Part 4: Less Frequent Cancers: Facts and Figures 141

Bone Cancer (C40-C41) 144

Pancreatic Cancer (C25) 146

Esophageal Cancer (C15) 148

Connective, Subcutaneous and Soft Tissue Cancer (C47; C49) 150

Stomach Cancer (C16) 152

Thyroid Cancer (C73) 154

Laryngeal Cancer (C32) 156

Uterine Cancer (C54-C55) 158

Oral Cavity Cancer (C00-C06) 160

Gall Bladder Cancer (C23-C24) 162

Skin Cancer (Non-Melanoma) (C44) 164

Hodgkin Lymphoma (C81) 166

Non-Hodgkin Lymphoma (C82-C85; C96) 168

Kidney and Renal Pelvis Cancer (C64-C65) 170

Part 5: Pediatric Malignancies 173

Incidence 174

Basis of Diagnosis 176

Stage at Diagnosis 178

Frequency by Site 180

Incidence Rates 182

Childhood Leukemias (ICCC Group I) 184

Childhood Lymphomas (ICCC Group II) 186

Childhood Brain and Miscellaneous Intracranial and Intraspinal Neoplasms (ICCC Group III) 188

Annex 191

Annex I: Statistical Methods 192

Annex II: Classification and Coding 194

Annex III: Age Grouping 202

Annex IV: Comparison of Cancer Incidence in Aswan, 2008 and Gharbiah 2000-2002 204

Epilogue 209

Executive Summary 9

Part 1: Background Information 15

National Cancer Registry Program of Egypt 16

Aswan Governorate 18

Aswan Cancer Registry 20

The Registry Population 22

Sources of Data 24

Data Collection 26

Data Flow and Processing 28

Data Analysis and Calculation of Proportions and Rates 30

Part 2: Cancer Incidence: An Overview and Profile of Frequent Cancers 33

Incidence Rates: Total and Gender-Specific 34

Incidence Rates 46

Distribution of Registered Cases by Sources of Data 50

Basis of Diagnosis 50

Staging of Cancer 54

Part 3: Profile of Frequent Cancers 57

The More Frequent Cancers in Males 60

The More Frequent Cancers in Females 62

Change In Frequency of Cancer by Age 64

Change by Age in Males 64

Change by Age in Females 66

Breast Cancer (C50) 68

Liver Cancer (C22) 78

Bladder Cancer (C67) 86

Leukemia (C91-C95) 94

Lung Cancer (C34) 100

Brain and Nervous System Cancer (C70-C72) 110

Ovarian Cancer (C56) 118

Colorectal Cancer (C18-C20) 126

Prostate Cancer (C61) 134

Contents

Part 1 Background Information

The National Cancer Registry Program of Egypt was initiated

through a protocol of cooperation between the ministries of

Communications and Information Technology, Health and

Higher Education. The Supreme Committee of the program

decided to start with population-based registration of cancer

cases and to explore the possibility of establishing a national

cancer database through hospital-based registries.

The first phase of the program started in 2008 in the Governorate

of Aswan, with further population-based registries to be included

in the governorates of Minya, Beheira and Damietta. Analysis

of data from these registries will be published during the last

quarter of 2010. The Governorate of Gharbiya has a registry

that was established 10 years ago, which will be included in

the national registry program in a subsequent phase. By the

end of the current phase, Egypt will be covered by a network

of population-based registries that fairly represent the entire

country. Sinai and Cairo are not included due to logistical

difficulties. Comparison of program results with data from the

National Cancer Institute in Cairo will shed light on the profile

of cancer in the Greater Cairo area.

The administrative structure of the program is represented in

Figure 1.1. The program is governed by a Supreme Committee

chaired by Professor Hossam Kamel and co-chaired by

Professors Hoda Baraka and Hussein Khaled. The committee

includes Professor Amal Samy Ibrahim, program director,

representatives of the concerned ministries and the directors

of the peripheral registries.

The peripheral registries are managed by the directors of the

cancer centers in different governorates with daily follow-up

of work by a data manager, a medical doctor trained for this

post. Data collection is carried out actively by 2-4 abstractors,

also medical doctors, helped by a team of data entry and support

staff. The number of personnel in each registry depends on the

size of the population covered. The entire staff is seconded to

the program on a part-time basis.

The National Cancer Registry Program is supported by a strong

technical unit from the Ministry of Communications and

Information Technology. The unit is responsible for the

establishment of the national cancer network, customization

of National Cancer Registry applications, development of data

analysis and reporting tools, training of program staff, and

establishment of the Egypt National Cancer Registry Portal

for program sustainability.

National Cancer Registry Program of Egypt

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Fig. 1.1: Organizational Structure of Phase 1 of the Registry Program

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Aswan Governorate

The Governorate of Aswan is the southernmost governorate

of Egypt, bordering Qena Governorate to the north, Red Sea

Governorate to the east, New Valley Governorate to the west

and Sudan to the south. The capital of the governorate is Aswan

City, located 982 kilometers south of Cairo.

The population of Aswan Governorate is 1,074,131 (2008). Its

area covers 34,608 square kilometers and is divided into five

administrative districts (markaz), namely:

Aswan (303,508)

Kom Ombo (268,870)

Daraw (93,242)

Edfu (333,460)

Nasr Al Nuba (75,051)

Facilities for cancer management in the governorate are located

predominantly in Aswan City. The district hospital in Edfu is

equipped with a CT scanner, though suspected cancer cases

are referred elsewhere for confirmation of diagnosis and

management, mostly in Aswan City.

The Governorate of Aswan was selected for the first of the

five registries that constitute the national population-based

cancer registry program. Parallel to these population-based

registries, a group of tertiary care facilities volunteered to share

in the initiation of a network of cancer registries that will

eventually lead to a national cancer database. These centers

include the Nasser Institute, Madinat Al Salam Cancer Center,

Childrenís Cancer Hospital 57357 and the Faculty of Medicine

of Suez Canal University. These centers were provided with

hardware and software, as needed, and training for local staff.

While their results are not included in the national database

during the current phase, efforts will be made to initiate

standardized hospital-based registries in these centers, and in

time the nucleus for a national cancer database will be

established.

Fig. 1.2: Map of Egypt showing the location of Aswan Governorate and the other registries ( SHAPE \*MERGEFORMAT ) scheduled to be launched during 2008-09

Part 2 Cancer IncidenceAn Overview and Profile of Frequent Cancers

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Incidence Rates: Total and Gender-Specific:

During 2008, 1150 incident cancer cases were registered, 525

males (45.7%) and 625 females. The male: female ratio was

1:1.2.

The crude incidence rate, C44 excluded (non melanoma skin

cancer), was 106.0 /100,000 for both genders together. The

rate was 96.2/100,000 males and 115.2/100,000 females.

The crude incidence rate, C44 included, was 107.1/100,000

for both genders together. The rate was 97.3/100,000 males

and 116.9/100,000 females.

The age-standardized (world) incidence rate, C44 excluded,

was 152.4 /100,000 for both genders together. The rate was

140.7/100,000 males and 164.0/100,000 females.

The age-standardized (world) incidence rate, C44 included,

was 154.7 /100,000 for both genders together. The rate was

142.5/100,000 males and 166.8/100,000 females.

Table 2.1: Number and Proportion of Incident Cases, by Site and 5-Year Age Group, Males, Aswan, 2008

Fig. 2.1: Incidence Rates, Aswan, 2008

Fig. 2.2: Incidence Rates of the more FrequentCancers, Both sexes, Aswan, 2008

The 10 most common cancer sites among males were bladder,

liver, lung, leukemia, prostate, brain and nervous tissue,

esophagus, larynx, pancreas and colorectal cancer. They

accounted for 64.8% of incident male cancer cases. Among

females the most common sites were breast, ovary, liver,

leukemia, bone, uterus, bladder, thyroid, colorectal and lung,

accounting for 72.3% of female incident cancer cases. For both

genders together, these sites were breast, liver, bladder, leukemia,

lung, brain and nervous tissue, ovary, colorectal, prostate and

bone. They accounted for 62.2% of all incident cancer cases.

Tables in the following pages depict the number of cases per

site (according to ICD10) and 5 year age groups for males and

females. Totals are expressed twice, with C44 included and

excluded. These frequency tables are followed by similar tables

of rates for males and females; with and without C44. All rates

are expressed /100,000 population.