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The Incidence of Nasopharyngeal Carcinoma in Pahang State of Malaysia from 2012 to 2017

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The Incidence of Nasopharyngeal Carcinoma in Pahang State of Malaysia from 2012 to 2017 The Incidence of Nasopharyngeal Carcinoma Original Article in Pahang State of Malaysia from 2012 to 2017 Azmir AHMAD1, Wardah MOHD YASSIN2, Nor Azlina A RAHMAN2, Wan Ishlah LEMAN3, Luqman ROSLA4, Mark PAUL4, Sharifah Nor Ezura SYED YUSSOF4, Kamariah MOHAMED@AWANG5, Kahairi ABDULLAH6, Mohd ArifinK ADERI2 Submitted: 14 Jun 2020 1 Department of Basic Medical Science for Nursing, Kulliyyah of Nursing, Accepted: 25 Oct 2020 International Islamic University Malaysia, Pahang, Malaysia Online: 24 Feb 2021 2 Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia 3 Department of Otorhinolaryngology-Head and Neck Surgery, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia 4 Department of Otorhinolaryngology, Hospital Sultan Haji Ahmad Shah, Pahang, Malaysia 5 Department of Otorhinolaryngology, Hospital Tengku Ampuan Afzan, Pahang, Malaysia 6 Ear, Nose and Throat Consultant, KPJ Batu Pahat Specialist Hospital, Johor, Malaysia To cite this article: Ahmad A, Mohd Yassin W, Rahman NAA, Leman WI, Rosla L, Paul M, Syed Yussof SNE, Mohamed@Awang K, Abdullah K, Kaderi MA. The incidence of nasopharyngeal carcinoma in Pahang state of Malaysia from 2012 to 2017. Malays J Med Sci. 2021;28(1):66–74. https://doi.org/10.21315/mjms2021.28.1.9 To link to this article: https://doi.org/10.21315/mjms2021.28.1.9 Abstract Background: Nasopharyngeal carcinoma (NPC) is the fifth most common cancer among Malaysians. While several studies have reported the trend of NPC in other states in Malaysia, no studies have reported the trend of NPC in Pahang state. This study was designed to report the number and distribution of newly diagnosed NPC cases in Pahang. Methods: NPC cases that were diagnosed between 2012 and 2017 in two referral hospitals in Pahang were traced. The crude incidence rate (CR) and age-standardised rate (ASR) were calculated to investigate the NPC incidence. Results: There were 143 new cases of NPC reported from the two hospitals. The mean age at diagnosis was 52.0 ± 13.7 years old. The majority of cases involved males (74.1%) with a male to female ratio of 2.9:1. Chinese males were found to have the highest incidence with a mean ASR of 4.7 per 100,000 population. Overall, the mean ASR for Pahang was 2.4 per 100,000 population for males and 0.9 per 100,000 population for females. Conclusion: The total number of NPC cases reveals an increasing trend from 2012 to 2014 and then a slightly decreasing trend from 2015 to 2017. The incidence of NPC in Pahang was intermediate in males and low in females. Keywords: nasopharyngeal carcinoma, incidence of nasopharyngeal carcinoma, Malaysia, incidence rate, crude, age-standardised rate Malays J Med Sci. 2021;28(1):66–74 www.mjms.usm.my © Penerbit Universiti Sains Malaysia, 2021 66 This work is licensed under the terms of the Creative Commons Attribution (CC BY) (http://creativecommons.org/licenses/by/4.0/). Original Article | Incidence of NPC in Pahang, Malaysia Introduction In Malaysia, NPC is a significant health burden, as it is among the five most commonly Nasopharyngeal carcinoma (NPC) is a type diagnosed cancers in the country’s population of malignant tumour of the nasopharynx that and fifth most common cancer among Malaysian arises from the mucosal epithelium. Globally, men (6). Malaysian National Cancer Registry NPC is considered a rare malignancy with an Report 2012–2016 discovered that there were incidence rate below 1 per 100,000 persons per on average 900–1,000 cases of NPC reported year for both genders. In 2012, NPC ranked as each year in 2007–2011. The incidence was more the 24th most common new cancer in the world than twofold higher among males compared to with 86,691 cases and 50,831 deaths (1). Notably, females. The ASR for males was 6.4 per 100,000 NPC is a disease with remarkable geographic population, whereas it was 2.2 per 100,000 and racial distribution worldwide in which it is population for females. According to ethnicity, prevalent in certain regions, such as Southern Chinese males were found to have a higher China, Southeast Asia, North Africa and the incidence with an ASR of 11.0 per 100,000 Arctic. population compared to Malay males (3.3 per Based on data from the Cancer Incidence 100,000 population) and Indian males (1.1 per in Five Continents, the highest rate according 100,000 population). Of specific interest, the to region was demonstrated in a population in incidence is particularly high among some native Southeast Asia that had an overall incidence of groups in Sarawak. In 1996–1998, an ethnic- 6.4 per 100,000 person-years among males and based study on NPC revealed that a native group 2.4 per 100,000 person-years among females. in Sarawak (Bidayuh) showed the highest rate A high incidence of NPC was also found in of NPC (31.5 per 100,000 population in males) populations in Micronesia/Polynesia, Eastern compared to other ethnicities in Malaysia or any Asia and Northern Africa, where incidence other ethnicity worldwide (7). rates were above 2.0 per 100,000 person-years NPC is a rare cancer worldwide, but it is in males and 1.0 per 100,000 person-years common in certain geographic regions, including in females. Specifically, the high incidence in Malaysia. It is necessary to determine the areas are centralised in the southern part of incidence and identify the affected groups. The China, particularly Guangdong Province, with existing data are limited, as research regarding approximately 20 to 40 cases per 100,000 this disease has been conducted in certain states person-years depending on the region (2). Cities only. There are limited updated NPC statistics in Guangdong Province, namely Zhongshan, in Pahang state of Malaysia. Basic information Guangzhou and Sihui, had a high incidence on NPC in Pahang is crucially needed before in males compared to elsewhere in the world, further research on the disease in the region can with an age-standardised rate (ASR) of 26.8 be carried out. Thus, this epidemiological study per 100,000 person-years (3), 22.2 per 100,000 is designed to feature the number of cases and person-years (4) and 30.94 per 100,000 distribution of NPC in Pahang. person-years (5), respectively. In addition, a high incidence of this tumour was observed in Methods nearby cities in Southern China, including Hong Kong and Macao, with ASRs of 14.4 and 15.7 per Data Collection 100,000 person-years among males, respectively (2). This study involved two main referral Intermediate rates have been reported in hospitals in Pahang, namely Hospital Tengku Southeast Asian countries, such as Singapore, Ampuan Afzan (HTAA) in Kuantan and Malaysia, the Philippines, Thailand, Indonesia Hospital Sultan Haji Ahmad Shah (HOSHAS) and Vietnam, where the ASR ranges from 3.4 in Temerloh. It included newly diagnosed cases to 12.9 per 100,000 person-years for males. of NPC reported from 1 January 2012 until Similarly, in Northeast India, intermediate ASRs 31 December 2017 from both hospitals. Newly were recorded for males in Mizoram and Sikkim diagnosed cases of NPC were defined as patients states (5.0 and 3.6 per 100,000 person-years, who were diagnosed with NPC for the first time respectively). Other than Asia, intermediate and not recurrent cases. This was confirmed incidence of NPC has been reported in North by reviewing the patients’ medical records Africa (Algeria, Tunisia and Libya), where it from both hospitals. All records were traced ranges from 1.0 to 6.0 per 100,000 person- from the Cancer Notification Registry from the years (2). www.mjms.usm.my 67 Malays J Med Sci. 2021;28(1):66–74 Department of Otorhinolaryngology — Head and population in the particular age group and Neck Surgery. Each patient’s information such multiplying by 100,000 population, as follows: as name, gender, address, identification number, date of diagnosis and type and stage of NPC Ni were collected from the records. Only Malaysian AR − × 100,000 Pi citizens who had been diagnosed with NPC in Pahang were included in the data analysis. The where Ni is the number of new cancers occurring histopathological classification was based on the in the ith age group and Pi is at-risk person-years World Health Organization (WHO) classification in the ith age group (6). This can be obtained of NPC (8). The tumours were staged according from the database of the Department of Statistics to the American Joint Committee on Cancer Malaysia for the years 2012 until 2017 (10). staging for NPC (2002) (9). Next, the ASR was calculated by summing the AR weighting to the world standard Calculation of Crude Incidence Rate and population (6), as follows: Age-Standardised Rate The incidence of NPC was computed ∑ (AR × P ) ASR = i i.std based on the number of individuals in the total Total world standard population population who were newly diagnosed with NPC in Pahang for 2012–2017. The formula for the where ARi is the age-specific rate in the ith calculation of the crude incidence rate (CR) and age class and Pi.std is the number in the ith age ASR were taken from the Malaysian National class of the world standard population (6). Cancer Registry Report 2012–2016 (6). CR is The calculated ASR was then called the world the number of newly diagnosed cases of NPC standardised incidence rate and also expressed observed in the Pahang population during the per 100,000 population. The world standard study period (2012–2017) divided by the total population that was modified by Doll et al.
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