01a.indd 3 16/01/2013 12:45:31 PM P01a.indd 4 16/01/2013 12:45:31 PM Introduction

This is the thirteenth incidence report published Part IV Cancer Incidence among Non-Saudis by the Saudi Cancer Registry. Previous publications include the Incidence Report for the years 1994- 1996, 1997-1998, 1999-2000 and yearly till 2008. This part presents the incidence of cancer cases among Non-Saudis including the most common types of cancer. The analysis of the Non-Saudis is The structure of this report can be outlined as performed separately due to the nature of the follows: expatriate population in Saudi Arabia. Particularly, a large part of the male and female population falls in the 25- 49 age group. Part I Materials and Methods

This part of the report contains information about Part V Incidence Tables the background of the Saudi Cancer Registry and methods used in collecting and analyzing the data. We present the basics of coding and classification Part V contains the following detailed tables for all of tumor topography, morphology and extent of newly diagnosed cancer types among Saudis and disease at the time of diagnosis. Also we describe Non-Saudis for 2009: the software programs we have used to analyze the data. • Distribution of cancer cases among Saudis by Part II Overview of Cancer Incidence age group and sex

Part II contains figures and tables that show overall • Distribution of cancer cases among Non- cancer incidence in Saudi Arabia for the year 2009. Saudis by age group and sex We present these figures and tables mainly by sex and in certain areas we have it analyzed by different • Cancer Incidence (per 100,000 population) age groups. There are bar charts representing the among Saudis by age group and sex age distribution of cancer incidence for the year 2009 among Saudis by sex and age groups. We • Cancer Incidence (per 100,000 population) present incidence and morphology tables for the among Non-Saudis by age group and sex most common types of cancers among adults and children. In addition, tables list the total number of • Age-standardized incidence rate and relative cases, the Age-Standardized Incidence Rate (ASR) frequencies among Saudis by cancer site, sex per 100,000 population, Crude Incidence Rate and administrative regions (CIR) and Cumulative rates by primary site and sex. Separate bar charts depict the most common types of cancer, by sex, in each of the 13 administrative Part VI Appendices regions of Saudi Arabia.

Part III Incidence of Selected-Sites Appendix A: Regional listing of all health care facilities from which cancer cases have been In this part the incidence of the most common reported. The objective is to receive feedback from cancers among Saudi males and females are outlined. facilities that have not been included in order to A standardized layout presents data for all patients improve our case-finding and reporting processes. and for both sexes where applicable. For each selected site the number and the percentage of all Appendix B: Names of the members of the Board newly diagnosed cases for the year 2009, the ASR, of Directors. morphological differentiation and staging for each sex and the specific cancer rank for both sexes is Appendix C: Cancer Registration Abstract Form. presented. In addition, ASR for the specified cancer among Saudis is compared with ASR among other Appendix D: Arabic Summary of Cancer Statistics populations from selected countries. in Saudi Arabia for the year 2009.

P01a.indd 5 16/01/2013 12:45:31 PM Table of Contents

Foreword...... 3 Acknowledgement...... 3 Introduction...... 5

PART I...... 9

Background on Saudi Arabia...... 10 Saudi Cancer Registry...... 10 Definitions of Statistical Terms...... 13

PART II...... 15

Cancer in Saudi Arabia 2009...... 16 Adult Cancers in Saudi Arabia, 2009 (above 14 years)...... 21 Childhood Cancers in Saudi Arabia 2009 (14 years and below)...... 24 Cancer in the 13 Administrative Regions of the Kingdom...... 27 International Comparison of Age-Standardized Incidence Rates ...... 32

PART III...... 33

Cancer Incidence for Most Common Sites, 2009...... 34 Female Breast (C 50)...... 35 Colo-rectal (C18-C20)...... 37 Non-Hodgkin Lymphoma (C82-C85; C96)...... 39 Thyroid (C73)...... 41 Leukemia (C91-C95)...... 43 Liver (C22)...... 45 Lung (C33-C34)...... 47 Hodgkin disease (C81)...... 49 Skin (C44)...... 51 Stomach (C16)...... 54 Prostate (C61)...... 56 Corpus Uteri (C54)...... 58 Bladder (C67)...... 60 Ovary (C56)...... 62 Sources...... 64

PART IV...... 65

Cancer Among Non-Saudi Population 2009...... 67

P01a.indd 6 16/01/2013 12:45:32 PM PART V...... 69

Table 5.1.1 Age Distribution of Cancer Cases among Saudi Males, 2009...... 70 Table 5.1.2 Age Distribution of Cancer Cases among Saudi Females, 2009...... 71 Table 5.3.4 Age-Specific Incidence Rate (AIR), Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site and Age Groups , 2009...... 72 Table 5.1.4 Age-Specific Incidence Rate (AIR), Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site and Age Groups, 2009...... 73

Table 5.2.1 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site, Age Groups, and Region, (Asir, Baha, Jazan), 2009...... 74 Table 5.2.2 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site, Age Groups, and Region, (Madinah, Hail, Qassim), 2009...... 75 Table 5.2.3 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site, Age Groups, and Region, (Najran, Jouf, Tabuk, Northern Region), 2009...... 76 Table 5.2.4 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site, Age Groups, and Region, (Riyadh, Makkah, Eastern Province), 2009...... 77

Table 5.3.1 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site, Age Groups, and Region, (Asir, Baha, Jazan), 2009...... 78 Table 5.3.2 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site, Age Groups, and Region, (Madinah, Hail, Qassim), 2009...... 79 Table 5.3.3 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site, Age Groups, and Region, (Najran, Tabuk, Jouf, Northern Region), 2009...... 80 Table 5.3.4 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site, Age Groups, and Region, (Riyadh, Makkah, Eastern Province), 2009...... 81

Table 5.4.1 Number of Cancer Cases among Non-Saudi Males by Primary Site and Age Groups, 2009 �� 82 Table 5.4.2 Number of Cancer Cases among Non-Saudi Females by Primary Site and Age Groups, 2009 �� 83 Table 5.4.3 Age-Specific Incidence Rate (AIR), Age-Standardized Incidence Rate (ASR) among Non-Saudi Males (per 100,000) by Primary Site and Age Groups , 2009 ...... 84 Table 5.4.4 Age-Specific Incidence Rate (AIR), Age-Standardized Incidence Rate (ASR) among Non-Saudi Females (per 100,000) by Primary Site and Age Groups, 2009...... 85

Table 5.5.1 Number of Cases by Primary Site and Years among Saudi Males, 1994-2009...... 86 Table 5.5.2 Number of Cases by Primary Site and Years among Saudi Females, 1994-2009...... 87 Table 5.5.3 Age Standardized Incidence Rate by Primary Site and Years among Saudi Males, 1994-2009 �� 88 Table 5.5.4 Age Standardized Incidence Rate by Primary Site and Years among Saudi Females, 1994-2009 �� 89 Table 6.1 Number of In Situ Cases among Saudis and Non-Saudis, 2009...... 90 Table 6.2 Number of Myelodysplastic syndromes and chronic Myeloproliferative disorders among Saudis and Non-Saudis, 2009...... 90

PART VI...... 91

APPENDIX A: Reporting Health Care Facilities...... 92-95 APPENDIX B: Members of SCR Board of Directors...... 96-97 APPENDIX C: Cancer Registration Abstract Form...... 98-99 APPENDIX D: Arabic Summary of Cancer Statistics in Saudi Arabia for the Year 2009...... 100-101

P01a.indd 7 16/01/2013 12:45:32 PM P01a.indd 8 16/01/2013 12:45:32 PM PART I MATERIALS AND METHODS

P01a.indd 9 16/01/2013 12:45:32 PM Background on Saudi Arabia

Saudi Arabia is a vast country extending over four- 16,222 5.3 75+ 0.4 9,509 fifths of the Arabian Peninsula. It stretches from the 14,002 0.2 70-74 0.4 10,331 Arabian Gulf in the east to the Red Sea in the west. 22,607 0.4 65-69 0.5 10,988 55,318 1.0 60-64 0.7 17,701 It is approximately 2,149,700* square kilometers in 140,160 2.4 55-59 1.3 31,942 area and is divided into 13 administrative regions 289,967 5.0 50-54 2.3 56,649 (Figure 1.1). 486,775 8.4 45-49 3.7 89,688 731,780 12.7 40-44 6.7 163,056 1,019,026 17.6 35-39 12.3 298,638 1,006,056 17.4 30-34 15.0 365,081 713,900 12.3 25-29 11.3 275,061 268,656 4.6 20-24 7.5 181,823 183,033 3.2 15-19 6.9 168,729 238,982 4.1 10-14 8.9 215,954 292,095 5.0 5-9 10.5 256,595 306,070 5.3 0-4 11.6 282,271

20 18 16 14 12 10 8 6 4 2 0 0 2468101214161820 Male Female 5,784,650 2,434,016 Figure 1.3 Population Pyramid of non-Saudis (%) by Sex and Age Group, 2009

Saudi Cancer Registry The Saudi Cancer Registry (SCR) of Saudi Arabia Figure 1.1 Administrative Regions of Saudi Arabia is a population-based registry established in 1992 under the jurisdiction of the Ministry of Health The estimated Saudi national population for year (MOH) by the order of His Excellency the Minister 2009 was 18,116,565**. Of these 9,225,451 (50.9%) of Health. The SCR commenced reporting cancer were males and 8,891,114 (49.1%)were females. The cases from 01 January 1994. Non-Saudi population in 2009 was 8,218666**; of these 5,784,650 (70.4%) were males and 2,434,016 (29.6%) females. Objectives:

Figures 1.2 and 1.3 show the Saudi and Non- The primary goal of the SCR is to define the Saudi population pyramids by sex and age group population-based incidence of cancer in Saudi respectively. Arabia. Additional objectives include programs for early detection and cancer screening, as well

121,560 1.3 75+ 1.3 118,683 as cancer research projects. 93,064 1.0 70-74 0.9 79,740 108,181 1.2 65-69 1.2 110,543 Organizational Structure: 157,596 1.7 60-64 1.7 151,261 211,437 2.3 55-59 2.2 195,802 287,210 3.1 50-54 3.1 273,809 A Board of Directors was appointed to include 368,180 4.0 45-49 3.9 343,144 representatives from the MOH, King Faisal Specialist 459,180 5.0 40-44 4.9 437,406 Hospital and Research Center (KFSH&RC), and 552,996 6.0 6.1 545,285 35-39 the Medical Services Departments of the Ministry 677,628 7.3 30-34 7.4 662,559 798,694 8.7 25-29 8.8 780,941 of Defense and Aviation, Ministry of Interior, 945,878 10.3 20-24 10.1 901,741 the National Guard, King Saud University, King 1,016,458 11.0 15-19 11.0 976,065 Faisal University, King Abdul-Aziz University and 1,084,084 11.8 10-14 12.0 1,063,291 King Khalid University. The Board is charged 1,134,096 12.3 5-9 12.4 1,099,244 1,209,207 13.1 0-4 13.0 1,151,599 with the responsibility of overseeing the SCR’s 20 18 16 14 12 10 8 6 4 2 0 0 2468101214161820 establishment, defining demographic and cancer- Male Female related data to be collected, approving research 9,225,451 8,891,114 requests, and reporting findings, as well as Figure 1.2 Population Pyramid of Saudis (%) by Sex disseminating information collected while ensuring and Age Group, 2009 the confidentiality of all data reported to the SCR.

* Source: Demographic and Health Indicators for Countries of the East Mediterranean, WHO, Regional Office for the EM, 1999 ** Source: 2009 SCR Estimation with 3.2% Growth Rate among saudis and 2.5% among non-Saudis based on 2010 Census, Central Department for Statistics (CDS) data, Ministry of Planning (website http:\\www.planning.gov.sa).

P01a.indd 10 16/01/2013 12:45:35 PM The SCR Main Office, including administrative and technical staff, is located in the premises of Ministry of Health the KFSH&RC in Riyadh. Additionally, five regional Saudi Arabia branches and four hospital-based offices were set up to ensure comprehensive data collection from all over the Kingdom (Figure 1.4).

Regional Offices: Saudi Cancer Registry 1 Central Region: King Fahad Medical City in Main Office Riyadh, covering Riyadh, Qassim, and Hail Health Regions. 2 Eastern Region: King Fahad Hospital of the Central Region University, Al Khobar, covering Dammam, Al (Riyadh, Qassim & Hail) Ahsa, and Hafr Al-Batin Health Regions. 3 Western Region: King Abdulaziz Hospital and Cancer Center, Jeddah, covering Jeddah, Eastern Region (Dammam, Ahsa & Hafr Al Batin) Makkah, Taif and Qunfudah Health Regions. 4 Southern Region: Asir Central Hospital, Abha, covering Asir, Baha, Najran, Jazan and Western Region Bisha Health Regions. (Jeddah, Makkah, Taif & Qunfudah) 5 Madinah/Northern Region: Maternity and Children Hospital, Madinah, covering Madinah, Southern Region Tabuk, Jouf and Northern Health Regions. (Asir, Baha, Jazan & Najran) Offices at the Medical Service Division or Oncology Department of the following establishments: Madinah Region (Madinah, Tabuk, Jouf & Northern Region) 6 King Faisal Specialist Hospital & Research Centre, Riyadh King Faisal Specialist Hospital 7 Ministry of Defense amd Aviation, Armed & Research Centre, Riyadh Forces Hospitals, Riyadh 8 National Guard Hospitals, King Abdulaziz Medical City, Princess Norah Oncology Armed Forces Hospitals Center, Jeddah (Riyadh, Western, South & Northern) 9 King Abdul Aziz University Hospital, Jeddah 10 Ministry of Interior, Security Forces Hospital, National Guard Hospitals Riyadh (Riyadh, Jeddah, Dammam & Ahsa)

Each of the SCR offices operates under the supervision of a member of the Board of Directors King Abdulaziz University Hospital who is responsible for the daily management of Jeddah that office. Staffing consists of tumor registrars and secretarial staff. Security Forces Hospital Riyadh The SCR Main Office indirectly supervises the regional offices and is responsible for ensuring the accuracy and quality of data collected in all of the regions. King Khalid University Hospital Riyadh Quality control processes include verification of site, morphology, and staging information as well as Figure 1.4 Organizational Chart of the Saudi Cancer case linkage (tumor and patient), and consolidation Registry of Saudi Arabia of data. The Main Office also prepares periodic Format reports for dissemination of information to the medical community, government establishments, The format of the current report is similar to the international organizations and the media. previous reports.

P01a.indd 11 16/01/2013 12:45:35 PM Data management

A ministerial decree has categorized cancer as in either reportability or definition. However, a mandatory notifiable disease. This ensures the as with the new staging guidelines, the ICD-O opportunity for comprehensive data collection. changes reflect advances in the understanding of The SCR strives for full access to cancer data the pathology and behavior of cancers. from all Ministry of Health, governmental and private hospitals, as well as clinics and laboratories throughout the Kingdom. Cancer data are abstracted It should be noted that in the 3rd edition of the from patients’ medical records, based on clinical International Classification of Diseases for Oncology, and/or histopathological diagnosis, by SCR-trained the behavior code of Myelodysplastic syndromes cancer registrars. (MDS) and chronic Myeloproliferative disorders (CMD) was changed from /1, borderline malignancy or low malignant potential, to /3, malignant primary The data abstract (see appendix D) includes site. These diagnoses became reportable for cases personal identification (name, ID Number, sex, diagnosed in 2001+ when ICD-O-3 went into effect. age), demographic information (address, telephone ICD-O-3 codes are converted to ICD-10 for analysis number, nationality), and tumor details (diagnosis purposes. Since the WHO has not yet converted date, primary site, histology, behavior, grade, stage, the ICD-10 hematopoietic disease behavior changes, basis of diagnosis). The primary site (topography) our software, CanReg 4.33, cannot include these and histology (morphology) of the malignancies cases for analysis and they have been excluded. are identified and coded according to the International Classification of Diseases for Oncology 3rd Edition (ICD-O-3), published by the World Health Every effort is made to accurately code patient and Organization (WHO), 2000. tumor information, to ensure that all data can be reviewed, linked, and consolidated, as appropriate, so that each malignancy is counted only once for Effective from year 2001, changes were made in statistical analysis. coding of cancer types and behaviors as well as staging according to International guidelines. The The computer software programs used for data new SEER Summary Stage 2000 guidelines should entry and incidence tables output are CanReg 4.33, result in increased accuracy and consistency in the developed by the International Agency for Research coding of stage. There are some differences in the on Cancer, (IARC) Lyon, France. timing rules for determining stage and some sites are coded differently using the new guidelines. However, the new criteria and guidelines should improve the The second part of the report includes the overall usefulness of staging as a predictor of prognosis and cancer incidence in Saudi Arabia and the relevant survival as the changes reflect a new understanding epidemiological and clinicopathological details for of the natural history of cancer. The new guidelines, the 14 most common cancers among Saudi nationals SEER Summary Stage Manual 2000, is available on for the year 2009. For each cancer site, the number the web at: http:/seer.cancer.gov/tools/ssm/. Cases and the percentage of all newly diagnosed cases for diagnosed on or after 01 January 2008 are classified the year 2009, the age-standardized incidence rate according to the updated ICD-O-3. Improvements (ASR) per 100,000 population for each sex, and the in the understanding of cancer pathology over the specific cancer rank in comparison to all cancers last decade are reflected in the changes to ICD-O-3. for both sexes are presented. While there have not been any changes in the primary site codes, there are significant changes regarding histology (cell types). Leukemias and Useful international statistics for the specified lymphomas, particularly are affected. Some cases cancer include the ranking of the cancer worldwide. that were previously considered benign are now The source for this information is summarized on counted as malignant. Also small number of cancers page 63. that were previously coded as borderline tumors are now considered benign. Counts of ovarian The relevant data incorporate details for all patients cancers, lymphomas and leukemias as well as some presented over the year 2009. For each cancer hematopoietic diseases will change due to changes there are five figures:

P01a.indd 12 16/01/2013 12:45:36 PM 1. An Arithmetic line graph represents the Moreover we don’t have up to date statistics age-specific incidence rate (AIR) for all age because we have to wait until all of the data from the groups at five-year intervals. The graph is regional cancer branches in Saudi Arabia has been plotted by sex, where applicable. collected before we can publish the annual incidence report. Also, the process of registering a cancer is 2. A Table lists the percentages of the most complicated and there are a number of processes common histology sub-types for each in place to ensure the data is of a high quality. This specific cancer. means there is usually a delay of around 2-3 years before the data is complete enough to be published. 3. A Pie chart shows the distribution of the clinical stages of each cancer such as Definitions of Statistical Terms localized, regional, distant metastasis and unknown. Age-Specific Incidence Rate (AIR)

4. A Bar chart shows regional distribution The number of cancer cases occurring during a of ASR for particular cancer across the specific period in a population of a specific age administrative regions by males and females. and sex group, divided by the number of midyear population of that age and sex group. 5. A Bar chart shows comparison of age- standardized incidence rate (ASR) for each Age-Standardized Rate (ASR) cancer type in Saudi Arabia with ASR in The Age-standardized rate is a summary measure selected countries. of a rate that a population would have if it had a In reviewing the data, its collection and analysis, two standard age structure. Standardization is necessary qualifying statements can be made: when comparing several populations that differ with respect to age structure. The most frequently a. The number of patients presenting with used standard population is the World Standard malignant disease from Riyadh region Population (see below). The calculated incidence is exceeds the expected number per known as the World Standardized Incidence Rate. population. The reason for this is that The rate is expressed per 100,000 populations. Riyadh has many referral centers providing patients from outside the region with Age Class Population cancer-related care. Some of these patients don’t provide their permanent address, 0-4 12,000 but instead, provide a temporary Riyadh 5-9 10,000 address. This situation is partially resolved 10-14 9,000 through tumor and patient linkage of cases 15-19 9,000 from all regions based on identifiers such 20-24 8,000 as national ID. 25-29 8,000 b. As previously noted, the software used in 30-34 6,000 analyzing this report, CanReg 4.33, does not 35-39 6,000 include in situ cases in the incidence tables. 40-44 6,000 These cases were added to the total cancer 45-49 6,000 cases in the overview. 50-54 5,000 Notification 55-59 4,000 60-64 4,000 The data included in this report were abstracted 65-69 3,000 up to June 2012. 2009 incident cases which are 70-74 2,000 identified after this date (late reporting) will be noted 75+ 2,000 in subsequent incidence reports. It is anticipated that the number of late-reported cases will decrease Total 100,000 * Doll R. Payne P. Waterhouse J. Cancer incidence in Five Continents Vol. I. International Union as case ascertainment processes are improved. Against Cancer. 1966

P01a.indd 13 16/01/2013 12:45:36 PM Crude Incidence Rate (CIR) Incidence Rate

The crude incidence rate for a cancer site is the An incidence rate is defined as the rate at which a total number of cases registered as a proportion new event occurs in a population. It is calculated of the total population. It denotes the approximate as the number of new cases of disease arising in a number of cases occurring in each 100,000 population over a defined time period, divided by the population at risk of developing that disease. individuals. All rates are thus, expressed as per 100,000 population. Mean Cancer rates vary greatly with age and the crude rate is strongly influenced by the demographic The simple mathematical average of two or more structure of the population. Hence, if the numbers. population structure changes over time the crude rate over that period may be artificially altered. It is not appropriate to compare crude rates across Median geographical areas of cancer registries with different The midpoint of the range numbers that are population age structures. Therefore, in order to arranged in order of value. assess time trends in registration data or compare incidence across geographical areas or between registries it is necessary to first standardize the Metastasis rates with respect to age. Metastasis is the distant spread of cancer from its original site to other organs of the body, including lymph nodes, skeletal and or visceral organs. Cumulative Incidence rate

Cumulative incidence is the probability or risk of Range individuals developing the disease during a specified period. For cancer, it is expressed as the number Is the difference between the maximum and of new born children (out of 100, or 1000) who minimum values in a set of observations. would be expected to develop a particular cancer before the age of 65 (or 70, or 75) if they had the rates of cancers currently observed. Like the age Rank standardized rate, it permits comparison between This measure reflects the importance of a specific populations of different age structures. In this cancer site relative to other sites, in terms of the report the age ranges 0-64 and 0-74 years are used. number of registrations. Ranking illustrates the The cumulative rate is the summation of the cancer most and least frequent cancer sites in a population age-specific rates; which are computed for five-year according to their frequency. age intervals. The cumulative rate is five times the sum of the age-specific rates calculated over the five-year age groups. Ratio The relation between two quantities. The ICD-10 first quantity as numerator and the second as denominator The World Health Organization’s International Classification of Diseases, tenth edition. Relative Frequency ICD-O-3 This statistic is defined as the number of specific The World Health Organization’s International cancer cases registered relative to the total number of all cancer. It is expressed as a percentage. Classification of Diseases for Oncology, 3rd Edition has been the standard coding system for neoplasms for over 25 years. The coding system includes a four Summary Stage character code for primary site, a four-digit numeric code for cell type, one-digit code for behavior and Staging is the grouping of cancer cases into broad a one-digit code for tumor aggressiveness (grade). categories based on the extent of disease.

P01a.indd 14 16/01/2013 12:45:36 PM PART II OVERVIEW OF CANCER INCIDENCE 2009

P02a.indd 15 16/02/2013 12:12:29 PM Reported Cancer Incidence Cases in Saudi Arabia, 2009

Between January 01 and December 31, 2009, the As shown on Table 2.1, 12,683 cases were analyzed, total number of cancer incident cases reported to of which 9,823 (77.5%) were Saudis and 2,860 the SCR was 13,254. Overall cancer was slightly (22.5%) were Non-Saudis. Among the saudis more among women than men. Cancers affected 4,618 (47%) were male and 5,205 (53%) were 6,426 (48.5%) males and 6,828 (51.5%), with a female. The male to female ratio was 89:100. The male to female ratio of 94:100. 10,095 cases were crude incidence rate (CIR) of all cancers among reported among Saudis, 2,948 among Non-Saudis Saudi Population was 54.4/100,000 (50.1/100,000 and 211 among unknown nationality. among males and 58.6/100,000 among females). The overall age-standardized incidence rate (ASR) The total number of cases excluded from analysis for all Saudis with a world standard population include 211 cases of unknown nationalities, other reference was 85.5/100,000 (80.9/100,000 in males exclusions were 291 in situ cases, the current and 90.1/100,000 in females). software program CanReg-4 version 4.33, does not include in situ cases in the statistical analysis. For all sites, the age-specific incidence rate (AIR) Also, 64 were ICD-O-3 coded cases that failed to increased with age for both males and females. convert to ICD-10 codes as described in the Data After the age of 64 years, the increase was nearly Management (see page 12) and Tables (6.1 and 6.2). one and one half fold for males compared to females. This puts the total number of exclusions from The median age at diagnosis is was 60 Range (0-119) the analysis as 571 cases. Table 2.1 illustrates the years for men and 50 Range (0-109) years for women. distribution of the cases by sex. The five geographic regions with the highest Diagnosis of malignancy was confirmed histologically ASR were Riyadh Region at 120.6/100,000, in 87.8% of the cases, and haematological & Eastern Region at 110.8/100,000, Tabuk Region at cytologically in 7.1% of cases. Clinically confirmed 89.9/100,000, Makkah Region at 87.2/100,000 and cases were 0.5%, radiologically confirmed cases Qassim Region at 77.4/100,000. were 2.5%, cases confirmed by Death Certificate Only were 1.6% and the method of diagnosis was unknown for 0.5% of the cases.

SaudisNon-Saudis Unknown Nationality All

Male Female TotalMaleFemale Total Male Female TotalTotal

Analyzed * 4618 5205 9823 1540 1320 2860 92 115207 12683 Invasive 4650 5233 9883 1545 1324 2869 92 115207 12959 In Situ 97 111208 42 37 79 224291 ICD 10 ** 29 28 57 437000 64 Total 4746 5349 1009515861362294894117 21113254

Table 2.1 Distribution of Cancer Cases in Saudi Arabia by Nationality and Sex, 2009

* Unknown nationalities, in situ cases and ICD-10 conversion failures are excluded from analysis ** ICD-10 conversion failure

P02a.indd 16 16/02/2013 12:12:29 PM Cancer among Saudis 2009

As explained earlier the total number of cancer cases 30-44 Years analyzed among Saudis during the year 2009 were Colo-rectal 16.5 38.7 Breast NHL 9,823. Following are figures presenting the percentage 11.5 17.1 Thyroid Thyroid 7.8 7.1 Colo-rectal distributions of cancer incidence and most frequent Leukemia 7.4 3.9 NHL Kidney types of cancers among Saudis by sex and age-group. 5.9 3.4 Ovary Hodgkin disease 5.9 2.9 Cervix Uteri Nasopharynx 5.4 Leukemia 18 2.6 Testis 4.1 2.1 Corpus Uteri 15.6 16 Male 14.9 Stomach 3.0 1.9 Stomach Female Liver 3.0 1.9 Kidney 14 12.3 Connective, Soft tissue 3.0 1.5 Skin 12 11.4 Bladder 3.0 1.5 Brain, CNS 10.0 Skin 1.5 10 2.8 Hodgkin disease 8.8 Other sites 20.6 13.7 Other sites 8 50 40 30 20 10 0 10 20 30 40 50

Percentage 5.5 6 5.5 5.3 Male (538) Female (1121) 4.3 4 3.6 2.8 45-59 Years 2 Colo-rectal 20.1 33.9 Breast 0 Colo-rectal 0-14 15-29 30-44 45-59 60-74 75+ NHL 8.8 12.0 Thyroid Age Group Lung 6.8 8.8 Liver 6.3 5.6 Corpus Uteri Figure 2.1 Percentage Distribution of Cancer Incidence Kidney 5.0 5.1 NHL among Saudis by Sex according to Age Group, 2009 Leukemia 4.9 3.0 Ovary Bladder 4.8 2.4 Liver All Ages Lung Stomach 4.0 2.3 Thyroid 2.3 Leukemia Colo-rectal 13.4 25.1 Breast 3.5 Nasopharynx 3.1 2.2 Stomach NHL 9.1 10.3 Thyroid Prostate 3.1 2.0 Cervix Uteri Leukemia 7.4 9.5 Colo-rectal Hodgkin disease 2.9 2.0 Kidney Liver 6.4 5.5 NHL Other sites 26.7 18.4 Other sites Prostate 6.4 5.3 Leukemia 50 40 30 20 10 0 10 20 30 40 50 Lung 6.0 4.9 Corpus uteri Stomach 4.4 3.3 Ovary Male (987) Female (1537) Bladder 4.3 2.9 Hodgkin disease Hodgkin disease 4.2 2.7 Skin 60-74 Years Skin 3.9 2.6 Liver Other sites 34.6 27.9 Other sites Colo-rectal 13.9 20.4 Breast 50 40 30 20 10 0 10 20 30 40 50 Prostate 10.4 11.4 Colo-rectal Male (4618) Female (5205) Lung 9.2 8.8 Corpus Uteri 0-14 Years Liver 8.8 6.4 NHL NHL 6.7 4.3 Liver Leukemia 31.8 39.6 Leukemia Stomach 5.8 4.2 Thyroid Brain, CNS 12.3 10.1 Brain, CNS Bladder 5.8 3.9 Skin Hodgkin disease 10.9 9.0 Kidney NHL 10.3 8.3 Hodgkin disease Skin 5.6 3.8 Ovary Kidney 7.4 6.5 Bone Kidney 3.5 3.0 Gallbladder, etc 5.4 Connective, Soft Tissue Bone 5.7 Leukemia 3.2 2.9 Pancreas Adrenal gland 4.6 5.0 Eye Other sites 27.0 30.8 Other sites Connective, Soft Tissue 4.0 3.6 NHL Eye 3.7 3.2 Adrenal Gland 50 40 30 20 10 0 10 20 30 40 50 Liver Liver 1.4 1.4 Male (1459) Female (1204) Other sites 7.7 7.9 Other sites 50 40 30 20 10 0 10 20 30 40 50 Male (349) Female (278) 75+ Years

15-29 Years Colo-rectal 12.5 14.6 Colo-rectal Hodgkin disease 17.7 26.8 Thyroid Prostate 12.5 10.0 Breast Liver Leukemia 17.0 15.3 Hodgkin disease 9.3 7.1 NHL NHL NHL 15.8 10.1 Breast 8.4 6.7 Skin Testis 8.9 10.1 Leukemia Lung 6.5 6.7 Corpus Uteri Brain, CNS 6.9 7.5 NHL Stomach 6.3 5.6 Liver Bone 6.2 4.6 Ovary Skin 5.5 3.8 Stomach Thyroid 6.2 3.7 Connective, Soft tissue Bladder 5.1 3.8 Gallbladder, etc Colo-rectal 4.3 3.1 Brain, CNS Pancreas 3.8 3.5 Lung Connective, Soft tissue 3.1 2.8 Colo-rectal Oesophagus 3.1 2.9 Pancreas Skin 2.9 2.4 Bone Leukemia 3.0 2.9 Ovary Other sites 11.0 13.6 Other sites Other sites 24.0 32.4 Other sites 50 40 30 20 10 0 10 20 30 40 50 50 40 30 20 10 0 10 20 30 40 50 Male (418) Female (544) Male (867) Female (521) Figure 2.2 Percentage Distribution of Most Frequent Types of Cancer by Sex among Saudis, 2009

P02a.indd 17 16/02/2013 12:12:33 PM Cancer No. %

Breast 1331 13.5 Colo-rectal 1109 11.3 NHL 709 7.2 Thyroid 679 6.9 Leukemia 619 6.3 Liver 431 4.4 Lung 379 3.9 Hodgkin disease 344 3.5 Skin 322 3.3 Stomach 313 3.2

Table 2.2 Ten Most Common Cancers among Saudis, 2009 (All Ages)

Male 4618 Female 5205

Colo-rectal 617 13.4% Breast 1308 25.1% NHL 422 9.1% Thyroid 538 10.3% Leukemia 343 7.4% Colo-rectal 492 9.5% Liver 295 6.4% NHL 287 5.5% Prostate 295 6.4% Leukemia 276 5.3% Lung 276 6.0% Corpus uteri 253 4.9% Stomach 201 4.4% Ovary 173 3.3% Bladder 197 4.3% Hodgkin disease 150 2.9% Hodgkin disease 194 4.2% Skin 141 2.7% Skin 181 3.9% Liver 136 2.6%

Figure 2.3 Ten Most Common Cancers among Saudis by Sex, 2009

P02a.indd 18 16/02/2013 12:12:33 PM 800

700 male female

600

500

400

300 AIR (per 100,000) 200

100

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 2.4 Age-Specific Incidence Rates (AIR) for All Cancers among Saudis, 2009

123.6 Riyadh 117.5 114.4 Eastern 107.1 102.1 Tabuk 77.6 93.3 Makkah 81.1 86.8 Qassim 68.0 70.9 Madinah 77.5 73.1 Northern 53.0 63.8 Jouf 56.9 60.5 Asir 56.3 58.2 Najran 50.6 47.3 Baha 49.2 54.8 Jazan 30.7 46.0 Hail 38.8

020406080100 120 140

Figure 2.5 Age Standardized Rate (ASR) Regional Distribution (per 100,000) of All Sites of Cancer among Saudis, 2009

P02a.indd 19 16/02/2013 12:12:33 PM Male Female ICD-10 Site No. % Crude ASRNCumulative Rate o. %Crude ASR Cumulative Rate Rate World 0-64 0-74 Rate World 0-64 0-74 All All sites Total 4618 100.0 50.1 80.9 40.7 92.2 5205 100.0 58.6 90.1 52.4 68.7 Not C44 All sites but C44 4437 96.1 48.1 77.4 40.7 87.9 5064 97.357 87.4 51.1 66.8 C00 Lip 6 0.1 0.1 0.10.1 0.280.20.1 0.20.1 0.4 C01-C02 Tongue 42 0.9 0.5 0.80.4 0.9370.7 0.40.7 0.50.8 C03-C06 Mouth 39 0.8 0.4 0.80.3 1.0370.7 0.40.7 0.30.9 C07-C08 Salivary glands 17 0.4 0.2 0.30.2 0.3210.4 0.20.3 0.20.3 C09 Tonsil 0 0.0 000.00.0 30.1 000.10.1 C10 Other Oropharynx 1 0.0 000.00.0 00.0 000.00.0 C11 Nasopharynx 93 2.0 11.5 1.11.7 42 0.80.5 0.70.5 0.7 C12-C13 Hypopharynx 6 0.1 0.1 0.10.1 0.2110.2 0.10.2 0.10.3 C14 Pharynx unspecified 1 0.0 000.00.0 30.1 00.1 0.00.0 C15 Oesophagus 67 1.5 0.7 1.30.5 1.4460.9 0.50.9 0.41.1 C16 Stomach 201 4.4 2.2 3.91.6 4.9 112 2.21.3 2.11.2 2.5 C17 Small intestine 30 0.6 0.3 0.60.3 0.7260.5 0.30.5 0.30.6 C18 Colon 341 7.4 3.7 6.53.6 7.5 299 5.73.4 5.73.4 6.5 C19-C20 Rectum 276 6.0 35.1 3.26.1 193 3.72.2 3.72.4 4.4 C21 Anus 21 0.5 0.2 0.40.2 0.4140.3 0.20.3 0.20.3 C22 Liver 295 6.4 3.2 5.92.7 7.2 136 2.61.5 2.71.5 3.4 C23-C24 Gallbladder etc. 56 1.2 0.6 1.10.5 1.2871.7 11.8 0.82.2 C25 Pancreas 117 2.5 1.3 2.31.2 2.5821.6 0.91.7 0.92.3 C30-C31 Nose, sinuses etc. 5 0.1 0.1 0.10.0 0.150.10.1 0.10.0 0.1 C32 Larynx 55 1.2 0.6 1.10.5 1.5180.3 0.20.4 0.20.4 C33-C34 Trachea, Bronchus, Lung 276 35.7 2.67.4 103 2.01.2 21.1 2.3 C37-C38 Other Thoracic organs 17 0.4 0.2 0.30.1 0.290.20.1 0.10.1 0.1 C40-C41 Bone 59 1.3 0.6 0.60.4 0.4430.8 0.50.5 0.30.4 C43 Melanoma of Skin 13 0.3 0.1 0.20.0 0.180.20.1 0.10.1 0.2 C44 Other Skin 181 3.9 23.5 1.44.3 141 2.71.6 2.71.3 3.0 C45 Mesothelioma 5 0.1 0.1 0.10.0 0.1100.2 0.10.2 0.20.2 C46 Kaposi sarcoma 33 0.7 0.4 0.60.3 0.640.100.1 0.1 C47;C49 Connective, Soft tissue 70 1.5 0.8 0.90.5 0.8651.2 0.70.8 0.60.6 C50 Breast 23 0.5 0.2 0.40.2 0.5 1308 25.1 14.7 22.7 17.9 24.7 C51 Vulva −−−−−−60.1 0.10.1 0.00.2 C52 Vagina −−−−−−30.1 00.1 0.00.1 C53 Cervix Uteri −−−−−−101 1.91.1 1.81.3 1.9 C54 Corpus Uteri −−−−−−253 4.92.8 5.33.0 7.1 C55 Uterus unspecified −−−−−−28 0.50.3 0.60.4 0.7 C56 Ovary −−−−−−173 3.31.9 32.0 3.4 C57 Other Female Genital −−−−−−80.2 0.10.1 0.10.2 C58 Placenta −−−−−−10 0.20.1 0.10.1 0.1 C60 Penis 2 0.0 000.00.1 −−−−−− C61 Prostate 295 6.4 3.2 6.11.8 7.7− −−−−− C62 Testis 74 1.6 0.8 0.80.6 0.6− −−−−− C63 Other male genital 2 0.0 000.00.1 −−−−−− C64 Kidney 174 3.8 1.9 31.9 3.6 120 2.31.4 1.91.2 2.1 C65 Renal Pelvis 5 0.1 0.1 0.10.0 0.130.100.10.1 0.1 C66 Ureter 2 0.0 000.00.0 10.0 000.00.0 C67 Bladder 197 4.3 2.1 3.91.9 4.9380.7 0.40.7 0.30.9 C68 Other Urinary organs 1 0.0 000.00.0 00.0 000.00.0 C69 Eye 28 0.6 0.3 0.40.2 0.3220.4 0.20.3 0.20.2 C70-C72 Brain, Nervous system 145 3.1 1.6 21.2 2.1 103 2.01.2 1.50.9 1.4 C73 Thyroid 141 3.1 1.5 2.11.4 2.2 538 10.36.1 7.65.8 7.3 C74 Adrenal gland 18 0.4 0.2 0.20.1 0.1100.2 0.10.1 0.10.1 C75 Other Endocrine 5 0.1 0.1 0.10.0 0.120.00 00.0 0.0 C81 Hodgkin disease 194 4.2 2.1 2.31.5 2.0 150 2.91.7 1.71.0 1.4 C82-C85;C96 Non-Hodgkin lymphoma 422 9.1 4.6 6.83.6 7.1 287 5.53.2 5.13.0 5.9 C88 Immunoproliferative dis. 1 0.0 000.00.1 10.0 000.00.0 C90 Multiple Myeloma 57 1.2 0.6 1.10.6 1.3390.7 0.40.8 0.51.0 C91 Lymphoid Leukaemia 180 3.9 22.3 1.21.8 127 2.41.4 1.50.8 1.3 C92-C94 Myeloid Leukaemia 145 3.1 1.6 21.3 2.1 126 2.41.4 1.81.1 1.8 C95 Leukaemia unspecified 18 0.4 0.2 0.30.1 0.3230.4 0.30.4 0.20.3 All Other & unspecified 166 3.6 1.8 3.11.3 3.7 162 3.11.8 3.11.6 3.5

Table 2.3 Number, Percentage, ASR,CIR, and Cumulative Rates (per 1000) of New Cases by Primary Site and Sex among Saudis, 2009

P02a.indd 20 16/02/2013 12:12:34 PM Adult Cancers in Saudi Arabia, 2009 (>14 years)

Between January and December 2009, the with male to female ratio 93:100. Of all cases, there total number of adult cancer incidence cases were 9,463 Saudis, 2,845 of Non-Saudis and 199 of reported was 12,516. Overall cancer was slightly unknown nationalities. As shown on table 2.4, the more in females than in males. Cancer affected total number of analyzed cases were 11,952. 5,844 (48.1%) males and 6,307 (51.9%) females

SaudisNon-Saudis Unknown Nationality All

Male Female TotalMaleFemale Total Male Female TotalTotal

Analyzed * 4269 4927 9196 1486 1270 2756 89 110199 11952 Invasive 4299 4954 9253 1490 1274 2764 89 110199 12216 In Situ 97 110207 42 37 79 224290 ICD 10 ** 27 27 54 336000 60 Total 4395 5068 9463 1532 1313 2845 93 115208 12516

Table 2.4.1 Distribution of Reported Adult Cancer Cases in Saudi Arabia by Nationality and Sex, 2009

Cancer No. % Breast 1330 14.5 Colo-rectal 1108 12.0 Thyroid 677 7.4 Non Hodgkin disease663 7.2 Liver 422 4.6 Leukemia 398 4.3 Lung 376 4.1 Skin 321 3.5 Stomach 311 3.4 Prostate 294 3.2

Table 2.4.2 Ten Most Common Cancers among Saudi Adults, 2009

Male 4269 Female 4927

Colo-rectal 616 14.4% Breast 1308 26.5% NHL 386 9.0% Thyroid 537 10.9% Prostate 294 6.9% Colo-rectal 492 10.0% Liver 290 6.8% NHL 277 5.6% Lung 274 6.4% Corpus Uteri 253 5.1% Leukemia 232 5.4% Ovary 170 3.5% Stomach 199 4.7% Leukemia 166 3.4% Bladder 197 4.6% Skin 140 2.8% Skin 181 4.2% Liver 132 2.7% Hodgkin disease 156 3.7% Hodgkin Disease 127 2.6%

Figure 2.6 Ten Most Common Cancers among Saudi Adults by sex, 2009

* Unknown nationalities, in situ cases and ICD-10 conversion failures are excluded from analysis ** ICD-10 conversion failure

P02a.indd 21 16/02/2013 12:12:34 PM Primary Site Code Morphology Male %Female%

Breast 8500 Infiltrating duct carcinoma, NOS 17 77.31023 78.2 8520 Lobular carcinoma, NOS 00.0 83 6.3 8010 Carcinoma, NOS 14.5 41 3.1 8523 Infiltrating duct mixed with other types of carcinoma 00.0 29 2.2 8000 Neoplasm, malignant 29.1 24 1.8 8140 Adenocarcinoma, NOS 00.0 19 1.5 8522 Infiltrating duct and lobular carcinoma 14.5 12 0.9 8480 Mucinous adenocarcinoma 00.0 11 0.8 8510 Medullary carcinoma, NOS 00.0 90.7 8575 Metaplastic carcinoma, NOS 00.0 90.7 Other 14.5 48 3.7 Colo-rectal 8140 Adenocarcinoma, NOS 461 74.8 382 77.6 8480 Mucinous adenocarcinoma 53 8.6285.7 8263 Adenocarcinoma in tubulovillous adenoma 12 1.9153.0 8000 Neoplasm, malignant 14 2.381.6 8490 Signet ring cell carcinoma 12 1.991.8 8481 Mucin-producing adenocarcinoma 81.3 12 2.4 8210 Adenocarcinoma in adenomatous polyp 11 1.881.6 8261 Adenocarcinoma in villous adenoma 12 1.971.4 8144 Adenocarcinoma, intestinal type 81.3 71.4 8010 Carcinoma, NOS 81.3 30.6 8260 Papillary adenocarcinoma, NOS 50.8 30.6 Others 12 1.9102.0 NHL 9680 Malignant lymphoma, large B-cell, diffuse, NOS 208 53.9 155 56.0 9590 Malignant lymphoma, NOS 26 6.7165.8 9591 Malignant lymphoma, non-Hodgkin, NOS 27 7.0145.1 9699 Marginal zone B-cell lymphoma, NOS 16 4.1124.3 9670 Malignant lymphoma, small B lymphocytic, NOS 15 3.982.9 9700 Mycosis fungoides 11 2.882.9 9690 Follicular lymphoma, NOS 92.3 82.9 9691 Follicular lymphoma, grade 2 82.1 93.2 9695 Follicular lymphoma, grade 1 10 2.651.8 9698 Follicular lymphoma, grade 3 51.3 93.2 9714 Anaplastic large cell lymphoma, T cell and Null cell type 61.6 82.9 9687 Burkitt lymphoma, NOS 82.1 41.4 9684 Malignant lymphoma, large B-cell, diffuse, immunoblastic, NOS71.841.4 9702 Mature T-cell lymphoma, NOS 82.1 20.7 9719 NK/T-cell lymphoma, nasal and nasal-type 51.3 41.4 9709 Cutaneous T-cell lymphoma, NOS 30.8 20.7 Others 14 3.693.2 Leukemia 9863 Chronic myeloid leukemia, NOS 40 17.241 24.7 9861 Acute myeloid leukemia, NOS 34 14.730 18.1 9823 B-cell chronic lymphocytic leukemia/small lymphocytic lymphom 43 18.5148.4 9836 Precursor B-cell lymphoblastic leukemia 24 10.318 10.8 9835 Precursor cell lymphoblastic leukemia, NOS 11 4.774.2 9801 Acute leukemia, NOS 73.0 95.4 9866 Acute promyelocytic leukemia, t(15;17)(q22;q11-12) 52.2 95.4 9800 Leukemia, NOS 62.6 74.2 9837 Precursor T-cell lymphoblastic leukemia 93.9 21.2 9891 Acute monocytic leukemia 62.6 42.4 9860 Myeloid leukemia, NOS 31.3 42.4 9874 Acute myeloid leukemia with maturation 52.2 21.2 9940 Hairy cell leukemia 52.2 21.2 9945 Chronic myelomonocytic leukemia, NOS 52.2 10.6 9867 Acute myelomonocytic leukemia 31.3 21.2 9873 Acute myeloid leukemia without maturation 41.7 10.6 9875 Chronic myelogenous leukemia, BCR/ABL positive 41.7 10.6 9820 Lymphoid leukemia, NOS 20.9 21.2 9896 Acute myeloid leukemia, t(8;21)(q22;q22) 31.3 10.6 Others 13 5.695.4 Liver 8170 Hepatocellular carcinoma, NOS 249 85.999 75.0 8000 Neoplasm, malignant 18 6.296.8 8160 Cholangiocarcinoma 82.8 53.8 8140 Adenocarcinoma, NOS 41.4 53.8 8010 Carcinoma, NOS 31.0 43.0 8246 Neuroendocrine carcinoma, NOS 20.7 21.5 8180 Combined hepatocellular carcinoma and cholangiocarcinoma20.710.8 Others 41.4 75.3 Prostate 8140 Adenocarcinoma, NOS 265 90.1 8000 Neoplasm, malignant 13 4.4− − 8010 Carcinoma, NOS 93.1 −− 8550 Acinar cell carcinoma 51.7 −− 8070 Squamous cell carcinoma, NOS 10.3 −− 8260 Papillary adenocarcinoma, NOS 10.3 −− Lung 8140 Adenocarcinoma, NOS 84 23.535 26.1 8046 Non-small cell carcinoma 63 17.617 12.7 8070 Squamous cell carcinoma, NOS 64 17.916 11.9 8041 Small cell carcinoma, NOS 46 12.99 6.7 8000 Neoplasm, malignant 23 6.4118.2 8010 Carcinoma, NOS 19 5.396.7 8250 Bronchiolo-alveolar adenocarcinoma, NOS 92.5 75.2 8071 Squamous cell carcinoma, keratinizing, NOS 61.7 64.5 8246 Neuroendocrine carcinoma, NOS 82.2 21.5 8240 Carcinoid tumor, NOS 20.6 64.5 8012 Large cell carcinoma, NOS 72.0 00.0 8020 Carcinoma, undifferentiated, NOS 51.4 00.0 8560 Adenosquamous carcinoma 10.3 43.0 8255 Adenocarcinoma with mixed subtypes 30.8 10.7 8490 Signet ring cell carcinoma 30.8 10.7 8072 Squamous cell carcinoma, large cell, nonkeratinizing, NOS20.610.7 Others 12 3.496.7

Table 2.5 Number and Percentage of Morphological Types for the Most Common Types of Cancer among Saudi Adults, 2009

P02a.indd 22 16/02/2013 12:12:34 PM Table 2.5 continued .....

Primary Site Code Morphology Male %Female%

Stomach 8140 Adenocarcinoma, NOS 92 46.237 33.0 8490 Signet ring cell carcinoma 49 24.646 41.1 8144 Adenocarcinoma, intestinal type 16 8.087.1 8936 Gastrointestinal stromal sarcoma 31.5 54.5 8000 Neoplasm, malignant 42.0 21.8 8010 Carcinoma, NOS 42.0 21.8 8246 Neuroendocrine carcinoma, NOS 52.5 00.0 8020 Carcinoma, undifferentiated, NOS 31.5 10.9 8070 Squamous cell carcinoma, NOS 42.0 00.0 8145 Carcinoma, diffuse type 31.5 10.9 8480 Mucinous adenocarcinoma 21.0 21.8 8240 Carcinoid tumor, NOS 10.5 21.8 8260 Papillary adenocarcinoma, NOS 31.5 00.0 8560 Adenosquamous carcinoma 10.5 10.9 8574 Adenocarcinoma with neuroendocrine differentiation 10.5 10.9 Others 84.0 43.6 Bladder 8130 Papillary transitional cell carcinoma 94 47.715 40.5 8120 Transitional cell carcinoma, NOS 69 35.014 37.8 8000 Neoplasm, malignant 84.1 12.7 8070 Squamous cell carcinoma, NOS 84.1 12.7 8071 Squamous cell carcinoma, keratinizing, NOS 42.0 25.4 8140 Adenocarcinoma, NOS 42.0 12.7 8010 Carcinoma, NOS 21.0 12.7 8072 Squamous cell carcinoma, large cell, nonkeratinizing, NOS21.012.7 Others 63.0 12.7 Hodgkin Disease 9663 Hodgkin lymphoma, nodular sclerosis, NOS 81 51.966 52.0 9652 Hodgkin lymphoma, mixed cellularity, NOS 29 18.614 11.0 9650 Hodgkin lymphoma, NOS 17 10.922 17.3 9651 Hodgkin lymphoma, lymphocyte-rich 10 6.497.1 9659 Hodgkin lymphoma, nodular lymphocyte predominance 85.1 75.5 9665 Hodgkin lymphoma, nodular sclerosis, grade 1 53.2 43.1 9664 Hodgkin lymphoma, nodular sclerosis, cellular phase21.332.4 9653 Hodgkin lymphoma, lymphocyte depletion, NOS 31.9 00.0 9667 Hodgkin lymphoma, nodular sclerosis, grade 2 10.6 21.6 Skin 8090 Basal cell carcinoma, NOS 80 44.257 40.7 8070 Squamous cell carcinoma, NOS 38 21.033 23.6 8832 Dermatofibrosarcoma, NOS 13 7.218 12.9 8071 Squamous cell carcinoma, keratinizing, NOS 16 8.875.0 8097 Basal cell carcinoma, nodular 84.4 64.3 8094 Basosquamous carcinoma 63.3 10.7 8410 Sebaceous adenocarcinoma 21.1 53.6 8200 Adenoid cystic carcinoma 00.0 42.9 8051 Verrucous carcinoma, NOS 21.1 10.7 8000 Neoplasm, malignant 21.1 00.0 8083 Basaloid squamous cell carcinoma 10.6 10.7 8091 Multifocal superficial basal cell carcinoma 21.1 00.0 8092 Infiltrating basal cell carcinoma, NOS 00.0 21.4 8095 Metatypical carcinoma 21.1 00.0 8140 Adenocarcinoma, NOS 21.1 00.0 8247 Merkel cell carcinoma 10.6 10.7 Others 63.3 42.9 Thyroid 8260 Papillary adenocarcinoma, NOS 78 55.7283 52.7 8340 Papillary carcinoma, follicular variant 20 14.3100 18.6 8341 Papillary microcarcinoma 14 10.0509.3 8343 Papillary carcinoma, encapsulated 53.6 23 4.3 8330 Follicular adenocarcinoma, NOS 21.4 14 2.6 8290 Oxyphilic adenocarcinoma 32.1 12 2.2 8335 Follicular carcinoma, minimally invasive 10.7 12 2.2 8510 Medullary carcinoma, NOS 42.9 81.5 8021 Carcinoma, anaplastic, NOS 42.9 61.1 8050 Papillary carcinoma, NOS 32.1 71.3 8000 Neoplasm, malignant 10.7 50.9 8344 Papillary carcinoma, columnar cell 00.0 61.1 8010 Carcinoma, NOS 21.4 20.4 Others 32.1 91.7 Corpus Uteri 8380 Endometrioid adenocarcinoma, NOS −−146 57.7 8140 Adenocarcinoma, NOS −−34 13.4 8010 Carcinoma, NOS −−11 4.3 8950 Mullerian mixed tumor −−10 4.0 8460 Papillary serous cystadenocarcinoma −−72.8 8930 Endometrial stromal sarcoma, NOS −−62.4 8310 Clear cell adenocarcinoma, NOS −−52.0 8441 Serous cystadenocarcinoma, NOS −−52.0 8461 Serous surface papillary carcinoma −−52.0 8980 Carcinosarcoma, NOS −−52.0 8931 Endometrial stromal sarcoma, low grade −−41.6 8382 Endometrioid adenocarcinoma, secretory variant −−31.2 8560 Adenosquamous carcinoma −−31.2 8050 Papillary carcinoma, NOS −−20.8 8890 Leiomyosarcoma, NOS −−20.8 Others −−52.0 Ovary 8460 Papillary serous cystadenocarcinoma −−30 17.6 8441 Serous cystadenocarcinoma, NOS −−28 16.5 8140 Adenocarcinoma, NOS −−22 12.9 8480 Mucinous adenocarcinoma −−17 10.0 8000 Neoplasm, malignant −−15 8.8 8010 Carcinoma, NOS −−95.3 8380 Endometrioid adenocarcinoma, NOS −−95.3 8461 Serous surface papillary carcinoma −−63.5 9060 Dysgerminoma −−63.5 9080 Teratoma, malignant, NOS −−52.9 8310 Clear cell adenocarcinoma, NOS −−31.8 8260 Papillary adenocarcinoma, NOS −−21.2 8470 Mucinous cystadenocarcinoma, NOS −−21.2 8950 Mullerian mixed tumor −−21.2 9085 Mixed germ cell tumor −−21.2 Others −−12 7.1

P02a.indd 23 16/02/2013 12:12:35 PM Childhood Cancers in Saudi Arabia, 2009 (≤ 14 years)

The total incident cases reported among children Childhood cancer is very important, not only (0-14 years) between January and December 2009 because of the age of occurrence, but also because were 738. This represents 5.6 % of the total number 37.2% of the Saudi population is under 15 years of of cancers in Saudi Arabia. The reported incidents age. In addition to this, recent years have shown show that cancer was more common among boys a breakthrough for the cure of many childhood than girls. 406 (55%) cases were reported among cancers. Childhood cancers accounted for 6.3% of boys and 332 (45%) among girls, with a male to female all cancer among Saudis. The leading cancer among ratio of 122:100. Of all the cases reported there Saudi children was leukemia, which accounted were 632 Saudis, 103 non-Saudis and 3 of “unknown for 35.2%, followed by Brain, CNS 11.3% then nationality”. Based on Table 2.6.1, the total number Hodgkin Disease 9.7% then Kidney 8.1% and NHL of cases analyzed was 729 including 627 (86%) Saudis 7.3%. Figure 2.7 shows the top ten sites by sex and and 102 (14%) non-Saudis. Among Saudis, 349 frequency, and Table 2.7 shows the number and (55.7%) were male and 278 (44.3%) were female. proportion of the morphological types for the most The male to female ratio among Saudis was 126:100. common types of cancer.

SaudisNon-Saudis Unknown Nationality All

Male Female TotalMaleFemale TotalMale Female TotalTotal

Analyzed * 349278 6275349102 1 2 3729 Invasive 351279 6305449103 1 2 3736 In Situ 0110000 0 01 ICD 10 ** 2131010 0 04 Total 351281 6325449103 123738

Table 2.6.1 Distribution of Reported Childhood Cancer Cases in Saudi Arabia by Nationality and Sex, 2009

Cancer No. % Leukemia 221 35.2 Brain, CNS 71 11.3 Hodgkin disease 61 9.7 Kidney 51 8.1 NHL 46 7.3 Bone 38 6.1 Connective, Soft tissue 29 4.6 Eye 27 4.3 Adrenal gland 25 4.0 Liver 91.4

Table 2.6.2 Ten Most Common Cancers among Saudi Children, 2009

* Unknown nationalities, in situ cases and ICD-10 conversion failures are excluded from analysis ** ICD-10 conversion failure

P02a.indd 24 16/02/2013 12:12:35 PM Boys 349 Girls 278

Leukemia 111 31.8% Leukemia 110 39.6% Brain, CNS 43 12.3% Brain, CNS 28 10.1% Hodgkin disease 38 10.9% Kidney 25 9.0% NHL 36 10.3% Hodgkin disease 23 8.3% Kidney 26 7.4% Bone 18 6.5% Bone 20 5.7% Connective, Soft tissue 15 5.4% Adrenal gland 16 4.6% Eye 14 5.0% Connective, Soft tissue 14 4.0% NHL 10 3.6% Eye 13 3.7% Adrenal gland 9 3.2% Liver 5 1.4% Liver 4 1.4%

Figure 2.7 Ten Most Common Cancers among Saudi Children by Sex, 2009

Primary Site Code Morphology Male %Female%

Leukemia 9836 Precursor B-cell lymphoblastic leukemia 42 37.849 44.5 9835 Precursor cell lymphoblastic leukemia, NOS 27 24.324 21.8 9837 Precursor T-cell lymphoblastic leukemia 10 9.054.5 9861 Acute myeloid leukemia, NOS 65.4 98.2 9863 Chronic myeloid leukemia, NOS 65.4 21.8 9801 Acute leukemia, NOS 21.8 32.7 9826 Burkitt cell leukemia 43.6 10.9 9800 Leukemia, NOS 10.9 21.8 9866 Acute promyelocytic leukemia, t(15;17)(q22;q11-12) 21.8 10.9 9873 Acute myeloid leukemia without maturation 21.8 10.9 9874 Acute myeloid leukemia with maturation 21.8 10.9 9891 Acute monocytic leukemia 10.9 21.8 9805 Acute biphenotypic leukemia 00.0 21.8 9840 Acute myeloid leukemia, M6 type 00.0 21.8 9867 Acute myelomonocytic leukemia 00.0 21.8 9896 Acute myeloid leukemia, t(8;21)(q22;q22) 10.9 10.9 9946 Juvenile myelomonocytic leukemia 10.9 10.9 Others43.621.8

Brain, CNS 9470 Medulloblastoma, NOS 20 46.5932.1 9440 Glioblastoma, NOS 7 16.31 3.6 9380 Glioma, malignant 12.3 6 21.4 9400 Astrocytoma, NOS 49.3 13.6 9508 Atypical teratoid/rhabdoid tumor 12.3 3 10.7 9424 Pleomorphic xanthoastrocytoma 12.3 27.1 8000 Neoplasm, malignant 12.3 13.6 9391 Ependymoma, NOS 00.0 27.1 9473 Primitive neuroectodermal tumor, NOS24.700.0 8249 A typical carcinoid tumor 12.3 00.0 8900 Rhabdomyosarcoma, NOS 12.3 00.0 8963 Malignant rhabdoid tumor 00.0 13.6 9064 Germinoma 00.0 13.6 9393 Papillary ependymoma 12.3 00.0 9401 Astrocytoma, anaplastic 12.3 00.0 9430 Astroblastoma 00.0 13.6 9490 Ganglioneuroblastoma 12.3 00.0 9500 Neuroblastoma, NOS 12.3 00.0

Table 2.7 Number and Percentage of Morphological Types for the Most Common Types of Cancer among Saudi Children, 2009

P02a.indd 25 16/02/2013 12:12:35 PM Table 2.7 continued .....

Primary Site Code Morphology Male %Female%

Hodgkin Disease 9663 Hodgkin lymphoma, nodular sclerosis, NOS 18 47.412 52.2 9652 Hodgkin lymphoma, mixed cellularity, NOS 4 10.5417.4 9650 Hodgkin lymphoma, NOS 37.9 4 17.4 9659 Hodgkin lymphoma, nodular lymphocyte predominance 37.9 28.7 9651 Hodgkin lymphoma, lymphocyte-rich 37.9 14.3 9664 Hodgkin lymphoma, nodular sclerosis, cellular phase25.300.0 9665 Hodgkin lymphoma, nodular sclerosis, grade 1 25.3 00.0 9667 Hodgkin lymphoma, nodular sclerosis, grade 2 25.3 00.0 9653 Hodgkin lymphoma, lymphocyte depletion, NOS 12.6 00.0

Kidney 8960 Nephroblastoma, NOS 21 80.825 100.0 8260 Papillary adenocarcinoma, NOS 13.8 00.0 8312 Renal cell carcinoma, NOS 13.8 00.0 9044 Clear cell sarcoma, NOS (except of kidney)13.800.0 9105 Trophoblastic tumor, epithelioid 13.8 00.0 9473 Primitive neuroectodermal tumor, NOS 13.8 00.0

NHL 9687 Burkitt lymphoma, NOS 11 30.6220.0 9680 Malignant lymphoma, large B-cell, diffuse, NOS 8 22.2220.0 9590 Malignant lymphoma, NOS 38.3 1 10.0 9591 Malignant lymphoma, non-Hodgkin, NOS 4 11.10 0.0 9700 Mycosis fungoides 25.6 2 20.0 9670 Malignant lymphoma, small B lymphocytic, NOS 38.3 00.0 9727 Precursor cell lymphoblastic lymphoma, NOS 25.6 1 10.0 9729 Precursor T-cell lymphoblastic lymphoma 12.8 1 10.0 9702 Mature T-cell lymphoma, NOS 12.8 00.0 9714 Anaplastic large cell lymphoma, T cell and Null cell type 00.0 1 10.0 9754 Langerhans cell histiocytosis, disseminated 12.8 00.0

Bone 9260 Ewing sarcoma 8 40.0950.0 9180 Osteosarcoma, NOS 8 40.0633.3 9181 Chondroblastic osteosarcoma 00.0 2 11.1 8910 Embryonal rhabdomyosarcoma, NOS 15.0 00.0 9183 Telangiectatic osteosarcoma 15.0 00.0 9185 Small cell osteosarcoma 15.0 00.0 9250 Giant cell tumor of bone, malignant 00.0 15.6 9540 Malignant peripheral nerve sheath tumor15.000.0

Connective Tissue 9500 Neuroblastoma, NOS 2 14.3533.3 8910 Embryonal rhabdomyosarcoma, NOS 4 28.61 6.7 8800 Sarcoma, NOS 17.1 16.7 8920 Alveolar rhabdomyosarcoma 17.1 16.7 8963 Malignant rhabdoid tumor 17.1 16.7 9473 Primitive neuroectodermal tumor, NOS 2 14.30 0.0 8804 Epithelioid sarcoma 17.1 00.0 8806 Desmoplastic small round cell tumor 00.0 16.7 8814 Infantile fibrosarcoma 17.1 00.0 8900 Rhabdomyosarcoma, NOS 00.0 16.7 9071 Yolk sac tumor 00.0 16.7 9120 Hemangiosarcoma 00.0 16.7 9240 Mesenchymal chondrosarcoma 17.1 00.0 9364 Peripheral neuroectodermal tumor 00.0 16.7 9540 Malignant peripheral nerve sheath tumor00.016.7

Eye 9510 Retinoblastoma, NOS 8 61.5428.6 9512 Retinoblastoma, undifferentiated 00.0 6 42.9 9511 Retinoblastoma, differentiated 2 15.41 7.1 8910 Embryonal rhabdomyosarcoma, NOS 17.7 17.1 8804 Epithelioid sarcoma 17.7 00.0 8810 Fibrosarcoma, NOS 17.7 00.0 9500 Neuroblastoma, NOS 00.0 17.1 9581 Alveolar soft part sarcoma 00.0 17.1

Adrenal Gland 9500 Neuroblastoma, NOS 15 93.8555.6 9490 Ganglioneuroblastoma 16.3 2 22.2 8370 Adrenal cortical carcinoma 00.0 1 11.1 8910 Embryonal rhabdomyosarcoma, NOS00.0111.1

Liver 8970 Hepatoblastoma 3 60.04100.0 8000 Neoplasm, malignant 1 20.00 0.0 8170 Hepatocellular carcinoma, NOS120.00 0.0

P02a.indd 26 16/02/2013 12:12:36 PM Cancer in the 13 Administrative Regions of the Kingdom, 2009

The following bar charts list the most common It is worth noting that the major regions such as cancer sites in the 13 administrative regions of Riyadh, Makkah and Eastern Province represent Saudi Arabia by sex. These sites are listed Relative the majority of cases. This can be attributed to Frequency based on total number of cases for the increasing number of people seeking medical each site reported by permanent address (region) attention in these urbanized cities with modern of the patient at the time of diagnosis. In most hospital facilities where permanent addresses may regions breast cancer was the leading cancer among not be documented in source records. women, while among men Colo-rectal and NHL.

Colo-rectal 14. 6 Breast 24.6 Female Breast 13.0

NHL 8.5 Thyroid 11.3 Colo-rectal 11.8

Liver 7.5 Colo-rectal 9.3 NHL 7.6 Leukemia 7.0 NHL 6.7 Thyroid 7.3

Prostate 5.6 Corpus Uteri 4.8 Liver 5.7

Hodgkin disease 5.3 Leukemia 4.3 Leukemia 5.6

Lung 4.8 Liver 3.9 Hodgkin disease 4.2

Kidney 4.5 Ovary 3.5 Kidney 3.3

Stomach 4.3 Hodgkin disease 3.2 Lung 3.2

Bladder 4.3 Cervix Uteri 2.3 Skin 3.2

Other Sites 33.7 Other Sites 26.2 Other Sites 35.2 010203040 010203040010 20 30 40 Males (1366) Females (1448) All (2814)

Figure 2.8.1 Riyadh Region, 2009 (Relative frequency Distribution)

Colo-rectal 13.2 Breast 28.2 Female Breast 15.5 NHL 9.3 Thyroid 10.2 Colo-rectal 11.2 Leukemia 7.4 Colo-rectal 9.6 NHL 7.4 Lung 6.6 Corpus Uteri 6.0 Thyroid 7.0 Prostate 6.6 NHL 5.8 Leukemia 5.3 Liver 5.5 Leukemia 3.4 Lung 4.1 Stomach 4.1 Ovary 3.4 Liver 3.3 Skin 4.1 Skin 2.7 Skin 3.3 Hodgkin disease 4.0 Stomach 2.5 Stomach 3.2 Bladder 3.9 Hodgkin disease 2.4 Corpus Uteri 3.2 Other Sites 35.5 Other Sites 25.9 Other Sites 36.4 010203040 010203040010 20 30 40

Males (1082) Females (1277) All (2359)

Figure 2.8.2 Makkah Region, 2009 (Relative frequency Distribution)

P02a.indd 27 16/02/2013 12:12:36 PM Cancer in the 13 Administrative Regions of the Kingdom, 2009

Colo-rectal 13.3 Breast 29.7 Female Breast 16.2 Lung 10.3 Thyroid 11.3 Colo-rectal 10.7 Prostate 9.2 Colo-rectal 8.4 Thyroid 7.5 NHL 8.7 Leukemia 6.1 NHL 6.5 Leukemia 6.7 NHL 4.7 Leukemia 6.4

Stomach 4.5 Corpus Uteri 4.0 Lung 5.9

Bladder 4.4 Hodgkin disease 2.9 Prostate 4.2

Skin 4.1 Skin 2.7 Skin 3.3

Kidney 3.8 Ovary 2. 7 Stomach 3.3

Liver 3.7 Kidney 2. 6 Kidney 3. 1

Other Sites 31.3 Other Sites 25.0 Other Sites 32.9 010203040010 20 30 40 010203040

Males (758) Females (900) All (1658) Figure 2.8.3 Eastern Region, 2009 (Relative frequency Distribution)

Colo-rectal 16.5 Breast 23.1 Colo-rectal 13.9 Leukemia 10.2 Colo-rectal 11.2 Female Breast 11.4 NHL 9.2 Leukemia 9.5 Leukemia 9.9 Lung 6.6 Thyroid 7.1 NHL 6.9 Liver 5.6 Corpus Uteri 6.1 Lung 5.0 Prostate 5.6 Ovary 4.7 Thyroid 4.8 Bladder 5.0 NHL 4.4 Liver 4.3 Brain, CNS 4.6 Hodgkin disease 3.7 Hodgkin disease 4.2 Hodgkin disease 4.6 Lung 3.4 Corpus Uteri 3.0 Stomach 4.3 Liver 3.1 Bladder 3.0 Other Sites 27.7 Other Sites 23.7 Other Sites 33.6 010203040010 20 30 40 010203040

Males (303) Females (295) All (598) Figure 2.8.4 Madinah Region, 2009 (Relative frequency Distribution)

NHL 16.3 Breast 12.7 NHL 10.2 Thyroid 12.7 8.2 Connective, Soft tissue 11.6 Thyroid Colo-rectal 7.3 Colo-rectal 7.1 Leukemia 11.6 Corpus Uteri 7.3 Female Breast 7.1 Kidney 7.3 Hodgkin disease 9.3 Stomach 5.5 Kidney 7.1 Colo-rectal 7.0 Lung 5.5 Connective, Soft tissue 6.1 Larynx 7.0 NHL 5.5 Hodgkin disease 6.1 Pancreas 3.6 Leukemia 6.1 Kidney 7.0 Bone 3.6 Stomach 5.1 Bladder 7.0 Skin 3.6 Larynx 4.1 Ovary 3.6 Stomach 4.7 Hodgkin disease 3.6 Corpus Uteri 4.1 Other Sites 18.6 Other Sites 18.2 Other Sites 28.6 010203040010 20 30 40 010203040

Males (43) Females (55) All (98) Figure 2.8.5 Northern Region, 2009 (Relative frequency Distribution)

P02a.indd 28 16/02/2013 12:12:37 PM Cancer in the 13 Administrative Regions of the Kingdom, 2009

Colo-rectal 12.6 Breast 30.1 Female Breast 16.7 Liver 9.8 Colo-rectal 9.8 Colo-rectal 11.1 NHL 9.8 Thyroid 8.9 NHL 6.7 6.5 Stomach 4.7 Leukemia 5.3 Liver Thyroid 6.5 Bladder 4.7 Skin 4.1 Leukemia 5.0 Leukemia 4.7 Kidney 4.1 Skin 4.1 Nasopharynx 4.2 NHL 4.1 Hodgkin disease 3.9 Lung 4.2 Liver 3.7 Stomach 3.3 Skin 4.2 3.7 Hodgkin disease Kidney 3.3 4.2 2.8 Hodgkin disease Connective, Soft tissue Nasopharynx 2.8 Prostate 3.7 Ovary 2.8 Connective, Soft tissue 2.8 Thyroid 3.7 Cervix Uteri 2.4 Bladder 2.8 Other Sites 29.4 Other Sites 18.3 Other Sites 24.3 010203040010 20 30 40 010203040 Males (214) Females (246) All (460) Figure 2.8.6 Qassim Region, 2009 (Relative frequency Distribution)

NHL 9.8 Breast 20.8 Female Breast 13.0 Tongue 9.0 Tongue 8.4 Tongue 8.7 Prostate 9.0 Thyroid 7.9 NHL 7.0 Leukemia 7.0 Skin 6.6 Leukemia 7.3 Skin 6.0 Leukemia 6.6 Mouth 6.2 Mouth 5.7 Mouth 4.9 Skin 5.6 Thyroid 5.3 Colo-rectal 4.1 NHL 5.1 Prostate 3.7 Liver 4.1 Corpus Uteri 3.9 Liver 3.3 4.1 3.4 Pancreas Gallbladder etc. Colo-rectal 3.0 Lung 4.1 Liver 2.8 Bladder 3.0 Connective, Soft tissue 4.1 Bladder 2.8 Gallbladder etc. 2.7 Hodgkin disease 4.1 Colo-rectal 2.2 Lung 2.7 Other Sites 29.5 Other Sites 23.6 Other Sites 29.0 010203040010 20 30 40 010203040

Males (122) Females (178) All (300) Figure 2.8.7 Jazan Region, 2009 (Relative01 frequency0203 Distribution)040 All (460)

Colo-rectal 18.2 Breast 23.3 Colo-rectal 17.8 Liver 10.4 Colo-rectal 17.4 Female Breast 12.3 NHL 7.8 Thyroid 8.1 Liver 6.1 16.7 Leukemia 7.8 Gallbladder etc. 4.7 NHL 6.1 Oesophagus 5.2 11.1 Corpus Uteri 4.7 Thyroid 5.5 Testis 5.2 6.7 NHL 4.7 Leukemia 4.9 5.2 3.5 4.3 Brain, CNS 6.5 Connective,Soft tissue Brain, CNS Lung 3.9 Eye 3.5 Oesophagus 3.7 6.5 Bone 3.9 Brain, CNS 3.5 Stomach 2.5 Kidney 3.9 5 Oesophagus 2.3 Gallbladder etc. 2.5 Stomach 2.6 4.1 Stomach 2.3 Bone 2.5 2.6 2.5 Skin 3.9 Liver 2.3 Skin Thyroid 2.6 Pancreas 2.3 Connective,Soft tissue 2.5 3.3 Hodgkin disease 2.6 Skin 2.3 Corpus Uteri 2.5 Multiple Myeloma 2.6 3.3 Leukemia 2.3 Testis 2.5 Other Sites 2.8 15.6 Other Sites 12.8 Other Sites 22.1 01022.8 03040010 20 30 40 010203040 Males (77) 24.3 Females (86) All (163)

Figure 2.8.8 Hail Region, 2009 (Relative frequency Distribution)

P02a.indd 29 16/02/2013 12:12:37 PM Cancer in the 13 Administrative Regions of the Kingdom, 2009

Leukemia 13.6 Breast 12.3 Leukemia 11.3 Colo-rectal 10.2 Thyroid 10.5 Thyroid 10.8 Liver 10.2 Colo-rectal 8.1 Leukemia 9.2 Thyroid 10.2 Female Breast 6.5 Colo-rectal 6.2 NHL 8.5 NHL 5.6 Oesophagus 6.8 Stomach 4.6 Stomach 4.8

Stomach 5.1 Pancreas 4.6 Liver 4.8 Kidney 5.1 Kidney 4.0 Skin 4.6 Gallbladder etc. 3.4 Oesophagus 3.2 Corpus Uteri 4.6 Bone 3.4 Skin 3.2 4.6 Prostate 3.4 Brain, CNS Brain, CNS 3.2 Other Sites 20.3 Other Sites 38.5 Other Sites 34.7 010203040010 20 30 40 010203040

Males (59) Females (65) All (124)

Figure 2.8.9 Najran Region, 2009 (Relative frequency Distribution)

Colo-rectal 10.3 Breast 18.2 Colo-rectal 11.9 Liver 8.8 Colo-rectal 13.6 Female Breast 9.0 Prostate 8.8 Corpus Uteri 7.6 Liver 6.0 Thyroid 6.1 NHL 8.8 Leukemia 6.0 Leukemia 6.1 Pancreas 5.9 NHL 5.2 Cervix Uteri 4.5 Lung 5.9 Nasopharynx 3.0 Pancreas 4.5 Brain, CNS 5.9 Small intestine 3.0 Lung 4.5 Leukemia 5.9 Liver 3.0 Prostate 4.5 Nasopharynx 4.4 Gallbladder etc. 3.0 Brain, CNS 4.5 Bone 4.4 Pancreas 3.0 Nasopharynx 3.7 Lung 3.0 Skin 4.4 Corpus Uteri 3.7 Ovary 3.0 Kidney 4.4 Kidney 3.7 Kidney 3.0 Bladder 4.4 Brain, CNS 3.0 Thyroid 3.7 Hodgkin disease 4.4 Hodgkin disease 3.0 Hodgkin disease 3.7 Other Sites 13.2 Other Sites 13.6 Other Sites 25.4 010203040010 20 30 40 010203040

Males (68) Females (66) All (134) Figure 2.8.10 Baha Region, 2009 (Relative frequency Distribution)

Colo-rectal 12.1 Breast 13.8 Colo-rectal 12.5 Leukemia 9.3 Colo-rectal 12.9 Leukemia 9.5 NHL 9.0 Thyroid 11.4 Female Breast 7.2 Liver 7.8 Leukemia 9.6 NHL 6.9 Prostate 6.5 Stomach 6.2 NHL 4.8 Thyroid 6.7 Bladder 5.6 Skin 4.2 Liver 5.5 Skin 5.3 Corpus Uteri 4.2 Skin 4.7 3.7 Kidney Ovary 4.2 Stomach 4.3 Lung 2.8 Liver 3.3 Prostate 3.2 Pancreas 2.5 Pancreas 3.0 Kidney 3.0 Kaposi sarcoma 2.5 3.0 3.0 Hodgkin disease 2.5 Hodgkin disease Bladder Other Sites 24.2 Other Sites 25.7 Other Sites 33.5 010203040010 20 30 40 010203040

Males (322) Females (334) All (656) Figure 2.8.11 Asir Region, 2009 (Relative frequency Distribution)

P02a.indd 30 16/02/2013 12:12:38 PM Cancer in the 13 Administrative Regions of the Kingdom, 2009

Colo-rectal 11.4 Breast 12.1 Colo-rectal 11.1 NHL 10.5 Colo-rectal 10.9 NHL 8.6 Lung 8.8 Thyroid 10.9 Thyroid 8.2 Liver 7.9 Leukemia 7.9 Female Breast 7.5 Leukemia 6.1 NHL 7.3 Leukemia 7.2 Stomach 5.3 Ovary 5.5 Lung 5.0 Pancreas 5.3 Stomach 4.2 Stomach 4.7 Bladder 5.3 Corpus Uteri 4.2 Hodgkin disease 3.6 Larynx 4.4 Cervix Uteri 3.6 Liver 3.2 Thyroid 4.4 Hodgkin disease 3.6 Ovary 3.2

Other Sites 30.7 Other Sites 29.7 Other Sites 37.6 010203040010 20 30 40 010203040 Males (114) Females (165) All (279)

Figure 2.8.12 Tabuk Region, 2009 (Relative frequency Distribution)

NHL 14.5 Breast 37.5 Female Breast 20.2 Leukemia 14.5 Colo-rectal 7.8 NHL 10.1 Colo-rectal 10.9 Thyroid 7.8 Colo-rectal 9.2 Prostate 7.3 Corpus Uteri 6.3 Leukemia 8.4 Stomach 5.5 NHL 6.3 Stomach 4.2 Gallbladder etc. 5.5 Stomach 3.1 Brain, CNS 4.2 Brain, CNS 5.5 Liver 3.1 Thyroid 4.2 Hodgkin disease 5.5 Uterus unspec. 3.1 Hodgkin disease 4.2 Nasopharynx 3.6 Kidney 3.1 Gallbladder etc. 3.4 Lung 3.6 3.1 3.4 Kidney 3.6 Brain, CNS Corpus Uteri Bladder 3.6 Hodgkin disease 3.1 Prostate 3.4 Multiple Myeloma 3.6 Leukemia 3.1 Kidney 3.4 Other Sites 12.7 Other Sites 12.5 Other Sites 21.8 010203040010 20 30 40 010203040

Males (55) Females (64) All (119)

Figure 2.8.13 Jouf Region, 2009 (Relative frequency Distribution)

P02a.indd 31 16/02/2013 12:12:39 PM International Comparison of Age-Standardized Incidence Rates

Worldwide, GLOBOCAN, 2008 estimated; with reasonably high survival (prostate, breast 7,564,802 cancer deaths; 4,819,962 (63.7%) in and colorectal cancers), whereas several common developing regions and 2,744,840 (36.3%) in cancers with poorer prognoses (liver, stomach and developed regions and 12,662,554 new cancer esophageal cancers) are more common in less cases; 7,107,273 (56.1%) in developing regions developed regions. The most common cancer site and 5,555,281(43.9%) in developed regions. In worldwide among men was lung cancer, followed by men, the incidence of cancer is high in Northern prostate then colo-rectal then stomach. However America, Australia/New Zealand and in Northern in developed countries prostate was the leading and Western Europe as a consequence of the high cancer followed by lung, colo-rectal, and bladder, rates of prostate cancer in these regions. As in while in developing countries lung cancer was males, the regions with the highest incidence rates first followed by stomach, liver, colo-rectal and in females are Northern America, Australia/New oesophagus cancers. In women, the most common Zealand and Northern and Western Europe as a cancer site was breast followed by colo-rectal then consequence of the high rates of breast cancer cervix uteri then lung cancers. Among women, in these regions. The lowest cancer incidence breast cancer was the most common followed rates are in Middle and Western Africa and in by colo-rectal, lung and corpus uteri cancers in South-Central Asia for men and in Middle and developed countries. While in the developing Northern Africa for women. A number of common countries breast cancer was the leading cancer cancers in developed countries are associated followed by cancers of the cervix, lung then stomach.

United States of America 526.55 United Kingdom 428.7 Western Australia 378.2 Norway 360 Korea 325.5 Singapore 230.2 Egypt 165.2 Tunisia 160.0 Bahrain 159.0 Uganda, kyadondo 157.5 Qatar 153.4 Jordan 132.1 Kuwait 131.0 Oman 92.5 United Arab Emirates 82.3 Saudi Arabia 80.9

050100 150 200 250 300 350 400450 500 550

Figure 2.9.A Comparison of ASR* for Saudi Males with Selected Countries**

United States of America 422.0 United Kingdom 372.1 Norway 288.0 Western Australia 264.5 Korea 259.3 Singapore 205.9 Uganda, kyadondo 173.5 Qatar 172.2 Bahrain 154.6 Jordan 143.1 Kuwait 142.0 Egypt 138.5 Tunisia 106.0 United Arab Emirates 95.1 Saudi Arabia 90.1 Oman 82.6

050 100 150 200 250 300 350 400 450 Figure 2.9.B Comparison of ASR* for Saudi Females with Selected Countries** * ASR Per 100,000 ** Source for this information is summarized on page 64

P02a.indd 32 16/02/2013 12:12:39 PM PART III CANCER INCIDENCE FOR MOST COMMON SITES 2009

P03a.indd 33 16/02/2013 12:16:33 PM P03a.indd 34 16/02/2013 12:16:33 PM Cancer Incidence for Most Common Sites, 2009

In this section, the incidence of the most frequencies. The relevant data incorporate details common cancers among Saudi males and females for all patients presented over the period of January are outlined in accordance to their relative through December 2009

Cancer Male Female All %

Breast 23 1308 1331 13.5 Colo-rectal 617 492 1109 11.3 NHL 422 287 709 7.2 Thyroid 141 538 679 6.9 Leukemia 343 276 619 6.3 Liver 295 136 431 4.4 Lung 276 103 379 3.9 Hodgkin disease 194 150 344 3.5 Skin 181 141 322 3.3 Stomach 201 112 313 3.2 Prostate 295 - 295 3.0 Corpus Uteri - 253 253 2.6 Bladder 197 38 235 2.4 Ovary − 173 173 1.8

Table 3.1 Most Common Cancers among Saudis by sex, 2009

P03a.indd 35 16/02/2013 12:16:33 PM Female Breast (C 50)

There were 1308 female breast cancer cases for the highest ASR were Eastern region at 33.1/100,000, year 2009. Breast cancer ranked first among females Riyadh region at 29.4/100,000, Makkah Region at accounting for 25.1% of all newly diagnosed female 26.4/100,000, Qassim Region at 25/100,000 and Jouf cancers (5,205) in year 2009. The ASR was 22.7/100,000 Region at 22.5/100,000. The median age at diagnosis for female population. The five regions with was 48 years (Range 19-99 years)

30 AIR (per 100,000) 20

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.1.1 Age-Specific Incidence Rate (AIR) for Female Breast Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Female %

8500 Infiltrating duct carcinoma, NOS 1023 78.2 8520 Lobular carcinoma, NOS 83 6.3

8010 Carcinoma, NOS 41 3.1

8523 Infiltrating duct mixed with other types of carcinoma 29 2.2 8000 Neoplasm, malignant 24 1.8

8140 Adenocarcinoma, NOS 19 1.5 8522 Infiltrating duct and lobular carcinoma 12 0.9

8480 Mucinous adenocarcinoma 11 0.8

8510 Medullary carcinoma, NOS 90.7 8575 Metaplastic carcinoma, NOS 90.7 Others 48 3.7 Table 3.1.1 Morphological Distribution of Female Breast Cancer in Saudi Arabia, 2009 8.4% 18.4%

Distant Localised Regional Unknown 42.2% 31.0%

Female Figure 3.1.2 Stage Distribution of Female Breast Cancer, 2009

P03a.indd 36 16/02/2013 12:16:33 PM Eastern 33.1

Riyadh 29.4

Makkah 26.4

Qassim 25.0

Jouf 22.5

Madinah 16.1

Tabuk 12.5

Jazan 11.5

Hail 11.4

Baha 10.0

Northern 9.9

Asir 9.1

Najran 6.4

0510 15 20 25 30 35

Figure 3.1.3 ASR* Regional Distribution of Female Breast Cancer in Saudi Arabia, 2009

United States of America 130.1 United Kingdom 124.4 Western Australia 81.7 Norway 70.7 Singapore 60.0 Bahrain 54.4 Jordan 53.2 Kuwait 48.0 Qatar 45.6 Egypt 41.4 Korea 38.3 South Africa 37.4 Tunisia 29.8 United Arab Emirates 25.1 Uganda, kyadondo 23.4 Saudi Arabia 22.7 Oman 15.7

020406080100 120140

Figure 3.1.4 Comparison of ASR* for Female Breast Cancer among Saudi Females with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 37 16/02/2013 12:16:34 PM Colo-rectal (C18-C20)

There were 1109 cases of colo-rectal cancer The five regions with the highest ASR were accounting for 11.3% of all newly diagnosed cases Riyadh region at 15.7/100,000, Eastern region in year 2009. This cancer ranked first among male at 13/100,000, Madinah region at 12.2/100,000, population and third among female population. Tabuk region at 10.6 /100,000 and Makkah region It affected 617 (55.6%) males and 492 (44.4%) at 10.6/100,000. The median age at diagnosis was females with a male to female ratio of 125:100. 60 years among males (range 10-103 years) and The overall ASR was 10.5/100,000. ASR for males 56 years among females (range 18-104 years). was 12/100,000 and for females 9.4/100,000.

100 90 male female 80 70 60 50 40

AIR (per 100,000) 30 20 10 0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.2.1 Age-Specific Incidence Rate (AIR) for Colo-rectal Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female % 8140 Adenocarcinoma, NOS 46174.7382 77.6 8480 Mucinous adenocarcinoma 53 8.6285.7 8263 Adenocarcinoma in tubulovillous adenoma 12 1.9153.0 8000 Neoplasm, malignant 14 2.381.6 8490 Signet ring cell carcinoma 12 1.991.8 8481 Mucin-producing adenocarcinoma 81.3 12 2.4 8210 Adenocarcinoma in adenomatous polyp 11 1.881.6 8261 Adenocarcinoma in villous adenoma 12 1.971.4 8144 Adenocarcinoma, intestinal type 81.3 71.4 8010 Carcinoma, NOS 81.3 30.6 Others 18 2.9132.6 Table 3.2.1 Morphological Distribution of Colo-rectal Cancer in Saudi Arabia, 2009

10.4% 25.3% 11.4% 25.8% 10.8% 25.5% Distant Localised Regional Unknown 38.9% 25.4% 39.2% 23.6% 39.0% 24.6% Male Female All

Figure 3.2.2 Stage Distribution of Colo-rectal Cancer in Saudi Arabia, 2009

P03a.indd 38 16/02/2013 12:16:35 PM 13.0 Riyadh 18.4 11.1 Eastern 14.9 9.5 Madinah 14.8 12.6 Tabuk 8.6 9.8 Makkah 11.3 9.9 Qassim 10.1 8.6 Hail 7.8 8.3 Asir 7.1 4.9 Jouf 7.3 6.0 Baha 5.1 6.6 Northern 4.5 3.8 Najran 3.8 1.0 Jazan 1.4

02468101214161820

Figure 3.2.3 ASR* Regional Distribution of Colo-rectal Cancer in Saudi Arabia, 2009

38.4 United Kingdom 58.9 38.0 United States of America 48.2 25.9 Korea 49.0 28.8 Western Australia 43.2 28.6 Singapore 40.1 14.6 South Africa 20.1 16.5 Jordan 18.2 16.6 Qatar 15.0 13.3 Kuwait 15.5 7.4 Bahrain 14.3 9.4 Saudi Arabia 12.0 9.0 Tunisia 11.6 8.1 Uganda, kyadondo 7.3 7.3 United Arab Emirates 8.0 4.1 Oman 5.5 3.1 Egypt 4.8

010203040506070

Figure 3.2.4 Comparison of ASR* for Colo-rectal Cancer among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 39 16/02/2013 12:16:35 PM Non-Hodgkin Lymphoma (C82-C85; C96)

There were 709 cases of Non-Hodgkin Lymphoma and 5.1/100,000 for females. The five regions with accounting for 7.2% of all newly diagnosed cancers in the highest ASR were Tabuk region at 9.5/100,000, year 2009. This cancer ranked second among male Riyadh region at 9.1/100,000, Northern region at population and fourth among female population. It 6.4/100,000, Eastern region at 6.3/100,000 and affected 422 (59.5%) males and 287 (40.5%) females Makkah regions at 6/100,000. The median age at with a male to female ratio of 147:100. The overall diagnosis was 53 years among males (range 0-98 years) ASR was 6/100,000. ASR for males was 6.8/100,000 and 53 years among females (range 2-100 years).

60 male female

AIR (per 100,000) 20

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups Figure 3.3.1 Age-Specific Incidence Rate (AIR) for NHL in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female % 9680 Malignant lymphoma, large B-cell, diffuse, NOS 21651.2157 54.7 9590 Malignant lymphoma, NOS 29 6.9175.9 9591 Malignant lymphoma, non-Hodgkin, NOS 31 7.3144.9 9699 Marginal zone B-cell lymphoma, NOS 16 3.8124.2 9670 Malignant lymphoma, small B lymphocytic, NOS 18 4.382.8 9687 Burkitt lymphoma, NOS 19 4.562.1 9700 Mycosis fungoides 13 3.1103.5 9690 Follicular lymphoma, NOS 92.1 82.8 9691 Follicular lymphoma, grade 2 81.9 93.1 9695 Follicular lymphoma, grade 1 10 2.451.7 9714 Anaplastic large cell lymphoma, T cell and Null cell type 61.4 93.1 9698 Follicular lymphoma, grade 3 51.2 93.1 9684 Malignant lymphoma, large B-cell, diffuse, immunoblastic, NOS7 1.741.4 9702 Mature T-cell lymphoma, NOS 92.1 20.7 9719 NK/T-cell lymphoma, nasal and nasal-type 51.2 41.4 Others 21 5.0134.5 Table 3.3.1 Morphological Distribution of NHL in Saudi Arabia, 2009

18.5% 16.4% 17.6% 41.3% 41.5% 41.1% Distant Localised Regional 18.1% 17.2% 16.6% Unknown

23.5% 24.4% 23.8% Male Female All

Figure 3.3.2 Stage Distribution of NHL, 2009

P03a.indd 40 16/02/2013 12:16:36 PM Tabuk 10.3 8.7 Riyadh 9.6 8.5 4.7 Northern 8.1 5.1 Eastern 7.5 5.4 Makkah 6.6 3.2 Jouf 7.6 3.3 Madinah 6.5 3.9 Qassim 5.8 2.9 Asir 5.0 2.9 Jazan 2.8 2.1 Hail 3.1 0.6 Baha 4.3 2.2 Najran 2.6

024681012

Figure 3.3.3 ASR* Regional Distribution of NHL in Saudi Arabia, 2009

16.9 United States of America 24.4 13.1 United Kingdom 18.0 9.2 Norway 12.5 8.0 Western Australia 12.8 9.1 Qatar 9.4 6.4 Kuwait 11.1 5.6 Bahrain 7.1 6.5 Jordan 6.1 5.0 Korea 7.3 4.6 Oman 7.6 5.1 Saudi Arabia 6.8 4.6 United Arab Emirates 6.6 4.4 Uganda, kyadondo 6.0 3.7 Tunisia 6.7 3.9 South Africa 6.1 3.3 Egypt 6.4

0510 15 20 25 30

Figure 3.3.4 Comparison of ASR* for NHL among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 41 16/02/2013 12:16:36 PM Thyroid (C 73)

There were 679 cases of thyroid cancer accounting and 7.6/100,000 for females. The five regions with for 6.9% of all newly diagnosed cases for the year the highest ASR were Riyadh region at 7/100,000, 2009. This cancer ranked second among female Eastern region at 6/100,000, Makkah region at population and thirteenth among male population. 5.1/100,000, Qassim region at 4.5/100,000 and Tabuk It affected 141(20.8%) males and 538(79.2%) females region at 4.4/100,000. The median age at diagnosis with a male to female ratio of 26:100. The overall was 45 years among males (range 13-96 years) ASR was 4.9/100,000. ASR was 2.1/100,000 for males and 38 years among females (range 13-90 years).

22 male female 20 18 16 14 12 10 8 AIR (per 100,000) 6 4 2 0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.4.1 Age-Specific Incidence Rate (AIR) for Thyroid Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female % 8260 Papillary adenocarcinoma, NOS 79 56.0 28352.6 8340 Papillary carcinoma, follicular variant 20 14.2 10018.6 8341 Papillary microcarcinoma 14 9.9519.5 8343 Papillary carcinoma, encapsulated 53.5 23 4.3 8330 Follicular adenocarcinoma, NOS 21.4 14 2.6 8290 Oxyphilic adenocarcinoma 32.1 12 2.2 8335 Follicular carcinoma, minimally invasive 10.7 12 2.2 8510 Medullary carcinoma, NOS 42.8 81.5 8021 Carcinoma, anaplastic, NOS 42.8 61.1 8050 Papillary carcinoma, NOS 32.1 71.3 8000 Neoplasm, malignant 10.7 50.9 8344 Papillary carcinoma, columnar cell 00.0 61.1 8010 Carcinoma, NOS 21.4 20.4 Others 32.1 91.7

Table 3.4.1 Morphological Distribution of Thyroid Cancer in Saudi Arabia, 2009

12.8% 9.2% 8.6% 6.3% 9.4% 6.9% Distant 25.8% Localised 26.5% Regional Unknown 48.9% 29.1% 59.3% 57.1% Male Female All

Figure 3.4.2 Stage Distribution of Thyroid Cancer, 2009

P03a.indd 42 16/02/2013 12:16:36 PM 10.7 Riyadh 3.2 Eastern 9.8 2.2 Makkah 7.9 2.2 Qassim 6.4 2.5 6.2 Tabuk 2.5 7.1 Northern 1.5 6.6 Asir 1.1 4.1 Najran 3.2 4.6 Madinah 1.8 Jouf 4.8 0.0 3.1 Hail 1.1 3.3 Jazan 0.5 2.4 Baha 0.6

024681012

Figure 3.4.3 ASR* Regional Distribution of Thyroid Cancer in Saudi Arabia, 2009

79.6 Korea 15.4 21.4 United States of America 6.9 11.6 Western Australia 4.3 10.9 Qatar 3.2 8.5 Kuwait 3.2 7.7 Bahrain 2.0 Saudi Arabia 7.6 2.1 7.1 United Arab Emirates 1.7 Norway 5.7 2.1 Jordan 6.1 1.7 5.6 Oman 1.7 5.0 United Kingdom 1.9 Egypt 5.1 1.0 Tunisia 3.1 1.3 1.5 Uganda, kyadondo 0.5

0102030405060708090

Figure 3.4.4 Comparison of ASR* for Thyroid Cancer among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 43 16/02/2013 12:16:37 PM Leukemia (C91-C95)

There were 619 cases of leukemia accounting 3.7/100,000 for females. The five regions with the for 6.3% of all newly diagnosed cancers in highest ASR were Najran region at 6.6/100,000, year 2009. This cancer ranked third for males Eastern region at 5.7/100,000, Madinah region at and fifth for females and affected 343 (55.4%) 5.4/100,000, Asir region at 4.9/100,000 and Riyadh males and 276 (44.6%) females with a male to region at 4.7/100,000. The median age at diagnosis female ratio of 124:100. The overall ASR was is 26 years among males (range 0-98 years) and 20 4.2/100,000. ASR for males was 4.6/100,000 and years among females (range 0-100 years).

24 22 male female 20 18 16 14 12 10 8 AIR (per 100,000) 6 4 2 0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.5.1 Age-Specific Incidence Rate (AIR) for Leukemia in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female % 9836 Precursor B-cell lymphoblastic leukemia 66 19.2 67 24.3 9863 Chronic myeloid leukemia, NOS 46 13.4 43 15.6 9861 Acute myeloid leukemia, NOS 40 11.7 39 14.1 9835 Precursor cell lymphoblastic leukemia, NOS 38 11.1 31 11.2 9823 B-cell chronic lymphocytic leukemia/small lymphocytic lymphom 43 12.5 14 5.1 9837 Precursor T-cell lymphoblastic leukemia 19 5.572.5 9801 Acute leukemia, NOS 92.6 12 4.3 9866 Acute promyelocytic leukemia, t(15;17)(q22;q11-12) 72.0 10 3.6 9800 Leukemia, NOS 72.0 93.3 9891 Acute monocytic leukemia 72.0 62.2 9874 Acute myeloid leukemia with maturation 72.0 31.1 9873 Acute myeloid leukemia without maturation 61.7 20.7 9860 Myeloid leukemia, NOS 30.9 41.4 9867 Acute myelomonocytic leukemia 30.9 41.4 9940 Hairy cell leukemia 51.5 20.7 9826 Burkitt cell leukemia 51.5 10.4 9896 Acute myeloid leukemia, t(8;21)(q22;q22) 41.2 20.7 9945 Chronic myelomonocytic leukemia, NOS 51.5 10.4 9820 Lymphoid leukemia, NOS 30.9 20.7 9840 Acute myeloid leukemia, M6 type 10.3 41.4 9875 Chronic myelogenous leukemia, BCR/ABL positive 41.2 10.4 9805 Acute biphenotypic leukemia 20.6 20.7 9872 Acute myeloid leukemia, minimal differentiation 20.6 20.7 9895 Acute myeloid leukemia with multilineage dysplasia 30.9 10.4 Others 82.3 72.5 Table 3.5.1 Morphological Distribution of Leukemia in Saudi Arabia, 2009

P03a.indd 44 16/02/2013 12:16:37 PM 5.9 Najran 7.3 5.7 Eastern 5.6 5.0 Madinah 5.8 5.3 Asir 4.4 3.5 Riyadh 5.8 3.3 Qassim 5.8 2.6 Makkah 4.4 4.2 Tabuk 2.5 2.0 Jouf 4.5 2.5 Baha 2.8 0.5 Northern 3.8 2.4 Jazan 1.6 1.1 Hail 2.6

0 12345678

Figure 3.5.2 ASR* Regional Distribution of Leukemia in Saudi Arabia, 2009

9.7 United States of America 16.1 8.6 Norway 13.2 7.9 United Kingdom 13.2 7.0 Western Australia 11.6 5.7 Jordan 9.0 4.8 Qatar 8.5 4.4 Bahrain 8.3 4.9 Kuwait 7.0 4.8 Egypt 5.7 4.2 Korea 5.9 3.8 Oman 5.4 3.6 Tunisia 5.1 3.7 Saudi Arabia 4.6 4.1 United Arab Emirates 3.5 1.4 Uganda, kyadondo 1.3 024681012141618

Figure 3.5.3 Comparison of ASR* for Leukemia among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 45 16/02/2013 12:16:37 PM Liver (C 22)

There were 431 cases of liver cancer accounting 2.7/100,000 for females. The five regions with the for 4.4% of all newly diagnosed cases in year highest ASR were Riyadh region at 8.3/100,000, 2009. This cancer ranked fourth in males, Qassim region at 5.2/100,000, Tabuk region at and tenth in females and affected 295 (68.4%) 4.2/100,000, Madinah region at 3.7/100,000 and males and 136 (31.6%) females with a male to Eastern region at 3.5/100,000. The median age at female ratio of 216:100. The overall ASR was diagnosis was 68 years in males (range 0-119 years) 4.3/100,000. ASR was 5.9/100,000 for males and and 63 years in female (range 0-109 years)

70 male female

30 AIR (per 100,000) 20

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.6.1 Age-Specific Incidence Rate (AIR) for Liver Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female %

8170 Hepatocellular carcinoma, NOS 25084.79972.8 8000 Neoplasm, malignant 19 6.496.6 8160 Cholangiocarcinoma 82.7 53.7 8140 Adenocarcinoma, NOS 41.4 53.7 8010 Carcinoma, NOS 31.0 42.9 8970 Hepatoblastoma 31.0 42.9 8246 Neuroendocrine carcinoma, NOS 20.7 21.5 8180 Combined hepatocellular carcinoma and cholangiocarcinoma 20.7 10.7 Others 41.4 75.1

Table 3.6.1 Morphological Distribution of Liver Cancer in Saudi Arabia, 2009

13.9% 11.8% 13.2%

Distant 30.8% 36.0% Localised Regional

44.1% Unknown 47.5% 46.4% 32.5% 7.8% 8.1% 7.9% Male Female All

Figure 3.6.2 Stage Distribution of Liver Cancer, 2009

P03a.indd 46 16/02/2013 12:16:38 PM 6.0 Riyadh 10.5 4.0 Qassim 6.3 0.0 Tabuk 8.3 2.3 Madinah 5.1 2.7 Eastern 4.3 1.6 Makkah 5.0 2.0 Asir 4.6 1.2 Baha 5.2 0.0 Najran 6.3 1.1 Hail 4.3 2.1 Jouf 1.6 0.0 Northern 3.0 1.7 Jazan 1.2

024681012

Figure 3.6.3 ASR* Regional Distribution of Liver Cancer in Saudi Arabia, 2009

24.6 Egypt 71.5 10.4 Korea 37.7 5.8 South Africa 15.7 7.6 Qatar 13.9 Singapore 17.2 4.0 United States of America 12.2 5.8 Uganda, kyadondo 8.7 3.0 Kuwait 7.2 United Kingdom 3 6.6 3.6 Bahrain 5.3 2.7 Saudi Arabia 5.9 2.2 Oman 5.7 1.9 Western Australia 4.7 1.9 United Arab Emirates 3.0 1.3 Norway 2.4 0.7 Tunisia 2.2 01020304050607080

Figure 3.6.4 Comparison of ASR* for Liver Cancer among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 47 16/02/2013 12:16:38 PM Lung (C33-C34)

There were 379 cases of lung cancer accounting 2/100,000 for females. The five regions with the for 3.9% of all diagnosed cases in year 2009. Lung highest ASR were Eastern region at 8.8/100,000, cancer ranked Sixth among male population and Tabuk region at 5.4/100,000, Riyadh region at thirteenth among female population. It affected 4.6/100,000, Madinah region at 4.4/100,000, and 276 (72.8%) males and 103 (27.2%) females with a Makkah region at 4.2/100,000. The median age at male to female ratio of 268:100. The overall ASR diagnosis was 66 years among males (range 3-94 was 3.9/100,000. ASR was 5.7/100,000 for males and years) and 60 years among females (range 6-98 years).

70 male female

30 AIR (per 100,000) 20

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.7.1 Age-Specific Incidence Rate (AIR) for Lung Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female %

8140 Adenocarcinoma, NOS 67 24.3 27 26.2 8046 Non-small cell carcinoma 52 18.8 12 11.7 8070 Squamous cell carcinoma, NOS 50 18.1 13 12.6 8041 Small cell carcinoma, NOS 34 12.3 65.8 8000 Neoplasm, malignant 18 6.59 8.7 8010 Carcinoma, NOS 82.9 65.8 8250 Bronchiolo-alveolar adenocarcinoma, NOS 51.8 65.8 8246 Neuroendocrine carcinoma, NOS 82.9 21.9 8071 Squamous cell carcinoma, keratinizing, NOS 62.2 21.9 8012 Large cell carcinoma, NOS 62.2 00.0 8240 Carcinoid tumor, NOS 10.4 54.9 8255 Adenocarcinoma with mixed subtypes 31.1 11.0 8490 Signet ring cell carcinoma 31.1 11.0 8560 Adenosquamous carcinoma 10.4 32.9 8072 Squamous cell carcinoma, large cell, nonkeratinizing, NOS2 0.71 1.0 Others 12 4.39 8.7 Table 3.7.1 Morphological Distribution of Lung Cancer in Saudi Arabia, 2009

16.3% 25.2% 18.7%

Distant Localised 13.2% 14.5% Regional 9.7% Unknown 51.5% 12.3% 56.9% 13.6% 12.7% 55.4% Male Female All Figure 3.7.2 Stage Distribution of Lung Cancer, 2009

P03a.indd 48 16/02/2013 12:16:39 PM 3.1 Eastern 14.4 2.3 Tabuk 8.5 2.6 Riyadh 6.6 2.5 Madinah 6.3 2.2 Makkah 6.1 0.0 Jouf 3.0 1.3 Baha 3.2 1.1 Qassim 3.4 4.1 Northern 0.0 1.6 Asir 1.7 1.1 Jazan 1.6 0.0 Hail 1.7 1.1 Najran 0.0

0246810121416

Figure 3.7.3 ASR* Regional Distribution of Lung Cancer in Saudi Arabia, 2009

51.3 United States of America 69.3 39.3 United Kingdom 58.8 13.9 Korea 46.8 24.1 Norway 35.5 15.4 Singapore 38.5 20.5 Western Australia 32.9 12.1 South Africa 35.5 10.7 Bahrain 31.1 1.7 Tunisia 37.2 4.5 Qatar 18.0 5.0 Kuwait 15.1 2.6 Jordan 16.6 4.4 Egypt 8.8 3.3 United Arab Emirates 9.3 2.0 Oman 7.9 3.8 Uganda, kyadondo 4.8 2.0 Saudi Arabia 5.7

01020304050607080

Figure 3.7.4 Comparison of ASR* for Lung Cancer among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 49 16/02/2013 12:16:39 PM Hodgkin disease (C 81)

There were 344 cases of hodgkin disease cancer for females. The five regions with highest ASR accounting for 3.5% of all newly diagnosed cases in were Riyadh region at 3.6/100,000, Tabuk region at year 2009. This cancer ranked ninth among male and 2/100,000, Northern region at 2/100,000, Madinah eighth in female population. It affected 194 (56.4%) at 2/100,000 then Makkah, Eastern and Qassim males and 150 (43.6%) females with a male to female regions at 1.9/100,000 for each. The median age at ratio of 129:100. The overall ASR was 2/100,000. diagnosis was 26 years (range 3-83 years) in males ASR was 2.3/100,000 for males and 1.7/100,000 and 21 year in females (range 4-96).

7 male female

3 AIR (per 100,000) 2

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.8.1 Age-Specific Incidence Rate (AIR) for Hodgkin disease in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female %

9663 Hodgkin lymphoma, nodular sclerosis, NOS 99 51.0 78 52.0 9652 Hodgkin lymphoma, mixed cellularity, NOS 33 17.0 18 12.0 9650 Hodgkin lymphoma, NOS 20 10.3 26 17.3 9651 Hodgkin lymphoma, lymphocyte-rich 13 6.7106.7 9659 Hodgkin lymphoma, nodular lymphocyte predominance 11 5.796.0 9665 Hodgkin lymphoma, nodular sclerosis, grade 1 73.6 42.7 9664 Hodgkin lymphoma, nodular sclerosis, cellular phase42.132.0 9667 Hodgkin lymphoma, nodular sclerosis, grade 2 31.5 21.3 9653 Hodgkin lymphoma, lymphocyte depletion, NOS 42.1 00.0 All 194100.0150 100.0

Table 3.8.1 Morphological Distribution of Hodgkin disease in Saudi Arabia, 2009

12.9% 12.7% 43.8% 12.8% 44.2% 44.7% Distant Localised 24.1% Regional 22.7% 26.0% Unknown

20.6% 16.7% 18.9% Male Female All

Figure 3.8.2 Stage Distribution of Hodgkin disease, 2009

P03a.indd 50 16/02/2013 12:16:40 PM 2.8 Riyadh 4.3 2.1 Tabuk 1.9 1.2 Northern 2.8 1.7 Madinah 2.3 1.6 Makkah 2.2 1.9 Qassim 1.9 2.0 Eastern 1.7 0.8 Baha 2.3 1.1 Jouf 1.9 1.4 Asir 1.3 1.1 Najran 0.4 0.3 Hail 0.9 0.3 Jazan 0.8

0 0.5 1 1.5 22.5 33.5 44.5 5

Figure 3.8.3 ASR* Regional Distribution of Hodgkin disease in Saudi Arabia, 2009

2.6 United States of America 3.1 2.5 United Kingdom 3.2 1.8 Qatar 3.9 2.0 Kuwait 3.3 2.6 Jordan 2.5 1.8 Norway 2.9 1.7 Western Australia 2.7 1.7 Saudi Arabia 2.3 1.8 Bahrain 2.0 1.2 Oman 2.4 1.4 United Arab Emirates 1.8 1.6 Uganda, kyadondo 1.4 0.1 Egypt 1.8 0.3 Korea 0.5

012345

Figure 3.8.4 Comparison of ASR* for Hodgkin disease among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 51 16/02/2013 12:16:40 PM Skin (Non-Melanoma) (C 44)

There were 322 cases of skin cancer accounting for The five regions with the highest ASR were Riyadh 3.3% of all newly diagnosed cases in year 2009. This region at 4.6/100,000, Eastern region at 4.1/100,000, cancer ranked tenth for males and ninth for females. Qassim region at 3.7/100,000, Makkah region at It affected 181 (56.2%) males and 141 (43.8%) 3.1/100,000 and Jazan region at 3.0/100,000. The females with a male to female ratio of 128:100. The median age at diagnosis was 68 years among males overall ASR was 3.1/100,000. ASR was 3.5/100,000 (range 15-109 years) and 63 years among female for males and 2.7/100,000 for females. (range 12-100 years).

40 male female 35

15 AIR (per 100,000) 10

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.9.1 Age-Specific Incidence Rate (AIR) for Skin Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female % 8090 Basal cell carcinoma, NOS 80 44.2 58 41.1 8070 Squamous cell carcinoma, NOS 38 21.0 33 23.4 8832 Dermatofibrosarcoma, NOS 13 7.21812.8 8071 Squamous cell carcinoma, keratinizing, NOS 16 8.875.0 8097 Basal cell carcinoma, nodular 84.4 64.3 8094 Basosquamous carcinoma 63.3 10.7 8410 Sebaceous adenocarcinoma 21.1 53.5 8200 Adenoid cystic carcinoma 00.0 42.8 8051 Verrucous carcinoma, NOS 21.1 10.7 8000 Neoplasm, malignant 21.1 00.0 8083 Basaloid squamous cell carcinoma 10.6 10.7 8091 Multifocal superficial basal cell carcinoma 21.1 00.0 8092 Infiltrating basal cell carcinoma, NOS 00.0 21.4 8095 Metatypical carcinoma 21.1 00.0 8140 Adenocarcinoma, NOS 21.1 00.0 8247 Merkel cell carcinoma 10.6 10.7 Others 63.3 42.8

Table 3.9.1 Morphological Distribution of Skin Cancer in Saudi Arabia, 2009 3.1% 13.8% 3.3% 8.5% 2.8% 11.5% 7.1% Distant 8.3% 7.8% Localised Regional Unknown

74.6% 81.6% 77.6% Male Female All

Figure 3.9.2 Stage Distribution of Skin Cancer, 2009

P03a.indd 52 16/02/2013 12:16:40 PM 3.4 Riyadh 5.8 3.5 Eastern 4.7 4.1 Qassim 3.3 2.6 Makkah 3.6 3.8 Jazan 2.2 2.0 Asir 3.0 2.5 Northern 1.3 1.3 Madinah 2.0 2.3 Tabuk 0.8 2.6 Najran 0.4 1.1 Hail 1.0 0.0 Baha 1.7 0.0 Jouf 0.0

01234567

Figure 3.9.3 ASR* Regional Distribution of Skin Cancer in Saudi Arabia, 2009

Norway 10.9 16.8

Singapore 7.8 10.9

5.0 Qatar 6.4

3.0 Oman 4.0

United Arab Emirates 2.5 4.0

2.7 Saudi Arabia 3.5

2.1 Uganda, kyadondo 3.9

2.0 Bahrain 3.6

2.1 Egypt 2.0

1.4 Kuwait 1.4

024681012141618

Figure 3.9.4 Comparison of ASR* for Skin Cancer among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 53 16/02/2013 12:16:41 PM Stomach (C 16)

There were 313 cases of stomach cancer accounting 2.1/100,000 for females. The five regions with the for 3.2% of all newly diagnosed cases in year 2009. highest ASR were Tabuk region at 4.9/100,000, Eastern This cancer ranked seventh among male population region at 4.5/100,000, Riyadh region at 3.9/100,000, and twelfth among female population. It affected Najran regions at 3.9/100,000 and Northern 201 (64.2%) males and 112 (35.8%) females with a region at 3.8/100,000. The median age at diagnosis male to female ratio of 179:100. The overall ASR was 69 years among males (range 1-106 years) was 3/100,000. ASR was 3.9/100,000 for male and and 59 years among female (range 25-100 years).

50 45 male female 40 35 30 25 20

AIR (per 100,000) 15 10 5 0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.10.1 Age-Specific Incidence Rate (AIR) for Stomach Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female %

8140 Adenocarcinoma, NOS 93 46.3 37 33.0 8490 Signet ring cell carcinoma 50 24.9 46 41.1 8144 Adenocarcinoma, intestinal type 16 8.087.1 8936 Gastrointestinal stromal sarcoma 31.5 54.5 8000 Neoplasm, malignant 42.0 21.8 8010 Carcinoma, NOS 42.0 21.8 8246 Neuroendocrine carcinoma, NOS 52.5 00.0 8020 Carcinoma, undifferentiated, NOS 31.5 10.9 8070 Squamous cell carcinoma, NOS 42.0 00.0 8145 Carcinoma, diffuse type 31.5 10.9 8480 Mucinous adenocarcinoma 21.0 21.8 8240 Carcinoid tumor, NOS 10.5 21.8 8260 Papillary adenocarcinoma, NOS 31.5 00.0 8560 Adenosquamous carcinoma 10.5 10.9 8574 Adenocarcinoma with neuroendocrine differentiation 10.5 10.9 Others 84.0 43.6 Table 3.10.1 Morphological Distribution of Stomach Cancer in Saudi Arabia, 2009

14.9% 25.9% 13.4% 25.0% 14.4% 25.6% Distant Localised Regional Unknown 32.3% 28.6% 33.0% 26.9% 31.0% 29.1% Male Female All

Figure 3.10.2 Stage Distribution of Stomach Cancer, 2009

P03a.indd 54 16/02/2013 12:16:41 PM 5.4 Tabuk 4.3 2.7 Eastern 6.3 2.1 Riyadh 5.7 4.7 Najran 3.1 5.2 Northern 2.3 2.6 Jouf 4.4 2.4 Makkah 3.4 2.3 Qassim 3.1 1.4 Asir 3.7 0.7 Madinah 3.9 1.4 Hail 1.0 0.9 Baha 1.0 1.2 Jazan 0.3

01234567

Figure 3.10.3 ASR* Regional Distribution of Stomach Cancer in Saudi Arabia, 2009

25.5 Korea 64.5 10.3 South Africa 22.0 7.3 Singapore 13.4 5.1 United Kingdom 12.3 5.8 Oman 10.5 5.0 United States of America 10.3 7.0 Western Australia 6.8 6.9 Uganda, kyadondo 6.2 4.7 Bahrain 6.8 5.5 Qatar 5.9 3.5 United Arab Emirates 6.5 3.6 Norway 5.7 4.6 Jordan 4.2 2.5 Tunisia 5.1 2.1 Kuwait 4.0 2.1 Saudi Arabia 3.9 1.4 Egypt 0.5

010203040506070

Figure 3.10.4 Comparison of ASR* for Stomach Cancer among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 55 16/02/2013 12:16:42 PM Prostate (C 61)

There were 295 cases of prostate cancer accounting were Eastern region at 13.4/100,000, Riyadh region for 6.1% of all newly diagnosed cases among males at 8.3/100,000, Makkah region at 6.4/100,000, in year 2009. This cancer ranked fifth among Jouf region at 5.3/100,000 and Madinah region at males. The ASR was 6.1/100,000 among male 4.8/100,000. The median age at diagnosis was 72 population. The five regions with the highest ASR years (range 1-103 years).

100 90 80 70 60 50 40

AIR (per 100,000) 30 20 10 0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.11.1 Age-Specific Incidence Rate (AIR) for Prostate Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Male %

8140 Adenocarcinoma, NOS 26589.8 8000 Neoplasm, malignant 13 4.4 8010 Carcinoma, NOS 93.1 8550 Acinar cell carcinoma 51.7 8070 Squamous cell carcinoma, NOS 10.3 8260 Papillary adenocarcinoma, NOS 10.3 8910 Embryonal rhabdomyosarcoma, NOS10.3 All295 100.0

Table 3.11.1 Morphological Distribution of Prostate Cancer in Saudi Arabia, 2009

13.9% 27.1% Distant 6.1% Localised Regional Unknown

52.9% Male

Figure 3.11.2 Stage Distribution of Prostate Cancer in Saudi Arabia, 2009

P03a.indd 56 16/02/2013 12:16:42 PM Eastern 13.4

Riyadh 8.3

Makkah 6.4

Jouf 5.3

Madinah 4.8

Baha 4.5

Asir 3.8

Jazan 3.1

Tabuk 2.9

Qassim 2.8

Najran 2.1

Northern 1.6

Hail 0.4

0246810121416

Figure 3.11.3 ASR* Regional Distribution of Prostate Cancer in Saudi Arabia, 2009

United States of America 151.0 Western Australia 121.4 United Kingdom 106.3 Norway 103.2 Uganda, kyadondo 37.6 Singapore 26.7 South Africa 25.3 Korea 24.8 Bahrain 14.6 Tunisia 14.1 Kuwait 13.3 Jordan 12.4 Qatar 10.0 Oman 8.4 United Arab Emirates 7.5 Egypt 6.8 Saudi Arabia 6.1

020406080100 120140 160

Figure 3.11.4 Comparison of ASR* for Prostate Cancer among Saudi males with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 57 16/02/2013 12:16:43 PM Corpus uteri (C 54)

There were 253 cases of corpus uteri cancer The five regions with the highest ASR were Riyadh among females accounting for 4.9% of all newly region at 7.9/100,000, Makkah region at 6.3/100,000, diagnosed cases for females (5,205) in year 2009. Eastern region at 6/100,000, Tabuk region at This cancer ranked sixth among female population. 5.9/100,000 and Jouf region at 5.8/100,000. The median The ASR was 5.3/100,000 for female population. age at diagnosis was 62 years (range 28-93 years).

15 AIR (per 100,000) 10

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups Figure 3.12.1 Age-Specific Incidence Rate (AIR) for Corpus uteri Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Female %

8380 Endometrioid adenocarcinoma, NOS 14657.7 8140 Adenocarcinoma, NOS 34 13.4 8010 Carcinoma, NOS 11 4.3 8950 Mullerian mixed tumor 10 4.0 8460 Papillary serous cystadenocarcinoma 72.8 8930 Endometrial stromal sarcoma, NOS 62.4 8310 Clear cell adenocarcinoma, NOS 52.0 8441 Serous cystadenocarcinoma, NOS 52.0 8461 Serous surface papillary carcinoma 52.0 8980 Carcinosarcoma, NOS 52.0 8931 Endometrial stromal sarcoma, low grade 41.6 8382 Endometrioid adenocarcinoma, secretory variant 31.2 8560 Adenosquamous carcinoma 31.2 8050 Papillary carcinoma, NOS 20.8 8890 Leiomyosarcoma, NOS 20.8 Others 52.0

Table 3.12.1 Morphological Distribution of Corpus uteri Cancer in Saudi Arabia, 2009

11.9% 13.4% Distant Localised Regional 24.9% Unknown 49.8%

Female

Figure 3.12.2 Stage Distribution of Corpus uteri Cancer, 2009

P03a.indd 58 16/02/2013 12:16:43 PM Riyadh 7.9

Makkah 6.3

Eastern 6.0

Tabuk 5.9

Jouf 5.8

Northern 5.4

Madinah 5.3

Baha 3.5

Najran 3.2

Jazan 3.0

Asir 2.8

Hail 2.6

Qassim 1.5

01 23 4 56789

Figure 3.12.3 ASR* Regional Distribution of Corpus uteri Cancer in Saudi Arabia, 2009

United States of America 27.3

United Kingdom 19.4

Norway 16.0

Singapore 12.1

Western Australia 10.5

Qatar 9.6

Kuwait 6.2

Bahrain 6.1

Saudi Arabia 5.3

Korea 5.0

Uganda, kyadondo 3.7

Tunisia 3.4

United Arab Emirates 3.3

Oman 1.5

Egypt 0.9

05 10 15 20 25 30

Figure 3.12.4 Comparison of ASR* for Corpus uteri Cancer among Saudi females with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 59 16/02/2013 12:16:43 PM Bladder (C 67)

There were 235 cases of bladder cancer accounting and 0.7/100,000 for females. The five regions with for 2.4% of all newly diagnosed cases in year 2009. the highest ASR were Riyadh region at 3.5/100,000, This cancer ranked eighth among male population Eastern region at 3.1/100,000, Tabuk region at and 23rd among female population. It affected 2.8/100,000, Northern region at 2.7/100,000 and 197 (83.8%) males and 38 (16.2%) females with a Madinah region at 2.5/100,000. The median age at male to female ratio of 517:100. The overall ASR diagnosis was 65 among males (range 18-100 years) was 2.3/100,000. ASR was 3.9/100,000 for males and 70 among females (range 7-95 years).

35 male female

15 AIR (per 100,000) 10

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.13.1 Age-Specific Incidence Rate (AIR) for Bladder Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Male % Female %

8130 Papillary transitional cell carcinoma 94 47.7 16 42.1 8120 Transitional cell carcinoma, NOS 69 35.0 14 36.8 8000 Neoplasm, malignant 84.1 12.6 8070 Squamous cell carcinoma, NOS 84.1 12.6 8071 Squamous cell carcinoma, keratinizing, NOS 42.0 25.3 8140 Adenocarcinoma, NOS 42.0 12.6 8010 Carcinoma, NOS 21.0 12.6 8072 Squamous cell carcinoma, large cell, nonkeratinizing, NOS2 1.012.6 Others 63.0 12.6 Table 3.13.1 Morphological Distribution of Bladder Cancer in Saudi Arabia, 2009

15.2% 14.7% 13.2% 15.8% 14.9% 14.9% Distant Localised

18.7% Regional 17.8% 23.7% Unknown 52.3% 47.4% 51.5% Male Female All

Figure 3.13.2 Stage Distribution of Bladder Cancer, 2009

P03a.indd 60 16/02/2013 12:16:44 PM 1.0 Riyadh 5.9 0.9 Eastern 5.2 1.9 Tabuk 3.6 0.0 Northern 5.3 0.9 Madinah 4.1 1.2 Qassim 3.7 1.1 Jouf 3.2 0.6 Makkah 3.6 2.8 Jazan 1.0 0.3 Asir 3.4 0.0 Baha 2.0 0.0 Najran 1.4 0.0 Hail 0.4

0 12345 67

Figure 3.13.3 ASR* Regional Distribution of Bladder Cancer in Saudi Arabia, 2009

8.7 United States of America 36.3 5.5 United Kingdom 18.9 5.1 Egypt 18.0 2.2 Tunisia 19.0 3.2 Bahrain 13.8 1.6 Jordan 12.1 1.9 Qatar 11.6 2.5 South Africa 10.1 3.0 Kuwait 7.2 1.5 Korea 8.5 1.9 United Arab Emirates 5.4 2.2 Oman 4.8 1.8 Uganda, kyadondo 3.0 0.7 Saudi Arabia 3.9

0510 15 20 25 30 35 40

Figure 3.13.4 Comparison of ASR* for Bladder Cancer among Saudis with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 61 16/02/2013 12:16:44 PM Ovarian Cancer (C 56)

There were 173 cases of ovarian cancer among with the highest ASR were Tabuk region at females accounting for 3.3% of all newly diagnosed 7.3/100,000, Riyadh region at 3.9/100,000, Makkah cases among females (5,205) in year 2009. This region at 3.4/100,000, Eastern region at 3.2/100,000, cancer ranked seventh among female population. and Qassim region at 3.2/100,000. The median age The ASR was 3/100,000 for females. The five regions at diagnosis was 51 years (range 0-97 years).

6 AIR (per 100,000) 4

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 3.14.1 Age-Specific Incidence Rate (AIR) for Ovarian Cancer in Saudi Arabia, 2009

ICD-O-3 Morphology Female %

8460 Papillary serous cystadenocarcinoma 30 17.3 8441 Serous cystadenocarcinoma, NOS 28 16.2 8140 Adenocarcinoma, NOS 22 12.7 8480 Mucinous adenocarcinoma 17 9.8 8000 Neoplasm, malignant 15 8.7 8010 Carcinoma, NOS 95.2 8380 Endometrioid adenocarcinoma, NOS 95.2 9060 Dysgerminoma 74.0 8461 Serous surface papillary carcinoma 63.5 9080 Teratoma, malignant, NOS 52.9 9085 Mixed germ cell tumor 42.3 8310 Clear cell adenocarcinoma, NOS 31.7 8260 Papillary adenocarcinoma, NOS 21.2 8470 Mucinous cystadenocarcinoma, NOS 21.2 8950 Mullerian mixed tumor 21.2 Others126.9

Table 3.14.1 Morphological Distribution of Ovarian Cancer in Saudi Arabia, 2009

10.4%

13.9% Distant Localised 55.5% Regional Unknown 20.2%

Female Figure 3.14.2 Stage Distribution of Ovarian Cancer, 2009

P03a.indd 62 16/02/2013 12:16:45 PM Tabuk 7.3

Riyadh 3.9

Makkah 3.4

Eastern 3.2

Qassim 3.2

Najran 3.0

Madinah 3.0

Asir 2.5

Jouf 2.2

Baha 1.8

Northern 1.2

Jazan 0.7

Hail 0.3

01 2345678

Figure 3.14.3 ASR* Regional Distribution of Ovarian Cancer in Saudi Arabia, 2009

United Kingdom 17.2

United States of America 12.7

Singapore 12

Norway 10.2

Uganda, kyadondo 8.1

Bahrain 7.4

Western Australia 7.3

Qatar 7.2

Egypt 5.2

Korea 5.2

Kuwait 5.1

Oman 4.5

United Arab Emirates 4.2

Tunisia 3.3

Saudi Arabia 3.0

0246 8101214161820

Figure 3.14.4 Comparison of ASR* for Ovarian Cancer among Saudi Females with ASR in Selected Countries**

* ASR Per 100,000 ** Source for this information is summarized on page 64

P03a.indd 63 16/02/2013 12:16:45 PM ** Sources:

1 Singapore Cancer Registry, Interim Annual Registry Report, Trends in Cancer Incidence in Singapore 2005-2009. Available from: http://www.nrdo.gov.sg/uploadedFiles/NRDO/Cancer_Trends_Report_05-09.pdf

2 Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2009. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322196/

3 Cancer in Norway 2009. Available from: http://www.kreftregisteret.no/Global/Publikasjonerograpporter/CancerinNorway/Cancer_in_ Norway_2009_and_Special_Issue.pdf

4 Cancer Incidence in Jordan 2009. Available from: http://www.moh.gov.jo/MOH/Files/Publication/AnnualIncidenceofcancerinJordan2009.pdf

5 Incidence 2009-UK, May 2012. cancerresearchuk.org. Available from: http://publications.cancerresearchuk.org/downloads/Product/CS_CS_INCIDENCE.pdf

6 Surveillance, Epidemiology, and End Results (SEER). Available from: http://seer.cancer.gov/csr/1975_2009_pops09/sections.html

7 Cancer incidence and mortality in Western Australia, 2009 A report of the Western Australian Cancer Registry. Available from: http://www.health.wa.gov.au/docreg/Reports/Diseases/Cancer/WACR_Cancer_incidence_ mortality_main_2009.pdf

8 Ten Years Cancer Incidence among Nationals of the GCC States, 1998-2007.

9 GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide. IARC Cancer Base No. 10, Lyon: International Agency for Research on Cancer. Available from: http://globocan.iarc.fr.

10 Cancer Epidemiology and Control in the Arab World - Past, Present and Future. Available from: http://www.apocpcontrol.com/paper_file/issue_abs/Volume10_No1/3bSalim.pdf

11 Overview of the South African cancer research environment as a basis for discussions concerning the activation of carisa (Cancer Research Initiative of South Africa), 2002. Available from: http://www.sahealthinfo.org/cancer/overviewdocument.pdf

12 Egypt National Cancer Registry Damietta Profile – 2009. Available from: http://www.cancerregistry.gov.eg/uploads/mainfiles/DamiettaCancerProfile.pdf

13 Cancer in Five Continents Vol IX, IARC. Scientific Publication, Lyon, France, 2007.

P03a.indd 64 16/02/2013 12:16:45 PM PART IV CANCER AMONG NON-SAUDIS 2009

P04a.indd 65 16/01/2013 04:18:55 PM P04a.indd 66 16/01/2013 04:18:55 PM Cancer Among Non- Saudi Population 2009

Between January and December 2009, a total that cancer is primarily a disease of the elderly, the of 2,948 cancer cases were reported among the pattern of cancer had some significant differences. Non-Saudi population. Seventy nine in situ cases Those under 15 years of age represented 19.4%, and 7 were ICD-O-3 coded cases that failed to over 60 years represented 2% and the 15 to convert to ICD-10 codes as described in the data 59 age-group represented 78.7% of non-Saudi Management (see page 12). This puts the total population. During 2009, approximately 3.6% of number of exclusions from the analysis as 86 cases. all cancers occurred before the age of 15, 23.2% As a result, the total number of cases analyzed were occurred between the ages 15 to 39 years, 57.6% 2,860 out of this 1540 (53.8%) were males and were between the ages 40-64, and 14.2% occured 1,320 (46.2%) were females. The male to female after the age of 64. The median age at diagnosis ratio was 117:100. Taking into consideration the was 52 years in males (range 0-95 years) and 45 population structure of non-Saudis and the fact years in females (range 0-108 years). Cancer No.%

Breast 55219.3 Colo-Rectal 32311.3 Leukemia 1605.6 Skin 1525.3 NHL 1485.2 Thyroid 1294.5 Prostate 1174.1 Lung 111 3.9 Stomach 86 3.0 Bladder 81 2.8 Other Sites 1001 35.0 Table 4.1 Ten Most common Cancers among non-Saudis, 2009

Nationality Male %Female% All% Yemen 274 17.3 19514.3469 15.9 Egypt 220 13.9 14210.4362 12.3 Sudan 141 8.9122 9.0263 8.9 Philippines 110 6.9132 9.7242 8.2 Pakistan 115 7.3685.0 1836.2 Syrian Arab Republic 103 6.5725.3 1755.9 India 100 6.3594.3 1595.4 Indonesia 15 0.9856.2 1003.4 Palestinian 75 4.7533.9 1284.3 Jordan 43 2.7533.9 96 3.3 Bahrain 21 1.3362.6 57 1.9 Bangladesh 46 2.990.7551.9 Eritrea 22 1.4322.3 54 1.8 United States of America 40 2.5131.0 53 1.8 Ethiopia 90.6 42 3.1511.7 Somalia 18 1.1261.9 44 1.5 United Kingdom 29 1.8110.8 40 1.4 Morocco 12 0.8231.7 35 1.2 Lebanon 19 1.2131.0 32 1.1 Nigeria 17 1.1151.1 32 1.1 Chad 15 0.9161.2 31 1.1 Afghanistan 16 1.0131.0 29 1.0 Kuwait 80.5 16 1.2240.8 Sri Lanka 10 0.6100.7 20 0.7 Myanmar (formerly Burma) 30.2 15 1.1180.6 Canada 80.5 80.6 16 0.5 Qatar 10.1 50.4 60.2 Oman 10.1 10.1 20.1 Other Nationalities 95 6.0775.7 1725.8 Table 4.2 Distribution of Cancer Cases among Different Nationalities in Order of Relative Frequency, 2009

P04a.indd 67 16/01/2013 04:18:56 PM Male 1540 Female 1320

Colo-rectal 233 15.1% Breast 542 41.1% Prostate 117 7.6% Colo-rectal 90 6.8% Skin 114 7.4% Thyroid 83 6.3% Leukemia 99 6.4% Leukemia 61 4.6% NHL 94 6.1% NHL 54 4.1% Lung 80 5.2% Cervix Uteri 51 3.9% Bladder 65 4.2% Corpus Uteri 43 3.3% Stomach 60 3.9% Skin 38 2.9% Hodgkin disease 49 3.2% Ovary 33 2.5% Brain, CNS 46 3.0% Lung 31 2.3% Thyroid 46 3.0% Stomach 26 2.0%

Figure 4.1 Ten Most Common Cancer among non-Saudis by sex, 2009

800

700 male female

600

500

400

300 AIR (per 100,000) 200

100

0 0- 5- 10- 15- 20- 25- 30- 35-40- 45-50- 55-60- 65-70- 75+ Age Groups

Figure 4.2 Age-Specific Incidence Rate (AIR) for All Cancers among non-Saudis in Saudi Arabia, 2009

P04a.indd 68 16/01/2013 04:18:56 PM PART V TABLES

P05a.indd 69 16/01/2013 04:20:55 PM ) .1 .8 .4 .0 .0 .1 .0 .5 .4 .6 .5 .4 .5 .1 .2 .4 .3 .3 .1 .5 .5 .0 .6 .0 .8 .1 .0 .3 .0 .6 .1 .4 .1 .2 .0 .2 .9 .4 0. 9 1. 2 0. 7 2. 0 7. 4 3. 9 6. 0 6. 4 3. 1 9. 1 3. 1 3. 6 6. 0 96. 1 100. 0 Total (% 00 70 10 00 00 00 00 70 50 00 40 11 60 10 71 40 00 11 10 20 10 00 60 00 00 64 00 20 71 54 16 32 21 63 44 23 11 63 10 19 10 63 48 56 73 42 45 819 108 867 75+ 71 12 71 45 78 03 01 2 21 24 09 08 01 29 35 41 35 25 31 498 533 70-74 61 71 61 71 94 24 71 11 56 22 63 50 22 57 34 22 26 472 494 65-69 51 21 04 71 55 71 72 05 39 24 36 29 18 28 408 432 60-64 51 85 42 44 01 83 51 02 30 10 26 31 37 320 330 55-59 4267 068847 969 21 73 01 05 11 61 42 77663 18 968 38 27 27 14 37 348 357 50-54 41 51 61 21 21 31 11 81 31 01 5 30 14 11 29 26 20 294 300 45-49 11 77 11 21 11 01 11 01 27 27 20 11 241 247 40-44 91 51 01 52 31 11 81 13 12 12 13 23 153 153 35-39 796450001 10 14 23 12 129 138 30-34 9336 58 22 26 15 133 137 25-29 62223210110 6614355 66 71 14 25 18 16 138 145 20-24 8 2 11 27 22 135 136 15-19 21 26 92 31 24 18 116 116 10-14 00000000111120 00011141321576 00000000000000 00000000000100 012219 00000000100000 000000015269 01000101001010 61 00011100010011 53562646681032 00020011323042 00000000000101 00000000000001 00000000200010 00000000000010 11100010100321 31100000000001 01100101000001 00101220 430006 41 11 41 00111010120120 -9 83 10 83 0 0 0 0 0 0 0 0 1 6 1 0 0 0 0 0 0 1 2 9 01 08 22 3 0- 45 150 150 0000000120464474 0010020016011112 0000000032044334 0000000021265669 02 0000001003522352 0000000000000100 01 01 0 01011030 0001317 02210204 0000000167 0000000000 0110012428 000017490669 0000000012000001 0100000012 01 00001313 02 04 01 04 06 05111442 0000000000021003 00000256 0000000000000001 0000010102132312 02116 00014 0111112001220013 Age Unk 60 00 10 10 50 20 20 50 10 50 90 30 70 30 00 30 70 70 42 17 30 56 59 33 28 18 55 21 74 18 201 341 295 117 276 181 295 174 197 145 194 422 180 145 166 276 141 61 80 4437 All Ages .1 e7 s1 n1 a5 a5 x9 x6 elanoma of Ski ultiple Myelom esotheliom ther Oropharynx ther Skin ther male genital ther Urinary organs ther Endocrine ther & unspecified rete r2 ll sites but C44 harynx unspecified. tomach ancreas aposi sarcoma enis idney ladder drenal gland ll sites Tota l4 nus onsil estis hyroid ip iver arynx ymphoid Leukemia eukemia unspecified mmunoproliferative dis Tongue Mout h3 Salivary glands Nasopharyn Oesophagu s6 Small intestine Colon Gallbladder etc. Nose, sinuses etc. Trachea, Bronchus, Lung Bone Connective, Soft tissu Breas t2 Prostate Renal Pelvis Eye Brain, Nervous system Hodgkin disease Non-Hodgkin lymphoma Myeloid Leukemia Site Hypopharyn Rectum Other Thoracic organ C0 0L Not C4 4A C01-C02 C03-C06 C07-C08 C0 9T C1 0O C11 C1 4P C15 C1 6S C17 C18 C2 2L C23-C24 C2 5P C30-C31 C3 2L C33-C34 C40-C41 C4 3M C4 4O C4 6K C47;C49 C50 C6 0P C61 C6 3O C6 4K C65 C6 6U C6 7B C6 8O C69 C70-C72 C7 4A C7 5O C81 C82-C85;C96 C9 0M C9 1L C92-C94 Othe rO ICD (10th) C12-C13 C19-C20 C4 5M C37-C38 C6 2T C7 3T C8 8I C9 5L Al lA C2 1A Table 5.1.1 Number of Cancer Cases among Saudi Males by Primary Site and Age Groups, 2009 Groups, Age Primary Site and 5.1.1 Number of Cancer Cases among Saudi Males by Table

P05a.indd 70 16/01/2013 04:20:55 PM .2 .7 .7 .4 .1 .0 .8 .2 .1 .2 .5 .7 .3 .6 .6 .1 .3 .0 .2 .8 .2 .7 .2 .1 .2 .1 .1 .5 .3 .2 .2 .3 .1 .0 .0 .4 .2 .0 .9 .0 .7 .4 .4 .4 .1 5. 5 3. 7 4. 9 1. 9 1. 7 2. 0 0. 9 0. 7 97.3 10.3 25.1 100. 0 Total (% ) 02 85 92 51 82 52 53 73 00 40 80 10 00 00 30 10 10 30 10 00 50 00 00 10 00 00 41 10 00 30 00 00 82 00 00 00 30 00 00 72 10 70 32 62 40 86 21 12 37 28 52 35 10 20 10 13 12 5+ 24 22 03 22 63 81 91 61 10 29 17 50 34 11 32 84 34 45 70-7 47 92 12 12 42 21 51 16 61 27 42 18 21 25 20 83 43 16 19 5-69 33 91 01 61 01 61 71 13 19 20 23 16 29 11 40 24 41 84 60-6 46 12 31 31 11 81 49 79 81 12 20 15 30 24 32 35 11 41 5-59 53 41 07 91 21 76495 70 13 40 31 17 11 34 11 20 52 34 53 14 50-5 45 2 44 01 48 41 31 11 72 86 18 66 23 25 12 17 23 71 5-49 23 0453233 71 61 41 71 81 81 09 15 56 15 16 17 10 49 15 49 55 40-4 44 32 11 42 49 13 77 13 11 13 13 22 35-3 9 11 566436783 93 10 59 16 27 13 27 73 30-34 76 873 71 44 14 11 68 16 232 240 25-29 4 91 00000000000 02002426351 33510102021 01002011011 00001110001 43334241345 00035653650 00002001000 00000000000 33217572411 01120362585 10012010010 2867 00002320300 86353631320 00000100011 00101011102 4768 00100001100 01013205427 00000000000 00112363754 10002102211 3194 00000000000 10 54 14 165 167 20-24 41 72 7 0 24 11 136 137 15-19 6 59 7 00 1000001001300 81 93 11 0-14

26 1733 81 26 12 5- 91 14 21 01 61 06 000000110233021 000000000010022 000000000001214 0000 000111022412384 0000 0003 000000000020000 0000 010001000110010 3000 25 0000 00 9426 0001 0000 0001 000111113200000 0000 0100 2000 -4 13 97 13 97 00000 0621000000000100 00000 00000 000000277 0002320026111011 00000 0100000003030012 0000000044334023 000022 00000137 040022202 00000000376 0100010128658 0000000100122412 00101032278 00011 01000033 011174 02 0000000000000010 01 01 0001 02 0325 00000 04 01 03132 02201 000000394 00000 ge Un k0 40 70 70 20 60 30 00 50 00 80 60 80 30 30 50 90 40 30 80 30 20 10 28 21 11 26 87 82 18 22 39 23 253 299 193 136 103 141 101 173 120 103 538 150 287 127 126 162 112 506 40 130 80 520 50 All Age sA .1 s0 n8 a1 x4 r3 out h3 elanoma of Ski esotheliom ultiple Myeloma ther Oropharyn x0 esophagu s4 allbladder etc. ther Thoracic organs ther Skin vary ther Female Genital ther Endocrine ther & unspecified ther Urinary organ terus unspecified. orpus Uteri asopharyn ypopharynx olon ectum ose, sinuses etc. onnective, Soft tissu e6 ervix Uteri enal Pelvis rete r1 odgkin disease drenal gland nu s1 ulva alivary glands harynx unspecified. ancreas on e4 aposi sarcoma agina lacent a1 idney ladde ll sites Total tomach ongu e3 onsil rachea, Bronchus, Lung hyroid ip iver mmunoproliferative dis Site All sites but C44 Small intestine Larynx Breast Eye Brain, Nervous system Non-Hodgkin lymphoma Lymphoid Leukemia Myeloid Leukemia Leukemia unspecified 2T 6M 8S 3H 0R 4G 1N 4T 8O 1B 9C ICD (10th) Not C44 C7 4A C8 8I C2 1A C5 1V C5 5U C5 4C C0 0L C01-C0 C03-C0 C07-C0 C0 9T C1 0O C1 1N C12-C1 C1 4P C1 5O C17 C1 8C C19-C2 C2 2L C23-C2 C2 5P C30-C3 C32 C33-C3 C37-C3 C40-C4 C4 3M C4 4O C4 5M C4 6K C47;C4 C50 C5 2V C5 3C C5 6O C5 7O C5 8P C6 4K C6 5R C6 6U C6 7B C69 C70-C72 C7 3T C7 5O C8 1H C82-C85;C96 C9 0M C91 C92-C94 C95 Othe rO Al lA C1 6S C6 8O Table 5.1.2 Number of Cancer Cases among Saudi Females by Primary Site and Age Groups, 2009 Groups, Age Primary by Site and 5.1.2 Number of Cancer Cases among Saudi Females Table

P05a.indd 71 16/01/2013 04:20:55 PM 3 0 0 0 0 0 .8 .3 .4 .1 .1 .2 .9 .4 .8 .4 .1 .1 .3 5. 1 6. 5 0. 1 1. 5 0. 6 2. 3 0. 6 5. 7 3. 1 3. 9 3. 9 0. 1 6. 8 0. 3 0. 8 0. 6 2. 3 0. 1 0. 1 6. 1 1. 3 2. 3 3. 5 0. 2 5. 9 1. 1 0. 1 77. 4 80. 9 ASR Worl d 40 20 20 10 61 10 80 20 80 30 62 52 61 62 20 00 00 00 .7 .9 .1 .3 .1 .6 .8 .1 .2 .1 .6 .2 .5 .4 .1 .1 .2 .7 .3 .2 .2 .6 .1 0. 0. 0. 0. 0. 1. 0. 0. 0. 1. 0. 0. 0. 0. 1. 48.1 50.1 Crude Rate 73 00 00 00 00 00 00 .1 .8 .8 .3 .9 .8 .9 .9 .6 .9 .6 .8 .8 .1 .4 1. 60 5. 81 5. 80 4. 92 0. 80 0. 80 0. 80 3. 30 8. 20 8. 20 674 714 75+ 51. 93 13. 21 34. 61 46. 13 36. 22 45. 32 60. 14 13. 22 88. 93 22. 20 27. 21 39. 52 66. 73 15. 60 00 00 .3 .3 .2 .5 .1 .2 .1 .1 .3 .2 .1 .7 .1 2. 24 6. 55 2. 25 2. 23 1. 14 3. 21 1. 10 1. 14 7. 59 2. 20 1. 10 535 573 33. 33 31.2 23.7 10. 89 10. 89 26.9 44.1 34.4 10. 86 47.3 37.6 66.7 11.8 10.8 37.6 10. 87 50.5 70-74 01 03 01 01 01 01 .9 .5 .8 .5 .7 .9 .6 .9 .9 .9 .5 .9 .5 0. 90 0. 90 7. 44 2. 84 5. 63 1. 90 4. 67 1. 90 00 5.6 0. 90 00 6. 54 4. 62 5. 69 437 457 24.1 46.3 11.1 10.2 52.7 20.4 24.1 17.6 31.5 50.9 15.7 20.4 38.9 65-69 02 03 00 00 00 .6 .1 .9 .8 .6 .2 .3 .6 .7 .5 .9 .8 14 1. 90 3. 26 0. 60 5. 16 3. 25 0. 6000 1. 91 0. 60 0. 60 3. 86 5. 76 259 274 17.8 24.8 10.8 22.9 11.4 17.1 18.4 22.2 10.8 15.2 25.4 60-64 00 00 .9 .5 .5 .1 .8 .4 .8 .5 .6 .5 .5 .7 .9 .8 2. 85 1. 91 3. 33 2. 43 2. 46 0. 50 0. 50 3.8 2. 85 1. 92 0. 91 8.5 2. 43 4.7 151 156 17.5 14.2 12.3 14.7 16.1 55-59 10 000 00000 00 00 .3 .5 .4 .4 .7 .5 .7 .3 .7 .8 .7 .1 .7 .8 .1 .5 0. 70 2. 80 5. 67 3. 12 0. 71 0. 30 9.4 4. 93 1. 7000 4. 99 4. 26 9.4 0. 70 0. 30 3. 14 3. 12 4. 90 5.9 121 124 12.9 13.2 50-54 01 0000 0000 .3 .1 .8 .6 .9 .4 .8 .8 .9 .1 .5 .5 .9 .5 .3 .6 .1 80 82 0.5 8.2 0. 50 4. 13 4. 12 0. 53 0. 30 1. 41 0. 30 2. 73 0.3 1. 40 1. 12 1. 40 0. 53 0. 52 1. 63 45-49 00 01 .9 .7 .4 .4 .2 .7 .4 .2 .4 .7 .4 .2 .5 53 54 0. 40 4. 47 0. 20 1. 31 4. 64 2. 45 0. 20 0. 20 1. 73 1. 31 2. 23 1. 51 1. 30 2. 43 1. 33 5. 97 0. 20 0.2 2. 63 1. 31 40-44 00 00 .4 .7 .7 .9 .2 .2 .4 .6 .5 .2 .2 .2 .9 .4 .5 .2 28 28 2. 45 0. 40 1. 62 0. 50 1. 42 0. 20 0. 70 0. 22 0. 20 0. 40 0. 20 0. 40 1. 11 35-39 00 00 11 00 00 00 .5 .3 .3 .1 .1 .3 .1 .1 19 20 0. 10 0. 92 0. 1000 0. 10 0. 10 0. 90 0. 90 1. 24 0. 60 1. 82 0. 40 0. 10 0. 60 1. 30 0. 40 3. 42 0. 30 30-34 00 00 .6 .1 .1 .3 .9 .3 .3 .8 .9 .1 .4 .5 .1 .1 .3 17 17 0. 91 0. 30 0. 11 2. 82 0. 10 0. 80 0. 50 0. 10 25-29 00 00 000000000 00 00 .1 .6 .2 .6 .1 .6 .4 15 15 0. 10 0. 20 0. 10 0. 10 0. 60 0. 71 0. 20 0. 10 0. 10 1. 70 1. 71 0. 30 0. 20 0. 20 0. 70 1. 51 1. 93 0-24 .5 .4 .1 .6 .1 .1 .1 .1 .1 .1 .1 .1 .6 .2 13 13 0. 30 1. 80 0. 20 2. 72 0. 10 2. 20 0. 10 15-1 92 00 00 00 00 00 .1 .1 .1 .2 .8 .1 11 11 0. 30 0. 10 0. 1000 0. 10 0. 3000 0. 10 1. 21 0. 10 0. 10 0. 10 0. 10 0. 10 1. 10 1. 72 0-14 000 000 00000000 00000000000 000 00 000 00000000000 000000000000 00000000 00 00000000 00 00000000000000 00000000 000000 000 00000000000 00 000000 000000 0000 .4 .1 .1 .4 .1 .4 .1 .3 .1 .2 .7 0. 51 0. 92 2. 11 0. 10 5- 91 27 0 27 0 0 0 0 0 0 0 00 0 00 10 00 0 0 00 00 0 0 00 00 0 .2 .3 .2 .5 .4 .1 -4 0.1 0. 50 0. 10 0. 10 1. 60 0. 90 0. 50 0. 20 0. 10 0. 20 0.1 1. 71 0. 80 01 00000000 00 00 00 01 00000000 00000000000000 00 00 00000000000000 000000 0000000000 000000 03 00 00 00 Age Un k0 10 30 00 90 80 80 40 80 70 30 70 50 20 20 10 60 60 00 10 50 50 20 50 41 94 80 66 95 30 59 93 67 55 17 42 33 56 618 27 60 27 60 17 40 14 10 14 50 19 70 20 10 29 50 18 10 14 50 42 20 11 70 4437 All Ages g .1 .1 a1 ans homa stem g an s1 p n1 y g nx s e1 m ecified y y s1 p ecified. or ecifie d1 enital p y p g elom a5 ha r nx nx us kin l y p land y y lan d1 roliferative dis g g g g p

y ha ha r ha r le M nx un s y hoid Leukemi kin diseas p p p ue y p nx p g osi sarcoma o g roid y eloid Leukemia p e2 y m elanoma of Ski y esothelioma ulti ther Urinar p es o ther Or o ther Skin ther male ther & un s ther Endocrine enal Pelvis olo n3 onnective, Soft tissu e7 yp as o od nu s2 ll sites but C44 idne ll sites Tota l4 a y ha r ladder tomach enis drenal ancreas esti s7 h onsil y i eukemia uns iver ar Site Rectum H Ureter Non-Hod Other Thoracic or Small intestine Immuno Bone M Mout h3 To n Prostat e2 Salivar Nose, sinuses etc. Trachea, Bronchus, Lun Breas t2 Brain, Nervous Gallbladder etc. 9C ICD (10th) C2 1A Not C4 4A C19-C20 C6 5R C66 C12-C13 C1 8C C82-C85;C96 C4 3M C6 4K Al lA C37-C38 C6 8O C17 C4 6K C88 C40-C41 C92-C94 C03-C06 C47;C4 C01-C02 C1 4P C0 0L C1 1N C61 C6 2T C6 7B C7 3T C9 5L C1 6S C1 5O C07-C08 C0 9T C1 0O C2 2L C30-C31 C3 2L C33-C34 C4 4O C4 5M C50 C6 0P C6 3O C70-C72 C7 4A C9 1L Othe rO C6 9E C9 0M C7 5O C23-C24 C2 5P C8 1H Table 5.1.3 Age-Specific Incidence Rate (AIR), Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site and Age Groups, 2009 Groups, Age by Primary Site and Incidence Rate (ASR) among Saudi Males (per 100,000) Age-Standardized Incidence Rate (AIR), Age-Specific 5.1.3 Table

P05a.indd 72 16/01/2013 04:20:55 PM 0 0 0 0 0 0 .7 .3 .7 .9 .5 .7 .7 .3 .7 .8 .4 .1 .7 .1 .8 .8 .6 .1 .1 .5 .7 .1 .5 .8 .4 .1 1. 9 0. 1 0. 1 0. 5 0. 1 0. 1 7. 6 0. 2 0. 7 0. 1 0. 2 2. 1 0. 2 5. 3 0. 1 0. 3 0. 8 1. 7 0. 1 0. 7 22.7 90.1 87.4 ASR World 40 20 50 50 30 45 23 20 52 20 22 10 62 70 11 30 93 10 21 71 25 41 41 30 83 11 00 00 .4 .1 .5 .1 .1 .1 .1 .4 .1 .1 .3 .1 .8 .2 .4 .9 .1 .4 57 1. 0. 3. 3. 1. 1. 1. 0. 0. 2. 0. 1. 1. 1. 1. 0. 1. 1. 0. 0. 0. 0. 0. 0. 0. 14.7 58.6 Crude Rate 00 00 00 00 00 00 00 00 00 00 00 00 00 .9 .8 .4 .5 .4 .5 .5 .4 .4 .1 .7 .8 .5 .8 .2 39 10 11 5+ 0. 16 6. 91 9. 52 2. 60 0. 10 6. 71 0. 80 3. 40 0. 80 0. 80 0. 80 2. 50 5. 90 31.2 40.5 43.8 12.6 23.6 16.9 31.2 24.5 15.2 29.5 00 03 56 .3 .5 .3 .5 .5 .3 .5 2. 51 5. 11 2. 72 2. 61 3. 85 1. 30 2. 58 6. 32 1. 33 3. 82 1. 32 1. 30 3. 88 6. 35 1. 30 1. 32 1. 30 2. 54 2. 50 8. 81 43 24 41 24 36.4 27.6 62.7 11.3 21.3 13.8 25.1 27.6 20.1 70-7 47 07 91 00 .7 .9 .6 .9 .8 .8 .5 .2 .2 .1 .9 .9 .8 .9 .8 00 87 10 10 0. 91 8. 94 7. 27 0. 91 1. 82 1. 81 4. 50 0. 95 0. 90 0. 92 7. 26 0. 90 4. 55 5. 42 0. 90 22.6 35.3 75.1 16.3 18.1 14.5 12.7 13.6 65-6 9 00 23 27 01 21 24 00 000 01 61 200 .6 .7 .3 .3 .6 .3 3. 21 9. 23 1. 32 4. 61 0. 70 1. 30 6. 61 4. 67 2. 68 2. 60 0. 70 2. 60 2. 61 27 74 26 63 15.2 15.2 74.8 12.6 10.6 10.6 12.6 10.6 0-64 00 000 0000 0200 00 00 13 00 .5 .5 .6 .5 .5 .5 .1 .7 .6 .1 .1 .6 .5 .5 .6 .6 .1 .5 .6 15 11 5. 31 7. 91 4. 16 1. 54 0.5 0.5 0. 51 1. 54 4. 17 12.3 15.8 58.3 16.4 5-5 96 000 00 010 01 00000 426 00000 00000 02 00000 .4 .8 .7 .2 .4 .1 .2 .2 .8 .4 4. 61 2. 41 1. 81 0. 40 3. 73 1. 50 1. 12 0.4 1. 10 0. 73 4. 87 0. 41 4. 45 0.7 1. 13 2. 63 6. 96 0. 40 2. 61 1. 11 5. 16 7. 33 2. 94 0. 40 0. 71 19 42 19 12 11.3 16.4 62.1 50-5 45 00 00 00 00 01 51 00 .2 .1 .6 .3 .9 .3 .7 .2 .2 .7 .3 .2 .2 .2 .9 .9 .6 .5 .8 .3 .5 .6 .9 .3 .1 .3 .6 71 67 9. 21 0.3 3. 54 1. 71 7. 36 1.7 0. 92 0. 92 1. 71 0. 30 69.1 5-49 00 00 59 00 00 .9 .1 .7 .6 .5 .5 .7 .3 .2 .5 .8 2. 81 2. 31 0. 50 1. 64 0. 90 0. 90 0. 20 0. 71 0. 51 3. 45 3. 46 0. 50 0. 51 1. 83 0. 50 0. 70 1. 41 1. 63 1. 83 1. 40 1. 61 1. 42 1. 62 0. 94 0. 20 0. 70 11 31 11 21 47.8 40-4 44 23 00 00 00 .2 .5 .6 .2 .4 .7 .9 .4 .4 .7 .4 .2 .1 .6 .7 .4 .2 .2 .4 .4 .3 .2 64 63 4. 11 2. 43 0. 61 0. 61 0. 20 0. 40 1. 32 0. 20 0. 41 24.2 35-3 9 00 00 00 00 00 00 00 00 000 .5 .1 .2 .1 .2 .2 14 42 41 0. 90 0. 91 0. 20 0. 50 0. 80 0. 50 1. 52 2. 42 1. 40 1. 72 0. 20 0. 81 8. 91 1. 10 1. 40 0. 30 0. 20 0. 30 0. 91 0. 20 0. 20 0-34 00 00 00 .2 .1 .9 .4 .1 .4 .8 .6 .3 .8 .1 .4 .9 .3 .1 .4 .7 .1 .4 .4 .1 .1 31 30 0. 40 0. 41 0. 10 0. 31 5-2 93 00 00 00 68 00 00 00 00 .1 .1 .1 19 18 3. 22 0. 40 0. 40 0. 10 0. 30 0. 90 1. 15 0. 41 1. 62 1. 61 0. 10 0. 20 0. 20 0. 20 0. 21 0. 10 0. 31 0. 30 0. 30 20-2 42 00000000 00 00 00 00 0000 14 14 3.8 0.9 0.1 0.7 0.6 0.1 0.7 2.5 1.1 1.4 0.2 0.3 0.2 0.2 0.1 0.1 0.1 0.3 0.1 0.1 0.3 5-19 00 1 0 00 0 00 0.8 0.1 1.4 0.2 0.1 0.1 0.5 0.8 0.3 0.2 0.1 0.1 0.7 10-1 41 0000 00000000000000 00 000000 00 00 1 76 76 0.4 1.1 0.2 0.5 1.6 0.1 0.4 0.1 0.1 0.2 0.5 0.1 0.2 0.1 0.1 5-9 000000 0000 000000 000000000 00000000 0000 00000000000 0000 000 000000 0 00000000 0000000000000 00 0000000000 000 000000 0000000000 0 12 12 0.1 0.2 1.8 0.2 0.5 0.2 0.3 0.1 0.3 0.1 0.8 0.1 0.9 0.3 0.9 0.3 0.2 0-4 0000000000 0 0 0000000000 0 0 00000000 0000 0000 04 0 000 00000000 00000000000 000000 0000 00000000 0 000 000000 0000 00 000000 0 0 0000 01 Age Unk 60 00 30 80 10 40 00 50 20 80 80 30 30 40 10 10 80 00 50 01 20 50 27 93 41 53 26 37 37 21 46 87 82 10 38 39 23 22 20 50 06 40 11 20 29 90 13 60 10 30 17 30 10 30 53 80 28 70 16 20 1308 All Ages s9 a1 .2 a1 e1 e2 e2 a1 d1 x1 x4 a3 y1 esophagus allbladder etc. vary enal Pelvis ervix Uter i1 odgkin diseas olon ectu m1 orpus Uter i2 on-Hodgkin lymphoma asopharyn ose, sinuses etc. eukemia unspecified. aryn x1 Vagin Melanoma of Skin Vulv a6 Other Endocrin Tongue Mouth Bon e4 Kidne Adrenal glan Pharynx unspecified. Small intestin Kaposi sarcoma Uterus unspecified Site Salivary glands Tonsi l3 Other Oropharyn x0 Hypopharyn Stomach Anu s1 Liver Pancreas Trachea, Bronchus, Lung Other Ski n1 Mesotheliom Connective, Soft tissu e6 Breast Placenta Ureter Bladder Brain, Nervous system Thyroid Immunoproliferative dis. Multiple Myeloma Lymphoid Leukemi Myeloid Leukemi Other & unspecified All sites Tota l5 Lip Other Thoracic organ Other Female Genita l8 All sites but C4 45 Other Urinary organs Eye 6N 0R 4G 1N C6 5R C52 C5 3C C43 C51 C75 C8 1H C64 C74 C01-C02 C03-C06 C40-C41 C14 C17 C46 C55 ICD (10th) C10 C1 5O C67 C70-C72 C90 C91 C07-C08 C09 C12-C13 C16 C1 8C C19-C2 C21 C22 C23-C2 C25 C33-C34 C44 C45 C47;C49 C50 C5 4C C5 6O C58 C66 C73 C82-C85;C9 C88 C92-C94 C9 5L Other All C00 C37-C38 C57 Not C44 C1 1N C30-C3 C3 2L C68 C69 Table 5.1.4 Age-Specific Incidence Rate (AIR), Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site and Age Groups, 2009 Groups, Age by PrimaryFemales (per 100,000) Site and Incidence Rate (ASR) among Saudi Age-Standardized Incidence Rate (AIR), Age-Specific 5.1.4 Table

P05a.indd 73 16/01/2013 04:20:56 PM 0 0 0 0 1 3 0 1 0 .4 .6 .6 .8 .8 .2 .6 .5 .3 .6 .1 .2 .6 .4 .3 .5 .2 .8 .4 8 0. 8 0. 5 0. 2 0. 3 0. 3 1. 1 0. 3 1. 7 0. 6 0. 5 3. 1 30. 7 ASR Worl d 92 40 40 50 50 91 40 91 20 91 20 52 40 40 40 40 20 22 91 00 00 00 00 00 00 00 00 00 00 00 00 00 . .9 .4 .2 .4 .1 .2 .7 .2 .9 .1 .4 .4 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 2. 0. 0. 1. 0. 0. 20 22.4 Crude Rate Jazan .4 .6 .0 .0 .8 .0 .0 .6 .1 .6 .6 .0 .1 .1 .0 .5 .8 .0 .1 .0 .6 .8 .8 .0 .0 .6 .0 .6 .0 .0 .5 .6 0. 00 4. 10 0. 00 0. 00 0. 00 1. 60 0. 80 4. 91 0. 80 1. 60 3. 30 9. 02 0. 80 0. 00 4. 10 4. 91 1. 60 1. 60 0. 00 9. 02 93 100.0 Total (% ) 4 29 10 54 54 54 21 21 54 21 10 21 86 32 1 11 11 122 ll Ages 61 22 24 11 .9 .5 .2 .6 .5 .6 .2 .5 .4 .5 .7 .8 .5 1. 10 2. 35 0. 50 4. 31 2. 51 0. 52 0. 86 1. 32 47. 49.2 ASR Worl dA 9 00 21 00 00 00 00 00 00 21 00 00 32 00 00 00 00 10 00 00 00 00 00 33 00 21 .6 .8 .6 .6 .8 .6 .8 .6 .8 .2 .2 0. 60 0. 60 0. 60 1. 82 2. 43 2. 43 3. 65 2. 42 1. 81 0. 60 1. 81 3. 64 40.8 Crude Rate Baha 63 .0 .5 .0 .0 .0 .0 .0 .5 .0 .4 .0 .9 .9 .5 .0 .0 .0 .0 .8 .0 .9 .4 .0 .5 .0 .4 .0 .0 .0 .4 .8 .0 4. 41 1. 50 1. 50 0. 0000 8. 83 0. 0000 4. 41 4. 41 1. 50 1. 50 0. 0001 5. 4. 41 2. 91 0. 0000 0. 0005 0. 0006 2. 91 0. 0002 0. 0000 9 100.0 Total (% ) 5 00 8 11 00 00 11 11 34 45 45 00 68 45 34 00 11 34 00 57 68 00 All Ages 36 56 . .4 .4 .6 .7 .4 .6 .5 .7 .1 .3 .6 .6 .2 .6 .6 .1 .1 .8 .5 3 6. 36 1. 33 0. 91 0. 20 1. 93 0. 40 2. 33 0. 61 1. 81 3. 43 3. 72 0. 60 1. 10 1. 10 0. 20 0. 30 5 ASR World 00 11 00 00 00 00 00 00 00 00 00 11 00 00 .5 .1 .6 .8 .7 .6 .7 .3 .5 .3 .6 .4 .9 .8 .1 .1 1. 75 0. 40 0. 30 0. 50 0. 81 1. 92 0. 50 1. 21 0. 10 3. 24 0. 50 0. 10 0. 50 0. 50 2. 23 0. 10 2. 13 2. 73 0. 40 39 Age Groups and Region, 2009 and Region, Groups Age Crude Rat e Asir .0 .9 .0 .6 .5 .0 .2 .0 .8 .9 .7 .2 .0 .0 .3 .0 .0 .8 .0 .2 .3 .0 .2 .2 .5 .0 .3 .0 .3 .1 .5 .9 4. 7 0. 0001 0. 30 2. 51 1. 60 9. 03 0. 0000 4. 01 3. 71 4. 01 0. 60 1. 20 5. 62 6. 22 0. 90 2. 20 1. 90 7. 1342 0. 30 0. 30 9 100. 04 Total (% ) 5 54 57 75 20 82 00 30 00 00 41 00 41 00 92 61 00 00 10 00 00 41 10 60 41 41 82 00 00 00 10 16 30 22 29 13 12 13 18 20 23 30 All Ages g an s0 homa stem g an s1 p n2 y g nx s e8 m ecified. y y s0 p ecified. 44 or e3 ecifie d1 enital s p y C p g elom a5 ha r nx nx us kin l y p land y y land roliferative dis. g g g g p

y ha ha r ha r r le M nx un s y hoid Leukemia kin diseas p p p ue y p nx p g osi sarcoma o g roid y eloid Leukemia p e4 y m y p yp y y All sites but Site Li Tonsil Other Or o Nas o Phar Oeso Live r2 La r Ka Kidne Ureter Bladder Hod Non-Hod Mult i L Other & un s E Bone M To n H Stomach Anus Gallbladder etc. Pancreas Nose, sinuses etc. Trachea, Bronchus, Lun Other Thoracic or Melanoma of Ski Other Ski n1 Mesothelioma Connective, Soft tissu e7 Other male Renal Pelvis Brain, Nervous Th Adrenal Other Endocrine Immun o Leukemia un All sites Tota l3 Other Urinar Mout h6 Small intestin Colon Breas t1 Saliva Rectu m1 Peni s1 Prostat e2 Testis 44 C C82-C85;C96 C91 C09 ICD (10th) C00 C10 C11 C14 C15 C22 C32 C46 C64 C66 C67 C81 C90 Other C69 C40-C41 C92-C94 C65 C95 C70-C72 C01-C02 C12-C13 C16 C21 C23-C24 C25 C30-C31 C33-C34 C37-C38 C43 C44 C45 C47;C49 C63 C73 C74 C75 C88 All C68 C03-C06 C17 C18 C50 C07-C08 C19-C20 C60 Not C61 C62 Table 5.2.1 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site, Primary Site, Incidence Rate (ASR) among Saudi Males (per 100,000) by Age-Standardized Crude Incidence Rate (CIR) Frequency, Relative 5.2.1 Number of Cases, Table

P05a.indd 74 16/01/2013 04:20:56 PM 8 0 2 0 0 .6 .3 .8 .3 .3 .3 .7 .4 .8 .5 .8 .4 .4 .5 .5 .2 .9 .3 68 4. 0. 3 3. 7 0. 5 5. 8 0. 9 3. 4 4. 2 0. 2 1. 6 3. 1 1. 3 3. 3 0. 9 6 ASR Worl d 32 94 15 66 20 52 20 70 40 82 40 20 11 82 20 11 00 00 00 00 00 22 00 00 00 00 00 00 00 00 00 21 00 00 .2 .2 .2 .5 .6 .1 .6 .2 .3 .2 .7 .7 45 47 0. 0. 1. 0. 1. 1. 1. 1. 0. 4. 3. 0. 0. 0. 2. 1. Crude Rate assi m 8 .0 .0 .0 .5 .0 .0 .0 .0 .2 .5 .0 .0 .0 .0 .3 .0 .4 .3 .0 .7 .0 .3 .2 .0 .8 .8 .5 .0 .5 .5 .9 .9 .1 .7 5. 0. 50 4. 72 0. 00 0. 50 3. 31 9. 84 2. 31 4. 22 5. 62 0. 50 2. 81 4. 72 1. 40 4. 22 1. 40 0. 00 0. 00 9 100.0 Total (% ) 5 19 46 94 00 36 00 31 52 83 52 94 62 00 20 20 83 0 10 21 12 10 214 All Ages 82 19 .4 .9 .1 .6 .7 .4 .5 .1 .8 .8 .7 .7 .6 .4 .6 .4 7. 0. 61 0. 81 1. 97 1. 85 1. 79 4. 32 0. 46 3. 91 3. 91 3 38.8 ASR Worl d 00 00 00 00 10 00 00 00 00 00 00 10 00 00 73 00 00 00 00 10 00 00 10 .7 .4 .7 .8 .7 .3 .4 .4 .8 0. 40 0. 80 2. 53 0. 40 0. 80 1. 31 0. 40 1. 31 1. 31 0. 81 0. 40 0. 40 1. 71 0. 81 0. 40 1. 71 0. 40 31 32.5 rude Rate ai lQ .0 .0 .0 .0 .0 .0 .0 .0 .3 .6 .8 .0 .3 .0 .0 .3 .0 .0 .9 .9 .0 .6 .0 .6 .9 .3 .2 .0 .3 .0 .6 .0 .3 .2 .3 7. 4 1. 30 2. 60 0. 0000 5. 21 5. 21 3. 91 0. 0001 1. 30 0. 0003 9. 13 2. 60 0. 0003 9. 13 0. 0000 0. 0000 9 10. 43 100.0 Total (% )C 7 11 22 67 00 00 11 00 33 00 33 33 22 22 11 11 45 00 22 00 11 45 11 75 All Ages 22 .1 .3 .5 .1 .5 .2 .9 .4 .9 .9 .8 .4 .8 .5 .3 .9 .9 .6 .2 .3 .8 7. 57 0. 11 0. 22 2. 84 2. 54 6. 33 0. 50 5. 18 0. 71 1. 20 6. 17 8. 77 75.5 ASR Worl d 8 00 00 00 00 00 00 00 00 00 11 11 00 10 00 00 00 .2 .2 .3 .4 .2 .5 .8 .6 .6 .2 .1 .9 9. 27 2. 44 2. 32 4. 56 0. 61 0. 20 0. 30 1. 31 1. 31 1. 31 2. 13 0. 50 1. 12 0. 81 0. 20 0. 50 2. 13 0. 30 0. 20 0. 30 2. 84 Age Groups and Region, 2009 and Region, Groups Age rude Rat e .0 .6 .2 .0 .7 .3 .3 .0 .0 .0 .6 .0 .3 .6 .6 .3 .0 .0 .7 .3 .0 .0 .0 .3 .0 .7 .0 .0 .0 .3 .7 .0 .0 .0 .6 Madina hH 7. 74 0. 30 0. 30 0. 0000 4. 62 5. 02 6. 63 1. 00 5. 62 1. 30 1. 30 6. 63 2. 31 0. 0000 9. 94 0. 0000 0. 0000 100. 04 Total (% )C 55 44 89 34 34 00 20 00 41 10 00 00 82 00 72 82 82 31 00 00 51 10 31 00 00 20 62 00 62 10 20 00 00 00 75 03 14 15 20 17 20 30 29 69 All Ages g n ans hom a2 stem g an s0 p y g nx s e1 m ecified. y y s1 p ecified. 44 or e4 ecifie d1 enital s a0 p y C p g elom a1 ha r nx nx us kin l y p land y y land roliferative dis. g g g g M p

r1 y ha ha r ha r r le nx un s y hoid Leukemia kin diseas p p p ue y p nx p g osi sarcoma o g roid y eloid Leukemia p e3 y m y p yp y y Sit e Li To n Mouth Saliva Other Or o Nas o Phar Oeso Liver La r Trachea, Bronchus, Lu Connective, Soft tissu e4 Ureter Bladde Other Urinar Hod Multi Other & un s All sites but E Th H Stomac h1 Rectum Anus Gallbladder etc. Pancreas Nose, sinuses etc. Other Thoracic or Bone Melanoma of Skin Other Ski n7 Testis Other male Kidn e Renal Pelvis Brain, Nervous Adrenal Other Endocrine Non-Hod Leukemia un All sites Tota l3 Tonsil Breas t0 L Immun o M Small intestin Colon Mesotheliom Peni s0 Ka Prostat e1 44 C ICD (10th) C00 C01-C02 C03-C06 C07-C08 C10 C11 C14 C15 C22 C32 C33-C34 C47;C49 C66 C67 C68 C81 C90 Other C69 C73 C37-C38 All C12-C13 C16 C19-C20 C21 C23-C24 C25 C30-C31 C40-C41 C43 C44 C62 C63 C64 C65 C74 C75 C82-C85;C96 C95 C70-C72 C50 C91 C09 C88 C92-C94 C17 C18 C45 C60 Not C46 C61 Table 5.2.2 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site, Primary Site, Incidence Rate (ASR) among Saudi Males (per 100,000) by Age-Standardized Crude Incidence Rate (CIR) Frequency, Relative 5.2.2 Number of Cases, Table

P05a.indd 75 16/01/2013 04:20:57 PM 0 0 0 0 0 0 3 0 0 0 0 0 0 0 .7 .5 .3 .9 .1 .6 .6 .3 .6 .6 .1 .2 .6 53 1. 3 1 1. 5 2. 8 2. 3 1. 6 5 ASR World 34 81 35 85 81 33 35 80 80 38 80 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 33 00 00 .8 .8 .5 .8 .8 32 0. 0. 3. 5. 2. 2. 2. 2. 0. 0. 0. 32.8 Rate Crude ) .3 .3 .0 .0 .0 .0 .0 .0 .0 .0 .1 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .3 .0 .3 .0 .3 .3 % 0. 00 2. 30 7. 7 0. 00 0. 00 2. 30 0. 00 9. 33 0. 00 0. 00 4. 71 0. 00 2. 30 0. 00 0. 00 0. 00 2. 30 0. 00 0. 00 0. 00 ( 11.6 16.3 00.0 Total Northern Regio n 12 12 00 00 00 29 00 00 37 00 00 00 00 30 00 31 37 00 00 00 00 00 00 37 12 00 00 49 00 00 12 12 4 All Ages 9 .9 .9 . .1 .8 .5 .6 .4 .1 .3 .4 .1 .8 .6 .4 .9 .3 .7 0. 81 6 0. 65 8. 77 7. 64 2. 51 1. 94 0. 70 4. 32 8. 31 2. 10 1. 10 0. 21 8. 50 7 ASR World 1 00 00 00 00 00 00 00 00 00 00 00 .3 .3 .6 .5 .2 .3 .8 .5 .7 .3 .3 0. 92 0. 31 4. 4. 47 0. 90 0. 31 0. 30 2. 46 1. 85 0. 30 1. 83 0. 30 1. 54 0. 90 0. 31 2. 13 0. 31 0. 60 0. 91 0. 30 1. 21 Rate Crude ) 13 abuk .6 .9 . .0 .6 .0 .9 .9 .0 .3 .0 .9 .0 .3 .9 .4 .6 .9 .0 .1 .9 .6 .0 .9 .8 .0 .0 .0 .5 .0 .0 % 0. 53 0. 0000 0. 90 0. 90 0. 0000 0. 0000 4. 41 3. 51 0. 0000 0. 90 0. 0000 5. 31 4. 41 7. 92 0. 90 0. 0000 0. 0000 0. 90 0. 0000 8. 83 0. 0000 ( 99 Total 100. 03 32 21 10 00 32 00 10 10 87 00 00 65 65 54 10 10 10 00 32 76 10 00 10 21 00 32 00 43 00 00 00 13 14 10 All Ages 91 .3 .3 . .5 .1 .4 .2 .5 .4 .7 .1 .8 .4 .8 6 6. 91 1. 94 3. 21 7. 61 4. 46 1. 95 1. 69 1. 71 1. 10 5 ASR World 2 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 . .8 .7 .2 .8 .6 .2 .6 .6 2. 35 1. 83 2 0. 60 0. 61 1. 23 2. 35 0. 60 1. 23 0. 61 2. 32 1. 22 1. 21 1. 81 2. 31 32. 25 Rat e Crude ) 03 Jou fT . .3 .0 .5 .0 .0 .0 .0 .0 .8 .0 .8 .0 .0 .0 .0 .0 .6 .0 .3 .8 .6 .8 .0 .0 .0 .3 .6 .6 .5 .0 .3 % 0. 0000 0. 0001 0. 0001 0. 0000 0. 0000 0. 0005 0. 0000 5. 51 3. 61 0. 0000 5. 51 1. 80 3. 61 0. 0001 0. 0000 0. 0000 1. 80 1. 80 0. 0000 ( 14. 54 Total 100.0 100 47 35 5 00 00 00 00 00 00 11 00 11 00 00 00 00 00 47 23 23 00 11 00 11 00 00 47 23 23 35 00 47 55 All Ages 2 10 .1 .7 . .1 .7 .8 .4 .4 .2 .5 .3 .2 .4 .8 0. 40 0 0. 70 3. 20 0. 43 1. 22 3. 13 6. 31 2. 68 3. 42 1. 41 1. 41 Age Groups and Region, 2009 and Region, Groups Age 50. 65 5 ASR Worl d 6 12 11 00 00 00 00 11 00 00 00 00 00 24 00 00 00 00 00 00 00 00 00 .5 . .5 .1 .5 .5 .5 .5 .1 .5 .5 .5 .5 0. 51 9 0. 50 0. 51 1. 52 0. 51 1. 52 0. 51 0. 50 2. 54 30.1 Rat e Crude ) 32 .4 .7 .0 .4 .0 . .7 .0 .4 .7 .0 .0 .0 .0 .0 .1 .7 .0 .8 .0 .0 .0 .1 .0 .7 .7 .0 .0 .5 .0 .0 .0 % Najran 0. 0000 1. 70 8 1. 70 0. 0000 0. 0000 0. 0000 1. 70 8. 52 1. 70 1. 70 0. 0000 5. 11 0. 0000 8. 52 0. 0000 0. 0000 1. 70 1. 70 ( 10. 23 10. 23 Total 100.0 9 23 89 11 23 00 00 11 00 00 23 00 11 00 00 6 35 11 00 00 46 00 00 35 11 00 00 11 00 58 00 00 00 00 5 All Ages .0 g e1 ans hom a5 stem g ans p n0 y g nx s e1 m ecified. a1 y y p ec .0 44 or ecified enital a0 p y C p g s0 elom a1 har nx nx us kin l y p lands y y land roliferative dis g g g g p

d y ha har har le M nx uns y hoid Leukemia p kin diseas p p ue y p nx p g osi sarcom o g roid y eloid Leukemia p e1 y m out h1 y ther Thoracic or p yp rain, Nervous ite ll sites Tota l5 y rachea,Bronchus,Lun y Ka Mesotheliom Other Ski n1 Prostate Adrenal Oes o Non-Ho L Other Or o Small intestine Gallbladder etc. Anus Peni s0 Ureter Mult i Connective,Soft tissu Li Ton Salivar Tonsi l0 Nas o Phar Stomac h3 Colon Rectu m5 Live r6 Pancreas Nose, sinuses etc. Lar Bone Melanoma of Ski Breas t0 Testis Other male Kidne Renal Pelvi Bladder Other Urinar E Th Other Endocrine Hod Immuno Leukemia uns Other & uns All sites but 2B 8O 6M 3H 4T 4M 44 C C46 C45 C44 C61 C74 C82-C85;C96 C15 C91 C10 C17 C23-C24 C90 C21 C60 C66 C70-C7 C47;C49 C37-C3 ICD (10th )S C00 C01-C02 C03-C0 C07-C08 C09 C11 C12-C1 C14 C16 C18 C22 C30-C31 C32 C40-C41 C43 C63 C64 C67 C69 C81 C95 Al lA C19-C20 C25 C33-C3 C50 C62 C65 C68 C73 C75 C88 C92-C9 Other Not Table 5.2.3 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site, Primary Site, Incidence Rate (ASR) among Saudi Males (per 100,000) by Age-Standardized Crude Incidence Rate (CIR) Frequency, Relative 5.2.3 Number of Cases, Table

P05a.indd 76 16/01/2013 04:20:57 PM 0 0 1 3 8 0 .4 .1 .3 .9 .1 .4 .8 .3 .7 .5 .9 .6 .1 .5 .2 .1 .1 .7 .5 .2 .6 .2 .2 0. 5 1. 7 2. 4 0. 3 0. 1 2. 2 1. 1 1. 6 0. 4 6. 9 4. 3 0. 4 0. 2 0. 1 3. 4 2. 3 1. 2 14. 4 13. 4 102 107.1 ASR Worl d 3 10 46 40 10 41 30 10 14 30 80 60 10 10 35 10 10 51 67 10 22 10 63 00 00 00 00 . .3 .4 .3 .6 .1 .4 .6 .9 .9 .1 .8 .3 .2 .9 .6 .1 .1 .8 .7 0 0. 0. 0. 2. 1. 1. 4. 0. 0. 0. 0. 1. 0. 0. 2. 0. 2. 0. 0. 0. 4.8 0. 0. 5 52.5 Crude Rate 9 .1 .0 .1 .1 .4 .9 .2 .7 .8 .7 .5 .0 .0 .1 .0 .1 .3 .0 .1 .5 .5 .3 .3 .8 .2 .3 .2 5. 0. 70 0. 00 0. 00 2. 61 3. 01 0. 70 0. 30 0. 30 3. 01 3. 61 1. 70 1. 50 0. 70 3. 82 6. 13 3. 71 1. 10 0. 30 0. 10 7. 33 2. 01 0. 00 1. 30 9 10. 35 100.0 Eastern Province Total (% ) 7 34 22 72 68 33 10 14 11 44 60 50 40 00 00 10 20 09 20 20 60 20 91 2 20 23 78 23 27 13 11 46 28 29 55 15 10 758 ll Ages 15 .2 .2 .4 .2 .7 .6 .1 .1 .1 .6 .1 .8 .2 .3 .3 .9 .4 .2 .1 .1 .4 .7 .1 .9 0. 10 3. 63 2. 22 0. 91 0. 45 6. 66 3. 92 0. 72 0. 22 0. 95 0. 48 3. 63 0. 12 0. 71 0. 41 3. 43 0. 10 6. 47 77. 57 81.1 ASR Worl dA 00 10 00 10 00 23 00 00 00 00 10 00 00 00 .4 .2 .1 .1 .5 .6 .4 .3 .2 .5 .4 .2 .1 .5 .3 .2 .5 1 0. 20 1. 72 0. 10 0. 81 0. 40 2. 42 3. 56 1. 82 1. 31 1. 21 0. 71 0. 30 4. 36 2. 95 2. 84 0. 61 0. 10 0. 20 1. 62 0. 80 5 53.6 Crude Rate 9 akkah .0 .0 .0 .4 .1 .5 .3 .8 .5 .6 .7 .1 .1 .5 .1 .3 .0 .3 .4 .6 .0 .9 .5 .1 .3 .2 .2 .5 .0 .1 .6 5. 0. 10 3. 92 4. 02 1. 00 0. 50 0. 0000 9. 35 1. 10 4. 32 0. 70 0. 40 0. 90 0. 80 4. 12 0. 20 0. 90 0. 60 4. 12 0. 10 6. 63 100.0 Total (% ) 43 61 94 16 03 72 52 63 51 00 67 95 30 90 10 75 31 10 00 60 23 20 10 50 71 10 42 43 11 12 47 10 44 10 44 71 101 103 89 1082 All Ages 8 32 19 85 11 . .1 .9 .3 .3 .6 .5 .8 .4 .1 .1 .5 .2 .7 .8 .1 .7 .2 .1 .3 .3 .1 0. 48 0. 55 0. 15 3. 33 9.6 2. 84 1. 61 0. 58 6. 67 4. 94 0. 64 3. 23 2. 32 1. 81 0. 12 0. 86 3. 33 1. 31 11 1 117.5 ASR World 00 00 00 00 40 00 00 10 00 .4 .1 .2 .4 .7 .3 .4 .9 .3 .3 .8 .1 .4 .1 .5 .7 .4 64 1 2. 85 3. 44 0. 71 0. 20 0. 30 0. 40 1. 94 0. 10 0. 20 0. 20 0. 30 5. 21 4. 81 2. 65 0. 81 2. 85 0. 10 0. 10 0. 20 3. 68 0. 10 Age Groups and Region, 2009 and Region, Groups Age Crude Rat e ) 96 .3 .3 .0 .4 .6 .0 .5 .1 .0 .0 .9 .0 .4 .4 .5 .2 .5 .1 .3 .1 .1 .3 .0 .1 .1 .4 .6 .1 5. 0. 0001 0. 10 0. 0000 3. 52 8. 55 1. 10 3. 62 4. 83 4. 52 0. 60 0. 50 3. 12 3. 4 2. 01 1. 20 1. 71 0. 10 0. 70 6. 44 0. 80 0. 0001 2. 61 2. 21 Riyad hM 00.0 9 Total (% 94 35 41 02 64 81 94 00 70 50 80 10 00 00 30 50 50 70 65 10 10 00 20 20 50 20 16 48 15 49 65 61 43 46 28 17 23 87 11 36 30 36 61 11 28 10 37 1310 All Ages g n ans hom a1 stem g an s0 p y g nx s e7 m ecified. y y s2 p ec .0 44 or e8 ecifie d4 enital s a1 p y C p g elom a1 ha r nx nx us kin l y p land y y land roliferative dis. g g g g M p

r5 y ha ha r ha r r le nx un s y hoid Leukemia kin diseas p p p ue y p nx p g osi sarcoma o g roid y eloid Leukemia p e7 y m y p yp y y Oeso All sites but Sit e Li To n Other Or o Nas o Bladde E Mouth Phar Small intestin Colon Liver La r Trachea, Bronchus, Lu Bone Other Ski n5 Mesotheliom Connective, Soft tissu e1 Breas t9 Other male Kidn e Ureter Other Urinar Other Endocrine Hod Non-Hod Immun o Multi L Leukemia un Other & un s All sites Tota l1 Tonsil Stomac h5 Th M Rectum Gallbladder etc. Other Thoracic or Melanoma of Skin Ka Peni s0 Renal Pelvis Brain, Nervous Adrenal H Saliva Anus Pancreas Prostat e7 Nose, sinuses etc. Testis 44 C C15 ICD (10th) C00 C01-C02 C10 C11 C67 C69 C03-C06 C14 C17 C18 C22 C32 C33-C34 C40-C41 C44 C45 C47;C49 C50 C63 C64 C66 C68 C75 C81 C82-C85;C96 C88 C90 C91 Other All C95 C16 C09 C73 C92-C94 C37-C38 C65 C19-C20 C23-C24 C43 C46 C60 Not C74 C70-C72 C12-C13 C07-C08 C21 C25 C61 C30-C31 C62 Table 5.2.4 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Males (per 100,000) by Primary Site, Primary Site, Incidence Rate (ASR) among Saudi Males (per 100,000) by Age-Standardized Crude Incidence Rate (CIR) Frequency, Relative 5.2.4 Number of Cases, Table

P05a.indd 77 16/01/2013 04:20:57 PM 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 . .1 .3 .2 .9 .1 .3 .8 .7 .2 .3 1. 5 4. 8 1 4. 1 3. 3 0. 2 0. 3 0. 5 0. 3 0. 7 1. 4 0. 2 0. 2 0. 3 0. 3 0. 3 0. 3 0. 7 2. 9 1. 2 1. 7 0. 2 2. 8 0. 2 0. 8 1. 7 ASR Worl d 55 65 14 61 61 81 11 61 40 93 33 60 20 40 00 00 71 . .8 .6 .2 .2 .6 .2 .6 .6 .2 .2 .2 .2 .2 .2 .6 .7 .3 .9 .2 .9 .2 .6 .9 1 2. 1. 0. 0. 0. 0. 0. 0. 0. 0. 1. 1. 33. Crude Rat e 43 azan . .2 .6 .1 .0 .7 .0 .2 .7 .7 .7 .9 .6 .1 .4 J 8. 42 7. 92 0. 60 0. 00 0. 00 0. 00 0. 60 1. 70 1. 70 0. 00 0. 00 0. 60 0. 60 0. 60 0. 60 0. 00 1. 70 0. 60 0. 00 0. 00 0. 00 0. 60 0. 00 0. 60 1. 70 0. 00 0. 00 5. 11 0. 00 0. 00 0. 00 3. 91 2. 80 0. 60 0. 60 0. 00 2. 80 0. 00 1. 70 2. 80 94 20.8 100.0 Total (% ) 16 05 21 42 00 31 00 31 31 31 10 21 73 63 15 14 37 168 178 ll Ages 3 01 01 . .5 .4 .9 .7 .2 .3 .6 .4 .5 .5 .8 .3 10 7 2. 80 1. 93 1. 81 0. 50 1. 83 0. 69 0. 67 3. 25 1. 93 1. 25 47.3 ASR Worl dA 44 001 000 00 000 000 001 003 003 000 001 001 001 000 001 000 000 001 000 001 000 000 000 000 000 001 001 000 005 000 . .7 .7 .1 .6 .1 .6 .6 .8 .3 .7 .1 7 0. 60 3. 43 2. 32 1. 11 0. 60 1. 11 1. 11 1. 11 0. 61 1. 11 1. 10 2. 83 1. 11 37.4 a Crude Rate h a 03 . .0 .0 .5 .0 .0 .0 .0 .0 .0 .5 .0 .1 .0 .0 .0 .0 .0 .1 .5 .0 .0 .0 .6 .0 .0 .0 .0 .0 .0 B 0. 00 0.0 0.0 4. 51 3. 01 0.0 0. 00 4. 51 0.0 1. 50 0.0 0.0 3. 01 0.0 1. 50 0.0 0.0 1. 50 6. 12 0.0 0.0 0.0 0.0 4. 51 3. 01 00 00.0 18. 26 Total (% ) 2 61 61 00 00 11 00 00 00 00 23 00 11 23 69 00 23 00 23 00 46 11 00 00 00 57 00 23 23 00 00 23 ll Ages 56 20 00 01 00 00 00 00 14 00 00 22 . .1 .6 .5 .3 .2 .5 .6 .1 .4 .2 .6 .2 .6 .3 .5 .2 .8 .4 .1 .8 .3 .4 8 0. 56 0. 90 1. 40 0. 30 3. 83 2. 53 2. 22 0. 10 0. 10 2. 52 2. 91 2. 51 9. 11 0. 30 0. 70 0. 73 ASR Worl dA 95 00 00 00 11 00 11 11 00 00 00 . .6 .4 .4 .8 .3 .1 .8 .1 .8 .9 .9 .9 .1 .4 .5 .4 0 2. 76 0. 10 0. 10 0. 60 0. 30 0. 10 0. 10 0. 10 3. 14 0. 10 4. 96 0. 30 0. 30 1. 82 0. 10 0. 60 1. 31 0. 10 0. 30 0. 81 Age Groups and Region, 2009 and Region, Groups Age r Crude Rate i s 84 . .3 .3 .5 .6 .0 .3 .0 .3 .0 .4 .3 .2 .0 .4 .3 .4 .0 .6 .0 .0 .6 .2 .3 .5 .0 .3 .6 .8 A 3. 85 5 1. 50 2. 41 0. 90 5. 72 3. 01 0. 30 4. 21 4. 21 0. 00 0. 00 0. 00 0. 30 4. 21 0. 00 4. 82 0. 00 0. 00 4. 51 2. 10 0. 30 0. 90 0. 00 0. 00 1. 20 3. 31 11.4 100. 04 Total (% ) 61 47 03 44 10 10 51 20 00 10 00 10 00 82 10 00 82 10 82 00 20 00 00 20 10 51 10 20 61 34 19 38 14 10 14 14 16 15 11 32 09 All Ages g .0 .3 ans .1 homa stem g an s0 p n1 y g nx s e1 m ecified y y s0 p ec .0 or ecifie d7 p y ecified C44 p

eloma ha r nx nx p t us kin l y p land y y lan d0 u roliferative dis g g g g b p

y ha ha r ha r le M nx un s y hoid Leukemia kin diseas p es p p ue us Uter i1 y y p nx p it g osi sarcoma in a0 o g roid p y eloid Leukemia p g e3 y s m elanoma of Ski esothelioma y ulti p ther & un s ther Skin es o ther Endocrine ther Or o va r ther Female Genital ther Urinar onnective, Soft tissu e8 as o yp olo n2 terus uns enal Pelvis rete r0 od ervix Uter i4 or drenal ha r tomach nu s1 ancreas a y ll ulva a lacent a0 ll sites Tota l3 ladder idne h onsil y i eukemia uns ar iver mmuno Mout h5 Bone Trachea, Bronchus, Lun Breas t4 Site H Rectum To n Salivar Small intestine Nose, sinuses etc. Other Thoracic or Non-Hod M Brain, Nervous Gallbladder etc. 9C C4 4A

t o C03-C06 C7 4A C40-C41 C33-C34 C47;C4 C50 C1 1N Othe rO ICD (10th) C0 0L C12-C13 C1 8C C19-C20 C2 1A C5 5U C9 5L N C07-C08 C1 6S C17 C2 5P C30-C31 C3 2L C37-C38 C4 3M C4 4O C4 5M C4 6K C6 5R C6 6U C7 3T C82-C85;C96 C1 4P C01-C02 C7 5O C8 1H C1 5O C5 1V C5 2V C9 1L C0 9T C1 0O C6 9E C5 6O C5 7O C5 8P C8 8I C9 0M C92-C94 C5 3C Al lA C2 2L C70-C72 C6 7B C6 8O C6 4K C5 4C C23-C24 Table 5.3.1 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site, Primary (per 100,000) by Site, Incidence Rate (ASR) among Saudi Females Age-Standardized Crude Incidence Rate (CIR) Frequency, Relative 5.3.1 Number of Cases, Table

P05a.indd 78 16/01/2013 04:20:58 PM 7 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 . .3 .8 .8 .3 .3 .5 .4 .9 .9 .4 6. 8 2 5. 1 4. 1 2. 9 0. 6 0. 3 0. 3 1. 7 0. 5 2. 2 1. 8 1. 2 0. 4 1. 1 3. 2 0. 5 0. 6 0. 3 0. 5 2. 7 ASR Worl d 72 58 38 51 12 74 91 20 50 91 12 33 91 00 00 24 56 21 . .7 .3 .3 .5 .2 .2 .6 .5 .8 .9 .7 .2 .7 .6 .2 .7 .2 .2 .4 3 2. 0. 0. 1. 0. 0. 0. 1. 2. 0. 16. 55. m i Crude Rat e 95 ass . .9 .8 .6 .0 .0 .0 .6 .4 .9 .8 .6 .0 .7 .1 .7 0.1 4. 92 4. 12 0. 00 4. 12 0. 00 0. 40 0. 80 0. 40 0. 00 0. 00 2. 81 0. 80 0. 00 1. 60 0. 00 0. 00 0. 00 1. 20 3. 31 0. 00 0. 00 0. 00 0. 00 0. 40 0. 40 0. 00 1. 20 0. 00 2. 81 0. 00 0. 00 0. 00 0. 40 0. 00 1. 20 0. 00 0. 40 0. 00 2. 41 Q 95 100.0 Total (% ) 24 43 28 04 20 41 52 00 41 10 00 20 52 93 41 93 12 10 10 236 246 ll Ages 9 . .6 .5 .5 .4 .5 .7 .3 .1 .3 .6 .4 .3 .1 46 4 4. 91 1. 17 0. 50 3. 12 0. 78 0. 41 0. 40 0. 37 2. 11 0. 43 1. 31 11. 47 ASR Worl dA 14 000 000 001 002 001 000 000 002 000 004 000 00 000 003 000 000 000 000 001 000 003 000 000 000 001 000 000 000 006 . .8 .3 .4 .9 .4 .4 .4 .4 .7 .4 .4 .3 5 0. 40 1. 31 0. 81 0. 40 2. 53 1. 72 0. 81 0. 81 0. 40 0. 81 1. 31 0. 40 1. 72 0. 81 35.9 il Crude Rate a 73 H . .0 .0 .0 .0 .2 .0 .0 .0 .5 .0 .0 .2 .3 .2 .0 .7 .3 .0 .3 .0 .0 .0 .3 .0 .0 .0 .0 .7 .0 .5 .2 .3 7 3. 51 0.0 1. 20 0.0 8. 12 1. 20 0.0 1. 20 0.0 1. 20 1. 20 0.0 4. 71 0.0 0.0 0.0 1. 20 0.0 3. 51 0.0 0.0 00.0 10. 53 23. 38 Total (% ) 0 49 61 00 00 00 00 11 00 00 00 33 00 00 11 22 11 67 44 22 00 22 00 00 00 22 00 00 00 00 44 00 33 11 22 ll Ages 68 01 00 31 00 00 00 00 . .4 .1 .5 .2 .1 .7 .3 .8 .4 .4 .3 .4 .8 .6 .1 .9 .6 .4 .7 .4 .3 .3 6. 12 0. 98 9 3. 79 0. 43 0. 90 4. 67 2. 51 0. 50 0. 21 2. 50 0. 41 3. 34 1. 61 0. 30 0. 73 0. 40 1. 30 ASR Worl dA 86 00 00 00 00 00 11 00 00 00 00 00 35 . .1 .3 .5 .4 .3 .3 .2 .6 .2 .3 .1 .8 .2 .5 .3 1. 21 7 8. 47 0. 20 0. 71 0. 20 0. 30 1. 83 0. 20 0. 50 0. 50 0. 30 0. 20 3. 35 0. 30 0. 20 0. 71 0. 50 0. 50 0. 30 0. 30 1. 81 1. 52 Age Groups and Region, 2009 and Region, Groups Age h rude Rate na di 64 . .3 .0 .4 .0 .3 .7 .0 .0 .7 .3 .0 .0 .7 .3 .8 .7 .3 .0 .4 .0 .0 .0 .0 .0 .0 .7 .0 .1 .0 .7 .7 .1 a 3. 11 8 4. 42 0. 70 1. 00 0. 00 0. 00 7. 13 4. 72 0. 70 0. 30 3. 41 0. 30 4. 72 0. 00 4. 42 0. 00 0. 30 0. 00 3. 71 0. 00 1. 00 0. 70 2. 01 M 100. 04 Total (% )C 82 13 06 13 86 10 00 41 00 10 20 00 00 10 31 31 20 10 20 10 00 41 62 31 00 31 00 00 20 00 00 20 93 95 13 21 14 10 14 13 11 29 19 All Ages g .0 .3 ans .1 homa stem g an s0 p n0 y g nx s e1 m ecified y y s1 p ecified. or ecifie d1 p y ecified C44 p

eloma ha r nx nx p t us kin l y p land y y lan d2 u roliferative dis g g g g b p

y ha ha r ha r le M nx un s y hoid Leukemia kin diseas p es p p ue us Uter i1 y y p nx p it g osi sarcoma in a0 o g roid p y eloid Leukemia p g e3 y s m esothelioma elanoma of Ski y ulti p ther & un s ther Skin ther Urinar es o ther Endocrine ther Or o va r ther Female Genital onnective, Soft tissu e2 enal Pelvis rete r0 as o yp olo n2 terus uns od ervix Uter i6 or a ha r tomach nu s0 ancreas ladder y drenal ll sites Tota l2 ll ulva a lacent a2 idne h onsil y i ar eukemia uns iver mmuno Rectum Bone Mout h1 Trachea, Bronchus, Lun Breas t6 Site Small intestine Gallbladder etc. Nose, sinuses etc. Non-Hod To n H Other Thoracic or M Salivar Brain, Nervous 9C C4 4A

t o C4 5M C4 6K C19-C20 C6 5R C6 6U C40-C41 C33-C34 C03-C06 C47;C4 C50 C1 1N Othe rO C17 C2 1A C2 5P C30-C31 C3 2L C4 3M C4 4O C5 5U C7 4A C82-C85;C96 C8 8I Al lA C9 5L ICD (10th) C0 0L C1 4P C1 6S C1 8C C23-C24 C7 3T N C01-C02 C12-C13 C6 7B C6 8O C7 5O C8 1H C1 5O C5 1V C5 2V C9 1L C0 9T C1 0O C6 9E C5 6O C37-C38 C5 7O C5 8P C9 0M C92-C94 C07-C08 C5 3C C2 2L C70-C72 C6 4K C5 4C Table 5.3.2 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site, Primary (per 100,000) by Site, Incidence Rate (ASR) among Saudi Females Age-Standardized Crude Incidence Rate (CIR) Frequency, Relative 5.3.2 Number of Cases, Table

P05a.indd 79 16/01/2013 04:20:58 PM 5 .7 .3 .2 .7 .9 .6 .2 .6 .1 .6 .5 .5 .6 .9 .4 .2 .9 .6 .2 .7 .9 . 7. 1 0. 5 0 73.1 ASR Worl d 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 81 81 35 80 35 81 54 81 34 80 54 52 80 49 15 51 14 80 51 34 52 77 .4 .8 . 0. 1. 2. 0. 1. 0. 1. 0. 2. 3. 1. 3. 1. 0. 2. 0. 0. 0. 1. 5. 2. 0 42.2 io n Rate g Crude 44 .8 .6 .0 .0 .5 .0 .8 .0 .6 .0 .0 .8 .6 .0 .0 .8 .5 .3 .6 .3 .0 .6 .8 .0 .0 .0 .5 .0 .0 .8 .8 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .8 .0 .0 .6 .0 .0 .5 . 1. 80 2. 75 6 (% ) 12.7 00.0 Total Northern Re 11 23 00 00 35 00 23 00 00 71 11 00 11 23 00 00 11 35 47 23 47 00 23 00 11 35 00 00 00 00 00 00 00 11 11 00 00 00 00 00 00 00 00 00 00 00 11 00 00 23 00 00 35 51 39 All Ages 85 .8 .1 .8 .2 .9 .7 .2 .5 .8 .5 .9 .9 .6 .3 .8 .8 .8 .3 .9 .3 .5 .3 .8 .5 .7 .4 .2 . 2. 91 9 2. 57 10.3 ASR 102. 15 Worl d 10 00 00 00 00 00 00 13 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 39 .5 .8 . 0. 60 1. 92 0. 30 0. 30 2. 95 1. 93 0. 61 0. 61 0. 30 0. 61 0. 60 0. 31 0. 61 5. 76 0. 30 1. 32 0. 30 0. 30 0. 60 1. 32 2. 25 2. 97 1. 62 0. 61 2. 96 0. 61 2. 26 2. 25 6. 41 1 52.6 Rate Crude 65 abuk .2 .6 .6 .0 .8 .5 .6 .0 .0 .2 .6 .0 .0 .2 .2 .0 .0 .8 .2 .6 .0 .2 .0 .0 .0 .0 .4 .0 .6 .0 .6 .6 .0 .0 .4 .0 .2 .5 .0 .2 .2 .0 .0 .0 .0 .2 .5 .0 .2 .2 .0 . 6. 73 7. 33 (% ) 10.9 97 12.1 00.0 Total 21 63 10 10 31 95 63 00 21 00 00 00 00 00 00 21 10 00 00 21 00 31 21 10 00 21 00 10 42 10 00 10 00 21 00 42 00 74 95 53 21 00 00 00 21 00 95 74 00 74 00 18 20 11 12 61 16 51 All Ages 81 .8 .1 .5 .6 .1 .2 .1 .9 .1 .1 .9 .8 .6 .8 .2 .2 .2 .3 .3 .6 . 3 63.8 22.5 ASR Worl d 34 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 66 . 1. 21 0. 60 0. 60 0. 61 1. 22 0. 61 0. 60 0. 61 0. 61 0. 60 1. 21 2. 45 0. 62 1. 21 1. 21 2. 43 2. 44 1. 23 1. 22 8 38.6 14.5 Rate Crude 03 Jou fT . 7.8 0.0 3.1 0.0 0.0 1.6 1.6 0.0 0.0 1.6 0.0 0.0 0.0 0.0 1.6 1.6 0.0 1.6 0.0 0.0 3.1 0.0 0.0 0.0 1.6 0.0 0.0 1.6 0.0 0.0 0.0 3.1 0.0 0.0 0.0 3.1 0.0 0.0 0.0 6.2 1.6 3.1 6.2 0.0 0.0 0.0 0.0 0.0 0.0 6.2 3.1 0.0 3.1 0.0 (%) 37.5 Total 100 100.0 5 0 2 0 1 1 1 0 0 1 1 1 0 2 0 4 2 4 0 0 4 2 2 4 24 64 All Ages 66 . 6.4 4.1 1.6 1.1 1.1 0.4 3.2 1.1 2.7 1.8 0.4 3.3 2.6 2.6 1.1 3.2 1.5 1.6 2.2 0.8 1.1 0.6 3.8 4.7 5 Age Groups and Region, 2009 and Region, Groups Age 58.2 ASR Worl d 1 1 1 000 000 000 000 001 000 000 002 000 000 000 000 001 000 000 000 000 000 000 002 000 000 000 000 131 1 1 000 000 000 120 000 000 25 . 4.2 3.6 0.5 1.6 0.5 1.6 0.5 0.5 1.6 1.6 1.6 1.6 0.5 1.6 0.5 0.5 0.5 2.1 1.6 2 33.7 Rate Crude ran j 43 . Na 3.1 3.1 3.1 0.0 1.5 4.6 0.0 0.0 0.0 0.0 0.0 1.5 4.6 0.0 0.0 1.5 1.5 0.0 0.0 0.0 0.0 0.0 0.0 4.6 0.0 0.0 0.0 0.0 0.0 4.6 1.6 0.0 0.0 0.0 4.6 3.1 0.0 1.5 0.0 4.6 3.1 3.1 0.0 0.0 1.5 1.5 3.1 0.0 1.5 6.2 4.6 0.0 0.0 5 (%) 12.3 10.8 Total 100.0 2 0 1 3 0 0 0 0 0 1 3 0 0 8 0 0 0 7 0 0 0 0 0 0 1 2 2 0 3 2 0 0 0 1 1 2 1 4 3 0 0 5 29 All Ages

g a3 ied. ans homa f stem g ans p a3 ied y f enital g ied. nx s e2 m eci ki n0 f y G y p ec .0 S or ec i

erative dis .0 p f f y ec i C4 46 p r

eloma har nx nx p t us kin l y p lands y y land u roli g g g g b p ro

ki n3 uns y ha har har O S & le M nx uns y hoid Leukemi kin diseas p es p p ue us Uter i3 y y p nx it p g osi sarcoma ina o g roid p y eloid Leukemi p g e0 y s m y p ther eso allbladder etc. ther Thoracic or ther var ther Female ther Endocrine ther onnective, Soft tissu e2 yp olon ervix Uter i0 or ll sites Tota l6 alivar tomach mall intestine y ll y Ton Mouth H Nose, sinuses etc. Trachea, Bronchus, Lun Bone Brain, Nervous M Rectum Li S Tonsil O Naso Phar O S S C Anus Liver G Pancreas Lar O Melanoma o O Mesothelioma Ka Breast Vulv a1 Va C C Uterus uns O O Placent a1 Kidne Renal Pelvis Ureter Bladder E Th Adrenal O Ho d Immuno Multi L Leukemia uns O Site Other Urina Non-Hod 96 C 9C 02 06 08 13 24 31 34 38 41 72 85; 94 C C C C C C C C C C C C C4 4A

t ther 00 01- 03- 07- 09 10 11 12- 14 15 16 17 18 21 22 23- 25 30- 32 33- 37- 40- 43 44 45 46 50 51 52 53 54 55 56 57 58 64 65 66 67 69 70- 73 74 75 81 82- 88 90 91 92- 95 o C19-C20 Al lA ICD (10th) C C C C C C C C C C C C C C C C C C C C C C C C C C C47;C4 C C C C C C C C C C C C C C68 C C C C C C C C C C C C O N Table 5.3.3 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site, Primary (per 100,000) by Site, Incidence Rate (ASR) among Saudi Females Age-Standardized Crude Incidence Rate (CIR) Frequency, Relative 5.3.3 Number of Cases, Table

P05a.indd 80 16/01/2013 04:20:59 PM 2 2 0 0 0 0 0 0 0 .9 .4 .6 .7 .5 .3 .7 .5 .2 .6 .9 .2 .9 .1 .1 .2 3. 2 7. 6 2. 1 9. 8 2. 3 5. 9 3. 1 0. 2 0. 3 0. 3 2. 7 0. 2 0. 6 0. 1 0. 6 1. 9 0. 8 0. 1 0. 4 0. 2 0. 1 33. 1 114. 4 110. 9 ASR Worl d 40 40 40 52 93 10 22 83 10 76 40 83 40 10 92 15 10 00 00 11 00 00 00 00 .9 .3 .7 .3 .6 .7 .8 .4 .2 .3 .1 .7 .1 .4 .1 .6 .8 .4 .1 .1 .1 .1 1. 0. 1. 1. 0. 0. 1. 3. 1. 0. 0. 2. 1. 0. 0. 0. 0. 67.1 65.3 19.9 rude Rate .0 .9 .1 .8 .0 .0 .2 .2 .7 .1 .0 .7 .7 .0 .0 .6 .1 .0 .9 .7 .7 .6 .6 .4 1. 30 3. 42 5. 63 1. 41 1. 91 2. 61 4. 12 0. 60 2. 11 0. 30 0. 40 0. 20 0. 10 0. 90 2. 61 0. 20 0. 00 1. 20 0. 00 0. 70 0. 00 0. 10 0. 20 0. 00 0. 10 0. 10 0. 00 0. 00 0. 00 11. 37 29.7 97.3 100.0 Eastern Province Total (% )C 62 61 42 62 24 02 64 42 31 00 10 00 60 00 50 00 00 20 10 00 10 60 50 50 12 31 50 13 17 23 37 19 23 11 102 900 876 267 ll Ages 01 21 .3 .4 .4 .2 .4 .1 .7 .4 .9 .1 .7 .2 .1 .6 .2 .6 .8 .8 .6 .1 .2 .6 .3 .5 3. 12 1. 61 7.9 0. 44 0. 12 2. 62 1. 62 5. 44 2. 42 0. 35 0. 41 0. 98 6. 33 3. 42 0. 20 0. 56 0. 71 0. 71 0. 10 93.3 90.6 26.4 ASR Worl dA 5 003 002 000 22 000 002 000 000 000 .9 .6 .5 .1 .7 .6 .8 .6 .3 .3 .8 .9 .2 .1 .3 .7 .4 .1 .1 .3 0. 20 0. 30 0. 81 0. 20 1. 21 0. 40 0. 10 0. 40 0. 10 0. 10 4. 36 0. 30 1. 11 0. 10 0. 20 0. 20 1. 41 0. 80 0. 30 0. 30 0. 61 1. 32 1. 11 0. 30 63.3 18.3 rude Rate akkah .2 .4 .3 .3 .9 .2 .7 .5 .6 .0 .1 .5 .2 .0 .1 .6 .0 .3 .1 .1 .2 .1 .5 .0 .9 .0 .7 .4 .5 .0 2. 91 2. 51 0. 40 1. 61 0. 70 0. 10 2. 71 0. 40 1. 20 6. 03 3. 42 2. 41 5. 83 0. 20 0. 50 0.0 1. 00 0.0 0. 50 0. 10 0. 10 0.0 2. 01 10. 26 28.2 97.3 100. 06 Total (% )C 61 41 56 11 72 51 03 20 52 21 30 50 40 20 60 00 10 70 30 00 10 80 00 40 10 60 00 50 60 00 37 34 31 74 32 20 15 76 43 13 26 130 360 1277 1243 ll Ages 31 15 00 01 00 .7 .3 .1 .1 .4 .8 .8 .5 .1 .4 .9 .9 .9 .3 .4 .4 .5 .2 .2 .4 .3 .3 1. 52 0. 59 0. 11 7. 38 2. 62 0. 15 2. 12 1. 71 3. 44 0. 22 0. 46 0. 40 1. 61 0. 17 2. 62 0. 11 2. 82 10.7 29.4 123.6 120.2 SR Worl dA 00 00 00 00 00 00 .4 .2 .6 .1 .6 .8 .2 .1 .6 .2 .7 .7 .1 .2 .2 .7 .1 .2 .1 .7 2.6 2. 95 0. 20 0. 20 1. 22 0. 20 2. 86 0. 10 1. 73 0. 80 3. 57 0. 40 2. 63 0. 20 0. 51 0. 30 0. 10 2. 32 4. 98 0. 30 0. 71 0. 10 0. 40 0. 71 0. 10 1. 73 70.9 17.8 Age Groups and Region, 2009 and Region, Groups Age rude Rat eA .0 .0 .3 .2 .0 .6 .3 .9 .1 .3 .0 .1 .8 .6 .5 .3 .0 .0 .6 .0 .4 .1 .2 .7 .3 .0 .1 .5 .9 .1 .3 1. 38 1. 91 1. 71 0. 80 5. 23 1. 71 0. 80 0. 10 0. 10 2. 21 2. 31 2. 31 0. 10 0. 00 0. 30 1. 00 0. 10 1. 71 0. 10 2. 31 0. 30 0. 00 0. 00 Riyad hM 24.6 97.7 100. 07 Total (% )C 84 32 63 76 31 63 61 94 13 41 30 42 00 40 30 00 40 20 00 80 40 00 00 90 00 60 10 50 20 70 20 56 28 24 11 11 76 24 32 34 34 14 24 33 448 16 31 1415 All Ages .0 a9 n2 a1 e4 a1 x4 x1 i6 i3 out h4 ther Thoracic organs allbladder etc. ose, sinuses etc. ectu m5 ypopharyn ll sites Tota l1 one alivary glands ongue rachea, Bronchus, Lung Leukemia unspecified. Pancreas Thyroid Adrenal gland Myeloid Leukemia Site Li p2 Other Oropharyn x0 Laryn x2 Melanoma of Ski Other Ski n3 Uterus unspecified. Placent a2 Renal Pelvis Ureter Bladder Other Endocrine Hodgkin diseas Non-Hodgkin lymphom All sites but C44 Tonsil Stomac h2 Small intestine Colon Anus Live r5 Mesotheliom Kaposi sarcoma Connective, Soft tissu e1 Breas t3 Corpus Uter Ovar y5 Other Female Genital Other Urinary organs Eye Brain, Nervous system Immunoproliferative dis Lymphoid Leukemia Other & unspecified Nasopharyn Pharynx unspecified. Oesophagus Vulv a0 Kidney Multiple Myelom Vagina Cervix Uter 1N 0R 8O 1B 6M 4G 2T 8S 3H 4T C30-C3 C95 C19-C2 C25 C73 C74 C92-C94 Al lA ICD (10th) C00 C10 C32 C37-C3 C40-C4 C43 C44 C55 C58 C65 C66 C67 C75 C81 C82-C85;C96 Not C44 C03-C0 C09 C16 C17 C18 C21 C22 C23-C2 C45 C46 C47;C49 C50 C54 C56 C57 C68 C69 C70-C72 C88 C91 Other C01-C0 C11 C12-C1 C14 C15 C33-C3 C64 C07-C0 C51 C90 C52 C53 Table 5.3.4 Number of Cases, Relative Frequency, Crude Incidence Rate (CIR) Age-Standardized Incidence Rate (ASR) among Saudi Females (per 100,000) by Primary Site, Primary (per 100,000) by Site, Incidence Rate (ASR) among Saudi Females Age-Standardized Crude Incidence Rate (CIR) Frequency, Relative 5.3.4 Number of Cases, Table

P05a.indd 81 16/01/2013 04:20:59 PM .1 .6 .4 .7 .1 .0 .9 .1 .1 .6 .7 .6 .5 .6 .9 .2 .8 .4 .7 .2 .3 .6 .6 .3 .1 .9 .6 .0 .3 .1 .8 .1 .1 .2 .0 .2 .0 .0 .4 .2 .2 .1 .3 .0 .0 .5 .8 6. 1 3. 9 7. 4 7. 6 92.6 100. 0 Total (% ) 00 10 01 00 00 00 01 00 00 21 10 49 15 00 52 31 21 00 01 75 00 01 10 10 00 01 10 00 02 00 12 00 00 24 00 00 03 13 00 00 03 00 02 03 13 00 44 62 12 55 75+ 17 67 10 11 66 0-74 97 16 15 14 21 96 10 5-69 3430 1415 10 17 11 19 25 52 17 11 60-6 46 61 71 1465 1853 10 20 16 18 28 10 19 21 5-59 46200 57220 11 61 12 16 11 24 13 20 16 16 23 62 50-5 45 41 1 31 1 13 24 13 10 95 18 52 5-49 21 41 13 15 11 41 14 81 40-4 44 28 27 05 81 10 35-3 9 81 31 31 81 59 47 30-3 16 06 25-29 35 35 20-24 54 54 15-19 21 11 10-14 00000002221200 02588475451000 00001110928724 00000000000000 00010010000000 00001102001200 0001552 00000021542520 00000010001000 00000001000000 000010677 00001012210210 0001129 00000013211001 00000103595862 00000202010010 00011144972000 00000012212100 00000000010000 00101100000000 02151 00000000100000 00010000000100 00000001001000 00000000000000 10000011101000 41 41 5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 71 71 -4 030306873 0000010002230100 0000000001684331 0890330162453110 00000103566 0400001029397421 0010002025874001 0000010002513031 0000000104653412 0032334131031100 0000000000000000 0000000010001000 000000123 0200000000010000 000011457 12 0100001101021211 0000000012233236 0502010744459320 0100000102000000 0000000000001000 0000042 1001001 00000000013 02 0000000011110000 0000146714714010 Age Un k0 00 20 70 20 10 90 60 10 30 20 20 10 00 60 00 90 50 10 00 10 50 50 90 00 60 40 94 10 26 46 19 28 80 25 43 65 46 30 11 24 46 36 148 114 117 1540 1426 All Ages g .1 an s4 homa stem g ans p a4 n1 y g nx s e4 m ecified. y y p ecified. or e1 ecifie d7 enital s a5 p y p g s2 elom a3 har nx nx us kin l y p lands y y land roliferative dis g g g g p

d y ha har har le M nx uns y hoid Leukemia p kin diseas p p ue y p nx p g osi sarcoma o g roid y eloid Leukemi p e3 y m y p yp y rain, Nervous ll sites Total ll sites but C44 on rachea, Bronchus, Lun y Immuno Li Mout h2 Salivar Tonsil Other Or o Nas o Phar Oes o Stomac h6 Colon Rectu m8 Anus Live r4 Gallbladder etc. Pancreas Nose, sinuses etc. Lar Other Thoracic or Bone Melanoma of Ski Other Skin Ka Connective, Soft tissu e2 Breas t1 Peni s0 Prostate Other male Kidne Renal Pelvi Ureter Bladder Other Urinar E Th Adrenal Other Endocrine Hod Non-Ho Multi L Leukemia un Other & uns Small intestin Site Mesotheliom Testis 2T 3H 4T 2B 4M C88 C00 C01-C0 C03-C06 C07-C08 C09 C10 C11 C12-C1 C14 C15 C16 C18 C19-C20 C21 C22 C23-C24 C25 C30-C31 C32 C33-C3 C37-C38 C40-C41 C43 C44 C46 C47;C49 C50 C60 C61 C63 C64 C65 C66 C67 C68 C69 C70-C7 C73 C74 C75 C81 C82-C85;C96 C90 C91 C92-C9 C95 Other Al lA C17 Not C4 4A ICD (10th) C45 C62 Table 5.4.1 Number of Cancer Cases among Non-Saudi Males by Primary Site and Age Groups, 2009 Groups, Age Primary 5.4.1 Number of Cancer Cases among Non-Saudi Males by Site and Table

P05a.indd 82 16/01/2013 04:20:59 PM 1 . .1 .6 .2 .7 .2 .0 .5 .2 .0 .1 .0 .0 .4 .4 .1 .2 .1 .7 .0 .2 .3 .0 .4 .2 .9 .1 .1 .1 .1 .2 .9 .9 .5 .4 .1 .3 .2 .0 .2 .0 .5 .2 .3 .3 .0 .4 .1 .0 .8 .0 .3 .4 .3 1. 1 3. 3 97 100. 0 Total (% ) 00 00 00 00 00 00 10 00 00 21 22 00 33 13 00 01 21 10 00 00 32 00 00 00 02 00 00 11 54 00 00 43 10 12 00 00 01 00 00 11 00 00 01 06 00 00 01 54 00 00 02 02 00 33 38 38 5+ 12 41 42 14 70-7 47 67 68 17 10 5-69 820 70 76 23 60-6 46 3 13 1012 5000 0000 0000 0100 3130 3113 0000 2010 1000 32 36 42 5-59 61 77 14 91 15 41 50-5 45 43 884110 92 98 06 5-49 2 91 18 21 18 71 40-4 44 01 59 48 51 35-3 9 81 68 11 31 11 51 0-34 21 45 51 53 5-2 93 61 41 33 35 20-2 42 17 17 15-19 14 14 10-14 0110012124 0000101301 00032136366324 00110101000100 00001010000000 00000000000000 00000000000000 00021100010120 10521110214000 00000000001000 00000000000000 00022275756332 00000000000000 00022235654611 0200267 61 000002143 61 0001002112 00000000000000 00001000110000 00020002200110 00000001000000 00002001000000 54221100201200 0000000020 00010001002112 00000000000000 00000000010000 0000000011 0000000010 00000000000000 11 11 5-9 1 0 0 0 0 0 4 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 -4 23 24 002124037322 0000000204343363 0020101528623011 0100010024222120 0000000041210102 0000000113623332 0000000131102112 0112010103211201 00011045342 0000000000000000 0000000310214010 00021 0100110000010100 0700000000000000 0000000000000000 0000000001200000 0000003156475371 0000000000100000 0100000101024511 0001202000000000 000000000021 000000000000 00000 0000001000000000 0000000000000000 Age Un k0 40 20 31 50 80 10 60 80 30 60 60 20 00 40 10 90 00 00 00 30 10 30 80 90 10 20 00 50 20 00 42 30 31 33 17 11 26 14 16 54 14 83 45 16 128 21 132 01 All Ages g .0 .5 a2 ans .1 homa stem g an s0 p n3 y g nx s e1 m ecified y y p ecified. or ecifie d4 a1 p y ecified C44 p

eloma ha r nx nx p t us kin l y p lands y y land u roliferative dis g g g g b p

d r1 y ha har ha r le M nx uns y hoid Leukemi kin diseas p es p p ue us Uter i4 y y p nx p it g osi sarcoma ina o g roid p y eloid Leukemia p g y e7 s m y out h3 elanoma of Ski esotheliom ult i p ther Or o ther Thoracic or ther Ski n3 var ther Female Genital ther Urina r ther Endocrine ther & uns onnective, Soft tissu e1 terus un s yp as o olon ectu m4 ose, sinuses etc. ervix Uter i5 or enal Pelvis rete r0 od y alivar ha r tomach nu s1 ancreas on e5 a ulva a lacent a1 idne ladde drenal ll sites Total on onsil rachea, Bronchus, Lun h y i iver mmuno Site Al l Oes o Small intestine Gallbladder etc. Lar Breas t5 Brain, Nervous Non-Ho Leukemia uns 2T 6M 8S 3H 0R 1N 4T 8O 1B 4M 9C C44

t o C5 5U C0 0L N ICD (10th) C5 1V C01-C0 C03-C0 C07-C0 C0 9T C1 0O C1 1N C12-C1 C1 4P C15 C1 6S C17 C1 8C C19-C2 C2 1A C2 2L C23-C24 C2 5P C30-C3 C32 C33-C3 C37-C3 C40-C4 C4 3M C4 4O C4 5M C4 6K C47;C4 C50 C5 2V C5 3C C5 4C C5 6O C5 7O C5 8P C6 4K C6 5R C6 6U C6 7B C6 8O C6 9E C70-C72 C7 3T C7 4A C7 5O C8 1H C82-C85;C96 C8 8I C9 0M C9 1L C92-C9 C95 Othe rO Al lA Table 5.4.2 Number of Cancer Cases among Non-Saudi Females by Primary Site and Age Groups, 2009 Groups, Age Primary by Site and 5.4.2 Number of Cancer Cases among Non-Saudi Females Table

P05a.indd 83 16/01/2013 04:20:59 PM 0 0 0 0 0 0 .3 .8 .7 .2 .7 .1 .2 .2 .5 .6 .4 .2 .1 .4 .3 .7 .9 .1 .1 .1 0. 2 0. 5 0. 5 1. 5 1. 3 1. 3 0. 1 0. 9 1. 3 0. 9 0. 6 6. 8 5. 5 8. 8 1. 7 0. 1 1. 1 1. 8 2. 9 3. 6 8. 1 SR World 00 00 12 00 00 00 00 20 40 20 82 31 51 10 44 40 20 10 50 20 60 12 10 10 63 33 66 75 .1 .2 .2 .7 .8 .1 .8 .8 .8 .5 .8 .6 .6 .1 .4 .4 .5 0. 0. 1. 0. 0. 0. 1. 1. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 1. 4. 6. rude Rat eA 00 00 00 00 00 00 00 00 00 00 00 00 00 00 42 .2 .2 .2 .2 6. 20 6. 20 6. 20 6. 20 6. 21 4. 72 3. 22 2. 30 33 92 38 22 75 +C 30.8 12.3 43.2 30.8 18.5 12.3 24.7 00 00 06 06 06 00 00 06 00 .1 .1 .1 .1 .1 .1 50 72 79 7. 14 7. 10 1. 52 8. 67 1. 40 2. 91 14.3 35.7 14.3 28.6 42.9 21.4 0-74 00 00 00 07 37 .9 .4 .4 .9 .4 .4 62 4. 47 4. 40 8. 97 8. 90 8. 90 4. 40 6. 47 7. 72 3. 34 7. 77 3. 37 3. 37 42 54 48 74 26.6 26.6 39.8 22.1 5-69 0000 0000 98 04 0000 01 00 0000 0000 0000 0000 00 0000 04 .6 .6 .6 .2 .2 .6 .4 .8 .6 75 09 3. 61 7. 24 3. 60 1. 80 1. 80 1. 80 5. 41 1. 80 0. 86 3. 51 9. 91 5. 29 2. 78 9. 94 14.5 18.1 34.4 14.5 60-6 46 03 57 53 51 04 .7 .7 .4 .6 .7 .1 .1 .1 .7 .4 .7 .7 .7 .9 .1 .7 .4 .9 .9 0. 73 0. 73 4. 32 7. 97 6. 45 0. 70 5. 71 2. 11 2. 90 4. 33 4. 33 1. 41 13 72 15 03 12.9 5-59 00 00 00000 00 00000 12 00 00 00000 10 10 .7 .3 .1 .5 .1 .7 .8 .9 .7 .7 .7 .7 .4 .4 75 81 1. 41 8. 31 3. 13 0. 30 0. 32 1. 72 0. 70 0. 30 0. 31 5. 52 2. 82 0. 30 5. 57 0. 30 4. 51 0. 30 2. 41 0. 32 3. 87 0-5 45 00 00 .9 .2 .4 .2 .4 .6 .2 .2 .2 .4 .7 .4 .9 .4 .2 .4 .8 38 40 0. 40 2. 74 2. 75 0. 63 0. 21 1. 43 2. 16 0. 81 0. 81 1. 90 0. 81 1. 62 2. 31 5-4 95 00 00 0000000 00 00 0000000 00 .3 .1 .3 .8 .3 .2 .7 .5 .7 .3 .7 .5 19 20 1. 14 0. 11 0. 41 0. 51 0. 30 0. 30 0. 10 0. 30 0. 10 0. 11 0. 81 0. 10 0. 10 0. 30 1. 52 0. 40 0. 31 0. 51 0. 51 0. 10 0. 30 0. 10 0. 30 2. 10 40-4 44 00 00 10 .1 .1 .2 .2 .1 .1 .5 .9 .1 .4 .1 .1 .1 .3 .1 .2 10 11 0. 10 0. 31 0. 30 0. 21 0. 61 1. 21 0. 40 0. 70 0. 10 0. 60 0. 20 0. 70 35-3 9 00 00 00 00 00 00 00 00 00 00 00 000000 47 .7 .2 .1 .3 .1 .7 .4 .1 .1 .3 .5 0. 81 0. 10 0. 10 0. 20 0. 10 0. 30 0. 20 0. 10 0. 70 0. 10 0. 10 0. 50 30-3 76 00 00 77 .3 .1 .1 .1 .8 .6 .7 0. 10 1. 10 0. 10 0. 10 0. 10 0. 10 0. 10 0. 10 1. 10 0. 10 0. 10 0. 30 0. 60 5-29 00 .2 .4 .1 .9 .4 16 16 1. 50 0. 40 0. 40 0. 40 1. 50 1. 10 0. 40 0. 40 0. 40 0. 40 0. 40 20-2 42 02 00 00 .5 .5 .6 1. 61 0. 51 0. 50 2. 73 5-19 00 00 000 0000 .3 .8 .4 .8 .8 0. 81 10-1 41 000 00000 0000 000 00000 00000 0000000 00000 000 00000 00000000000000 0000000 01 000 558 0000 0000000 000000000 00 0000000 0000 0000000 0000 00 00 00 00000 000000000 00000000000000 000 -9 3. 10 0.3 0.3 0 0 0 0 0 0 0 0 0 0 0 00 00 01 0 9 0 0 0 0 0 .3 .6 .3 .7 .3 .6 .3 .3 0.3 0- 45 0000000 09558 0000000 00 00000 0000000 01 00000 000000000 00000000000 000000 02 00000 01 000000 00 00 00000 00 0000 0000000 00 0000000 10 00 0000000000000000 01 00 000000 00 00 Age Unk 20 60 50 00 30 20 20 10 10 00 20 10 10 50 00 90 00 60 50 21 45 19 28 94 26 46 10 80 43 65 46 74 30 46 24 60 46 49 35 14 14 80 11 70 54 01 1426 All Ages g .1 n .7 an s4 homa stem g an s0 p n1 y g nx s m ecified y y s1 p ecified. or e1 ecified enital s p y p g eloma ha r nx nx us kin l y p land y y lan d6 roliferative dis g g g g p

y ha ha r ha r le M nx un s y hoid Leukemia kin disease p p p ue y p nx p g osi sarcoma o g roid y eloid Leukemia p e3 y m outh elanoma of Ski esothelioma ulti y allbladder etc. p es o yp drenal alivar ancreas a enis on e2 y ha r nu s9 onsi l2 h esti s3 on eukemia un iver ar i y Other & un s Colon Renal Pelvis Hod Non-Hod All sites but C44 Small intestin Rectu m8 Nose, sinuses etc. Other Thoracic or Other Ski n1 Connective, Soft tissu e2 Breas t1 Prostate Other male Other Urinar Brain, Nervous Other Endocrine Immun o Other Or o Trachea, Bronchus, Lu Urete r1 Bladder All sites Tota l1 Site Stomach Nas o Kidne 4M 3H 6M 8S 4G 1B 2T Other C18 C0 9T C65 C9 5L C81 C7 3T C82-C85;C96 C92-C9 Not C44 C7 4A C12-C1 C03-C0 C07-C0 C17 C19-C20 C2 2L C23-C2 C2 5P C30-C31 C3 2L C37-C38 C4 3M C44 C4 5M C4 6K C47;C49 C50 C6 0P C61 C6 2T C63 C68 C70-C72 C75 C88 C9 1L C40-C4 C33-C34 C0 0L C01-C0 C10 C66 C67 C9 0M All ICD (10th) C1 4P C2 1A C1 5O C16 C6 9E C11 C64 Table 5.4.3 Age-Specific Incidence Rate (AIR), Age-Standardized Incidence Rate (ASR) among Non-Saudi Males (per 100,000) by Primary Site and Age Groups, 2009 Groups, Age by Primary Site and Incidence Rate (ASR) among Non-Saudi Males (per 100,000) Age-Standardized Incidence Rate (AIR), Age-Specific 5.4.3 Table

P05a.indd 84 16/01/2013 04:21:00 PM 1 0 0 2 0 0 0 .1 .8 .1 .5 .4 .2 .6 .2 .1 .3 .7 .2 .3 .3 .8 4. 3 0. 1 9. 6 1. 6 3. 9 0. 2 5. 4 0. 9 4. 7 4. 6 1. 6 0. 2 0. 2 1. 1 0. 2 1. 2 6. 2 0. 6 3. 4 1. 4 0. 1 4. 1 2. 2 0. 5 1. 7 113. 7 110. 1 ASR Worl d 33 30 41 10 61 72 20 63 86 20 10 30 71 21 00 00 00 00 00 00 00 00 00 00 .9 .7 .4 .2 .9 .6 .8 .3 .5 .1 .1 .1 .5 .1 .7 .7 .2 .2 .1 .4 .1 .1 .4 .2 .1 .6 2. 0. 0. 1. 0. 1. 1. 0. 0. 0. 0. 0. 0. 0. 54.3 52.7 Crude Rate 00 11 10 00 03 00 00 01 00 00 00 00 00 00 00 00 00 00 00 21 21 400 400 75+ 10. 51 52. 62 31. 61 10. 50 31. 61 31. 61 10. 50 10. 50 52. 62 10. 50 10. 50 42. 12 10. 51 00 00 0 00 .7 .7 .7 9.4 8.7 9. 70 9. 40 9. 42 9.1 9. 42 9. 70 9. 70 136 407 397 29.1 19.4 19.4 70-74 00 00 00 .1 .1 .1 .1 .1 55 19 10 7. 31 3. 79 8. 20 1. 19 8. 23 8. 20 7. 31 9. 10 9. 11 9. 10 9. 12 9. 11 9. 19 54.6 18.2 27.3 65-69 72 76 79 71 72 0000 09 0000 .7 .7 .7 .7 .7 .7 .7 17 8. 39 3. 99 5. 21 5. 71 1. 30 5. 79 5. 70 5. 7000 5. 79 13 01 43 06 39 66 11.3 0-64 05 0000 0000 05 05 .3 .1 .1 .4 .3 .1 .3 3. 10 9. 41 9. 45 9. 40 9. 45 6. 35 3. 11 132 426 414 12. 52 18. 81 12. 55 15. 71 12. 53 34. 51 15. 7000 18. 81 12. 50 12. 5000 40. 74 55-5 96 03 03 00 03 000000 06 .5 .8 .5 .8 .5 .8 .8 .3 .5 .8 .5 .8 .8 4.1 0.6 7. 10000 3. 56 1. 80 1.8 1.8 7. 19 1.8 1. 800000 1. 86 136 272 263 12.4 10.6 10.6 50-54 03 01 00 000000 01 .1 .5 .2 .2 .2 .2 .2 .3 .3 .2 .2 .3 .2 .1 1. 100000 7. 88 8. 91 2. 23 2. 200000 6. 73 2. 21 6. 78 6. 73 1. 11 1. 13 2. 21 1. 10 2. 21 118 221 214 15. 65 45-49 01 02 02 02 02 01 .6 .1 .4 .8 .6 .8 .1 .7 .9 .6 .5 .6 .6 .6 .8 3. 74 0. 62 1. 22 0. 60000000 1. 80 2. 52 0. 62 2. 53 3. 73 2. 53 0. 60 115 112 60.8 40-44 00 00 00 13 12 00 10 00 01 .7 .7 .3 .7 .3 .3 .3 .3 51 50 2. 33 3. 47 2. 31 0. 31 2. 33 0. 74 0. 70 0. 30000000 28.5 35-3 9 00 00 0000000000 01 .3 .5 .9 .8 .3 .5 .4 .3 .3 .3 .6 .4 .3 32 31 5.3 0. 30 0. 31 0. 30 0. 31 0. 80 0. 50 0. 30 0. 50 30-34 00 00 00 00 00 00 0000 00 .4 .4 .1 .7 .7 .4 19 19 0. 70 5. 11 4. 44 0. 40 0. 70 1. 51 0. 70 0. 71 0. 41 0. 4000000000 0. 4000 0. 40 5-29 00 01 00 00 .1 .2 .2 .3 .1 .6 .1 .6 .6 .6 19 18 1. 10 1. 1000 0. 60 1. 70 1. 10 0. 6000 20-2 42 01 02 01 01 00 00 00 .2 .6 .2 10 10 1. 22 0. 63 0. 60 0. 60 0. 60 0. 60 5-19 03 .5 .9 .9 .5 .9 0. 51 0. 50 1. 91 10-1 41 0000 00000000000000 00 00 00 00 00 00 .9 .4 0. 80 0. 80 0. 40 5-9 00000000 0000000000000000 0000000000000000 0000 000000000000 00000000 0000 0000000000000000 0000000000 00000000 000000 0000 000000 00 000000 0000000000 0000000000000000 0000000000000000 000000 00000000 0000 00 0000000000000000 0000 .4 .4 .4 .4 .4 .4 0. 40 0. 4000 2. 5000000000000000 2. 11 0-4 0000000000 00 01 0000 0000 1946 00 00000000 00 0000000000000000 0000 000000 000000 0000000000 00 000000 00 000000 00 00 00 000000 0000 0000000000000000 00 0000000000000000 1846 000000 00 Age Unk 40 20 70 40 50 10 10 60 30 31 80 20 00 00 80 10 10 00 10 20 50 70 10 00 00 50 00 90 42 16 45 30 26 14 38 33 16 83 16 54 51 320 1282 All Ages g3 .0 .5 s0 a2 .1 d4 n3 a1 e1 s9 d4 x6 x2 s1 a3 y1 elanoma of Ski esothelioma ultiple Myelom ther Endocrine ther Oropharyn x0 ther Skin vary esophagu ther Urinary organ ther Female Genital ther & unspecifie enal Pelvis onnective, Soft tissu e1 asopharyn terus unspecified olo n4 odgkin diseas ervix Uteri orpus Uter i4 nu s1 drenal glan ll sites Tota l1 tomach aposi sarcoma agin lacent a1 idne ladder ll sites but C44 ulva harynx unspecified. ancreas hyroid onsil iver ymphoid Leukemi eukemia unspecified ip aryn x3 Rectum Breas t5 Other Thoracic organs Myeloid Leukemia Tongue Mout h3 Salivary gland Gallbladder etc. Ureter Brain, Nervous system Trachea, Bronchus, Lun Bone Eye Non-Hodgkin lymphoma Immunoproliferative dis Site Hypopharyn Small intestine Nose, sinuses etc. 9C C2 1A C2 2L C6 5R C7 4A C7 5O C19-C20 C50 Al lA C37-C38 C9 1L C92-C94 C01-C02 C03-C06 C07-C08 C1 0O C1 1N C1 6S C23-C24 C4 3M C4 4O C4 5M C4 6K C5 2V C5 5U C5 6O C5 8P C6 4K C66 C70-C72 C7 3T C9 5L C0 0L C0 9T C1 5O C1 8C C3 2L C33-C34 C40-C41 C47;C4 C6 7B C6 8O C69 C8 1H C82-C85;C96 C88 C9 0M Not C4 4A ICD (10th) C5 1V C12-C13 C17 C30-C31 C5 3C C5 4C C5 7O Othe rO C1 4P C2 5P Table 5.4.4Age-Specific Incidence Rate (AIR), Age-Standardized Incidence Rate (ASR) among Non-Saudi Females (per 100,000) by Primary Site and Age Groups, 2009 Groups, Age by PrimaryFemales (per 100,000) Site and Incidence Rate (ASR) among Non-Saudi Age-Standardized Incidence Rate (AIR), 5.4.4Age-Specific Table

P05a.indd 85 16/01/2013 04:21:00 PM Table 5.5.1 Number of New Cases by Primary Site and Years among Saudi Males, 1994 - 2009

ICD-10 Site 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 C00 Lip 82454161558651296 C01-C02 Tongue 32 15 21 24 13 25 29 14 23 29 32 38 38 40 30 42 C03-C06 Mouth24233025242724272626382930394039 C07-C08 Salivary glands 410611 712816 14 11 14 15 17 20 17 17 C09 Tonsil 4924621455230420 C10 Other Oropharynx2331130330230221 C11 Nasopharynx 78 59 86 99 1099688121 84 87 101113 97 92 12293 C12-C13 Hypopharynx 10 10 18 7665867710 91456 C14 Pharynx unspecified. 0200110224443231 C15 Oesophagus77716860805367627068545758705267 C16 Stomach 130128 133108 123103 124125 146182 150160 168169 166201 C17 Small intestine 10 81110151315131715222322283130 C18 Colon 61 87 72 85 104100 115119 152177 201262 231269 291341 C19-C20 Rectum83666666648982108 123143 173191 181203 196276 C21 Anus109786510 12 14 11 17 16 8121221 C22 Liver299 298276 268327 296290 274291 281276 289316 330322 295 C23-C24 Gallbladder etc. 24 32 25 22 28 25 27 39 42 39 26 37 48 54 55 56 C25 Pancreas504953456058685375858298101 128101 117 C30-C31 Nose, sinuses etc. 5610 410135914101014910 14 5 C32 Larynx49484340464344533260555164556055 C33-C34 Trachea, Bronchus, Lung 188183 184163 223203 197189 195201 253280 237324 293276 C37-C38 Other Thoracic organs711 12 13 81776512 12 21 15 19 11 17 C40-C41 Bone47503446515351675045665765687759 C43 Melanoma of Skin218886711 91210131312171213 C44 Other Skin 104117 113107 98 120112 154149 166140 156190 167160 181 C45 Mesothelioma 545572753669812185 C46 Kaposi sarcoma 15 10 14 14 12 11 19 19 21 26 26 22 22 18 18 33 C47;C49 Connective, Soft tissue84685160506855486469587464727170 C50 Breast 11 15 612191115121616131517201823 C60 Penis 3418011131351032 C61 Prostate 150147 154123 159149 184169 196192 247271 235256 274295 C62 Testis 32 21 25 29 38 31 35 35 45 38 47 44 39 63 74 74 C63 Other male genital1203123334324002 C64 Kidney69785663717973869083124 104120 145152 174 C65 Renal Pelvis 550010 26217845455 C66 Ureter 1310304106331232 C67 Bladder 165154 126126 152152 156143 160176 174168 173174 175197 C68 Other Urinary organs 1110110011100111 C69 Eye 21 12 18 34 16 24 25 22 24 21 21 17 28 23 27 28 C70-C72 Brain, Nervous system131 99 126122 101120 139120 121148 155141 154138 163145 C73 Thyroid 73 61 58 73 84 84 77 74 91 87 94 93 120121 135141 C74 Adrenal gland898849107615610 20 16 16 18 C75 Other Endocrine2351221415365495 C81 Hodgkin disease 104105 10596134 118125 136121 144175 166176 178184 194 C82-C85;C96 Non-Hodgkin lymphoma272 214231 226283 268266 246271 328351 352363 424383 422 C88 Immunoproliferative dis. 0001010001200001 C90 Multiple Myeloma 59 41 30 36 48 37 46 36 30 39 45 60 52 46 40 57 C91 Lymphoid Leukemia 151118 146139 150137 152159 145165 154166 161194 167180 C92-C94 Myeloid Leukemia 94 90 84 10394109 91 128115 90 117107 129114 143145 C95 Leukemia unspecified. 10 5558614131214141526283718 Other Other & unspecified 148122 98 131142 138126 135153 140149 180181 169154 166

All All sites Total294226952639264730092933 3016 3092 3248 3501 3757 3980 4028 4370 4353 4618 Not C44 All sites but C44283825782526254029112813 2904 2938 3099 3335 3617 3824 3838 4203 4193 4437

P05a.indd 86 16/01/2013 04:21:01 PM Table 5.5.2 Number of New Cases by Primary Site and Years among Saudi Females, 1994-2009

ICD-10 Site 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 C00 Lip 3342154365864568 C01-C02 Tongue21202828293123193030292225382937 C03-C06 Mouth 23 38 37 22 32 39 26 27 29 29 22 43 36 51 46 37 C07-C08 Salivary glands876311814 8610 12 13 14 18 17 21 C09 Tonsil 0333113154111333 C10 Other Oropharynx0100100020220100 C11 Nasopharynx38273931373623414139453544574742 C12-C13 Hypopharynx191014151916101212216 16 10 91711 C14 Pharynx unspecified. 2311112031301313 C15 Oesophagus 75 54 68 52 45 49 55 37 58 50 51 65 63 56 56 46 C16 Stomach 67 72 64 58 66 71 62 73 77 75 76 74 114126 101112 C17 Small intestine911 91016810 14 811131313141426 C18 Colon6580857672 105 108142 133145 179197 222244 276299 C19-C20 Rectum 44 50 52 59 57 86 72 87 104107 118143 142151 162193 C21 Anus 631352425978812714 C22 Liver 109 88 101 86 123 93 121101 116128 120114 137130 123136 C23-C24 Gallbladder etc. 51 37 25 32 50 59 46 54 41 60 53 68 72 85 82 87 C25 Pancreas28302425504135355441355378537082 C30-C31 Nose, sinuses etc.6954986582610121375 C32 Larynx 10 2710 910927466910518 C33-C34 Trachea, Bronchus, Lung 51 55 48 53 50 47 52 57 52 64 69 87 81 92 83 103 C37-C38 Other Thoracic organs 76565585310 91111712 9 C40-C41 Bone 26 37 38 25 44 37 38 43 36 39 40 41 39 29 49 43 C43 Melanoma of Skin 11 77288687912 91418118 C44 Other Skin78558758827780101 95 123132 131135 120126 141 C45 Mesothelioma 10110411375653210 C46 Kaposi sarcoma 03087845365815 654 C47;C49 Connective, Soft tissue 42 55 42 46 61 50 48 43 39 53 75 51 41 66 55 65 C50 Breast 430 434 462 467 517 515 604558 673714 817945 988117111941308 C51 Vulva 867333875611 13456 C52 Vagina 5624231551571403 C53 Cervix Uteri 79 73 83 75 94 79 82 84 86 91 92 97 74 10293101 C54 Corpus Uteri 58 47 39 48 60 58 92 79 88 111125 150150 184194 253 C55 Uterus unspecified. 4211 10 17 13 5131414131724282228 C56 Ovary 96 100 97 114 107 100 104111 108123 119146 138148 169173 C57 Other Female Genital 110224354510 69868 C58 Placenta 16 10 11 7912 91416581423121310 C64 Kidney 60 37 50 57 53 64 49 70 69 68 84 65 79 83 96 120 C65 Renal Pelvis 0102332112154113 C66 Ureter 0110110111242001 C67 Bladder28392330393739514143423942364038 C68 Other Urinary organs 0000011000110010 C69 Eye 15 16 18 13 12 24 24 17 20 16 18 20 19 20 17 22 C70-C72 Brain, Nervous system 78 73 76 93 85 78 84 84 85 95 108102 108118 95 103 C73 Thyroid 207 218 198 210 266 281 260259 278365 346391 429458 488538 C74 Adrenal gland 10 61011910 14 8101317910 91310 C75 Other Endocrine 2121231001255422 C81 Hodgkin disease596959577475877876113 105103 120135 137150 C82-C85;C96 Non-Hodgkin lymphoma 143 150 142 146 185 176 186202 202238 244259 245289 308287 C88 Immunoproliferative dis.0001011101000001 C90 Multiple Myeloma 20 33 20 13 24 27 25 19 19 16 26 26 33 49 29 39 C91 Lymphoid Leukemia 76 89 80 80 74 95 11286101 93 85 85 91 117117 127 C92-C94 Myeloid Leukemia 78 78 74 90 83 90 93 103100 99 124100 121105 107126 C95 Leukemia unspecified. 661561294511 11 17 9193023 Other Other & unspecified 105 95 93 95 138 127 122116 117162 175147 171152 166162

All All sites Total 2384 2357 2360 2353 2756 2797 2887 2903 3107 3470 3740 3994 4244 4676 4755 5205 Not C44 All sites but C44 2306 2302 2273 2295 2674 2720 2807 2802 3012 3347 3608 3863 4109 4556 4629 5064

P05a.indd 87 16/01/2013 04:21:01 PM Table 5.5.3 Age Standardized Incidence Rate by Primary Site and Years among Saudi Males, 1994-2009

ICD-10 Site 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 C00 Lip 0.20.1 0.10.1 0.100.100.10.1 0.20.1 0.10.2 0.20.1 C01-C02 Tongue 0.90.5 0.60.6 0.30.6 0.80.3 0.50.6 0.80.9 0.80.8 0.60.8 C03-C06 Mouth0.7 0.70.9 0.60.6 0.60.5 0.70.6 0.60.8 0.70.8 0.80.8 0.8 C07-C08 Salivary glands 0.10.3 0.20.3 0.10.2 0.20.3 0.30.2 0.20.2 0.30.4 0.30.3 C09 Tonsil 0.10.2 0.10.1 0.10.1 00.1 0.10.1 0.10.1 00.1 00 C10 Other Oropharynx0.1 0.10.1 000.100.10.1 000.10000 C11 Nasopharynx 2.11.5 2.32.5 2.62.2 22.5 1.81.7 22.2 1.71.5 21.5 C12-C13 Hypopharynx 0.30.2 0.40.2 0.20.1 0.10.2 0.10.1 0.20.2 0.20.3 0.10.1 C14 Pharynx unspecified. 0000000000.10.1 0.10.1 00.1 0 C15 Oesophagus 2.21.9 1.71.5 21.2 1.51.6 1.61.6 1.21.3 1.41.4 11.3 C16 Stomach3.7 3.63.5 2.732.432.93.2 4.23.5 3.54.1 3.53.2 3.9 C17 Small intestine 0.30.2 0.30.3 0.40.3 0.40.3 0.40.3 0.50.5 0.50.5 0.60.6 C18 Colon 1.82.4 1.92.1 2.62.5 2.82.8 3.54.1 4.45.8 5.35.4 5.46.5 C19-C20 Rectum 2.41.9 1.61.7 1.62.4 22.5 2.73.3 4.14.3 4.343.85.1 C21 Anus 0.30.2 0.20.2 0.20.1 0.30.3 0.30.3 0.40.3 0.20.2 0.20.4 C22 Liver 8.78.6 7.57.1 8.37.5 7.37.3 776.66.8 8.27.2 6.65.9 C23-C24 Gallbladder etc. 0.70.9 0.70.6 0.70.6 0.7 1110.60.9 1.31.2 11.1 C25 Pancreas 1.41.3 1.51.2 1.51.4 1.61.3 1.7222.2 2.62.7 22.3 C30-C31 Nose, sinuses etc. 0.10.2 0.30.1 0.20.3 0.10.3 0.30.2 0.20.2 0.20.2 0.20.1 C32 Larynx 1.51.4 1.211.21.1 1.11.5 0.81.5 1.31.3 1.61.2 1.21.1 C33-C34 Trachea, Bronchus, Lung 5.65.3 54.4 5.85.1 54.8 55.2 5.96.6 6.26.9 65.7 C37-C38 Other Thoracic organs 0.20.2 0.20.2 0.20.3 0.10.1 0.10.3 0.20.3 0.20.3 0.20.3 C40-C41 Bone 0.70.7 0.50.7 0.70.7 0.70.8 0.60.6 0.70.6 0.70.7 0.90.6 C43 Melanoma of Skin0.6 0.20.2 0.20.2 0.20.3 0.20.3 0.20.3 0.30.3 0.40.2 0.2 C44 Other Skin2.7 32.8 2.82.4 2.72.5 3.63.2 3.73.1 3.44.5 3.333.5 C45 Mesothelioma 0.10.1 0.20.1 0.20.1 0.20.1 0.10.1 0.10.2 0.20.2 0.40.1 C46 Kaposi sarcoma 0.50.3 0.30.3 0.30.2 0.40.5 0.50.6 0.60.4 0.50.3 0.30.6 C47;C49 Connective, Soft tissue1.7 1.411.20.8 1.210.91.1 1.20.8 11110.9 C50 Breast 0.30.4 0.10.3 0.50.2 0.40.3 0.40.4 0.30.3 0.40.4 0.30.4 C60 Penis 0.10.1 00.2 00000.1 00.1 0.1000.1 0 C61 Prostate43.83.8 2.93.9 3.544.34.3 4.65.8 6.46.3 5.65.8 6.1 C62 Testis 0.70.4 0.50.5 0.70.6 0.60.5 0.70.5 0.60.5 0.50.7 0.80.8 C63 Other male genital0000.1000.1 0.10.1 0.10.1 00.1 000 C64 Kidney 1.821.41.5 1.71.6 1.71.9 1.81.7 2.52.1 2.62.7 2.63 C65 Renal Pelvis 0.10.1 000.30.1 0.1000.2 0.20.1 0.10.1 0.10.1 C66 Ureter 00.1 000.100.1000.2 0.10.1 000.10 C67 Bladder 4.64.3 3.43.2 3.83.7 43.4 3.54.1 4.13.6 4.13.5 3.63.9 C68 Other Urinary organs 0000000000000000 C69 Eye 0.50.2 0.30.5 0.20.4 0.30.5 0.40.3 0.40.3 0.40.3 0.30.4 C70-C72 Brain, Nervous system 2.91.8 2.42.2 1.62.1 2.32.1 22.5 2.52.2 2.622.22 C73 Thyroid21.51.5 1.81.9 1.71.5 1.61.9 1.71.7 1.62.1 1.92.1 2.1 C74 Adrenal gland 0.10.1 0.20.1 00.1 0.20.1 0.10.2 0.10.1 0.20.2 0.20.2 C75 Other Endocrine 0.10.1 0.10000000.100.10.1 00.1 0.1 C81 Hodgkin disease 2.11.9 1.71.5 2.21.9 1.821.81.9 2.32.1 2.12.1 22.3 C82-C85;C96 Non-Hodgkin lymphoma6.7 5.15.5 56.2 6.15.4 55.2 6.46.3 6.56.7 7.16.2 6.8 C88 Immunoproliferative dis.00000000000.100000 C90 Multiple Myeloma1.8 1.10.8 11.3 11.1 0.90.6 0.91.1 1.31.3 10.8 1.1 C91 Lymphoid Leukemia 2.21.8 2.122.322.12.4 22.2 2.122.42.4 2.12.3 C92-C94 Myeloid Leukemia 1.91.7 1.7221.8 1.72.1 21.6 1.81.6 21.6 22 C95 Leukemia unspecified. 0.20.1 0.10.1 0.20.1 0.30.3 0.20.3 0.20.2 0.50.4 0.60.3 Other Other & unspecified43.12.6 3.33.4 3.42.8 3.43.5 3.23.3 3.94.2 3.433.1

All All sites Total 75.8 67.1 63.161 68.7 64.9 65.2 67.9 67.4 73.8 76.2 79.9 86.2 80.3 76.1 80.9 Not C44 All sites but C44 73.164 60.3 58.2 66.4 62.2 62.7 64.3 64.2 70.1 73.2 76.5 81.777 73.2 77.4

P05a.indd 88 16/01/2013 04:21:01 PM Table 5.5.4 Age Standardized Incidence Rate by Primary Site and Years among Saudi Females, 1994-2009

ICD-10 Site 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 C00 Lip 0.10.1 0.1000.1 0.10.1 0.20.1 0.20.1 0.10.1 0.10.2 C01-C02 Tongue 0.70.7 0.90.8 0.90.9 0.60.5 0.80.7 0.70.5 0.60.8 0.60.7 C03-C06 Mouth0.7 1.21.1 0.711.10.7 0.60.7 0.70.5 0.90.8 10.9 0.7 C07-C08 Salivary glands 0.20.2 0.20.1 0.30.2 0.20.2 0.10.2 0.30.2 0.20.3 0.20.3 C09 Tonsil 00.1 0.10.1 000.100.10.1 0000.1 0.10 C10 Other Oropharynx000000000.1 00.1 0.10000 C11 Nasopharynx 0.90.6 10.7 0.90.8 0.40.7 0.80.7 0.90.7 0.80.9 0.70.7 C12-C13 Hypopharynx 0.60.3 0.50.5 0.60.4 0.30.3 0.200.40.4 0.20.2 0.30.2 C14 Pharynx unspecified. 00.1 00000.100.100.100000.1 C15 Oesophagus 2.71.8 2.21.7 1.41.4 1.511.51.2 1.21.5 1.61.2 1.10.9 C16 Stomach2.4 2.42.1 1.821.91.6 1.71.8 1.81.7 1.72.7 2.51.9 2.1 C17 Small intestine 0.30.4 0.30.3 0.50.2 0.20.3 0.20.3 0.30.3 0.30.3 0.30.5 C18 Colon 2.32.7 2.62.3 2.22.9 2.63.4 33.4 4.14.2 5.14.6 5.35.7 C19-C20 Rectum 1.61.7 1.61.9 1.72.3 1.822.32.5 2.73.1 3.22.9 3.23.7 C21 Anus 0.20.1 00.1 0.200.10.1 0.10.2 0.10.2 0.20.2 0.10.3 C22 Liver 3.933.32.9 3.82.7 3.22.7 2.83.3 2.92.6 3.32.8 2.52.7 C23-C24 Gallbladder etc. 1.81.3 0.811.61.7 1.31.4 1.11.5 1.21.6 1.71.9 1.71.8 C25 Pancreas 1.11.1 0.80.9 1.61.2 0.90.8 1.410.91.3 1.91.2 1.51.7 C30-C31 Nose, sinuses etc. 0.20.2 0.10.1 0.20.2 0.10.1 0.200.10.2 0.30.2 0.10.1 C32 Larynx 0.30.1 0.20.3 0.30.3 0.200.20.1 0.10.1 0.20.2 0.10.4 C33-C34 Trachea, Bronchus, Lung 1.921.51.6 1.51.4 1.51.5 1.21.6 1.61.9 21.9 1.72 C37-C38 Other Thoracic organs 0.20.2 0.10.1 0.10.1 0.20.1 00.1 0.20.2 0.20.1 0.20.1 C40-C41 Bone 0.40.7 0.70.4 0.60.5 0.40.5 0.40.5 0.50.4 0.40.3 0.60.5 C43 Melanoma of Skin0.3 0.20.2 0.10.2 0.20.1 0.20.2 0.20.2 0.20.3 0.40.2 0.1 C44 Other Skin2.7 1.72.7 1.82.4 2.122.42.2 2.93.1 2.932.52.4 2.7 C45 Mesothelioma000000.1000.1 0.20.1 0.10.1 0.100.2 C46 Kaposi sarcoma 00.1 00.3 0.20.2 0.10.1 0.10.1 0.10.2 0.40.1 0.10.1 C47;C49 Connective, Soft tissue0.9 1.3111.1 10.8 0.60.6 0.81.3 0.70.6 0.80.8 0.8 C50 Breast 13.3 12.9 13.2 12.7 13.8 12.5 13.512 13.9 14.6 16.2 18.3 18.2 20.5 19.9 22.7 C51 Vulva 0.30.2 0.20.1 0.10.1 0.20.2 0.10.1 0.200.10.1 0.10.1 C52 Vagina 0.20.2 00.2 00.1 00.1 0.100.10.2 00.1 00.1 C53 Cervix Uteri2.4 2.22.5 2.22.8 21.9 21.8 1.91.9 2.11.5 1.81.7 1.8 C54 Corpus Uteri2.1 1.41.4 1.521.62.5 22.2 2.733.53.8 445.3 C55 Uterus unspecified. 0.10.1 0.30.3 0.50.4 0.10.3 0.30.3 0.30.4 0.60.7 0.40.6 C56 Ovary 2.932.73.1 3.12.3 2.22.4 2.22.3 2.432.92.7 3.23 C57 Other Female Genital 0000.1 0.10.1 0.10.1 0.10.1 0.20.1 0.20.2 0.10.1 C58 Placenta0.4 0.20.2 0.10.2 0.20.2 0.20.2 0.10.1 0.20.3 0.20.1 0.1 C64 Kidney 1.411.11.3 1.41.4 0.91.4 1.41.4 1.81.2 1.51.4 1.61.9 C65 Renal Pelvis 0000.1 0.10.1 0.1000.1 00.1 0.1000.1 C66 Ureter 000000000000.1 0000 C67 Bladder 0.91.1 0.711.311.11.2 1110.8 10.7 0.80.7 C68 Other Urinary organs 0000000000000000 C69 Eye 0.30.3 0.40.2 0.20.4 0.40.3 0.40.3 0.30.3 0.30.3 0.20.3 C70-C72 Brain, Nervous system 1.41.4 1.41.8 1.51.4 1.51.5 1.31.6 1.71.4 1.71.7 1.41.5 C73 Thyroid5.5 5.24.6 4.95.7 5.54.7 4.64.8 6.15.7 6.26.5 6.46.9 7.6 C74 Adrenal gland 0.20.1 0.10.1 0.10.1 0.20.1 0.10.2 0.20.1 0.10.1 0.10.1 C75 Other Endocrine 0.100000000000.1 0.10.1 00 C81 Hodgkin disease 1.41.3 11.1 1.31.2 1.21.2 11.5 1.41.3 1.61.6 1.61.7 C82-C85;C96 Non-Hodgkin lymphoma4.3 4.34.1 454.24.1 4.44.3 54.9 5.25.1 5.25.5 5.1 C88 Immunoproliferative dis.0000000000000000 C90 Multiple Myeloma0.8 1.20.7 0.40.7 0.80.7 0.50.5 0.40.6 0.60.8 10.6 0.8 C91 Lymphoid Leukemia 11.6 1.2111.3 1.71.3 1.21.2 1.111.21.5 1.41.5 C92-C94 Myeloid Leukemia 1.81.6 1.61.7 1.61.6 1.61.8 1.81.6 21.6 2.21.6 1.41.8 C95 Leukemia unspecified. 0.10.1 00.1 0.10.3 0.20.1 0.10.2 0.20.2 0.20.3 0.40.4 Other Other & unspecified 3.53.1 2.82.8 4.13.2 3.12.9 2.73.8 43.2 43.1 3.33.1

All All sites Total 70.8 66.9 64.4 62.372 65.9 63.3 62.3 64.171 74.9 77.6 84.4 82.7 81.8 90.1 Not C44 All sites but C44 68.1 65.1 61.7 60.5 69.6 63.8 61.4 59.9 61.9 68.1 71.8 74.7 81.4 80.2 79.3 87.4

P05a.indd 89 16/01/2013 04:21:02 PM Table 6.1 Number of In situ Cases among Saudis and Non-Saudis, 2009

Saudis Non-Saudis ICD-10 Topography All Male Female TotalMaleFemaleTotal D013 Anus 3140004 D015 Bile tract 0110001 D090 Bladder 71 12 83 11 31497 D050;D051;D057;D059 Breast 160610 7768 D60; D69 Cervix 029290 8837 D010 Colon 7411 01112 D001 Esophagus 1120002 D049; D092 Eye 11 5161 0117 D020 Glottis 4153149 D000 Lip 0000111 D000 Nasopharynx 1010001 D000 Oropharynx 1010001 D073 Ovary 0330114 D091 Renal pelvis 1010001 D074 Penis 1010001 D011 Recto sigmoid 2020002 D012 Rectum 5050116 D033;D035;D036;D039;D042;D045-D047;D049 Skin 11 3143 1418 D014 Small intestine 1120002 D000 Floor of mouth10 10001 D002 Stomach 0220002 D091 Ureter 1010001 D073 Uterus 0110001 D071 Vulva 0220002 Total 123 126 249 18 24 42 291

Table 6.2 Number of Myelodysplastic syndromes and chronic Myeloproliferative disorders among Saudis and Non-Saudis, 2009

Saudis Non-Saudis ICD-O-3 Morphology All Male Female Total Male Female Total 9963 Chronic neutrophilic leukemia00 00111 9950 Polycythemia vera 4370007 9960 Chronic myeloproliferative disease, NOS11920 11222 9961 Myelosclerosis with myeloid metaplasia 0110001 9962 Essential thrombocythemia 4711 10112 9982 Refractory anemia with sideroblasts 2020002 9983 Refractory anemia with excess blasts10 10112 9984 Refractory anemia with excess blasts in transformation 0112023 9985 Refractory cytopenia with multilineage dysplasia01 10001 9986 Myelodysplastic syndrome with 5q-syndrome 0110001 9987 Therapy-related myelodysplastic syndrome, NOS10 10001 9989 Myelodysplastic syndrome, NOS65110 0011 Total2928574 3764

P05a.indd 90 16/01/2013 04:21:02 PM PART VI APPENDICES

P06a.indd 91 16/01/2013 04:41:11 PM APPENDIX: A Reporting Health care Facilities

Asir Region Abha General Hospital (Maternity) Khamis Mushayt General Hospital Abha Private Hospital King Fahad Hospital (Bisha) AFS Military South Hospital King Fahad Hospital, AFH Ahli Hospital (Abha) King Faisal Military Hospital Al-Borg Laboratory (KhM) Mahael General Hospital Asir Central Hospital (Abha) Majaridah General Hospital Balasmar General Hospital Namas General Hospital Bashayer Hospital Prince Abd Bin Abd Aziz Hospital Bisha General Hospital Sabt Alaya Hospital Dhahran Janoob Hospital Sarat Obeidah General Hospital Ghassan Nagib Pharaon Saudi German Hospital (Abha) Hayat Hospital (KhM) Tathleeth General Hospital Khamis Mushayt Civil Hospital Zafer Hospital Baha Region Baljurashi General Hospital Mikhwah Hospital Ghodran Hospital Physical Therapy Center King Fahd Hospital (Baha) Psychiatric Hospital (Baljurashi) Mandaq Hospital Qilwah Hospital Eastern Province Ahli Hospital King Fahad Specialist Hospital Ahsa Hospital (Hofuf) King Khalid General Hospital Al-Borg Laboratory (DM) Magrabi Eye Hospital (DM) Amal Hospital (DM) Mana General Hospital (DM) Anak General Hospital Mana General Hospital (Hofuf) ARAMCO Clinic Mana General Hospital (Jubail) Armed Forces Hospital (Hafuf) Mana General Hospital (Khobar) Astoon Hospital (Thomairy) Maternity & Children's Badr Rubaie Dispensary Mousa Hospital (Hofuf) Dammam Central Hospital Mouwasat Dispensary (DM) Dammam National Dispensary Mouwasat Hospital (DM) Dhahran General Hospital Mouwasat Hospital (Jubail) Dossary Hospital (Khobar) Mouwasat Hospital (Qatif) Dr Fakhry & Mouhawis Hospital Naim Clinic (Hofuf) Dr Fakhry & Rajhi Hospital Naireia General Hospital Dr Noor Khan Hospital (Hafuf) Obeid Hospital (Hofuf) Fanateer Hospital Prince Saud Bin Jalawi Hospital Hafr Batin Hospital Prince Sultan Hospital Huwaylat Hospital Qatif Central Hospital Imam Abd Rahman Bin Faisal Hospital Rafiaah Hospital Jabir Eye & ENT Hospital Rowdha Dispensary Jubail General Hospital Royal Commission Hospital Jufer Hospital (Hofuf) Saad Specialist Medical Center Khafji General Hospital Salama Hospital Khafji Joint Operation Saudi ARAMCO Medical Services King Abd Aziz Airbase Sulaiman Sulaiman Clinic King Abdul Aziz Navy Tadawy General Hospital King Abdulaziz NGH Hospital Taheeli Hospital King Fahad Hospital (Hofuf) Udhailiyah Health Center King Fahad Hospital of the University Uyun Hospital (Ahsa) King Fahad Military Hospital Yousif Hospital Hail Region Al-Borg Laboratory (Hail) Maternity & Children's Hospital Baqa Hospital Rashid Hospital Hail General Hospital Salamat Private Hospital King Khaled General Hospital Salimi Hospital (Shanan)

P06a.indd 92 16/01/2013 04:41:11 PM APPENDIX: A (continued...)

Jazan Region Abu Arish General Hospital Garrash Polyclinic Ahad Masarha Hospital Jazan General Hospital Al-Borg Laboratory (Ja King Fahd Central Hospital Aridah Hospital King Fahd Specialist H Baysh General Hospital Sabia General Hospital Darb Hospital Samtah General Hospital Dental Center (JZ) Tuwal Hospital Emeis National Hospital Jouf Region Dawamat Jandal Hospital Qurayat Psychiatric Hospital Maternity & Children's Suwair General Hospital Pr Abd Rahman Sudairi Tabarjal General Hospital Qurayat General Hospital Madinah Region Al-Borg Laboratory Meeqat Hospital Ansar Hospital (MD) Mouwasat Hospital (Madinah) Ansary Spicialist Hospital Ohoud Hospital Badr General Hospital (Yanboa) Prince Abd Mohsen Ola Hospital Dar Hospital Rahmah Hospital Dr Erfan Saadi Hospital (Yanboa) Royal Commission Medical Center Dr Hamed Al Ahmadi Hospital Safa Madinah Hospital Ees General Hospital (Yanboa) Saudi German Hospital (MD) Hanakyah General Hospital Taiba Diagnostic Cente King Fahad Hospital (MD) Yanboa Al Bahr Hospital Madina National Hospital Yanboa General Hospital Madinah Maternity & Chest Hospital Yanboa National Hospital Magrabi Eye Hospital (MD) Zahra Private Hospital Mahd General Hospital Makkah Region Abd Rahman Qari Center King Fahad General Hospital Abdulllah Saeim Daher King Fahad, AFH(JD) Abeer Polyclinic (JD) King Fahd Air Base Hospital Abuzinada Hospital King Faisal (Al Shesha) Hospital Adhm Hospital (Leeth) King Faisal Hospital (Taif ) Adwani General Hospital (Taif) King Faisal Specialist Hosital Alawi Tunsi & Bros Hospital King Saud Hospital (JD) Al-Borg Laboratory (JD) Maghraby Eye Hospital (JD) Al-Borg Laboratory (MK) Maternity & Children's Amen Hospital (Taif) Mohammad Saleh Bashrahil Hospital Ansar Hospital (JD) Mustaqbal Hospital Bugshan General Hospital Nahda National Hospital (Taif) Chest Disease Hospital (Taif) New Jedaani (Qulail) Hospital Dr Abd Rahman Bakhsh Hospital New Jeddah Clinic Dr Erfan & Bagedo Hospital New Jeddah Hospital Dr Ghassan Pharaon Hospital Noor Specialist Hospital ( MK) Dr Halla Bin Laden Hospital Nourah Oncology Center, NGH Dr Khalid Idriss Hospital Pioneers Laboratory Dr Khalid Idriss Hospital Dr Solaiman Fakeeh Hospital Prince Mansour Military Hospital Eye Hospital (JD) Qunfudah General Hospital Hada Military Hospital (AFH) Rabegh General Hospital Hai Jamea Hospital Rafie Hospital (MK) Hamra Hospital Royal Commission Medical Center Hassan Qaznaoi Hospital Saedy Medical Clinic Hayat Hospital (JD) Sahan Bani Saad Hospital Heda Sanitorium Hospital Salam Hospital

P06a.indd 93 16/01/2013 04:41:11 PM APPENDIX: A (continued...)

Makkah Region Continued….. Hera General Hospital (MK) Saudi German Hospital (JD) International Medical Center Saudi Hospital Jedaani (Safa) Hospital Sheffaa Hospital Jeddah Clinic Hospital Jeddah National Hospital Taif Chest Hospital Khadra Lab (JD) Taif Children's Hospital Khalid Idriss Hospital (JD) Thagher Hospital King Abd Aziz Hospital Umm Qura General private King Abd Aziz Hospital & Oncology Center United Doctors Hospital King Abd Aziz Specialist Hospital Zahra Hospital (JD) King Abd Aziz University Najran Region Dhafer Hospital (Najran) Najran General Hospital King Khaled Hospital (Najran) Sharourah Armed Forces Hospital Maternity & Children's Hospital Sharourah General Hospital Najran Armed Forces Hospital Northern Region Arar Central Hospital Prince Abduaziz Bin Musaed Hospital Arar Psychiatric Hospital Rafha General Hospital Owaiqaliah Hospital Turayf General Hospital Qassim Region Al-Borg Laboratory (Buraidah) King Fahd Specialist Hospital Asyah Hospital King Saud University Hospital Badaya Hospital Maternity & Children's Hospital Bukairiya General Hospital Midhnab General Hospital Buraidah Central Hospital Rass General Hospital Dr Suliman Al Habib Mecical Center Riyadh Region Abdul Azeem Bassam Medical King Khaled Eye Specialist Hospital Abdullah Medical Clinic King Khaled General Hospital Adama Hospital King Khaled International Hospital Advance Cell Laboratory King Khaled University Advanced Medicine Center King Saud Medical City AFH Millitary (RKH Program) Maghraby Eye Hospital (RY) Afif General Hospital Mamlaka Hospital (Kingdom) Aflaj General Hospital Mansoura Medical Clinic Ahmed Aba Nami Hospital Maternity & Children's Hospital Alam Medical Center Mobarak Hospital Al-Borg Laboratory (RY) Modern Laboratories Amal Clinic (1) Mohd Anazi Medical Cener Amal Psychiatric Hospital Mouwasat Hospital (Ry) Anda Medical Laborator Muzhamiyah General Hospital Armed Forces Wadi Dawaser Hospital Obeid Hospital(RY) Artwiyah General Hospitai Olaya Medical Center Aviccenna Polyclinic Osrah Clinic Badri Medical Center Osrah International Hospital Badruddin Medical Group Prince Nasser Bin Saad Hospital Bustan Clinic Prince Salman Bin Abduaziz Hospital Chest Diseases Hospital (Kharj) Quwayiyah General Hospital College of Dentistry KSU Rathawiah Medical Specialist Center Consultative Medical Center Rawdhah National Clinic Consulting Radiologist Center Riyadh Care Hospital Dallah Hospital Riyadh Medical Center Dar Shifa Hospital Romah Hospital

P06a.indd 94 16/01/2013 04:41:12 PM APPENDIX: A (continued....)

Riyadh Region Continued… Dawadmi General Hospital Safa Makka Polyclinic Delta Medical Laboratoy Sajir Hospital (Dawadmi) Dr Abdl Rahman Mishari Hospital Saleh Eye Care Center Dr Daouk Clinic Saudi German Hospital Dr Moagel's Polyclinic Security Forces Hospital Dr Mofarreh Polyclinic Shaqra General Hospital Dr Mohamed Anazi Med Center Shifa Health Center Dr Suliman Habib Med Center Shifa Jazeera Polyclin Elite Medical&Surgical Specialized Medical Center Eman General Hospital Sports Medicine Hospital ENT Medical Center Subhi Specialized Center Faleh International Hospital Sulail Hospital Faraidy National Clinic Taawin Polyclinic Finger Print Laboratory Thadeq General Hospital Green Cresent Hospital Thuriah Medical Center Hammadi Hospital Tumayr (Majmaah) Hariq General Hospital United Medical Laboratory Heraa Medical Clinic Wadi Dawasser Hospital Hotta Bani Tammim Hospital Watan Clinic Howtat Sudair Hospital Watani Hospital (Ry National) Huraymila General Hospital Wroud Medical Clinic Jafel International Ho Yamamah Hospital Jazeera Medical Clinic Zulfi General Hospital Jazirah Clinical Lab King Abd Aziz Medical City King Abdul Aziz University King Fahad Medical City King Faisal Specialist Hospital & RC Tabuk Region Dhuba General Hospital North West Armed Forces Hospital King Fahad Hospital (Tabuk) Prince Fahad Bin Sultan Hospital King Khalid Civil Taima General Hospital King Khalid General Hospital Umlujj General Hospital King Khalid Military Hospital Wajh General Hospital Maternity & Children's Hospital

International Hospitals in the following Countries: Bahrain Nigeria Canada Pakistan China Philippines Egypt Qatar Eritrea Russian Federation Ethiopia Sudan France Switzerland Germany Syrian Arab Republic Hong Kong (SARC) India Thailand Jordan Turkey Kuwait United Arab Emirates Lebanon United Kingdom Malaysia United States of America Mauritius Yemen

P06a.indd 95 16/01/2013 04:41:12 PM APPENDIX: B SCR Board Member Contact Information

SCR Main Ofﬁce Chairman: Shouki Bazarbashi, MD MBC 64 PO Box 3354, Riyadh 11211 Admin. Director: Haya Al Eid, BDS, DFE, CTR Saudi Arabia Tumor Registrar: Mohamed Hayder, CTR Tel: 01 442 3430 Tumor Registrar: Maisoun Khaled Fax: 01 448 3924 Tumor Registrar: Abeer Mohamed Hayder Email: [email protected] Secretary: Angelica D. Garcia [email protected] Website: www.scr.org.sa

Armed Forces Hospitals Director: Col. Dr. Ali Matar Al Zahrani Riyadh Military Hospital PO Box 7897, Riyadh 11159 Tel: 01 477 7714 x25261 Fax: 01 477 7714 x26743 Email: [email protected]

Central Region Director: Abdulaziz Al Humaidi, MD King Fahad Medical City PO Box 59046, Riyadh 11525 Tel: 01 288 9999 x7086 Fax: 01 288 1965 Email: [email protected]

Eastern Region Director: Prof. Hassan Al Idrissi, MD King Fahd Hospital of the University PO Box 40004, Al Khobar 31952 Tel: 03 896 6741 Fax: 03 896 6741 Email: [email protected]

King Abdulaziz University Hospital Director: Prof. Mahmoud Shaheen Al Ahwal, MD Faculty of Medicine PO Box 80215, Jeddah 21589 Tel: 02 624 0000 x18244/18253 Fax: 02 617 1412 Email: [email protected]

King Faisal Specialist Hospital & Representative: Ali Al-Zahrani, MD, PhD Research Center MBC-64 PO Box 3354, Riyadh 11211 Tel: 01 442 4286 Fax: 01 442 4542 Email: [email protected]

Madinah & Northern Region Director:Ahmed Tarawa, MD Maternity & Children Hospital Madinah Al Monawarah Tel: 04 836 2000 x2465/2462 Fax: 04 836 0937 Email: [email protected]

P06a.indd 96 16/01/2013 04:41:12 PM APPENDIX: B Continued....

National Guard Hospitals Director: Amer Naeem Radwi, MD King Abdulaziz Medical City (KKNGH) PO Box 9515, Jeddah 21423 Tel: 02 624 0000 x24087/24181 Fax: 02 624 7242 Email: [email protected]

Security Forces Hospital Director: Abdulaziz Saleh Aba Hussein, MD PO Box 3643, Riyadh 11481 Tel: 01 802 4801 / 802 3613 Fax: 01 802 3814 Email: [email protected]

Southern Region Director: Amjad Rehman, MD Assir Central Hospital PO Box 61421, Abha Tel: 07 224 0711 / 224 7800 x118 Fax: 07 224 0964 / 224 7570 Email: [email protected]

Western Region Director: Hasnah Al Ghamdi, MD King Abdulaziz Hosp. & Oncology Center PO Box 31467, Jeddah 21497 Tel: 02 637 5555 x2276 Fax: 02 635 6410 Email: [email protected]

King Saud University Director: Khalid Al Saleh, MD King Khalid University Hospital College of Medicine PO Box 7805 (80), Riyadh 11472 Tel: 01 467 9488 Fax: 01 467 9487 Email: [email protected]

Ministry of Health Representative: Mohammad Y. Saeedi, MD Kingdom of Saudi Arabia Dep. Chairman PO Box 335157, Riyadh 11314 Tel: 01 475 0426 x201 Fax: 01 475 0428 Email: [email protected]

P06a.indd 97 16/01/2013 04:41:12 PM APPENDIX C: Cancer Registration Abstract Form

SAUDI CANCER REGISTRY CANCER REGISTRATION ABSTRACT Ministry of Health Revised September 2012 Kingdom of Saudi Arabia

1. ACCESSION DATE 2. CanReg-4 No. (Accession Number)

d dm m y y y y (Computer Assigned) PATIENT 3. (Must be filled in Arabic) 4. (Must be filled in Arabic) 5. 6. (Must be filled in Arabic)

3. First (Must be filled ) 4. FATHER (Must be filled) 5. GRANDFATHER6. FAMILY (Must be filled)

Use SCR standardized name spellings 7. Saudi ID/Passport/ Iqama Number 8. Sex 9. Date of Birth 10. Age at Diagnosis --

1-Male d d m m y y y y 2-Female (if only year is known, use 01/07//_ _ _ _ ) 9-Unknown 11.Nationality Code 12. Nationality Text (Must be filled) 13. Marital Status 1. Single 4. Widowed 2. Married 9. Unknown 3. Divorced 14. Address Code (Must be filled) 15. Address Details (Must be filled) City: Suburb /District P.O. Box Zip Code:

16. Mobile Number (Must be ﬁlled)

17. Telephone Number 1 (Must be ﬁlled) 18. Extension 1 19. Telephone Number 2 20. Extension 2

TUMOR 21. Date of Diagnosis (Must be ﬁlled) (First time physician states that patient has a malignancy clinically or pathologically) (if only year is known, use 01/07/_ _ _ _ )

d d m m y y y y 22. Topography Code 23. Topography Text (Must be ﬁlled)

C0B

24. Morphology Code 25. Morphology Text (Must be ﬁlled) / (behavior)

26. Behavior 27. Grade28. SEER Summary Stage (Extent)

1. In situ 2. In situ 1. Well differentiated / Differentiated, NOS 3. Malignant/Invasive 2. Moderately / Moderately well differentiated 2. Localized 3. Poorly Differentiated 3. Regional by direct extent 4. Undifferentiated / Anaplastic 4. Regional by lymph node 5. T-Cell* 5. Regional (both 3 and 4) 6. B-Cell/Pre-B/B-cursor* 6. Regional, NOS 7. Null Cell/Non-T-Non-B* 8. Natural Killer cell* 7. Distant Metastasis / Systemic disease 9. Unknown* 9. Unknown * for leukemias & lymphomas only

29. Laterality 30. Basis of Diagnosis

0. Not paired (unknown, ill deﬁned) 0. DCO (death certiﬁcate only) 5. Cytology / Hematology 1. Right 1. Clinical 6. Histology of Metastasis 2. Left 2. Medical Imaging (Radiology) 7. Histology of Primary 3. One side, but unknown 3. Surgery (Visualization without Biopsy) 4. Bilateral involvement, laterality origin unknown 8.Autopsy 9. Paired site, laterally not stated 4. Lab test (tumor marker) 9. Unknown

P06a.indd 98 16/01/2013 04:41:13 PM APPENDIX C: Cancer Registration Abstract Form

HOSPITAL

31. Date ﬁrst seen at Source1 for this cancer (Must be ﬁlled) d d m m y y y y

32. Source 1 33. Reporting Hospital Text 34. MRN 1 35. Path 1

36. Source 237. Referral Hospital Text 38. MRN 2 39. Path 2

40. Source 3 41. Referral Hospital Text 42. MRN 3 43. Path 3

44. Source 4 45. Referral Hospital Text 46. MRN 4 47. Path 4

48. Source 5 49. Referral Hospital Text 50. MRN 5 51. Path 5

52. Source 6 53. Referral Hospital Text 54. MRN 6 55. Path 6

FOLLOW-UP

56. Last Contact 57. Status 58. Cause of Death

1. Cancer 1. Dead 2. Other 2. Alive 3. Not Applicable d d m m y y y y 9. Unknown 9. Unknown

59. Coder ID # 60. Data Entry ID #

Signature: ______Signature: ______

QUESTIONS / QUERIES / PROBLEMS:

P06a.indd 99 16/01/2013 04:41:13 PM

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100

P06a.indd 100 16/01/2013 04:41:14 PM APPENDIX D: Summary of Cancer Statistics in Saudi Arabia for the Year 2009

101

P06a.indd 101 16/01/2013 04:41:15 PM P06a.indd 102 16/01/2013 04:41:15 PM

Kingdom of Saudi Arabia Ministry of Health Saudi Cancer Registry Saudi Arabia 2009

Cancer Incidence Report Saudi Arabia 2009

December 2012

ISSN: 1658-0559 Cancer Incidence Report www.scr.org.sa