International Journal of Epidemiologic Research, 2017; 4(1): 61-68. ijer.skums.ac.ir Epidemiological study of colon cancer in educational hospitals of Birjand University of Medical Sciences (2006-2011) Azam Sabahi1,2, Leila Ahmadian3*, Fatemeh Salehi2, Sayed Mahmoud Mirzaee4 1 2 Birjand University of Medical Sciences, South Khorasan, I.R. Iran; Student, Kerman University of Medical Sciences, Kerman, I.R. Iran; 3Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, I.R. Iran; 4Health Center of Ferdows, Birjand University of Medical Sciences, South Khorasan, I.R. Iran. Received: 16/Jun/2016 Accepted: 1/Nov/2016 ABSTRACT Background and aims: Among all cancers, colon cancer is common and deadly, yet preventable. The estimated worldwide incidence of colon cancer is more than one million new cases per year. This study was done to identify the epidemiological features and risk factors of colon cancer in different regions of Birjand. Methods: This retrospective, descriptive analytical study of patients with colon cancer was conducted in Birjand educational hospitals. This study examined the patients whose colon Original article cancers had been confirmed by a pathologist (2006-11). Statistics related to these patients were collected from pathology centers affiliated to Birjand University of Medical Sciences. Data were analyzed using descriptive (frequency and relative frequency) and analytical (chi square test) statistics. SPSS software was used to analyze the collected data. Results: Results of the present research showed that a total of 38 people with colon cancer were hospitalized in Birjand educational hospitals between 2006 and 2011. In the present study, there was a significant difference between the patients’ job and the type of morphology (P=0.018) and the therapeutic procedures (P=0.001); Adenocarcinoma was mainly reported among housewives (n=10, 76.9%). Concerning therapeutic procedures, housewives underwent colectomy surgery more than other groups (n=8, 61.5%). Conclusion: Controlling colon cancer which is one of the most common cancers in the world is a great epidemiologic success. The findings of this study presented a complete and exact image of epidemiology of this cancer in the region and provided the authorities with precious information; therefore, they can make decisions about identifying colon cancer risk factors in the region. Keywords: Colon cancer, Cancer epidemiology, Prevalence. INTRODUCTION Prevalence of cancer in the world is due fertility patterns associated with urbanization to increasing aging population. Changes in and economic development, smoking, *Corresponding author: Leila Ahmadian, Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, I.R. Iran, Tel: 00989132969728, E-mail: [email protected] 61 Sabahi A, et al. Epidemiological study of colon cancer overweight and physical inactivity are the can be prevented. In general, colorectal most common carcinogenic risk factors.1 cancer is much better than other cancers of Among all cancers, colon cancer is the digestive system. If diagnosed and common and deadly, yet preventable. This treated at an early stage, this cancer will cancer has attracted the attention of health have a good prognosis.14,16 Therefore, centers all around the world. The estimated understanding risk factors of this cancer and worldwide incidence of colon cancer is more encouraging people to do screening tests is than one million new cases per year.2 It is important in early diagnosis. Since among the five most common cancers identifying epidemiologic factors and risk diagnosed in both men and women.3 factors of diseases in different regions can According to statistics, almost one out of help to prevent, control and treat diseases and every three patients with colon cancer died.2 since no research has been carried out on the It must be noted that more than half of these epidemiology of colon cancer in Southern cases (55%) occurred in developing Khorasan, this study aimed to investigate the countries.4 epidemiology of colon cancer in educational Despite high incidence of colon cancer hospitals of Birjand University of Medical in Western countries, its mortality is Sciences during 2006-2011. decreasing due to increased level of people's awareness of the early symptoms of colon cancer and its timely diagnosis. Unlike METHODS western countries, incidence of this cancer is This retrospective, descriptive and low in Iran; it is the fifth most common analytical study of patients with colon cancer among men and the third most cancer was conducted in Birjand educational common one among women. However, hospitals. This study examined patients statistics show that its incidence in Iran has whose colon cancer had been confirmed by increased considerably over the last 25 years a pathologist (2006-11). Statistics related to and among young people is higher than what these patients were collected from pathology is expected.5-8 It is predicted that it may centers affiliated to Birjand University of increase dramatically in Iran.9,10 Medical Sciences. In order to collect data, Therefore, the importance of examining patients' medical records were reviewed. and studying this cancer as an important Data was extracted using a researcher-made health problem is obvious. Colon cancer is checklist that its validity was confirmed by highly associated with unhealthy life styles. five faculty members. This checklist Several epidemiologic and laboratory consisted of three parts. The first part was studies have examined the relationship related to the patients’ demographic data. To between colon cancer and life style factors collect this data, the researchers reviewed such as low fiber intake, smoking, low the patients’ hospital admission sheets. To calcium diet, high fat diet and physical ensure the accuracy of the collected data, the inactivity.11-14 researchers telephoned the patients. The Generally, colorectal cancer is widely second part of the checklist included records regarded as an environmental disease of drug abuse, history of family cancer, because some environmental, geographical, hypertension, diabetes, hyperlipidemia and cultural, social and lifestyle factors can have surgery. The researchers reviewed the a significant effect on its incidence.15 patients’ history, summary and physicians’ Fortunately, although it is progressive and order sheets to collect this part of data. The fatal, colon cancer is one of few cancers that last part was designed to collect data about 62 International Journal of Epidemiologic Research, 2017; 4(1): 61-68. the diagnosis, treatment and morphological patients’ files). Medical Records staff type of colon cancer; in this case, patients’ helped the researches in this regard and summary sheets, surgical operations sheets, accelerated this process. pathological reports and physicians’ order sheets were studied. Data was analyzed using descriptive (frequency and relative RESULTS frequency) and analytical (chi square test) Results of the present research showed statistics. SPSS software was used to that a total of 38 people with colon cancer analyze the collected data. In order to were hospitalized in Birjand educational protect the patients’ rights, the data hospitals between 2006 and 2011. Most remained confidential. patients (n=24, 63.2%) were male aged One of the limitations of this study 60-80 (n=26, 68.4%). The majority of was difficult access to patients’ patients lived in the city (n=26, 68.4%), pathological reports which were kept were housewives (n=13, 34.2%) and married separately (they were not found in the (n=36, 94.7%) (Table 1). Table 1: Frequency distribution of patients with colon cancerbased on demographic data Demographic features Frequency(%) Male 24)63.2( Gender Female 14)36.8( 20-39 2)5.3( 40-59 9)23.7( Age 60-79 26)68.4( 80 and more 1)2.6( Married 36)94.7( Marital status Single 1)2.6( Widowed 1)2.6( Urban 26)68.4( Rural 12)31.6( Birjand districts 2)5.3( Ghaen districts 4)10.5( Ferdows districts 1)2.6( Residence Nehbandan districts 1)2.6( Khosef districts 0(0) Shoosef districts 1)2.6( Sarbishe districts 1)2.6( Darmian districts 2)5.3( Employee 2)5.3( Worker 0(0) Farmer 7)18.4( Occupation Self-employed 2)5.3( Housewife 13)34.2( Other 14)36.8( In this study, a family history of cancer small percentage of patients had a history of was not reported in any of these patients. A substance abuse (n=9, 23.7%), hypertension 63 Sabahi A, et al. Epidemiological study of colon cancer (n=5, 13.2%), diabetes (n=3, 7.9%) and revealed that most of the patients (n=30, hyperlipidemia (n=4, 10.5%). Of all 78.9%) had no history of surgery. patients, 5.3% (n=2) had a history of Colectomy was the surgical procedure for prostatectomy surgery, 2.6% (n=1) most patients (n=24, 63.2%). Moreover, the herniotomy, and 13.2% (n=5) a type of most common diagnostic methods for colon surgery (which wasn’t recorded in their cancer were the combination of colonoscopy medical records). The recorded reports and biopsy (n=28, 73.7%) (Table 2). Table 2: The relationship between peoples’ occupation and the cancer morphology type and the therapeutic procedure Variable Employee Farmer Selfemployed Housewife Other P n(%) n(%) n(%) n(%) n(%) Job Carcinoma 0(0) 0(0) 0(0) 3(23.1) 6(42.9) 0.018 Adenocarcinoma 2(100) 7(100) 2(100) 10(76.9) 8(57.1) Morphology Colectomy 1(50) 2(28.6) 1(50) 8(61.5) 4(28.6) 0.001 type and the Medical treatment 0(0) 0(0) 1(50) 3(23.1) 6(42.9) therapeutic Other therapeutic 1(50) 5(71.4) 0 (0) 2(15.4) 4(28.5) measure procedures Adenocarcinoma was the most common family history of colon cancer or history of morphology in colon cancer (n=29, 76.3).