Immunopathol Persa. 2018;4(1):e10 Original

Immunopathologia Persa http www.immunopathol.comm DOI:10.15171/ipp.2018.10 Epidemiology of common cancers in Dezful county, southwest of

Reza Norouzirad1, Zaher Khazaei2, Masoumeh Mousavi3, Hossein Ali Adineh4, Mansooreh Hoghooghi1, Mehdi Khabazkhoob5, Fereidon Nirouzad1, Mohammad Dorchin1, Salman Khazaei6, Malihe Sohrabi Vafa1, Seyedeh Leila Dehghani7, Ali Shahrouzian8, Bita Chaeideh1, Reza Beiranvand9*

1Dezful University of Medical Sciences, Dezful, Iran 2Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran 3Epidemiology Department, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran 4Department of Epidemiology and Biostatistics, Iranshahr University of Medical Sciences, Iranshahr, Iran 5Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, , Iran 6Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran 7Department of Public Health, Faculty of Medical sciences, Behbahan, Iran 8Polyclinic, Iranian Social Security Organization, Dezful, Iran 9Shoushtar Faculty of Medical Sciences, Jundishapur University of Medical Sciences, Ahvaz, Iran

*Correspondence to Abstract Reza Beiranvand, Email: Introduction: Cancers is considered as the third reason of death after cardiovascular disease and [email protected] accidents. These types of disease are one of the most critical issues in health and treatment in Iran and the world. Received 28 July 2017 Objectives: The aim of this study was to conduct an epidemiologic investigation on types of cancers Accepted 4 November 2017 in Dezful. Published online 5 December 2017 Patients and Methods: In this epidemiologic study, recorded data of cancers during 2006-2011 was considered. The data were gathered from all of health centers, pathobiology laboratories, and all Keywords: Epidemiology, Cancer, public and private hospitals in the city of Dezful. Additionally the data of oncology and radiotherapy Dezful, Iran, Stomach departments were considered. The, incidence rate in every 100 000 people had been calculated in subgroups of gender and age groups. Results: Of 2202 registered cases of cancers during 6 years in Dezful, 42.38% were female and 57.61% were male. Cancer incidence during 6 years reached to 525 (incidence of 111.68 per 100 000) in 2011 to 223 (incidence 55.4 per 100 000) in 2006. During this period, skin cancers (16.47 per 100 000) and stomach (10.88 per 100 000) had the highest incidence. The most common cancers in males and females were skin and breast cancers, respectively. Breast cancer in females had two peaks from ages 50-54 years and more than 85 years old. Conclusion: Regarding ascending order of cancer incidence in the region and also the high incidence Citation: Norouzirad R, of skin and stomach cancers, preventive modalities including individuals’ personal protection of Khazaei Z, Mousavi M, sunlight and dietary patterns modification are suggested. Additionally, individual’s screening and Adineh HA, Hoghooghi self-examining are suggested too. M, Khabazkhoob M, et al. Epidemiology of common cancers Introduction in Dezful county, Key point southwest of Iran. During recent years pattern of some diseases Immunopathol Persa. have changed in the world. The reduction The prevalence of cancer, especially the 2018;4(1):e10. of communicable diseases and increasing skin cancer, in Dezful has a high prevalence DOI:10.15171/ the incidence rate and prevalence of non- and needs more attention and care, such as ipp.2018.10. preventing sunlight direct exposure to the communicable diseases is detectable. In skin. spite of successful modalities in the field of controlling and preventing of epidemic diseases, the rate of chronic diseases is death after cardiovascular diseases and increasing significantly (1,2). In some accidents (4) and is considered as one of regions, cancer is considered as the second the important health problems in many cause of death after cardiovascular diseases advanced and developing countries (5, 6). (3). In Iran cancer was the third cause of Regarding molecular and cellular biology,

Copyright © 2018 The Author(s); Published by Nickan Research Institute. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Norouzirad R et al cancerNorouzirad is referred R et al to molecular defects in cellular activity project have done their commitments about confining which causes changes in various genes (7). Cancers are demographic information. onecellular of the activity main andwhich critical causes issues changes for in public various health genes and (7). demographic information. treatmentCancers inare Iran one andof the all main over and the critical world issues(8). Cancer for public in Data collection futurehealth decades and treatment will be one in ofIran the and main all reasonsover the of world diseases (8). StatisticalData collection analysis of information was done using SPSS burdenCancer in thein future world. decades It is also will expected be one theof the cases main of cancersreasons 21Statistical software. analysis The ofincidence information rate wasof cancers done using in different SPSS willof increase diseases toburden 15 million in the in world. 2020 thatIt is 60also percent, expected while the urban21 software. regions The was incidence calculated rate based of cancers on ICD, in genderdifferent and cases of cancers will increase to 15 million in 2020 that 60 urban regions was calculated based on ICD, gender and most of them will happen in less developed countries (9). age groups. The proportion of cancer cases in a year was percent, while most of them will happen in less developed age groups. The proportion of cancer cases in a year was At the present time, around 7 million deaths occurred in determined (according to involved area, gender and age countries (9). At the present time, around 7 million deaths determined (according to involved area, gender and age the world due to cancers (equal to 13% of all deaths) (10). groups) or estimated crowd in a year. Death was calculated occurred in the world due to cancers (equal to 13% of groups) or estimated crowd in a year. Death was calculated Riskall factors deaths) consisting (10). Risk of age,factors gender consisting and genetic of age, structure gender according toto aa numbernumber of of new new cases cases (based (based on on involved involved areand unchangeable. genetic structure Other arefactors unchangeable. comprise environmental Other factors area, gender andand age age groups). groups). factorscomprise like smoking,environmental ionizing factors rays, like chemical smoking, and ionizing toxic materialsrays, chemical (11). and toxic materials (11). Results In this study,study, ofof 22022202 patients patients with with cancer, cancer, 1270 1270 patients patients ObjectivesObjectives (57.67%) werewere malemale andand 932 932 were were (42.32%) (42.32%) female. female. The The TheThe aim aim of thisof this study study was was to to determine determine cancer cancer epidemiologic epidemiologic most incidence raterate ofof cancers cancers (128.01 (128.01 per per 100 100 000) 000) was was patternpattern in inDezful Dezful during during 2006-2011 2006-2011 to to establishestablish aa basebase in men andand (93.13(93.13 per per 100 100 000) 000) were were related related to to the the year year of of forfor etiological etiological surveys surveys and and control control programs programs onon typestypes ofof 2011 (Figure 1).1). cancers.cancers. As shown inin FigureFigure 2, 2, the the most most incidence incidence rate rate of ofcancers cancers during thesethese yearsyears generallygenerally waswas related related to to skin skin and and PatientsPatients and and Methods Methods stomach cancers.cancers. PatientsPatients The most incidenceincidence raterate ofof cancers cancers in in males males was was skin skin TheThe study study is isa across-sectional. cross-sectional. Patients’Patients’ recordsrecords casescases cancer withwith 16.4716.47 per per 100 100 000, 000, followed followed by by stomach stomach cancer cancer of ofcancers cancers were were collected collected fromfrom allall healthhealth centers,centers, with 10.7 perper 100100 000. 000. The The most most incidence incidence rate rate in inwomen women pathobiologypathobiology laboratories, laboratories, hospitals hospitals andand oncologyoncology andand was related toto breastbreast cancercancer with with 24.13 24.13 per per 100 100 000 000 and and radiologyradiology departments departments during during 2006 2006 to to 2011.2011. DataData werewere skin cancer withwith 7.5 7.5 per per 100 100 000 000 (Table (Table 1). 1). includedincluded age, age, gender, gender, death death reason, reason, cancer cancer type, type, anatomic anatomic The most incidenceincidence of of skin skin cancer cancer was was in in age age group group of of60 60 locationlocation and and involved involved organs. organs. years in menmen andand stomach stomach cancer cancer in in the the age age group group of of65 65 to to Diagnosis of cancer type was done by international code 80 years (Table 2). The most incidence of breast cancer was Diagnosis of cancer type was done by international code 80 years (Table 2). The most incidence of breast cancer was ICD-O (International Classification of Diseases for in the age group of 40 to 55 in women and also age group ICD-O (International Classification of Diseases for in the age group of 40 to 55 in women and also age group Oncology). In this cross-sectional study, epidemiologic more than (≥80) and kin cancer in age group more than Oncology). In this cross-sectional study, epidemiologic more than (≥80) and kin cancer in age group more than state of cancer types was investigated in Dezful. (≥70) (Tables 2 and 3). state of cancer types was investigated in Dezful. (≥70)Generally, (Tables 9 cases 2 and (2.8%) 3). of whole cases of breast cancer Ethical issues Generally,were detected 9 cases in men (2.8%) while of whole305 cases cases (97.2%) of breast were cancer in EthicalThe researchissues followed the tenets of the Declaration of werewomen. detected We found, in menbreast while cancer 305 in womencases (97.2%) has two peakswere in TheHelsinki. research Before followed the thestudy, tenets written of the informed Declaration consent of women.in the age We group found, of 50-54 breast and cancer more in than women 85 years has withtwo peaksthe Helsinki.was obtained Before from the allstudy, patients written who informedparticipated consent in the inincidence the age rategroup of 132.2of 50-54 and and 166.3 more per than100 000 85 respectively.years with the wasstudy. obtained All information from all patients about individuals who participated was coded in andthe incidenceAlso, the most rate ofincidence 132.2 and rate 166.3 of breast per 100 cancer 000 wasrespectively. in the study.kept All confidential. information This about study individuals was approved was by coded the Ethics and Also,age group the mostof 70-74 incidence years andrate withof breast the incidence cancer was rate in of the keptCommittee confidential. of Dezful This studyUniversity was ofapproved Medical bySciences the Ethics with age14.96 group per 100 of 00070-74 in men.years and with the incidence rate of Committeecode DUR125. of Dezful Questioners University and of researchers Medical Sciences of the current with 14.96Total casesper 100 of prostate000 in men. cancer in men were 93 cases in the codeproject DUR125. have Questionersdone their commitmentsand researchers about of the confining current Totalage group cases of of 80-84 prostate years cancer and inhad men the werehighest 93 incidencecases in the

140 120 100 80 60 Percent 40 20 0 2006 2007 2008 2009 2010 2011 Male 59.63 77.36 120.8 103.47 65.51 129.25 Female 50.8 59.31 92.7 76.86 61.99 93.13 Total 55.4 68.62 107.2 90.63 63.81 111.68

Figure 1. Trend of cancer incidence in Dezful by gender in 2006-2011. Figure 1. Trend of cancer incidence in Dezful by gender in 2006-2011.

2 Immunopathologia Persa Volume 4, Issue 1, January 2018 2 Immunopathologia Persa Volume 4, Issue 1, January 2018 CommonCommon cancers cancers in Dezful in Dezfulcounty county

16.47

10.88

7.94 6.84 6.76 Percent 5.73 5.66 3.68 3.53 3.09 3.01 2.72

Figure 2. Common cancers in Dezful in 2006-2011. Figure 2. Common cancers in Dezful in 2006-2011. Table 1. Cancers incidence in 2006-2011 rate of 228.228 during 6 years. Total cases of skin cancer Incidence in 100 000 in men and women were 224 and 98 from 2006 to 2011, Table 1. TopologyCancers incidence in 2006-2011 age group of 80-84 years and had the highest incidence Male Female respectively. Skin cancer in women in age group of 76- Incidence in 100 000 rate of 228.228 during 6 years. Total cases of skin cancer TopologySkin 16.47 7.60 80 years had the incidence of 189.3 per 100 000. In men Male Female Stomach 10.88 3.29 inin the men age andgroup women of more were or equal 224 toand 85 98 years from we 2006had the to 2011, Skin 16.47 7.60 Hematopoietic and reticuloendothelial system 7.94 3.92 incidencerespectively. rate ofSkin 333.3 cancer per 100 in 000 women which wasin age the grouphighest of 76- Stomach 10.88 3.29 Prostate gland 6.84 -- incidence80 years during had the 6 years. incidence Total cases of 189.3 of stomach per 100 cancer 000. in In men HematopoieticBladder and reticuloendothelial system 7.946.76 3.921.41 menin the and age women group were of 146 more and or 42 equalper 100 to 000, 85 respectively.years we had the ProstateOther, gland unspecified 6.845.73 4.54-- Stomachincidence cancer rate in of women 333.3 inper the 100 age 000 group which of 70-74 was yearsthe highest BladderBronchus and lung 6.765.66 1.412.19 withincidence the incidence during of 6 64.55 years. per Total 100 000cases and of in stomach men in thecancer in Rectum 3.68 1.88 Other, unspecified 5.73 4.54 agemen group and of women 75-79 years were with 146 andthe incidence 42 per 100 rate 000, of 123.64respectively. Esophagus 3.53 2.19 Bronchus and lung 5.66 2.19 per 100 000 had the highest incidence during 6 years. Total Brain, nervous system 3.09 1.10 Stomach cancer in women in the age group of 70-74 years Rectum 3.68 1.88 cases of colon cancer in men and women from 2006 to 2011 Colon 3.01 2.74 with the incidence of 64.55 per 100 000 and in men in the Esophagus 3.53 2.19 were 41 and 35 per 100 000, respectively. Above cancer in Lymph node 2.72 1.57 age group of 75-79 years with the incidence rate of 123.64 Brain, nervous system 3.09 1.10 women and men in age group of more than 85 with the Liver and intrahepatic bile ducts 2.21 1.41 incidenceper 100 000of 55.4 had and the 55.6highest per incidence100 000, respectively, during 6 years. had Total Colon 3.01 2.74 Larynx 1.84 0.24 thecases highest of colon incidence cancer during in men 6 years. and Totalwomen cases from of bladder 2006 to 2011 Lymph node 2.72 1.57 Kidney 1.76 1.96 cancerwere 41in menand 35and per women 100 000, were respectively. 92 and 18 respectively Above cancer in Liver andPancreas intrahepatic bile ducts 2.211.40 1.410.71 whichwomen had and the highestmen in incidence age group during of more 6 years than in women 85 with the LarynxBones, joints and articular cartilage 1.841.10 0.240.55 inincidence the age group of 55.4 of 75-79 and years 55.6 with per the100 incidence 000, respectively, of 37.19 had Testis 1.03 -- Kidney 1.76 1.96 perthe 100 highest 000 and incidence in men duringin the age 6 years. group Total of 80-84 cases years of bladder PancreasConnective, subcutaneous and other soft tissues 1.400.88 0.711.33 with the incidence rate of 156.16 per 100 000 (Figures 3 Small intestine 0.88 .039 cancer in men and women were 92 and 18 respectively Bones, joints and articular cartilage 1.10 0.55 and 4). Breast 0.66 24.13 which had the highest incidence during 6 years in women Testis 1.03 -- The results show that most percentage of death due to Heart, mediastinum and pleura 0.66 0.31 in the age group of 75-79 years with the incidence of 37.19 Connective, subcutaneous and other soft tissues 0.88 1.33 cancer (70.47%) was related to 2010 and least percentage Tongue 0.59 0.24 (37.33%)per 100 was 000 related and in to men2011 (Figurein the age5). group of 80-84 years Small intestine 0.88 .039 Anus and anal canal 0.51 0.24 with the incidence rate of 156.16 per 100 000 (Figures 3 Breast Retroperitoneum and peritoneum 0.660.37 24.130.24 Discussionand 4). Heart, Salivarymediastinum gland and pleura 0.660.37 0.31 TheThe goal results of the show study that was mostto investigate percentage the diagramof death of due to TongueThyroid gland 0.590.37 0.241.25 Dezfulcancer malignant (70.47%) andwas distributerelated to its2010 division and leastin terms percentage Mouth 0.22 0.31 Anus and anal canal 0.51 0.24 of(37.33%) epidemiologic was related data toand 2011 compare (Figure it 5). with existing RetroperitoneumNasopharynx and peritoneum 0.370.22 0.240.08 information of other canters of Iran. In this study, the Adrenal gland 0.15 0.08 Salivary gland 0.37 0.31 incidence rate pattern of cancers was investigated in Gallbladder 0.15 0.47 Discussion Thyroid gland 0.37 1.25 Dezful. From 2202 cancer cases of obtained cancer record Hypopharynx 0.15 -- The goal of the study was to investigate the diagram of Mouth 0.22 0.31 data, 2199 cases were determined true record during 6 Ovary -- 2.04 Dezful malignant and distribute its division in terms Nasopharynx 0.22 0.08 years which 42.38% were observed in women and 57.61% Thymus 0.15 0.08 inof men. epidemiologic data and compare it with existing Adrenal gland 0.15 0.08 Corpus uteri -- 1.33 Cancerinformation incidence of duringother 6canters years fromof Iran. 2006 Into 2011this study,had the Gallbladder 0.15 0.47 Nose and sinuses 0.07 0.16 ascendingincidence order rate and pattern from 223 of casescancers (55.4 wasper 100investigated 000) in in HypopharynxCervix and uterine 0.15-- 1.25-- 2006Dezful. reached From to 525 2202 cases cancer (111.68 cases per of100 obtained 000) in 2011. cancer The record Ovary Uterus unspecified ---- 2.040.63 studydata, results 2199 showedcases were that duringdetermined 6 years, true skin record(16.47 perduring 6 Vulva, vagina, unspecified female genital areas -- 0.55 Thymus 0.15 0.08 100years 000) which and stomach 42.38% cancers were (10.88observed per 100in women 000) had and most 57.61% Corpus uteri -- 1.33 in men. Nose and sinuses 0.07 0.16 ImmunopathologiaCancer incidence Persa Volume during 4, Issue 6 years 1, January from 2018 2006 to3 2011 had Cervix and uterine -- 1.25 ascending order and from 223 cases (55.4 per 100 000) in Uterus unspecified -- 0.63 2006 reached to 525 cases (111.68 per 100 000) in 2011. The Vulva, vagina, unspecified female genital areas -- 0.55 study results showed that during 6 years, skin (16.47 per

Immunopathologia Persa Volume 4, Issue 1, January 2018 3 Norouzirad R et al

Table 2. Male cancer incidence per 100 000 according to topology and age groups in 2006-2011 Norouzirad R et al TopologyNorouzirad R et al 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- ≥85 All SkinTable 2. Male cancer incidence per0.6 100 000 4.8according8.2 to topology5.4 and12.9 age groups33.7 in 2006-201126.8 59.6 95.9 114.5 139.6 178.6 228.2 333.3 16.5 StomachTable 2. Male cancer incidence per0.6 100 0002.1 according0.0 to topology1.1 and10.3 age groups24.9 in 13.42006-201156.6 61.1 105.3 114.7 123.6 108.1 83.3 10.7 HematopoieticTopology and 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- ≥85 All Topology 2.320- 6.225- 3.730- 3.235- 6.440- 4.445- 50-13.4 55-29.8 60-48.0 65-32.0 70-24.9 75-27.5 80-96.1≥85 27.8All 7.9 reticuloendothelialSkin systems 0.6 4.8 8.2 5.4 12.9 33.7 26.8 59.6 95.9 114.5 139.6 178.6 228.2 333.3 16.5 ProstateStomachSkin gland 0.00.60.6 0.02.14.8 0.00.08.2 1.10.05.4 10.30.012.9 24.94.433.7 13.426.81.9 56.659.68.9 61.195.939.2 105.3114.536.6114.7139.6109.7123.6178.6116.8108.1228.2288.383.3333.3138.910.716.56.8 HematopoieticStomach and 0.6 2.1 0.0 1.1 10.3 24.9 13.4 56.6 61.1 105.3 114.7 123.6 108.1 83.3 10.7 Bladder 0.62.3 6.20.7 3.70.0 3.20.0 6.41.3 4.44.4 13.417.3 29.826.8 48.048.0 32.059.524.984.827.568.796.1156.227.8 55.67.9 6.7 Hematopoietic and reticuloendothelial systems 2.3 6.2 3.7 3.2 6.4 4.4 13.4 29.8 48.0 32.0 24.9 27.5 96.1 27.8 7.9 BronchusProstatereticuloendothelial andgland lung systems 0.00.0 0.00.7 0.00.0 0.00.0 0.07.7 4.41.5 1.911.5 8.98.9 39.217.4 36.641.2109.754.9116.8151.1288.384.1138.9166.76.8 5.7 Prostate gland 0.0 0.0 0.0 0.0 0.0 4.4 1.9 8.9 39.2 36.6 109.7 116.8 288.3 138.9 6.8 Other,Bladder unspecified 1.20.6 0.74.8 0.02.7 0.04.3 1.31.3 4.413.2 17.313.4 26.814.9 48.021.8 59.532.084.849.968.754.9156.224.055.6 55.66.7 5.6 Bladder 0.6 0.7 0.0 0.0 1.3 4.4 17.3 26.8 48.0 59.5 84.8 68.7 156.2 55.6 6.7 RectumBronchus and lung 0.00.0 0.72.1 0.00.9 0.02.2 7.77.7 1.51.5 11.517.3 8.914.9 17.44.4 41.241.254.924.9151.127.584.1 36.0166.70.05.7 3.7 Bronchus and lung 0.0 0.7 0.0 0.0 7.7 1.5 11.5 8.9 17.4 41.2 54.9 151.1 84.1 166.7 5.7 EsophagusOther, unspecified 0.01.2 4.80.0 2.71.8 4.31.1 1.30.0 13.25.9 13.47.7 14.914.9 21.821.8 32.027.549.934.954.948.124.0 84.155.6 0.05.6 3.5 Other, unspecified 1.2 4.8 2.7 4.3 1.3 13.2 13.4 14.9 21.8 32.0 49.9 54.9 24.0 55.6 5.6 Brain,Rectum nervous system 1.20.0 2.10.7 0.95.5 2.22.2 7.76.4 1.52.9 17.311.5 14.96.0 4.44.4 41.218.324.95.0 27.520.636.0 12.00.0 0.03.7 3.1 Rectum 0.0 2.1 0.9 2.2 7.7 1.5 17.3 14.9 4.4 41.2 24.9 27.5 36.0 0.0 3.7 ColonEsophagus 0.60.0 0.00.7 1.80.9 1.10.0 0.01.3 5.91.5 7.717.3 14.914.9 21.821.8 27.522.934.919.948.120.684.1 36.00.0 55.63.5 3.0 Esophagus 0.0 0.0 1.8 1.1 0.0 5.9 7.7 14.9 21.8 27.5 34.9 48.1 84.1 0.0 3.5 LymphBrain, node nervous system 1.71.2 0.74.8 5.52.7 2.26.5 6.43.9 2.94.4 11.50.0 6.03.0 4.44.4 18.34.6 5.0 10.020.60.0 12.0 12.00.0 0.03.1 2.7 Brain, nervous system 1.2 0.7 5.5 2.2 6.4 2.9 11.5 6.0 4.4 18.3 5.0 20.6 12.0 0.0 3.1 LiverColon and intrahepatic bile ducts 0.00.6 0.70.0 0.90.0 0.00.0 1.30.0 1.50.0 17.37.7 14.917.9 21.88.7 22.913.719.924.920.620.636.0 60.155.6 55.63.0 2.2 Colon 0.6 0.7 0.9 0.0 1.3 1.5 17.3 14.9 21.8 22.9 19.9 20.6 36.0 55.6 3.0 LarynxLymph node 0.01.7 4.80.0 2.71.8 6.52.2 3.90.0 4.42.9 0.011.5 3.08.9 4.426.2 4.6 4.6 10.00.0 0.0 0.0 12.0 0.0 0.0 83.32.7 1.8 Lymph node 1.7 4.8 2.7 6.5 3.9 4.4 0.0 3.0 4.4 4.6 10.0 0.0 12.0 0.0 2.7 KidneyLiver and intrahepatic bile ducts 0.00.0 0.00.7 0.00.0 0.01.1 0.01.3 0.05.9 7.71.9 17.923.8 8.74.4 13.74.6 24.95.0 20.613.760.1 0.0 55.6 0.02.2 1.8 Liver and intrahepatic bile ducts 0.0 0.0 0.0 0.0 0.0 0.0 7.7 17.9 8.7 13.7 24.9 20.6 60.1 55.6 2.2 Larynx 0.0 0.0 1.8 2.2 0.0 2.9 11.5 8.9 26.2 4.6 0.0 0.0 0.0 83.3 1.8 Larynx 0.0 0.0 1.8 2.2 0.0 2.9 11.5 8.9 26.2 4.6 0.0 0.0 0.0 83.3 1.8 Kidney 0.0 0.7 0.0 1.1 1.3 5.9 1.9 23.8 4.4 4.6 5.0 13.7 0.0 0.0 1.8 Kidney 0.0 0.7 0.0 1.1 1.3 5.9 1.9 23.8 4.4 4.6 5.0 13.7 0.0 0.0 1.8 Table 3. Female cancer incidence per 100 000 according to topology and age groups in 2006-2011

TopologyTable 3. Female cancer incidence20- per 10025- 000 according30- to35- topology40- and age45- groups in50- 2006-201155- 60- 65- 70- 75- 80- ≥85 All Table 3. Female cancer incidence per 100 000 according to topology and age groups in 2006-2011 BreastTopology 2.320- 25-5.0 20.730- 35-39.0 40-70.9 45-80.9 50-132.3 55-89.3 60-48.7 65-73.1 70-57.475- 46.580- 63.1≥85 166.3All 23.9 Topology 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- ≥85 All SkinBreast 1.22.3 0.75.0 20.75.9 39.07.1 70.912.5 80.93.2 132.325.2 89.331.9 48.748.7 73.126.1 57.471.746.537.263.1189.3166.355.423.9 7.5 Breast 2.3 5.0 20.7 39.0 70.9 80.9 132.3 89.3 48.7 73.1 57.4 46.5 63.1 166.3 23.9 Other,Skin unspecified 0.61.2 2.90.7 5.91.0 7.11.2 12.52.8 3.26.5 25.210.5 31.931.9 48.726.6 26.120.9 71.750.237.227.9189.378.955.4 0.0 7.5 4.5 Skin 1.2 0.7 5.9 7.1 12.5 3.2 25.2 31.9 48.7 26.1 71.7 37.2 189.3 55.4 7.5 Hematopoietic and Other, unspecified 1.80.6 2.12.9 1.00.0 1.22.4 2.82.8 6.513.0 10.56.3 31.96.4 26.68.9 20.910.4 50.235.927.918.678.9 0.0 0.0 27.74.5 3.9 reticuloendothelialOther, unspecified systems 0.6 2.9 1.0 1.2 2.8 6.5 10.5 31.9 26.6 20.9 50.2 27.9 78.9 0.0 4.5 Hematopoietic and StomachHematopoietic and 1.21.8 0.02.1 0.00.0 2.41.2 2.81.4 13.08.1 6.310.5 6.49.6 8.917.7 10.415.7 35.964.618.646.50.0 47.327.7 27.73.9 3.3 reticuloendothelial systems 1.8 2.1 0.0 2.4 2.8 13.0 6.3 6.4 8.9 10.4 35.9 18.6 0.0 27.7 3.9 reticuloendothelial systems Stomach 1.2 0.0 0.0 1.2 1.4 8.1 10.5 9.6 17.7 15.7 64.6 46.5 47.3 27.7 3.3 ColonStomach 0.61.2 1.40.0 2.00.0 1.21.2 1.41.4 4.98.1 10.56.3 9.615.9 17.722.1 15.715.7 64.628.7 46.518.6 47.315.8 27.755.4 3.3 2.7 Colon 0.6 1.4 2.0 1.2 1.4 4.9 6.3 15.9 22.1 15.7 28.7 18.6 15.8 55.4 2.7 BronchusColon and lung 0.00.6 0.71.4 0.02.0 0.01.2 2.81.4 3.24.9 6.38.4 15.99.6 22.117.7 15.715.7 28.721.5 18.627.9 15.847.3 55.4 0.0 2.7 2.2 Bronchus and lung 0.0 0.7 0.0 0.0 2.8 3.2 8.4 9.6 17.7 15.7 21.5 27.9 47.3 0.0 2.2 EsophagusBronchus and lung 0.00.0 0.00.7 1.00.0 3.50.0 7.02.8 3.23.2 8.44.2 9.619.1 17.74.4 15.710.4 21.57.2 27.918.6 47.331.5 0.027.7 2.2 2.2 Esophagus 0.0 0.0 1.0 3.5 7.0 3.2 4.2 19.1 4.4 10.4 7.2 18.6 31.5 27.7 2.2 OvaryEsophagus 0.00.0 2.90.0 1.01.0 1.23.5 2.87.0 4.93.2 4.20.0 19.16.4 4.422.1 10.45.2 7.228.7 18.618.6 31.50.0 27.7 0.0 2.2 2.0 Ovary 0.0 2.9 1.0 1.2 2.8 4.9 0.0 6.4 22.1 5.2 28.7 18.6 0.0 0.0 2.0 KidneyOvary 0.00.0 0.72.9 2.01.0 0.01.2 0.02.8 4.94.9 0.0 6.46.4 22.117.7 5.215.7 28.735.9 18.69.3 0.0 0.0 0.0 0.0 2.0 2.0 Kidney 0.0 0.7 2.0 0.0 0.0 4.9 0.0 6.4 17.7 15.7 35.9 9.3 0.0 0.0 2.0 RectumKidney 0.00.0 0.00.7 3.02.0 2.40.0 2.80.0 0.04.9 0.02.1 6.422.3 17.78.9 15.720.9 35.97.2 9.30.0 0.015.8 0.0 0.0 2.0 1.9 Rectum 0.0 0.0 3.0 2.4 2.8 0.0 2.1 22.3 8.9 20.9 7.2 0.0 15.8 0.0 1.9 Rectum 0.0 0.0 3.0 2.4 2.8 0.0 2.1 22.3 8.9 20.9 7.2 0.0 15.8 0.0 1.9

25

20

15

10

5

Incidence per 100000 0 2006 2007 2008 2009 2010 2011 Skin 15.87 15.6 16.2 16.96 14.1 19.89 Stomach 6.73 8 14 9.75 6.63 19.47 Reticuloendothelial 4.33 8.5 9.5 8.48 5.39 11.19 Prostat 3.37 5.7 7.2 9.33 5.39 9.53 Bladder 4.33 4.7 5.9 11.45 4.98 8.7 Rectum 4.33 2.4 4.1 2.12 1.66 7.46

Figure 3. Male cancers Incidence per 100000 according topology of 2006-2011. Figure 3. MaleMale cancerscancers Incidence Incidence per per 100000 100000 according according topology topology of 2006-2011.of 2006-2011.

incidence rate. Additionally, the most common cancer in due to cancer (54.18) was observed in 2008. incidence100men 000) and andrate. women stomach Additionally, was cancers skin andthe (10.88 mostbreast per common cancer,100 000) respectively. hadcancer most in ageIndue groupthe to study cancer of 80-84 of (54.18)Esmaili years. was NasabThe observed most et al incidence in inKurdistan, 2008. rate ofthe death total menincidenceThe and results women rate. showed Additionally, was skinthat breastand the breast mostcancer cancer,common in women respectively. cancer had twoin dueincidenceIn tothe cancer study of (54.18) cancersof Esmaili was in 2003observedNasab and et in 2004al 2008.in Kurdistan,was 60 and the66.9 total Themenpeaks results and in women showedthe age was group that skin breast of and50-54 cancerbreast years cancer, inand women more respectively. than had ≥80two . Inperincidence the 100 study 000 ofof people. Esmailicancers Around, Nasabin 2003 et 62% aland in of Kurdistan,2004 cases was and the60 38% andtotal of 66.9 peaksTheProstate resultsin the cancer ageshowed group in thatmen of breast50-54 had the canceryears highest and in women incidencemore than had rate two≥80 in . incidencecasesper 100 of cancer000of cancers people. have in been Around,2003 reported and 62% 2004 in of menwas cases 60and andand women, 66.938% of peaks in the age group of 50-54 years and more than ≥80. per 100 000 people. Around, 62% of cases and 38% of Prostateage group cancer of 80-84in men years. had The the most highest incidence incidence rate of rate death in respectivelycases of cancer (12). have Cancer been incidence reported in in Dezfulmen and in 2006women, Prostate cancer in men had the highest incidence rate in cases of cancer have been reported in men and women, age group of 80-84 years. The most incidence rate of death respectively (12). Cancer incidence in Dezful in 2006 4 4 Immunopathologia Immunopathologia Persa Persa Volume Volume 4, 4, Issue Issue 1, 1, January January 2018 2018 4 Immunopathologia Persa Volume 4, Issue 1, January 2018 Common cancers in Dezful county CommonCommon cancers cancers in in Dezful Dezful county county 45 CommonCommon cancers cancers in in Dezful Dezful county county 40 45 CommonCommon cancers cancers in in Dezful Dezful county county 354045 30354045 25303540 30 2025 35 25 1520 30 20 1015 25 1520 10 5 1015 0 5

Incidence per 100000 510 0 2006 2007 2008 2009 2010 2011 Incidence per 100000 0 5

Incidence per 100000 2006 2007 2008 2009 2010 2011 Breast 0 182006 22.122007 22.572008 200927.81 201016.83 201142.41 Breast Incidence per 100000 182006 22.122007 22.572008 200927.81 201016.83 201142.41 Skin Breast 6.7 18 8.5522.12 7.6822.57 27.818.88 16.838.86 42.41 7 Breast 18 22.12 22.57 27.81 16.83 42.41 SkinSkin 6.76.7 8.558.55 7.687.68 8.888.88 8.86 77 ReticuloendothelialSkin 4.1 6.7 3.528.55 7.684.8 8.885.33 8.863.99 7 3.06 ReticuloendothelialReticuloendothelial 4.14.1 3.523.52 4.84.8 5.335.33 3.99 3.063.06 Cervix uteriReticuloendothelial 2.6 4.1 0.53.52 0.484.8 5.331.18 3.990.89 3.06 2.19 CervixCervix uteri uteri 2.62.6 0.50.5 0.480.48 1.181.18 0.89 2.192.19 StomachCervix uteri 2.6 2.6 1.010.5 5.280.48 1.186.51 0.892.21 2.19 3.5 StomachStomach 2.62.6 1.011.01 5.285.28 6.516.51 2.21 3.53.5 Stomach 2.6 1.01 5.28 6.51 2.21 3.5

FigureFigureFigureFigureFigure 4.Figure 4.Female4. 4. Female4.Female 4. FemaleFemale Female cancers cancerscancers cancerscancers cancers Incidence Incidence Incidence IncidenceIncidence Incidence perper per perper 100100 100100 000 000 accordingaccording accordingaccording topology topologytopology topology of ofof 2006-2011. of of 2006-2011.2006-2011. 2006-2011.2006-2011. Figure 4. Female cancers Incidence per 100 000 according topology of 2006-2011.

80808080 70 707070 60 606060 5050 5050 4040 40 30 40 30 30 20 30 20

20100000per Incidence 10

20100000per Incidence 10 Incidence per 100000per Incidence 10 0

Incidence per 100000per Incidence 10 0 2006 2007 2008 2009 2010 2011 0 2006 2007 2008 2009 2010 2011 0 Male 200632.22 200756.13 200866.71 55.982009 53.92010 50.132011 Male 200632.22 200756.13 200866.71 55.982009 53.92010 50.132011 MaleFemale 32.2218.5 56.1340.21 66.7140.83 31.3855.98 35.4253.9 32.7950.13 MaleFemale 32.2218.5 56.1340.21 66.7140.83 31.3855.98 35.4253.9 32.7950.13 FemaleTotal 18.525.59 40.2148.42 40.8354.18 44.1131.38 44.9735.42 41.6932.79 FemaleTotal 18.525.59 40.2148.42 40.8354.18 44.1131.38 44.9735.42 41.6932.79 Total 25.59 48.42 54.18 44.11 44.97 41.69 Total 25.59 48.42 54.18 44.11 44.97 41.69 Figure 5. Death rate from cancers in Dezful 2006-2011. Figure 5. Death rate from cancers in Dezful 2006-2011. FigureFigure 5. 5. DeathDeath raterate fromfrom cancers inin DezfulDezful 2006-2011. 2006-2011. FigureFigure 5. 5. Death Death rate rate from from cancers cancers in in Dezful Dezful 2006-2011. 2006-2011. (55.4 per 100 000) was similar to Figurethe report 5. Death and rate 57.61% from cancers sunlight in Dezful has 2006-2011. an important role in future cancer emersion (55.4(55.4respectively per per 100 100 000) (12).000) waswasCancer similarsimilar incidence toto thethe reportinreport Dezful andand in57.61% 2006 beensunlight most has common anan importantimportant cancer in rolerole Khozestan inin futurefuture (22). cancer cancer Exposure emersion emersion to (55.4 perof cancer 100 000) cases was were similar in men. toThe the studies report showed and that57.61% total sunlightin childhood has anand important teenagerhood. role in Therefore, future cancer protective emersion (55.4ofof (55.4 cancer percancerincidence 100per cases cases 000)100 rate were 000)were ofwas skin in wasin similar men. men.cancer similar The The toin to studiesIranthestudies the wasreport report showedshowed 10.13 and and per that 57.61% 57.61%100 total 000 sunlightbehaviorsinsunlight childhood has hastoward an an andandimportant sunlightimportant teenagerhood.teenagerhood. torole preventrole in futurein Therefore, cancerTherefore,future cancer arecancer effectiveemersion protectiveprotective emersion (55.4of percancer 100 cases 000) were was in similar men. 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(18). the rate Sun The of modificationhabits,antibiotic food is preservation inof dietaryclinical habits,andtrials also (29).quit the orRegion prevalence decrease changes of smoke in totalthetotal measured beenlight light mostrate in ratecommonAhvazin coastal of ultravioletis cancermore countries thanin Khozestanin other Ahvaz(19). provincesAlso, (22).is higher Exposurethe (20,21).rate than ofto stomachcanHelicobacterhabits, be becausefood cancer infection preservation of distribution reaching (30). toTheand showmammography study also a resultsdifferencethe prevalence showedscreening in dietary that of radiationtotal totalmeasured is significant light in rate Ahvaz ofin ultravioletisKhozestan more than in andother Ahvaz Dezful, provinces is higher because (20,21). than useHelicobacterstomach and cancerscreening infection distribution (30).and The extirpation showstudy resultsa difference of showed H. pyloriin that dietary using thetotal Inlight the light ratestudy in in Ahvaz conducted coastal is morecountries in thisthan province, other(19). Also,provinces skin the cancer rate(20,21). hasof habits,breastHelicobacter cancerfood infection preservationhad highest (30). incidence Theand study also rate resultsthe in prevalencewomen showed that that of of proximitytheIn light Inthe the studyrateto study equator in conducted conductedcoastal compared countries in in this this to province, province, other(19). Also,provinces. skinskin the cancercancer rate The has of antibioticbreastbreasthabits, cancercancer food is hadhadinpreservation highest clinicalhighest incidence incidencetrials and (29). alsorate rate intheRegion inwomen womenprevalence changesthat that of in totalbeen light most in Ahvaz common is morecancer than in Khozestan other provinces (22). Exposure (20,21). to ImmunopathologiaHelicobactercan be because Persa infection of Volume reaching (30). 4, Issue Theto 1,mammography studyJanuary results 2018 showedscreening5 that totaltotal measuredbeen light most in ratecommonAhvaz of ultravioletis cancermore thanin Khozestanin other Ahvaz provinces (22).is higher Exposure (20,21). than to stomachcanHelicobacter be because cancer infection of distribution reaching (30). toThe showmammography study a resultsdifference showedscreening in dietary that In the study conducted in this province, skin cancer has breast cancer had highest incidence rate in women that the Inlight the ratestudy in conducted coastal countries in this province, (19). Also, skin the cancer rate has of Immunopathologiahabits,breast cancerfood Persa preservationhad Volume highest 4, Issue incidence and 1, January also rate 2018the in prevalencewomen5 that of been most common cancer in Khozestan (22). Exposure to Immunopathologiacan be because Persa of Volume reaching 4, Issue to mammography1, January 2018 screening5 totalbeen light most in Ahvaz common is morecancer than in Khozestan other provinces (22). Exposure (20,21). to ImmunopathologiaHelicobactercan be because Persa infection of Volume reaching (30). 4, Issue Theto 1,mammography studyJanuary results 2018 showedscreening5 that In the study conducted in this province, skin cancer has breast cancer had highest incidence rate in women that Immunopathologia Persa Volume 4, Issue 1, January 2018 5 been most common cancer in Khozestan (22). Exposure to Immunopathologiacan be because Persa of Volume reaching 4, Issue to mammography1, January 2018 screening5

Immunopathologia Persa Volume 4, Issue 1, January 2018 5 Norouzirad R et al can be because of reaching to mammography screening Conflicts of interest program, so the highest incidence rate of breast cancer The authors declare no conflict of interest. in 2011 can be referred to screening of this cancer. The Ethical considerations results were in line with the results of study conducted by Ethical issues (including plagiarism, data fabrication, double Asgarian et al (31). publication) have been completely observed by the authors. In the study of Babaei et al, also breast cancer had the first Funding/Support rank in women cancers (32). Finally, breast cancer almost This project was funded by the Dezful University of Medical has steady dispersion in all regions of Iran and has the first Sciences.(Grant No. DUR 125). rank of common cancer among women in all provinces (33). Breast cancer in women has the most prevalence References in two peaks in the age group of 50-54 or higher than or 1. Lopez A, Murray C. The global burden of disease 1990-2020. Nat Med. 1998;1:1241-3. equal 85 years. Reasons are not completely specified but 2. Khazaei S, Rezaeian S, Khazaei Z, Molaeipoor L, Nematollahi probably reflect changing fertility patterns, increasing S, Lak P, et al. National Breast cancer mortality and incidence fatness, decreasing physical activities and screening rates according to the human development index: an program of breast cancer (34). Maintaining body weight ecological study. Adv Breast Cancer Res. 2016;5:30-6. doi: and minimizing alcohol use is the best and the most 10.4236/abcr.2016.51003. 3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA available strategy to decrease risk of breast cancer (35). Cancer J Clin. 2015;65:5-29. doi: 10.3322/caac.21254 As a result of growth and getting old of crowd and 4. Malekzadeh R, Bishehsari F, Mahdavinia M, Ansari R. increasing prevalence of risk factors, incidence order of Epidemiology and molecular genetics of colorectal cancer in cancer like developed countries is increasing (36,37). iran: a review. Arch Iran Med. 2009;12:161-9. 5. Khazaei S, Mansori K, Soheylizad M, Gholamaliee B, Important pollution resources in this region include Shadmani FK, Khazaei Z, Ayubi E. Epidemiology of lung hanging particles in shape of dust, sooty dust, sulfate cancer in Iran: sex difference and geographical distribution. particles, metals and mineral salts, that these contaminant Mid-East J Cancer. 2017;8:223-8. particles can be carcinogenic potentially. Hence, it can be 6. Rahimi Pordanjani S, Baeradeh N, Khazaei Z, Goodarzi E, noted that environmental encounters have the main role of Beiranvand R, Alikhani A, et al. Epidemiological trend and distribution of prevalent cancers in Razavi Khorasan province increasing cancer’s incidence. during 2005-201. Int J Prev. 2017;5:8-12. doi: 10.17354/ ijpphs/2016/47. Conclusion 7. Almasi Z, Salehiniya H, Amoori N, Enayatrad M. Epidemiology Regarding the location of the city, people are exposed to characteristics and trends of lung cancer incidence in Iran. Asian Pac J Cancer Prev. 2016;17:557-62. doi: 10.7314/ significant sun light most of the days. Preventive researches APJCP.2015.17.2.557. and controlling cancer about epidemic investigation of 8. Amiri M, Kunst AE, Janssen F. Trends in stomach cancer breast, skin and stomach cancer in future should be done mortality in relation to living conditions in childhood. A regarding their high incidence in the region. study among cohorts born between 1860 and 1939 in seven This study is the first study in Dezful during 2006 -2011 European countries. Eur J Cancer. 2006;3:3212-8. doi: 10.1016/j.ejca.2006.04.020. which has investigated incidence rate of cancer during the 9. Norouzi Nejad F, Ramezani Daryasari R, Ghafari F. years. Quality of collecting data is important factor to true Epidemiology of cancer in Mazandaran province 2006. J estimation of decreasing or increasing cancer incidence. Mazandaran Univ Med Sci 2009;19:61-5. Hence, fast increase of the disease in recent years can be 10. Mathers CD, Boschi C, Lopez Christopher Murray A. Cancer incidence, Mortality and survival by site for 14 Region of the referred to change of cancer record system and real record world. Geneva: WHO;2001:22-8. of cancer. In fact, it can be said that during recent years 11. Wu S, Powers S, Zhu W, Hannun YA. Substantial contribution because using cancer record system based on crowd, of extrinsic risk factors to cancer development. Nature. estimation of incidence rate has been approached to real 2016;529:43–7. doi:10.1038/nature16166 rate. 12. Esmaili Nasab N, Moradi G, Zareie M, Ghaderi E, Gheytasi B. Survey of epidemilogic status and incidence rates of cancers in the patients above 15 years old in Kurdistan province. Sci J Limitations of the study Kurdistan Univ Med Sci. 2007;11:18-25. We had little access to data on cancer staging at the time 13. Nabizadeh R, Salehi S, Younesian M, Naddafi K. Evaluation of of diagnosis, which limited our ability to conduct a more the relationship between global ultraviolet indea in different regions of Iran with skin cancer in 2004. Iran J Health Environ. detailed investigation. 2010;2:258-67. 14. Marjani A, Kabir MJ. Male skin cancer incidence in Golestan Acknowledgments province, Iran. J Pak Med Assoc. 2009;59:287-9. We would like to thank all people who helped us in conducting of 15. Kavoussi H, Rezaei M, Ebrahimi A, Hosseini S. Epidemiological study. indices of non-melanoma skin cancers in Kermanshah, Iran. J Pakistan Assoc Dermatol. 2012;22:112-7. Authors’ contribution 16. WHO. Global disease burden from solar ultraviolet radiation. In this study, RB was correspondibg author. SK, RN, LD, MSV and AS World Health Organization; 2006:15-43. performed the data collection. HAA and BC analyzed the results and 17. Forghani H, Holakoee K. Study of the sun protection behaviors interpreted the data. ZK, MH, MK, FN and MD collected the data. in order to prevent skin cancer in women. Toloo e Behdasht. All authors assisted in drafting and approving of the manuscript. 2004;1:17-21. [Persian].

6 Immunopathologia Persa Volume 4, Issue 1, January 2018 Common cancers in Dezful county

18. Afzali M, Mirzaei M, Saadati H, Mazloomi-Mahmood-Abadi Uni Med Sci. 2010;32:74-9. [Persian]. SS. Epidemiology of skin cancer and changes in its trends in 29. Park JY, von Karsa L, Herrero R. Prevention strategies for gastric Iran. Feyz. 2013;17.501-11. [Persian]. cancer: a global perspective. Clin Endosc 2014;47:478-89. 19. Trabea A, Salem I. Empirical relationship for ultraviolet solar doi: 10.5946/ce.2014.47.6.478. radiation over Egypt. Egypt J Sol. 2001;24:123-32. 30. Parkin DM. The global health burden of infection‐associated 20. Behrooz M, Seyf F, Fatahi Asl J, Behrooz l. Variation of cosmic cancers in the year 2002. Int J Cancer. 2006;118:3030-44. ultraviolet radiation measurements in Ahvaz at different doi:10.1002/ijc.21731 months of year. Sci Med J. 2010;9:45-51. [Persian]. 31. Asgarian F, Mirzaei M, Asgarian S, Jazayeri M. Epidemiology of 21. Tavakoli M, Shahi Z. Solar ultraviolet radiation on the ground breast cancer and the age distribution of patients over a period level of Isfahan. Iran J Radiat Res. 2007;5:101-4. of ten years. Iranian J Breast Dis. 2016;9:32-6. 22. Valavi E, Rafie S, Pakseresht P, Siadat S. Prevalence of skin 32. Babaei M, Mousavi S, Malek M, Tosi G, Masoumeh Z, Danaei cancer in southwest of Iran. Koomesh. 2013;15:83-8. [Persian]. N, et al. Cancer occurrence in Semnan Province, Iran: results 23. Baghianimoghadam MH, Mohammadi S, Mazloomi of a population-based cancer registry. Asian Pac J Cancer Prev. Mahmoudabad SS, Norbala MT. The effect of education based 2005;6:159-64. on protection–motivation theory on skin cancer preventive 33. Nejad FN, Daryasari RR, Ghafari F. Epidemiology of cancer practices among female high school students in Yazd. Horizon in Mazandaran province 2006. J Mazand Univ Med Sci. Med Sci. 2011;17:27-34. 2009;19:61-5. 24. Baghianimoghaddam MH, Mohammadi S, norbala MT, 34. Colditz GA, Sellers TA, Trapido E. Epidemiology—identifying mazloomi SS. The study of factors relevant to skin cancer the causes and preventability of cancer? Nat Rev Cancer.. preventive behavior in female high school students in Yazd 2006;6:75-83. doi:10.1038/nrc1784. based on protection motivation theory. Knowledge Health. 35. Kushi LH, Doyle C, McCullough M, Rock CL, Demark‐ 2010;5:10-15. Wahnefried W, Bandera EV, et al. American Cancer Society 25. Chen W, Zheng R, Zeng H, Zhang S, He J. Annual report on guidelines on nutrition and physical activity for cancer status of cancer in China, 2011. J Cancer Res. 2015;27:2-12. prevention: reducing the risk of cancer with healthy food 26. Tian J, Chen J-S. Time trends of incidence of digestive system choices and physical activity. CA Cancer J Clin. 2012; 62:30- cancers in changle of China during 1988-2002. World J 67. doi: 10.3322/canjclin.56.5.254. Gastroenterol. 2006;12:4569-71. 36. Bray F, Møller B. Predicting the future burden of cancer. Nat 27. Nishimoto IN, Hamada GS, Kowalski LP, Rodrigues JG, Iriya Rev Cancer. 2006;6:63-74. doi: 10.1038/nrc1781. K, Sasazuki S, et al. Risk factors for stomach cancer in Brazil 37. Weiderpass E, Pukkala E. Time trends in socioeconomic (I): a case-control study among non-Japanese Brazilians in Sao differences in incidence rates of cancers of gastro-intestinal Paulo. Jpn J Clin Oncol. 2002;32:277-83. tract in Finland. BMC Gastroenterol. 2006;6:41. doi: 28. Kosha A, Farahbakhsh M, Hakimi S, Abdollahi L, Golzari M, 10.1186/1471-230X-6-41. Seaf M. Cancer Epidemiology in East Azarbaijan. Med J Tabriz

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