Epidemiological Study of Lung Cancer in East Azerbaijan, Iran
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Archive of SID Tabriz University of Medical Sciences Original Article Epidemiological Study of Lung Cancer in East Azerbaijan, Iran Shahryar Hashemzadeh MD1, Khosrow Hashemzadeh MD2* 1. Dept. of General and Thoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran. 2. Dept. of Cardiac Surgery, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. (Received 14 Sep 2009; Accepted 18 Nov 2009) Abstract Background: Lung cancer is the most common cause of cancer death worldwide with more than 1.3 million people dying of the disease annually. In Asia, the incidence and mortality rates of lung cancer are generally lower than those in western countries. We aimed to obtain cancer incidence data from the East Azerbaijan, Iran; to select the target populations for our future cancer field studies. Methods: Diagnosed primary lung cancer cases and pleura and trachea during five years (2002-2006) were collected from the hospital or private pathology laboratories in East Azerbaijan and analyzed using SPSS 13.0 after metastatic and same cases exclusion. Results: In this study 159314 pathology records were studied in hospitals and laboratories; 12083 of them were cancer cases. 9166 of them were primary cancer patients and Azerbaijan residents. A total of 469 new lung cancer cases (81% male, 19% female) were diagnosed during the years 2002–2006, the age-adjusted incidence rate (ASR) per 100,000 being 16.6 for males and 4.2 for females. Squamous cell carcinoma was the most common histological type (58.5%), the proportion of adenocarcinoma being 27.6%, small cell carcinoma 12.6% and large cell carcinoma 0.6%. ASR was calculated for cancer of pleura (0.4, 0.3) and for cancer of trachea (0.2, 0.1) per 100000 in male and female, respectively. Conclusion: This study is the first report of respiratory tract cancer incidence in East Azerbaijan. The results of the present study are statistic analysis of the cancer prevalence and incidence in Iran which mainly correspond with the international reports and is a scientific tool we want to offer to all those who work in the prevention, care and treatment of cancer in Iran. J Cardiovasc Thorac Res 2009; Vol.1 (4): 7-12 Keywords: Epidemiology ý Cancer ý Lung *Corresponding Author: Khosrow Hashemzadeh MD, Department of Cardiovascular Surgery, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Tel: +98 411 - 3317214 Fax: +98 411 - 3316214 Email: [email protected] www.SID.ir J Cardiovasc Thorac Res / 7 Archive of SID Journal of Cardiovascular and Thoracic Research Hashemzadeh et al Introduction (Chicago, IL) software, version 13, and Microsoft word and excel 2003 software. We calculated Cancer is a major public health problem in person-years of the population at risk using each developed countries. Currently, one in four deaths year method. The results are presented as incidence in the United States is due to cancer. A total of rates of cases by site (ICD-10), sex, age (mean ± 1444920 new cancer cases and 559650 deaths for SD) and Age-Specific (crude) incidence rate by sex cancers are projected to occur in the United States and site and Age-Adjusted incidence rate per in 2007.1,2 In Asia, the incidence and mortality rates 100,000 person-years, using the direct method of of lung cancer in women are generally lower than standardization to the world standard population.[2] those in western countries 3,4 and Lung cancer was Statistics were generated from primary malignant the most common cause of death from cancer in cases only. The world standard population was men (29%) 5. For almost 30 years no population- chosen because it is more similar to the resident based cancer statistics have been available with population than other standards (e.g. the World or which to estimate the cancer burden in Iran. The US 1970 ones). More than fifty percent of the incidence rate of lung cancer is very low in population in our province is younger than 25 years compromising with the world average 6. Suitable (Figure 1). information of different cancers in special >80 geographic areas can help define medical treatment female male and screening of high risk groups and map out the 70-74 risk of kinds of cancers. Therefore, several research centers might be focus on cancer research in Iran. 60-64 We aimed to obtain cancer incidence data from the whole province, to select the target populations and 50-54 hot spots for our future cancer field studies. 40-44 Methods 30-34 20-24 The Cancer Registry office is located in Tabriz, the capital city of East Azerbaijan Province. This 10-14 registry is run by Tabriz University of Medical 0-4 Sciences. The Medical Ethics Committee of Tuberculosis and Lung Disease Research Center (TLDRC) of Tabriz sponsored and approved the Fig 1- Population cascade of East Azerbaijan province. survey methods. The survey team had been trained to go to hospitals and pathology laboratories and The world standard has a greater percentage of check records for cancer cases and, whenever younger subjects (48% ≤ 25 years old) and a lower possible, to make a copy of the documents, percentage of older subjects (60+ years), with 11% according to which a diagnosis of cancer was made. population. The use of such a standard gives more These were then sent to the registry office in Tabriz. weight to the events in the younger population. During a period of 10 months (2007), the survey team actively collected and compiled data for a Results period of 5 years (2002-2006) from 8 hospitals and 9 private pathology laboratories in Tabriz and 5 Over a 5-year period (2002-2006), 159314 main township of East Azerbaijan province pathologic reports were observed in hospital and (Mianeh, Marand, Benab, Ahar and Maragheh). A private centers in East Azerbaijan province; 12083 copy of the pathology records made and sent to the of them were cancer cases. 10717 of the cancer registry office. The data were summarized in a data patients were East Azerbaijan residents and 748 sheet. The data were computerized using SPSS cases were of the other regions. Non melanoma www.SID.ir 8 /J Cardiovasc Thorac Res Archive of SID Epidemiological Study of Lung Cancer Lung Cancer … Tabriz University of Medical Sciences cancers of the skin (BCC, SCC & Baso-esquamous age ± standard deviation for all cancers of cell cancer) and in situ carcinomas (except urinary respiratory tract were shown in table 3. bladder) were excluded and 9166 cases were considered as primary malignancies. (Table 1) Table 2 - Distribution of cancers in respiratory tract system by organ in East Azerbaijan, Iran (2002-2006). Table 1- Anatomical sites and number of all cancers in East male female total Azerbaijan, Iran (2002-2006). site frequency percent frequency percent frequency percent Lung 380 66.9 89 27.9 469 94.8 Pleura 10 1.7 8 2.1 18 3.8 Anatomical site No. of cancers percent Trachea 5 0.9 2 0.5 7 1.4 Head and Neck 1863 20.3 total 395 69.5 99 30.5 494 100 Thorax and chest wall 1434 15.6 Abdomen: Table 3 - Male to female ratio and mean age ± SD for respiratory GI tract 3365 36.7 tract cancers in East Azerbaijan, Iran (2002-2006). Urinary system 1233 13.5 Common age group M/F Mean age ± SD Genitalia 705 7.7 Site Limbs 566 6.2 male female Ratio male female Total 9166 100 All cancers 45-54 65-74 1.34 60.1±17.0(0-120) 52.3±17.0 (1-101) Lung 65-74 65-74 4.25 62.5±12.5(19-88) 58.2±13.8 (26-97) Pleura 45-55 45-55 1.43 52.7+12.4(37-74) 55.6+10.2 (42-71) Of 9166 cancer in total, 5252 (57.3%) were male Trachea * * 2.5 49.8+10.0(23-65) 58.5+10.6 (51-66) and 3602 (42.6%) were female and 12 (0.1%) * There were no enough cases in series undefined sex. The mean (±SD) age at the time of first diagnosis was 60.1 ± 17.0 for males and A total of 469 new lung cancers (81% male, 19% 52.3 ± 17.0 for females. The top 7 cancers in males female) were diagnosed in this study. Age-specific were stomach (18.2%), bladder (16.6%), esophagus (crude) incidence rates in 7 age-groups for lung (12.3%), lung and bronchus (7.2%), prostate cancers were shown in figure 3. ASR per 100000 (6.4%), colon and rectum (5.7%) and brain (5.5%); was being 16.6 for males and 4.2 for females. (Figure 4) Squamous cell carcinoma was the most male female common histological type (58.5%, n=274), the lung 4.2 16.6 proportion of Adenocarcinoma of lung being 27.6% and Small cell carcinoma 12.6 %.( Table 4) There were 18 cases of mesothelioma of pleura in our pleura 0.3 0.4 study (55.6%male, 44.4% female). In trachea, Adenocystic carcinoma and SCC was the most common cancers. 0.1 0.2 trachea male female Fig 2- Age-adjusted cancer incidence rates (per 100000) for respiratory tract cancers, by sex in East Azerbaijan, Iran 250 (2002-2006). 200 in women, these were breast (22.2%), esophagus 150 (13.8%), stomach (9%), thyroid (7.9%), brain (7%), 100 colon and rectum (6.6%) and bladder (4.5%). Cancer of respiratory tract consists of 1/18 (5.3%, 50 494 cases) of all diagnosed cancers. In this study, 0 395 (69.5%) were men and 99 (30.5%) were female.