Cancer Incidence in Jordan - 2012
The Hashemite Kingdom of Jordan Ministry of Health Non-Communicable Diseases Directorate Jordan Cancer Registry
Cancer Incidence in Jordan - 2012
Prepared By:
Dr. Ayoub Al-Sayaideh Dr. Kamal Arqoub
Dr. Omar Nimri Dr. Marwan Al- Zaghal
Dr. Wafa Halasa 1
Cancer Incidence in Jordan - 2012 Comments and suggestions concerning the contents are encouraged and highly appreciated .Don’t hesitate to send your comments to the address below (email). You can download this report from the Ministry of Health web site www.moh.gov.jo.
Ministry of Health Non communicable diseases Directorate Cancer Prevention Department Jordan Cancer Registry Telefax:00962-6-5662067
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[email protected]
وزارة ال�صحة مديرية الأمرا�ض غري ال�سارية ق�سم مكافحة ال�سرطان ال�سجل الوطني لل�سرطان 0096265562067 :تلفاك�س
Cancer Incidence in Jordan - 2012
His Majesty King Abdullah II
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Foreword With my utmost pleasure, I forward to you the 17th annual report of cancer incidence in Jordan prepared by the Jordan Cancer Registry. This registry as an ambitious goal was established, and developed over the last 20 years under the auspices of the Ministry of Health. The report provides comprehensive information about the trends and characteristics of cancer in Jordan. I have every confidence that the Jordan Cancer Registry will continue to develop and to help Jordan intensify its efforts to decrease the huge burden of cancer as one of the major NCDs especially in a developing country with limited resources; mainly after various programs of the primary health care services had successfully controlled and eradicated most of communicable diseases. The functions of the Jordan cancer registry cover a wide scope of activities including collection, filtering, coding and analysis of all newly diagnosed cancer cases, as well as dissemination of informative data to oncologists, scientists, researchers and decision makers concerned with cancer control and prevention on national and international levels. I will be proud to mention the success story of the national Jordan breast cancer program which was a fruitful result of the joint collaboration between the various public, and private health institutions, and the opportunity is rising now to develop a national colorectal cancer screening program based on the fact that, this type of cancer is the second most common cancer among Jordanians after breast cancer. It is worthy to mention that this valuable report was a result of the continuous efforts of devoted and hardworking staff at the Jordan Cancer Registry, and the continuous cooperation from other concerned health sectors. I highly appreciate these great efforts and I would like to extend my sincere thanks to everyone who helped in the development of this report, and stress as the Minister of Health that the Jordan Cancer Registry will continue to receive full support and enforcement by the Ministry of Health. Minister of Health Dr. Ali Hyasat
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Cancer Incidence in Jordan - 2012 Acknowledgment The Jordan Cancer Registry would like to acknowledge with deep appreciation and gratitude the invaluable help and the hard work of all health care and medical professionals from the various governmental, non – governmental, universities and private facilities, and all other health sectors in the kingdom, upon whose commitment, hard work, and timely data submissions this report ultimately depends on and making this conceivable report a reality. Our thankful gratefulness and pride to everybody of the Cancer Registry staff, Dr. Marwan Al Zaghal, Dr. Wafa Halasa for their continuous supervision of the data processing they tirelessly provide, in collect, collate and coding the data are commendable. However, it would not have been possible without the kind support and the hard work of constantly entering the data, Mrs. Rasha Kokash, Mrs. Jameieha Al Sarway, Ms. Hala Daoud, Mr. Haytham Shqirate and last but not least our sincere thanks to Ms. Shaniaz Rahala and Dr. Ghazi Sharkas for their efforts. We would like to extend our genuine thanks to Dr. Kamal Arqoub, tumor registrar for his efforts in cleaning and the analysis of the data. We would like to express our gratitude towards all and every one for their kind co-operation and encouragement that help the cancer registry in completion of this report. Special thanks go to our focal personals in different hospitals and laboratories for the timely collection and compliance by providing cancer patients data to the central cancer registry. Our IT department for their continuous technical support and maintenance. We are indebted to the National Cancer institute (NCI – USA) and the Middle East Cancer Consortium (MECC) for their constant valued support that made this reports publication possible. Director of NCD Directorate Head. Cancer prevention Dept. Director – Pl. Jordan Cancer Registry Dr. Omar Nimri Dr. Ayyoub As Sayaideh
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Cancer Incidence in Jordan - 2012 Exceptional thanks and appreciations to the directors of all public, private, military and university and other health sector hospitals as well the private laboratories listed below. Highly appreciate the efforts and the hard work of our focal points personnel’s listed below for their contribution in this report of cancer incidence in Jordan. Aiming to accretion the number of the facilities in the clinical community to report their cancer data notification to the registry, making more coverage of the kingdom and continue best quality data with best available global standards. Name 1 2 3 4 5 6 7 8 9
10 11
Name
Hospital – Facilities
Rawan Alghoul
Al Basheer Hospital-MOH
Rufaida Nababteh Anwar Nabil
Khaled Jamal Suliemann Mohammad Flaifel
Dr Yassin Al Tawarah May Ali Yassin
Dalia Musa Naser
Suad Khaleel Allam Dena Abdel Alaal
Amani Mohammad Alsayed
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May Sabra
14
Maher Sawalmeh
13 15 16 17 18 19 20 21 22 23 24 25
Ruba Subhi Aletewi
Al Basheer Hospital-MOH Al Basheer Hospital-MOH
King Hussein Cancer Center King Hussein Cancer Center Royal Medical Services
Islamic Hospital-Private Islamic Hospital-Private
Specialty Hospital-Private Specialty Hospital-Private
Prince Hamza Hospital-MOH Prince Hamza Hospital-MOH
King Abdallah University Hospital King Abdallah University Hospital
Lubna Abu Ghosh
Al khalidi Hospital-Private
Suad Rashed Khlaeel
Jordan University Hospital-Private
Mohammad Al zarro Yusra Aljamal
Nedal Helmi Al Salymah Ahlam Ali Motlaq Rasha Al Twait
Mohammad Ababneh Amani Metani
Sakha’a Deif Allah Batayneh Heilda Zeyad halsah
Al khalidi Hospital-Private
Jordan University Hospital-Private Arab Center Hospital-Private Arab Center Hospital-Private Al Afia Center-Private
Prince Basma Hospital- Irbid-MOH Prince Basma Hospital- Irbid-MOH Prince Basma Hospital- Irbid-MOH Amman Surgery Hospital-Private
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Cancer Incidence in Jordan - 2012 26
Soud Meslem Al Shaweesh
Ma’an Hospital-MOH
28
Isra Al dewiri
Jordan Hospital-Private
30
Reem Moh. Mezher
27 29
31 32 33 34 35 36 37 38 39 40 41 42 43 44 45
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Hana Ali Abu Hatab
Seham Alshaim
Kefah MuneerAtwan
Hanade Ahmad Al Jazzazy Tarq Al Zobaidi
Suleiman Khalil Al Asi Kholoud Karaymeh Safa Momani
Hamda Ahnmad Esmaeel
Hamza Abd Al Hafeth Hasan Baha’aBarham
Ibrahim Awad Swalha Raed Jabali Ahmad Ola Hani
Fatema Abd Al Mo’ate Aqel Fatima Hammad
Abd alhakeem Saada
Jordan Hospital-Private
Istishari Hospital-Private Istishari Hospital-Private Israa Hospital-Private
Al Hussein Hospital –Salt-MOH Ibn Al Haitham Hospital-Private Jarash Hoapital-MOH
Jabal Al Zaitoun Hospital
Jordan University Hospital – IT Jabal Al Hussein LAB.
Al Basheer Hospital LAB-MOH
Jordan University Hospital– LAB Al Bashir Hospital- IT
Middle East LAB- Private Middle East LAB- Private
Zarqa Hospital LAB-MOH IT –MOH
Forensic medicine - Al Bashir Hospital
Cancer Incidence in Jordan - 2012 Executive Summary There is no doubt that cancer became an over whelming problem worldwide. In Jordan, as well the incidence and burden of cancer are increasing. Documentation of cancer cases helps to determine the magnitude of the problem and to provide suitable prevention cancer programs. This is the seventeenth 17th annual report of cancer incidence and epidemiology in Jordan which describes cancer cases in the year 2012. The total number of new cancer cases was 7454, of them 5013 were Jordanians (67.3%) and 2441 were non-Jordanian (32.7%). For Jordanians the number of male was 2346 (46.8%) while in females were 2667 (53.2%), In 2012,the number of new cases among Jordanians increased by 338 cases compared to the 2011 cases. The number of new cancer cases diagnosed among Jordanians has increased up to 46% in the past10 years, from 3362 cases in the year 2000 to 5013 in the year 2012. The male to female ratio was 0.88:1 in both years 2011 and 2012. The over- all median age at diagnosis was 56 (60 years for males and 53 years for females). The crude incidence rate of all cancers among Jordanians was 78.5per100,000
(71.2for
males and 86.2for females). The Age Standardized Rate (ASR) adjusted to the world standard population was 133.4 per 100,000 population (126.1 for males and 141.4 for females). The Age-Standardized Rate (ASR) for all cancers combined has increased by 7% (from 124.5 per 100,000 population in 2000 to 133.4 per 100,000 population in 2012). Overall, 42.7% of the cases in 2012 were diagnosed among people aged 60 years and older, males (56.8%) were more than female (43.2%) in this particular age group. Meanwhile; new cancer cases by age group showed that 4.3% of the cases were below15 years old, males (55.8%) were more than female (44.2%), and 24.7%
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Cancer Incidence in Jordan - 2012 were
in the age group 15- 44 years, and 28.0% in the age group 45-59 years in
which females predominated in this age group with ( 60.4%) over males (39.6%). The top five cancers among Jordanians (males and females) were :breast 1008 (20.1%), colorectal 567 (11.3%),lung 371(7.4%),lymphoma 327 (6.5%),and urinary bladder 246 (4.9%).Among Jordanian males, the top five cancer types were: lung 292 (12.4%) , colorectal 282 (12.0%), urinary bladder 217 (9.2%) , prostate 198 (8.4%), and lymphoma 177 (7.5%), while among Jordanian females , the top five cancers were: breast 994 (37.3%), colorectal 285 (10.7%), thyroid 158 (5.9%), lymphoma 150 (5.6%) and uterus 121 (4.5%). The distribution of cancer cases by regions showed that, 77 % of the cases were in the central region (Amman accounted for 61.9%), 16.9% in the north region and 5.1% in the south region .In the pediatric age group (less than 15years ) the total number of cancer cases was 217 accounted for (4.3%) of all cancer cases in Jordan with a male to female ratio 1.3:1. The top five cancer types in the pediatric age group were :leukemia 30%, brain and CNS 21.2%, lymphoma 14.3%, eye 6.9% and neuroblastoma 6%. Mortality due to cancer based on the data from the JCR database showed that the most common causes of death due to neoplasms in males were Lung (23.1%), Colorectal (10,9%) Pancreas (6.7% ) Leukemia (6.2%) and U.Bladder (6.0%) . While in females Breast (20.4%), Colorectal (14.6%) Lung (8.5%) , Leukemia (6.2%) and Pancreas (5.4%).
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Cancer Incidence in Jordan - 2012 Table of Contents Acknowledgement Executive Summary List of Tables………………………………………....................……………..…………12 List of Figures &Annexes ………………………………...………...……………………14 Chapter One…………………………………………………………………...…………17 Introduction Jordan Population and Geography Jordan Cancer Registry (JCR) Data Collection Methodology Trend of Cancer types of all sites 2000–2012 Non Jordanians :Trend of cancer cases by year and gender - 2012
Chapter Two………………………………………………............……………………...31 Cancer Incidence among Jordanians -2012 Distribution of cases by Age and Gender Frequency of incident cases of Site, Age group and Gender Top ten cancers by gender Top ten cancers by age group Geographical distribution of cancer types in Jordan
Chapter Three………………………………………………...........………......………..51 Ten most common cancers among Jordanians, 2012 1-Breast 2-Colo-Rectal 3- Lung 4- Lymphoma 5- Urinary Bladder 6- Leukemia 7-Thyroid 8- Prostate 9- Brain and CNS 10-Stomach
Chapter Four Chapter Five Chapter Six Arabic Summary
Pediatric Malignancies in Jordan, 2012…………..…....…..… 83 Cancers among Non-Jordanians, 2012…………….........…...…91 Cancer Mortality, 2012………………...............…..…..……..... 99 Cancer in Jordan 2012………………................................……118
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Cancer Incidence in Jordan - 2012 List of Tables Table1
Estimated population of the Kingdom by Age and Gender, 2012...................20
Table2
Estimated population of the Kingdom by Governorate and gender, 2012.......21
Table3
World Standard Population used for age adjustment (ASR)................................27
Table4
Basis of diagnosis of cancer cases among Jordanian,2012..............................33
Table5
Distribution of cancer cases among Jordanian according to staging, 2012........33
Table6
Percentage and ASIR of cancer by age group and gender-Jordan, 2012..............35
Table7
No. & percentage of cancer cases by primary site and gender, Jordan, 2012.....37
Table8
Frequency of Incidence cases among Jordanians by site and age (Males), 2012...38
Table9
Frequency of Incidence cases among Jordanians by site and age (Females), 2012.39
Table10 Ten most common cancers among Jordanians (both genders), 2012................40 Table11 Ten most common cancers among Jordanians (Males), 2012 ..............................40 Table12 Ten most common cancers among Jordanians (Females), 2012.........................41 Table13 Top ten cancer for the age group 0-19 years ,both genders Jordan, 2012...... 43 Table14 Top ten cancer for the age group 20-49 years , both genders 2012-Jordanian...........43 Table15 Top ten cancer for the age group 50+ years ,both genders 2012-Jordanian...............44 Table16 Percentage and ASIR of cancer cases by Governorate,regions and gender, 2012.45 Table17 Trend Frequencies of cancers among Jordanian, Males 2000-2012....................48 Table18 Trend Frequencies of cancers among Jordanian, Females 2000-2012.................49 Table19 Median age for top ten cancers among Jordanian both genders ,2012.............54 Table20 Frequency and ASIR of Breast cancer by Age-group and gender,2012.........55 Table21 Morphological Distribution for breast cancer-Jordan, 2012...............................56 Table22 Incidence and distribution of breast cancer by governorates in Jordan,2012...... 58 Table23 Frequency distribution of female breast cancer cases by age group 2000-2012 ... 59 Table24 Colo-Rectal cancer by Age-group and gender.....................................................61 Table25 Distribution of Colo-rectal cancers by topography and gender ............................63 Table26 Distribution of colorectal cancer by morphology -Jordan, 2012.....................63
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Cancer Incidence in Jordan - 2012 Continue – list of tables Table27 Distribution of colorectal cancer cases by stage (SEER staging),2012.......... 64 Table28 Number and rate of colorectal cancer by governorate, Jordan 2012................64 Table29 Lung cancer by Age-group and gender.................................................................66 Table30 Hodgkin’s Disease by Age-group and gender......................................................68 Table31 Non-Hodgkin’s Lymphoma by Age-group and gender.......................................69 Table32 Bladder cancer by Age-group and gender-2012...............................................71 Table33 Leukemia by Age-group and gender 2012...........................................................73 Table34 Thyroid cancer by Age-group and gender 2012.................................................... 75 Table35 Prostate cancer by Age - group 2012......................................................................76 Table36 Brain & CNS cancer by Age-group and gender 2012..........................................79 Table37 Stomach cancer by Age-group and gender 2012..................................................81 Table38 Distribution of childhood cancers by gender and age group, Jordan, 2012........86 Table39 Distribution of childhood cancer by governorates and gender 2012....................87 Table40 Distribution of childhood cancer by age group, governorates and gender, 2012.88 Table41 Cancers among Non-Jordanians by age group & gender - 2012..........................93 Table42 Cancers among Non-Jordanians by topography and gender, 2012.....................94 Table43 Top ten cancers among Non-Jordanians Males, 2012 ..........................................95 Table44 Top ten cancers among Non-Jordanians Females, 2012.....................................96 Table45 Number and percentage of deaths due to cancer by age group and gender....100 Table46 Mortality for Top ten cancer, both gender - 2012.................................................102 Table47 Mortality for Top ten cancer, Male -2012..........................................................102 Table48 Mortality for Top ten cancer, Female -2012........................................................103 Table49 Percentage distribution of deaths due to cancer by governorates , Jordan 2012..103 Table50 Percentage distribution of male deaths due to neoplasm, Jordan 2012............104 Table51 Percentage distribution of females deaths due to neoplasm, Jordan 2012...105
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Cancer Incidence in Jordan - 2012 List of Figures Figure1
Map of The Hashemite Kingdom of Jordan……………………………........…..20
Figure2
Population Pyramid, Jordan 2012………………..…...……………….………….. 21
Figure3
Trend of cancer in Jordan, 1986-2012…………..................………………………...27
Figure4
Trend of cancer in Jordan (Jordanian) by gender, 2003-2012………........……...28
Figure5
Trend of (ASIR) of cancer in (Jordanian) by gender 2003-2012………..…….…..28
Figure6
Trend of cancer in Jordan, Non Jordanian by gender 2003-2012………............…….29
Figure7
Percentage distribution of cancer among Jordanians by age-group and gender, 2012. .34
Figure8
Percentage gender distribution of cancer among Jordanians by age-group,2012…34
Figure9
Age-Specific Incidence Rate (all sites) by age group & gender - Jordan, 2012 ……...36
Figure10 Age Standardized Rate (all sites) by age group & gender-Jordan, 2012……...….…..36 Figure11 ASR for Male cancers (all sites), Jordan compared with other countries...............…36 Figure12 ASR for Female cancers (all sites), Jordan compared with other countries..........….36 Figure13 Percentage of Top ten cancers by Age group, Males-2012….......................………..41 Figure14 Percentage of Top ten cancers by Age group, Females-2012……...….......…………41 Figure15 Percentage of cancers (all sites)and three main age group and gender - 2012...…42 Figure16 Crude Incidence Rate by gender and governorates, Jordan, 2012…….................…….46 Figure17 Crude Incidence Rate by Regions & gender, Jordan, 2012……...…......…………46 Figure18 Percentage distribution of the top ten cancers by gender, Central Region, 2012........46 Figure19 Percentage distribution of top ten cancer by gender, North Region, Jordan-2012.....…47 Figure20 Percentage distribution of top ten cancers by gender (South Region), Jordan–2012..47 Figure21 Percentage of top ten cancers among Jordanians both gender, 2012…….........…52 Figure22 Number of top ten cancers among Jordanians by gender, 2012…...................……52 Figure23 ASR of top ten cancers among Jordanians, both genders, 2012………...…..………53 Figure 24 Top ten ASR for cancers among Jordanian Males, 2012……….…....................…….53 Figure25 Top ten ASR of cancers among Jordanian Females, 2012…….........…..........………..53 Figure26 Breast Cancer Age-Specific Incidence rate by age group & gender 2012.........……..56 Figure27 Distribution of breast cancer cases by laterality , Jordan 2012……...….......….……56
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Cancer Incidence in Jordan - 2012 Figure28 Distribution of female breast cancer by grade–Jordanians-2012…….…..............……57 Figure29 Distribution of female breast cancer by Summary Stage, 2012………..................………57 Figure30 Trend of number of female breast cancer 2000-2012, Jordan……….......…………..58 Figure31 Trend of ASR for female breast cancer ,2000-2012, Jordan…….……....…………..59 Figure32 Colorectal cancer ASIR by age group & gender 2012, Jordan....................................61 Figure33 Distribution of colorectal caner by topography.2012, Jordan……................…….…..62 Figure34 Trend number of Colorectal cancer 2003-2012, Jordan………..................…………63 Figure 35 Trend of ASR for Colorectal cancer 2003-2012, Jordan………….....................………63 Figure36 Distribution of colorectal caner by grade.2012, Jordan….…………...............…….…..64 Figure37 Morphological Distribution of lung cancer-Jordan, 2012…….....………....………65 Figure38 Lung cancer ASIR by Age-group and gender - 2012……………….........…………..…66 Figure39 Hodgkin’s Lymphoma ASIR byAge-group and gender………............………….68 Figure40 Non-Hodgkin’s Lymphoma ASIR by Age-group and gender…………..............…….69 Figure41 Morphological distribution of Urinary bladder cancer 2012, Jordan…................……..70 Figur 42
U.Bladder cancer ASIR by Age-group and gender 2012………...………71
Figure43 Morphological distribution of Leukemia -2012, Jordan…….......................………72 Figure 44 Leukemia ASIR by Age-group and gender 2012, Jordan…………............………..73 Figure 45 Morphological distribution of Thyroid cancer 2012, Jordan………........…………….74 Figure 46 Thyroid cancer ASIR by Age-group and gender, 2012……………………………….75 Figure47 Prostate caner ASIR -2012, Jordan…….......................................……………………77 Figure48 Distribution of prostate cancer by SEER summary stage -2012, Jordan ……..……77 Figure49 Morphological distribution of Brain and CNS cancer -2012, Jordan…......……..78 Figure50 Brain and CNS cancer ASIR by age group and gender-2012, Jordan……………..79 Figure 51 Morphological distribution of stomach cancer – Jordan, 2012…….......................…80 Figure 52 Stomach cancer ASIR by age group and gender -2012, Jordan...……....………81 Figure53 Percentage of gender for pediatric cancer cases -2012, Jordan……………………...84 Figure54
Percentage distribution of pediatric cancer cases by age group-2012, Jordan............85
Figure55 Top ten cancers in Pediatric age group both genders, 2012, Jordan ………………. 85
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Cancer Incidence in Jordan - 2012
Figure56 Top five cancer in pediatric age group by gender-2012, Jordan……………...……85 Figure57 Distribution of childhood cancer by age group and site, 2012 Jordan……….......…..86 Figure58 Distribution of childhood cancer by governorate and gender, 2012 - Jordan……..….87 Figure59 Distribution of childhood Leukemia by age and gender, 2012-Jordan…………88 Figure60 Distribution of childhood Brain & CNS by age and gender, 2012-Jordan…………..88 Figure61 Distribution of childhood lymphoma by age and gender, 2012-Jordan…………….89 Figure62 Distribution of childhood eye tumor by age and gender, 2012-Jordan…………….89 Figure63 Distribution of childhood neuroblastoma by age and gender, 2012 - Jordan.............89 Figure64 Cancer among Non-Jordanians reported in (1996–2012)…….................…….……..97 Figure65 Cancer among Non-Jordanians by nationality, 2012……………......……………..97 Figure66 Perecentage distribution of deaths due to cancer by gender and age group, 2012...101 Figure67 Distribution of deaths due to cancer by gender , 2012 Jordanian................................101 Figure68 Number of cancer cases and number of deaths due to cancer by gender, 2012......101 Figure69 Percentage distribution of deaths due to cancer by governorates, 2012...104 Figure70 Distribution of male deaths due to cancer by age group, 2012 Jordanian........106 Figure71 Distribution of female deaths due to cancer by age group, 2012 Jordanian.........106
Annexes :
Annex(1) Jordan Cancer Registry ( JCR) Notification Form.......................................................107 Annex(2) Jordan Cancer Registry Data Request Application Form..................................108
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Cancer Incidence in Jordan - 2012
1
Chapter one • Introduction • Population & Geography of Jordan • Jordan Cancer Registry ( JCR ) : - Data collection - Trend of Cancer in Jordan 2003-2012
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Cancer Incidence in Jordan - 2012 1-1 Introduction This is the 17th annual report of the incidence of cancer in Jordan published by Jordan Cancer Registry. It comprises the data for the year 2012 and a description of trends covering the period of 1996-2012. This report aims to explore the incidence of cancer in Jordan. Cancer is one of the leading causes of morbidity and mortality in Jordan. It is the second cause of death (16.2%) after cardiovascular disease (36.7%).(mortality 2012 report) . Many factors play role in cancer development, but it is important to mention that many types of cancers can be prevented by simple life style change ; like smoking cessation and decrease exposure to smoke as smoking is the most significant cancer risk factor that we can reduce. Smoking is responsible for not only lung cancer, but for many other types of cancer. Well-balanced diet is advantageous for many reasons: a diet rich in fruits and vegetables can reduce the risk of developing cancer and many other health related conditions. Fruits and vegetables contain antioxidants, which help in repairing damaged cells. Numerous studies showed that a diet high in animal fat increases the risk for several types of cancer, particularly colon cancer.Red meat
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contains much more fat than poultry and fish, so reducing amount of red meat in diet may help to prevent cancer. A diet high in fat is a major cause of obesity, which is a risk factor for many types of cancer. Physical activity is also important factor for cancer prevention. The American Cancer Society recommends exercising 30 or more minutes, at least 5 days a week for cancer prevention. The main purpose of this report is to provide health professionals, researchers and policy-makers and others who are interested with detailed information about the most common types of cancer in Jordan and their distribution by age, gender and address . Data provided by JCR may help in promoting new researches, to assist in planning and evaluation of Cancer Control Strategies and identify priorities for public health actions. Initiation of Jordan Breast Cancer Programe (JBCP) is a good example for the utilization of Jordan cancer registry data of breast cancer epidemiology and clinical data about stage of tumor and median age at diagnosis. The availbility of cancer data at JCR is a solid data base for intiating and establishing other screening programmes.
Cancer Incidence in Jordan - 2012 1-2 Population & Geography Population: The estimated population of Jordan in 2012 reached 6387986, among those 3292986 were males and 3095000 were females with male: female ratio 1.06 : 1. (Department of Statistics Jordan, 2012). About 12.7 % of the population were under 5 years old, and 37.2 % were under 15 years old. Only 3.3 % of the total population were above the 65 years old age groups .The percentage of males was a little higher than females in most of the age groups of the population, except in the age group 55-59 years and 80 years and above, where the percentage of females was slightly higher than males Table (1) and figure (2) show age distribution of Jordan population, 2012 (Jordanian Population Pyramid). Table (2) shows the population distribution of Jordanians by governorates and gender. The Central region (Amman, Balqa,Zarqa, and Madaba governorates) constitute (62.8%) of Jordan population with popula- tion density (249.7) Km2, compared with Northern region (Irbid,Mafraq, Jarash and Ajlun) which consitute (27.8%) with population density (55 Km2) and Southern region ( Karak, Tafiela, Ma’an and Aqaba) (9.4%) with population density (11.7 Km2).
Geography : Jordan is located in the Middle East, between Latitudes 29-33 North and between Longitude 35-39 East, extending about 500 Kilometers from North to South. It is bounded in the North by Syria, in the East by Iraq and Saudi Arabia, in the South also by Saudi Arabia, and in the West by Israel and Palestine Authority. The total area is 89.3 thousand Km2. Out of the total area, 75% is desert along the Eastern part of the country. Mountains height ranged between 1100 – 1854 meters above sea level. The Dead Sea area is the lowest location in the world and it is around 407 meter below sea level. The climate of the country as a whole is moderate, there are four seasons summer, autumn, winter and spring. The temperature ranges from 4 C in winter to 38 C in summer. Jordan is divided from the administrative point of view into three regions (Central , North, and South) and twelve governorates ( Figure 1 Map of Jordan. )
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Cancer Incidence in Jordan - 2012 Figure (1) Map of The Hashemite Kingdom of Jordan
Table (1) Estimated population of Jordan by age group and gender , 2012 Age group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total
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No
Male
417555 412379 392200 360405 350468 300740 259992 210573 155733 109387 81113 70023 65369 46522 29411 15857 7692 7567 3292986
%
12.7 12.5 11.9 10.9 10.6 9.1 7.9 6.4 4.7 3.3 2.5 2.1 2.0 1.4 0.9 0.5 0.2 0.2 100.0
Female No %
396067 391785 370932 339847 325586 270408 239862 194608 146905 104259 79606 72528 58376 43373 29151 14505 9284 7918 3095000
12.8 12.7 12.0 11.0 10.5 8.7 7.7 6.3 4.7 3.4 2.6 2.3 1.9 1.4 0.9 0.5 0.3 0.3 100.0
No.
Total
813622 804164 763132 700252 676054 571148 499854 405181 302638 213646 160719 142551 123745 89895 58562 30362 16976 15485 6387986
%
12.7 12.6 11.9 11.0 10.6 8.9 7.8 6.3 4.7 3.3 2.5 2.2 1.9 1.4 0.9 0.5 0.3 0.2 100.0
Gender Ratio 105.4 105.3 105.7 106.0 107.6 111.2 108.4 108.2 106.0 104.9 101.9 96.5 112.0 107.3 100.9 109.3 82.9 95.6 106.4
Cancer Incidence in Jordan - 2012 Figure ( 2) Population Pyramid , Jordan 2012
Table (2) Estimated Population of Jordan by Governorates (Regions) and gender , 2012 gender Governorate Amman Zaraqa Balqa Madaba Central Region Irbid Jarash Ajlun Mafraq North Region Karak Aqaba Maan Tafiela South region Total
Male
Female
Total
1271900 492500 222200 82300 2068900 582400 98600 74800 155600 911400 126100 77500 63600 45500 312700 3293000
1201500 459300 205800 77400 1944000 554700 93100 72100 144700 864600 123000 61700 57800 43900 286400 3095000
2473400 951800 428000 159700 4012900 1137100 191700 146900 300300 1776000 249100 139200 121400 89400 599100 6388000
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Cancer Incidence in Jordan - 2012 1-3 Jordan Cancer Registry ( JCR ) Jordan
Cancer
Registry
(JCR)
is
a
identified and linked to data base systems as
population-based registry established in
mortality data and data base in other hospitals
1996 under the jurisdiction of the Ministry
In many countries, the cancer registry has
of Health (MOH) by the order of His
proved to be an important tool for public
Excellency the Minister of Health. JCR is a
health surveillance, including the planning
unit of Cancer Prevention Department in the
and evaluation of health services.
Non-communicable Disease Directorate. Cancer notification is compulsory since
Vision
1996 through a ministerial decree.
To meet the highest attainable international
JCR monitor cancer incidence in Jordan
standards in cancer registration, surveillance
and trends over time. The aim of JCR is to
and control.
provide national cancer incidence data to the public in a timely and accurate manner.
Mission
JCR also provide a data for clinical and
To register all cancer cases reported in
epidemiological
cancer
various health institution in Jordan and to
registry plays a central role in all aspects of
avail the data and /or information gathered
cancer control not only for the population
for policy development and support in cancer
covered but also for other populations with
research, treatment, control ,prevention, and
which results can be compared.
surveillance.
The
systematic
and analysis of
research.
The
collection,
recording
data relating to cancer
Objectives of JCR
and
To define the size of cancer problem and
cancer,
pattern of cancer occurrence in Jordan. To
cancer incidence, mortality, for various
provide data on cancer for epidemiological
population and sub- groups. It also opens
and clinical studies. To make data of cancer
the way for epidemiological researches
incidence and prevalence available for use
about the causes of cancer, and effects
by health planners and professionals in
of interventions in prevention and early
order to plan for cancer prevention, control
diagnosis, provided that patients can be
and management in a cost effective manner.
enables interpretation
of
pathological characteristics
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clinical of
Cancer Incidence in Jordan - 2012 1-4 Methodology Data management 1-4-1 Methodology:
Sources of information
For Jordanian all malignant and in-situ cases diagnosed from 1st Jan- 31 Dec.2012 were notified and registered to JCR, and for non-Jordanians all cancer patients that treated in our hospitals during this year were notified to our registry. There are two methods of data collection : 1. Active method Data was collected and abstracted by a trained registry staff through regular visits to all hospitals distributed all over the country. The JCR strives for full access to cancer data from all governmental hospitals, private hospitals, Royal Medical Services and University hospitals as well as clinics and laboratories throughout the Kingdom. Cancer data are abstracted by JCR trained staff (Cancer Tumor Registrar) from patients’ medical records, based on clinical and/or histopathological diagnosis. 2. Passive method trained focal points medical staff, abstract cancer data from patients files, complete a standardized form and forward it to the Jordan Cancer Registry. The data abstracted: includes personal identification (name, ID number, gender, age), demographic information (address, telephone number, nationality), and tumor details (diagnosis date, primary site, histology, behavior, grade, stage, basis of diagnosis).
This Registry collect the most important data about cancer patients and ensure that it is complete and of high quality. Notifications of cancer derived from many sources, such as: Hospital admissions and medical records departments from all public ,private military and university hospitals all over Jordan (hospital discharge report) through international classification of disease and operation ICD-9 or 10 morbidity and mortality coding system. Histopathology report in all these hospitals. Hospital based Registry such as King Hussein Cancer Center (KHCC). Histopathology laboratories: cytology, hematology in public and private histopathology laboratories as Med-lab, Ennab lab and others. Forensic medicine records through (death certificates).
Reportable list Reportable lists may range from a simple list of invasive and in-situ tumors to a complex s list that includes benign and borderline tumors. Cases with a behavior code 2 and 3 of the International Classification of Diseases for Oncology, third Edition (ICD-O-3) included in the registry.
23
Cancer Incidence in Jordan - 2012 ICD-O-3 Behavior Codes
• Patients details: first name, median name,
0 Benign
last name, ID number, age/ date of birth,
1 Bordereline, benign or malignant
gender current residence (governorate).
2 Carcinoma in situ,
• Tumor : diagnosis date ,Basis of diagnosis,
3 Malignant, primary site
primary site /topography (ICD-O) code,
Benign (behavior code 0) or borderline
histology/morphology
(behavior code 1) these cases were collected
behavior ,grade and stage at diagnosis
in JCR but not entered in the Can-
(SEER summary stage)
reg4 program and kept in special files
• Treatments: initial and subsequent treatments
specially those of brain and CNS. Localized
surgery, radiotherapy, chemotherapy, hormonal
basal cell and squamous cell carcinoma of
therapy.
non-genital skin sites (C44.0-C44.9) were
• Sources of data: hospital/laboratory name,
included in our registry.
hospital / facility code number,
Abstracting information is the essence of
date of abstracter.
the cancer registry. The accuracy and
• Follow up: patient status (alive or
completeness with which this function
dead) as the date of incidence, last date
is performed determines the value of the
of contact with physician/ health care
registry. Users of cancer registry data must
provider or if dead – date of death and
be confident that the abstracted information
cause of death.
is a true representation of the patients’
• A complete JCR abstract form is append to
demographics, diagnosis, and treatment. An
this report for more details.
(ICD-O)
code,
name and
abstract completed for each reportable case.
Classification and Coding Data variables
The
The number of assessment variables used by
histology (morphology) of the malignancies
JCR is based on the international standard
are identified and coded according to
variables for all cancer registries .They
the International Classification of Diseases
are various formats that may used. JCR
for Oncology third Edition (ICDO-3),
uses standards provided by the International
published by the World Health Organization
Agency for Research on Cancer (IARC).
(WHO), 2000.
They include:
24
primary
site
(topography)
and
Cancer Incidence in Jordan - 2012 1-4-2 Data management (storage and retrieval)
information. Information users interested
Completeness of data :
required to obtain authority for access to data
JCR collects data from Al Basher hospital,
from non-communicable disease directorate
the biggest governmental hospital in Jordan
(NCD) director and are mutually bound
that treat cancer patient with separate
to acknowledge the registry in their data
department
radiotherapy,
usage. In order to maintain confidentiality
chemotherapy and inpatient and outpatients
of facility and patient information, inclusion
clinic the same on king Hussein cancer
of facility and patient identification details
center (KHCC) and Al Basher hospital .
is restricted. Quality Assurance & Data analysis Accuracy and consistency are essential in tumor registry reporting. Quality control means assessing for completeness, accuracy, and uniformity of data at the case finding, abstracting, coding, and data processing levels. Quality control should be an ongoing process, and time should be allotted for registry personnel to carry out special quality control functions. The registry always perform quality control on data before presenting reports Every effort is made to accurately code patient and tumor information, to ensure that all data can be reviewed, linked, and consolidated, as appropriate. Before and during the phase of data entry, validation of data was done through the following : Assurance of data completeness through continuous generation of patients’ lists who have rare or invalid categories or behavior less than three to check for it .
including
Data is managed using server with net work computers at the registry, a local area network is established to allow staff to work on the registry data base simultaneously. In the future online system will be established for receiving abstract forms electronically from health facilities with internet access. This is intended to ease and speed
up
submission of abstract forms to the registry. Data is primarily managed and filtered and prepared for submission to Can Reg4 Software, which also allows statistical analysis. Abstract forms submitted from health –care facilities are kept in box files and shelved in straight numerical order in cabinets. In order to ensure good flow of data/ information between the registry and health care facilities. All cancer registrars are strictly bound by the professional code of observing confidentiality of patient
in JCR data and information services are
25
Cancer Incidence in Jordan - 2012 Checking essential demographic data such as age, date of birth, gender, address. Patient lists were evaluated for duplicates. Internal quality checks include : random selection of some records was done systematically for double checks of data abstraction and to ensure completeness. Procedures for review include visual review, computerized data edits, and hospital queries. JCR staff performed quality assurance tasks upon receipt of abstracts from each reporting institution. Periodic review procedures also include reabstracting of cases and case finding studies. The reporting facility is required to resolve incomplete, incorrect, or inconsistent data upon JCR query. The computer software program used for data entry and incidence tables output is CanReg 4.31, which developed by the International Agency for Research on Cancer, (IARC) Lyon, France, this software has a duplicate entry checking facility. Validity checks are performed for consistency between items: site/histology, gender/site and age/site/histology combinations by CanReg4. Epi-info and other statistical programmers were used for further analysis by the JCR staff as SPSS. Frequencies for most of the variables collected are presented in this report mainly primary site of cancer, age group, gender, governorate and regions, tables and graphs for cancer cases for Jordanian and non-
26
Jordanian and pediatric malignancy and top ten cancer for both genders presented, tables and graphs from literature presented for comparison of the rates to other countries .also one chapter for mortality due to cancer presented in the last chapter to identify most common deaths due to cancer by gender and governorates. World standard population is used for calculation of standard rates, to facilitate national and international comparisons (Table 3).
Confidentiality To ensure the protection and confidentiality of the identifying information collected by the JCR staff , Procedure Manual contains, among other things: 1. Procedures to safeguard and secure the registry database and printed data generated from the database containing identifying information 2. Procedures to destroy (e.g., by shredding) all printed materials containing identifying information when such materials are to be disposed of. 3. Procedures to make certain and ensure that all persons with access to JCR identifying information have signed a written statement acknowledging their responsibility to maintain confidentiality and subjecting them to penalties for violation of confidentiality requirements.
Cancer Incidence in Jordan - 2012 Table (3) World Standard Population used for Age Adjustment Age (Years)
0- 4 5-9 10-14 15- 19 20- 24 25- 29 30- 34 35- 39 40- 44 45- 49
Count
120,000 100,000 90,000 90,000 80,000 80,000 60,000 60,000 60,000 60,000
Age (Years)
50- 54 55- 59 60- 64 65- 69 70- 74 75- 79 80- 84 85+ Total
Count 50,000 40,000 40,000 30,000 20,000 10,000 5,000 5,000
1,000,000
1-5 Trend of cancers of all sites ( Jordanian, Non Jordanian) Figure (3) shows the trend of cancer cases in Jordan during the period 1986 – 2012, which shows that prior to the establishment of Jordan Cancer Registry ( JCR) in 1996, the reported cancer cases were presented as a Hospital – Based Registry which is mainly from Albasheer hospital after JCR establishment from1996 the reported cancer
cases were collected from all over the country as Population- Based Cancer Registry. It shows the number of reported malignancies according to the years of incidence in the years 1980 to 2011.The number of registered cases markedly increase when the Registry was transformed from Hospital – Based to Population –Based Registry.
Figure (3) Trend of cancer in Jordan, 1986-2012
27
Cancer Incidence in Jordan - 2012 Figures (4,5 ) shows the number of reported cases to JCR by gender and also crude incidence rate for Jordanian from the year 2003 to 2012 (ten years period) by gender. These figures shows that there is slight increase in the number of incident cases and
crude incidence in Jordanian for both males and females .The number of Jordanian males increase from 2194 in 2011 to 2346 in 2012 while in females the number increase from 2481in 2011 to 2667 in 2012.
Figure (4) Trend of cancer for Jordanian by gender,2003-2012
Figure (5) Trend of Crude incidence rate of cancer in (Jordanian) by gender2003-2012
28
Cancer Incidence in Jordan - 2012 Figure (6) shows the trend number of cases for non Jordanian apparnetly the number of cancer cases increased in both males and females for the year 2012.
Figure (6) Trend of cancer for Non Jordanian by gender 2003-2012
29
Cancer Incidence in Jordan - 2012
2
Chapter two
Cancer Incidence in Jordan -2012, Jordanian
• Distribution of cases by basis of diagnosis and summary stage • Frequency of incident cases by site and age group & gender • Top ten cancers by age group & gender • Geographical distribution of cancer in Jordan • Top ten cancers by regions
31
Cancer Incidence in Jordan - 2012 In the17th annual report for the year 2012, we explored the number of new incident cases among Jordanians and Non-Jordanians (Resident or Non-residents) referred from neighboring and other countries for diagnosis and treatment in Jordan. Malignant and in situ behavior are reportable to our registry, while benign and borderline malignancy are not reportable in this registry. In 2012, the registry received around 12000 different notification forms, JCR forms, self-designed abstracted forms from all hospitals including governmental, private ,military and universities hospitals and also histopathology reports and lists of names from histopathology laboratories and forensic medicine. There are more than 60 sources for cancer notification to JCR covering all sectors in Jordan, with average of 2-3 notifications per one case. After checking, filtering all forms received we update data and exclude: duplicate and registered cases
(prevalent cases after checking the case and ensure that it is not multi-primary case) depending on multi-primary standard rules. Benign and borderline forms and histopathology report received were kept separately in special files in the registry. Total number of new cancer cases registered to JCR in 2012 were (7454) compared with (6971) in 2011 with increase of (7%). The number of Jordanian was 5013 patients compared with 4675 in 2011 while for non-Jordanian the number registered in 2012 was 2441 compared with 2296 in 2011. About 106 (2.1%) of cases were insitu behavior (not invasive) and the remaining (97.9%) were invasive cancer .There were 150 cases with multi primary tumors constituted about (2%) of cases in both Jordanian and non-Jordanian. Multi-primary tumors in Jordanian were( 130) cases (1.7%).
2.1 Distribution of cases by basis of diagnosis and summary stage : The following tables (4) and (5) show distribution of cases by basis of diagnosis and summary stage of the cases, it shows that the basis of diagnosis of cancer cases among Jordanian; clearly most of the cases were diagnosed by taking biopsy from primary site (94.9%), and (2.5%) of the cases were diagnosed by clinical and clinical investigation, and only 0.6% were diagnosed by death certificate only (DCO).
32
Table (5) shows distribution of cancer cases diagnosed in 2012among Jordanian distributed by SEER summary stage: insitu stage (2.1%), 32.5% were localized, regional was 32.5% while about 27.9% were advanced stage (distant metastasis).On the other hand in (20.5%) of the cases the stage was not recorded in the forms received.
Cancer Incidence in Jordan - 2012 Table ( 4 ) Basis of diagnosis of cancer cases among Jordanians , 2012 Basis of diagnosis
Frequency
( %)
Histology of primary site
4757
94.9
Clinical & clinical investigation/ ultrasound
123
2.5
Cytology/Hematology
92
1.8
Death Certificate Only ( DCO)
29
0.6
Histology of metastases
5
0.1
Laboratory test
2
0.0
Unknown
5
0.1
5013
100.0
Total
Table ( 5 ) Stage distribution of incident cases among Jordanians according to SEER *Staging , 2012 SEER Summary Staging
Frequency
( %)
In situ
106
2.1
Localized
1628
32.5
Regional
854
17.0
Distant Metastasis
1399
27.9
Not Known
1026
20.5
Total
5013
100.0
*SEER : Surveillance , Epidemiology and End Results
33
Cancer Incidence in Jordan - 2012 2.2 Distribution of cases by Age group and gender: A total of (5013) new cases of cancer were recorded among Jordanian population for the year 2012,of these, (2346) cases (46.7%) were males and (2667) were females cases (53.3%).Male to female ratio is 0.88:1 the same ratio in the year 2011. Distribution of cancer cases by age group shows that 42.7% of the cases occurred in the age group 60 years and above, with
males higher (56.8%) than females (43.2%) in this age group. While 46% the cases were in the age group 30-59 years ,and females predominate (61.9%) over males (38.1%) , this is mostly due to high incidence of breast cancer in this age group. In child hood period 0-14 years males were higher (55.8%) than females (44.2%), as shown in Figures (7) and (8).
Figure (7) Percentage distribution of cancer among Jordanians by age-group and gender , 2012
Figure (8) Percentage gender distribution of cancer among Jordanians by age group -2012
34
Cancer Incidence in Jordan - 2012 The overall median age at diagnosis
and (141.4)
was 56 years with considerable variation
compared with 2011 ASR was128.1 (for
according to the cancer site and gender (60
males 121.1 for females) 135.6 /100,000
years for males and 53 years for females).
population). For all cancer the number of
In 2012, the crude incidence rate of all
cases increased with age in both males
cancers among Jordanians was 78.5 per
and females as shown in table (6) the
100,000 population (71.2 for males and
same also is seen for age specific incidence
86.2 for females). The age-standardized
rate (ASIR) which increased with age for
rate (ASR) adjusted to the World Standard
both males and females
Population
figure (9).
was (133.4)
per
100,000
per 100,000
for females)
as shown in
population (126.1 per 100,000 for males
Table (6) Number and ASIR of cancer cases by age group and gender –Jordan ,2012 Age group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 75-79 80-84 85+ Unknown Total
N 54 31 36 42 44 56 99 93 139 164 195 198 249 300 307 199 94 41 5 2346
Male
ASIR 12.9 7.5 9.2 11.7 12.6 18.6 38.1 44.2 89.3 149.9 240.4 282.8 380.9 644.9 1043.8 1255.0 1222.0 541.8 - 71.2
Female N ASIR 47 11.9 21 5.4 28 7.5 50 14.7 70 21.5 72 26.6 127 52.9 179 92.0 266 181.1 281 269.5 294 369.3 274 377.8 264 452.2 260 599.5 201 689.5 128 882.5 67 721.7 32 404.1 6 - 2667 86.2
N 101 52 64 92 114 128 226 272 405 445 489 472 513 560 508 327 161 73 11 5013
Total
ASIR 12.4 6.5 8.4 13.1 16.9 22.4 45.2 67.1 133.8 208.3 304.3 331.1 414.6 622.9 867.5 1077.0 948.4 471.4 - 78.5
35
Cancer Incidence in Jordan - 2012 Figure (9) ASIR for cancer cases by age group and gender –Jordanian ,2012
Figure (10) ASR for cancer cases by age group and gender –Jordanian ,2012
Figure (11) ASR of cancer of Jordan compared with other countries-Males
Figure (12) ASR of cancer of Jordan compared with other countries-Females
36
Cancer Incidence in Jordan - 2012 Table (7) Number & percantage of new cancer cases by primary site & gender Jordan, 2012 Primary Site All Sites Lip Tongue Mouth Salivary glands Pharynx Oesophagus Stomach Small intestine Colon Rectum Liver, Biliary Passages Pancreas Other & Unspecified Digestive Larynx Trachea,Bronchus,Lung Other Thoracic organs Bone Melanoma of Skin Other Skin Connective,Soft tissue Breast Cervix Uteri Corpus Uteri, unspecified Ovary Other reproductive Female Prostate Testis Other reproductive Male Kidney Urinary Bladder Eye Brain, Nervous system Thyroid Other Endocrine Hodgkin disease Non-Hodgkin lymphoma Lymphoid Leukemia Myeloid Leukemia Leukemia unspecified. Other bone marrow disorders Multiple Myeloma Other & unspecified Primary site unknown
N 2346 18 17 5 11 29 17 86 12 181 101 56 75 13 89 292 11 26 4 132 33 14 0 0 0 0 198 59 2 85 217 13 101 45 9 49 128 59 61 9 22 30 6 31
Male
% 100.0 0.8 0.7 0.2 0.5 1.2 0.7 3.7 0.5 7.7 4.3 2.4 3.2 0.6 3.8 12.4 0.5 1.1 0.2 5.6 1.4 0.6 0.0 0.0 0.0 0.0 8.4 2.5 0.1 3.6 9.2 0.6 4.3 1.9 0.4 2.1 5.5 2.5 2.6 0.4 0.9 1.3 0.3 1.3
Female
N 2667 6 4 10 9 17 7 50 11 191 94 36 51 12 10 79 10 21 8 78 27 994 50 121 87 20 0 0 0 48 29 14 66 158 12 60 90 37 71 6 6 28 7 32
% 100.0 0.2 0.1 0.4 0.3 0.6 0.3 1.9 0.4 7.2 3.5 1.3 1.9 0.4 0.4 3.0 0.4 0.8 0.3 2.9 1.0 37.3 1.9 4.5 3.3 0.7 0.0 0.0 0.0 1.8 1.1 0.5 2.5 5.9 0.4 2.2 3.4 1.4 2.7 0.2 0.2 1.0 0.3 1.2
N 5013 24 21 15 20 46 24 136 23 372 195 92 126 25 99 371 21 47 12 210 60 1008 50 121 87 20 198 59 2 133 246 27 167 203 21 109 218 96 132 15 28 58 13 63
Total
% 100.0 0.5 0.4 0.3 0.4 0.9 0.5 2.7 0.5 7.4 3.9 1.8 2.5 0.5 2.0 7.4 0.4 0.9 0.2 4.2 1.2 20.1 1.0 2.4 1.7 0.4 3.9 1.2 0.0 2.7 4.9 0.5 3.3 4.0 0.4 2.2 4.3 1.9 2.6 0.3 0.6 1.2 0.3 1.3
37
All Ages
lip 18 Tongue 17 Mouth 5 Salivary gland 11 Other Oropharynx 1 Nasopharynx 25 Pharynx unspecified 3 Oesophagus 17 Stomach 86 Small intestine 12 Colon 181 Rectum 101 Liver 38 Gallbladder etc. 18 Pancreas 75 Nose. sinuses etc 5 Larynx 89 Bronchus. lung 292 Other thoracic organs 2 Bone 26 Melanoma of Skin 4 Other Skin 132 Mesothelioma 4 Kaposi sarcoma 5 Connective,Soft tissue 33 Breast 14 Penis 1 Prostate 198 Testis 59 Other male genital 1 Kidney 85 Bladder 216 Eye 13 Brain, Nervous system 101 Thyroid 45 Other Endocrine 9 Hodgkin disease 49 Non-Hodgkin lymphoma 128 Multiple Myeloma 30 Lymphoid Leukaemia 59 Myeloid Leukaemia 61 Leukaemia unspecified 9 Other Bone marrow dis. 22 Other & unspecified 14 Primary site unknown 31 All sites 2346 All sites except C44 2214
Primary site
Age Unk. 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 5 4
0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 2 0 0 0 1 0 2 0 6 13 0 4 2 2 0 13 2 1 0 2 0 54 54
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 1 0 0 0 0 0 1 0 1 6 0 0 3 6 0 8 1 1 1 0 0 31 31
5-9 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 2 0 2 0 0 1 0 0 0 1 0 0 0 0 11 0 1 3 5 0 7 2 0 0 0 0 36 34
0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 8 0 0 0 0 1 0 0 0 6 0 0 0 0 3 0 0 6 2 0 6 5 1 0 0 0 42 42
1 0 0 0 0 2 1 0 0 0 1 0 0 0 0 0 0 1 0 3 0 0 0 0 5 1 0 0 8 0 0 0 0 2 2 0 6 2 0 4 4 1 0 0 0 44 44
1 0 0 0 0 1 0 1 1 1 3 1 0 0 1 0 1 0 0 1 0 0 0 0 1 1 0 0 13 0 3 2 1 1 5 0 4 4 0 1 6 0 1 0 1 56 56
1 1 1 1 0 1 0 1 1 1 5 5 2 1 0 0 1 1 0 6 0 5 0 0 3 0 0 0 18 0 1 4 0 4 8 0 9 9 0 2 6 0 0 1 0 99 94
0 3 0 0 0 2 0 2 3 1 6 9 1 1 0 0 1 6 0 2 0 5 0 0 2 0 0 0 5 0 4 7 0 2 4 1 3 11 0 3 6 1 1 0 1 93 88
3 0 0 2 0 2 0 1 6 1 10 7 1 0 8 0 3 13 1 0 0 12 0 0 1 1 0 0 5 0 6 10 3 13 3 1 3 7 3 3 2 0 3 2 3 139 127
0 3 0 0 0 5 0 1 7 1 11 13 4 0 10 2 12 22 0 0 1 3 0 0 2 2 0 4 0 0 9 9 0 9 6 0 2 10 4 2 4 0 2 1 3 164 161
4 2 1 2 1 1 0 2 8 0 19 7 5 1 8 0 16 22 0 0 1 6 0 0 3 2 1 4 1 0 13 16 0 7 8 0 4 14 4 2 3 0 4 1 2 195 189
1 2 0 2 0 1 0 2 16 0 18 7 3 2 12 0 14 31 0 0 1 9 2 1 1 1 0 14 0 0 10 21 0 8 3 1 2 5 2 0 2 0 0 1 3 198 189
1 1 3 2 0 2 0 0 14 1 24 13 5 3 6 0 13 44 0 0 1 14 0 0 1 2 0 18 1 0 10 25 0 10 2 0 1 11 7 0 4 1 0 2 7 249 235
1 0 0 1 0 4 0 2 8 3 27 18 7 4 8 1 10 49 1 0 0 20 1 0 6 3 0 44 0 0 8 37 1 4 2 0 0 18 1 1 3 1 2 1 3 300 280
4 3 0 0 0 3 1 2 9 1 25 9 2 0 9 0 10 59 0 1 0 25 1 1 0 0 0 50 0 1 11 41 1 6 1 1 1 11 3 4 4 2 3 1 2 308 283
1 1 0 0 0 1 1 2 7 1 17 6 2 3 6 0 4 32 0 0 0 17 0 1 3 1 0 41 0 0 5 27 0 1 1 0 0 5 3 1 3 0 2 0 3 198 181
0 1 0 0 0 0 0 1 4 1 9 3 4 2 4 1 2 8 0 0 0 8 0 2 0 0 0 14 0 0 2 11 0 0 0 0 0 4 2 2 4 0 3 1 1 94 86
10-14 15-19 20 -24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
Table (8 )Frequency of incidence cases among Jordanians by site and age-group (Males ) , 2012 0 0 0 0 0 0 0 0 1 0 4 3 1 1 3 0 1 2 0 0 0 5 0 0 0 0 0 9 0 0 0 6 0 1 0 0 0 1 1 0 0 0 0 0 2 41 36
0.8 0.7 0.2 0.5 0.0 1.1 0.1 0.7 3.7 0.5 7.7 4.3 1.6 0.8 3.2 0.2 3.8 12.4 0.1 1.1 0.2 5.6 0.2 0.2 1.4 0.6 0.0 8.4 2.5 0.0 3.6 9.2 0.6 4.3 1.9 0.4 2.1 5.5 1.3 2.5 2.6 0.4 0.9 0.6 1.3 100.0 94.4
85+ %Total
C00 C01-C02 C03-C06 C07-C08 C10 C11 C14 C15 C16 C17 C18 C19-C21 C22 C23-C24 C25 C30-C31 C32 C33-C34 C37-C38 C40-C41 C43 C44 C45 C46 C47;C49 C50 C60 C61 C62 C63 C64-65 C67 C69 C70-C72 C73 C74-C75 C81 C82-C85;C96 C90 C91 C92-C94 C95 C96 C76- C48 C80 Not C44
ICD-O3
Cancer Incidence in Jordan - 2012
38
Lip Tongue Mouth Salivary glands Oropharynx Nasopharynx Pharynx unspecified Oesophagus Stomach Small intestine Colon Rectum Liver Gallbladder etc. Pancreas Nose, sinuses etc. Larynx Trachea,Bronchus,Lung Other Thoracic organs Bone Melanoma of Skin Other Skin Mesothelioma Kaposi sarcoma Connective,Soft tissue Breast Cervix Uteri Corpus Uteri Uterus unspecified Ovary Other Female Genital Placenta Kidney Bladder Eye Brain, Nervous system Thyroid Other Endocrine Hodgkin disease Non-Hodgkin lymphoma Multiple Myeloma Lymphoid Leukaemia Myeloid Leukaemia Leukaemia unspecified Other bone marrow dis Other & unspecified Primary site unknown All Sites All sites except C44
Primary site
All Age Ages Unk. 6 0 4 0 10 0 9 0 1 0 15 1 1 0 7 0 50 0 11 0 191 1 94 0 13 0 23 0 51 0 4 0 10 0 79 0 4 0 21 0 8 0 78 1 2 0 0 0 27 0 994 0 50 0 87 0 34 0 87 0 13 0 7 0 48 1 29 0 14 0 66 0 158 0 12 0 60 2 90 0 28 0 37 0 71 0 6 0 6 0 19 0 32 0 2667 6 2589 5
0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 6 0 5 8 0 5 1 1 0 13 2 1 1 1 0 47 47
0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 1 0 0 0 0 0 0 0 0 0 3 6 0 1 1 1 0 5 0 0 0 0 0 21 21
5-9 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 3 0 0 0 0 1 0 0 0 0 3 0 0 2 0 0 2 0 0 5 1 0 4 5 0 0 0 0 28 28
0 0 0 0 0 2 0 0 0 0 4 0 0 0 0 1 0 0 0 5 0 0 0 0 3 0 1 0 0 5 0 0 2 0 0 3 2 0 15 0 0 3 3 1 0 0 0 50 50
0 0 1 0 0 1 0 0 0 0 2 1 0 0 1 0 0 0 1 6 0 0 0 0 0 5 0 0 0 6 0 2 1 0 1 3 12 1 13 3 0 1 6 1 0 1 1 70 70
0 0 0 0 0 0 0 0 0 1 2 1 0 0 0 0 0 0 0 0 0 1 0 0 1 15 3 1 0 4 0 3 1 0 0 8 15 0 5 6 0 0 3 0 0 1 1 72 71
0 0 1 0 0 4 0 0 5 0 5 0 0 0 0 0 0 1 0 1 0 3 0 0 3 47 1 1 0 7 0 0 1 1 0 2 24 2 6 6 0 0 6 0 0 0 0 127 124
0 0 0 3 0 1 1 0 2 1 5 7 1 0 1 1 0 1 0 1 1 3 0 0 2 80 6 3 4 3 1 1 2 1 0 6 25 1 1 6 0 1 5 0 0 1 1 179 176
0 0 2 0 0 2 0 0 0 0 19 11 0 2 2 0 0 1 1 0 1 5 0 0 1 151 7 2 3 7 3 0 0 2 0 3 21 1 0 7 4 1 4 0 0 1 2 266 261
0 0 1 2 0 1 0 1 5 3 14 6 1 2 1 0 0 5 0 0 1 4 1 0 1 156 10 6 3 6 0 1 3 1 0 5 10 1 2 12 5 0 6 0 0 2 3 281 277
0 2 0 1 0 0 0 0 7 1 23 11 1 8 2 1 2 6 0 0 2 5 0 0 4 140 8 10 4 12 1 0 6 4 0 2 10 0 5 5 1 0 6 0 0 0 4 294 289
0 0 1 1 0 0 0 0 4 1 17 9 1 1 10 0 5 6 0 1 0 10 0 0 0 118 2 20 5 6 1 0 3 3 1 7 14 0 1 11 5 0 5 0 0 2 3 274 264
2 0 1 0 1 1 0 0 6 1 26 10 2 1 10 0 1 13 0 0 0 5 0 0 2 114 4 7 3 8 2 0 4 1 1 1 11 0 1 8 3 1 5 1 2 1 4 264 259
0 2 2 0 0 1 0 1 9 0 26 11 2 1 7 0 0 13 0 0 1 12 0 0 4 87 3 12 7 10 2 0 10 1 0 6 7 0 0 6 4 3 4 0 0 1 5 260 248
0 0 0 2 0 0 0 2 5 1 30 13 3 2 7 1 0 15 1 0 0 12 1 0 2 42 2 10 1 6 1 0 3 3 1 2 5 0 1 7 2 1 6 0 3 5 3 201 189
0 0 1 0 0 0 0 0 2 1 11 5 1 3 4 0 1 12 0 0 2 7 0 0 0 26 1 11 4 4 2 0 2 6 1 2 1 0 0 5 4 2 1 2 0 1 3 128 121
2 0 0 0 0 0 0 2 2 1 6 5 0 2 2 0 0 5 0 0 0 6 0 0 1 7 1 3 0 0 0 0 1 4 1 0 1 0 1 5 0 2 3 0 0 2 2 67 61
10-14 15-19 20 -24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 2 0 0 0 0 0 0 1 3 0 0 3 0 1 4 0 1 1 0 1 0 4 0 0 0 6 1 1 0 0 0 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 0 32 28
0.2 0.1 0.4 0.3 0.0 0.6 0.0 0.3 1.9 0.4 7.2 3.5 0.5 0.9 1.9 0.1 0.4 3.0 0.1 0.8 0.3 2.9 0.1 0.0 1.0 37.3 1.9 3.3 1.3 3.3 0.5 0.3 1.8 1.1 0.5 2.5 5.9 0.4 2.2 3.4 1.0 1.4 2.7 0.2 0.2 0.7 1.2 100.0 97.1
85+ %Total
Table (9) Frequency of incidence cases among Jordanians by site and age-group ( Females ) , 2012 C00 C01-C02 C03-C06 C07-C08 C10 C11 C14 C15 C16 C17 C18 C19-C20 C22 C23-C24 C25 C30-C31 C32 C33-C34 C37-C38 C40-C41 C43 C44 C45 C46 C47;C49 C50 C53 C54 C55 C56 C57 C58 C64 C67 C69 C70-C72 C73 C74-C75 C81 C82-C85;C96 C90 C91 C92-C94 C95 C96 C76- C48 C80 Not C44
ICD-O3
Cancer Incidence in Jordan - 2012
39
Cancer Incidence in Jordan - 2012 2.3 Top ten cancers in both genders, Age group & primary site, Jordanian -2012 The following tables are of top ten cancers in Jordan for the year 2012 , in both genders (Males & Females).
Table (10 ) Ten most common cancers among Jordanians both genders, 2012 Rank 1
Breast
3
Lung
2 4 5 6 7 8 9
Cancer
No
Colorectal
1008
20.1
371
7.4
567
Lymphoma
327
U.Bladder
246
Leukemia
243
Thyroid
203
Prostate
198
Brain,CNS
10 Stomach N.B: The total of the top Ten cancers accounted 3466 ( 69.1%)
%
167 136
11.3 6.5 4.9 4.8 4.0 3.9 3.3 2.7
Table (11) Ten most common cancers among Jordanians, Males, 2012 1
2
3
4
5
6
7
8
9
Lung
Site
Colorectal
Urinary Bladder
Prostate
Lymphoma
Leukemia
Frequency
Percent
282
12.0
198
8.4
292
217
177
129
Brain, Nervous system
101
Stomach
86
Larynx
89
10 Kidney 85 N.B: The total of the top Ten male cancers accounted 1656 ( 70.6%)
40
12.4 9.2
7.5
5.5
4.3
3.8
3.7
3.6
Cancer Incidence in Jordan - 2012 Table (12) Ten most common cancers among Jordanian Females , 2012 Rank 1
Breast
2
Cancer
No
%
994
37.3
Colorectal
285
10.7
3
Thyroid
158
5.9
4
Lymphoma
150
5.6
5
Uterus
121
4.5
6
Leukemia
114
4.3
7
Ovary
87
3.3
8
Lung
79
3.0
9
Brain, Nervous system
66
2.5
10
Pancreas
51
1.9
N.B: The total of the top ten female cancers accounted 2105(78.9%)
Figure ( 13 ) Percentage distribution of Top ten cancers by age group, Males-2012
Figure (14) Percentage distribution of Top ten cancers by age group, Females-2012
41
Cancer Incidence in Jordan - 2012 2-4 Percentage distribution of cancer and top ten cancer for three main categories of age group (0-19,20-49 years and 50 years and above). The percentage distribution of cancer cases by age group shows that most of the cases occur in the age group 50 years and more (62%) while in 20-49 years (31.8%) and only (6.2% ) in the age group 0-19 years. Distribution of cases by gender with variation of the number of cases by gender ;the percent of males cancer by age group is 7%, 25.4% and 67.6% in the age groups 0-19, 20-49 years and 50 years and more while in females it is 5.5%,37.4% and 57.1%respectively.Cancer is slightly higher in males in the age group 0-19 years and 50 years and above while it is markedly higher in female in the age group 20-49 years (25.4%) vs (37.4%) % in this age group while in 50 years and more it is slightly higher in males than female (67.6%) vs (57.1%). As shown in figure (15 ). Tables from (13-15 ) show the top ten cancers for males and females, shows that the most common cancer for these three main categories of age
group shows that; leukemia , lymphoma , brain and CNS were predominate cancers in the age group 0-19 years in both genderes accounted for more than two third of the cases in this age group, while breast cancer is markedly the commonest (45.6%) in female in the age group 20-49 years followed by thyroid cancer 10.8% in this age group and colorectal cancer (7.3%),. For males the commonest cancer in the age group 20-49 years were colorectal cancer(11.9%), testis (8.2%), leukemia (7.6%) and lung (7.2%). For the age group 50 years and above lung(15.6%), colorectal cancer (13.1%)and prostate cancer (12.3%) were the commonest in this age group in males while in females in this age group breast was still the commonest (35.5%) followed by colorectal cancer (13.6%) then uterus (6.4%). Lymphomas was the only type of cancer that present in the top ten cancer in these three main categories of age group and in both genders.
Figure ( 15 ) Percentage distribution of cancer cases by age group and genders -2012
42
Cancer Incidence in Jordan - 2012 Table (13) Top ten cancer for the age group 0-19 years, both genders , 2012 Site Leukemia Brain,CNS NHL Hodgkin disease Bone Testis Eye Connective tissue Endocrine Kidney Others Total
Male
No. 47 33 15 14 13 8 7 5 5 3 13 163
% 28.8 20.2 9.2 8.6 8.0 4.9 4.3 3.1 3.1 1.8 8.0 100.0
Site Leukemia Hodgkin disease Brain.CNS Bone Kidney Ovary Eye Connective tissue Endocrine Colorectal Others Total
Female
No. 37 22 19 11 10 8 8 6 6 5 14 146
% 25.3 15.1 13.0 7.5 6.8 5.5 5.5 4.1 4.1 3.4 9.6 100.0
Table (14 ) Top ten cancer for the age group 20-49 years ,both genders , 2012 Male Site
Colorectal Testis
Leukemia
Lung
NHL
U.Bladder
Brain,CNS
Thyroid
Hodgkin disease
Skin
Others
Total
No.
Female %
71
11.9
45
7.6
49
43
43
32
31
28
27
25
201
595
8.2
7.2
7.2
5.4
5.2
4.7
4.5
4.2
33.8
100.0
Breast
Site
No.
454
%
45.6
Thyroid
107
10.8
NHL
40
4.0
Colorectal
Leukemia
Ovary
Cervix
Brain,CNS
Hodgkin disease
Uterus
Others
Total
73
34
33
27
27
27
23
150
995
7.3
3.4
3.3
2.7
2.7
2.7
2.3
15.1
100.0
43
Cancer Incidence in Jordan - 2012 Table (15) Top ten cancer for the age group 50+ years ,both genders, 2012 Site
Lung
Colorectal
Prostate
Male
No.
247
208
%
15.6
13.1
194
12.3
Skin
104
6.6
Larynx
70
U.Bladder
NHL
Stomach
Kidney
Pancreas
Others
Total
185 69
67
59
56
324
1583
11.7 4.4
4.4
4.2
3.7
3.5
20.5
100.0
Breast
Site
Female
No.
540
%
35.5
Colorectal
206
13.6
Lung
71
4.7
Uterous
Skin
Thyroid
NHL
Pancreas
Ovary
Leukemia
Others
Total
98
61
49
47
46
46
43
313
1520
6.4
4.0
3.2
3.1
3.0
3.0
2.8
20.6
100.0
2-5 Geographical distribution of cancer in Jordan , 2012 by governorate and regions Distribution of the numbers and rates of cancer cases by governorates and regions in 2012 is shown in table (16). Amman, the capital reported (61.9 %) of all cases followed by Irbid (12.6 %), Zarqa (9.2 %) and Balqa(4%) meanwhile only (0.7 %) was reported from Tafila, and (0.9%) was reported from Ajloun. Regarding the median age at diagnosis in governorates and regions the highest median age at diagnosis in cancer was seen in Amman and Madaba governorates (57) years and the lowest was in Ajloun
44
(46) years and Karak (48) years.For males also Amman and Irbid showed the highest median age at diagnosis of cancer(61) years followed by Maan (59) years, and the lowest was seen in Jarash (45) years and Tafiela (51.5) years. In females the highest median age was seen in Madaba (57) years and Amman 54 years, while the lowest median age was seen in Ajlun governorate (38.5) years followed by Aqaba (47) years and Karak (47.5) years. Regarding the crude cancer incidence rate per 100,000 population by governorates.
Cancer Incidence in Jordan - 2012 Amman showed the highest rate (125.5) per 100,000 population and the lowest was in Mafraq (31.6) /100,000 population followed by Ajloun (32) and Tafiela (38) per 100,000 population.; The incidence rate of cancer in the Central region was (96.2) per 100,000 population while it was (47.8) per 100,000 population in the North region and (42.7) per 100,000 population in the South region. Figures (16-17) show the crude incidence
rate in governorate and regions by gender. Figures (18-20) show the top ten types of cancer by gender and the regions of Jordan (Central,Northern,and Southern regions). Tables ( 17-18) show the Trend number of Cancers among Jordanian by primary site and gender (Males, female) from 2000-2012.
Table ( 16) Crude rates and percentages of cases by genders, governorates and regions,2012 Governorate Amman
Zarka
Balqa
Madaba
Central Region
Irbid
Jarash
Ajloun
Mafraq
N
%
1648
137.2
3103
125.5
61.9
89
40.1
110
53.4
199
46.5
4.0
216 45
1805 309 36
25
39
Aqaba
32
Tafiela
N
Total CR
114.4
409
Maan
CR
Female N CR
1455
North Region
Karak
Male
35
27
17
43.9
54.7
243 55
52.9
71.1
459
100
87.2
2056
105.8
3861
36.5
39
41.9
75
53.1
33.4
25.1
323 22
56
44.9
440
41.3
31
27.8
42.5
37.4
68
29
17
58.2
30.5
38.7
50.9
632 47
95
849
55.3
103
50.2
56
50.2
38.7
63
34
48.2
62.6
96.2
9.2
2.0
77.0
55.6
12.6
32.0
0.9
39.1
31.6
1.5
1.9
47.8
16.9
45.3
1.3
41.3
46.1
38.0
2.1
1.1
0.7
South Region
111
35.5
145
50.6
256
42.7
5.1
Unknown
10
-
4
-
14
-
0.2
Outside
Total
11
2346
-
71.2
22
2667
-
86.2
33
5013
-
78.5
0.7
100.0
45
Cancer Incidence in Jordan - 2012 Figure (16 ) Crude incidence rate of cancer by governorate and gender Jordan -2012
Figure ( 17) Crude incidence rate of cancer by regions and gender, Jordan -2012
Figure ( 18 ) Percentage distribution of top ten cancers by gender, Central Region, Jordan , 2012
46
Cancer Incidence in Jordan - 2012 Figure (19) Percentage distribution of top ten cancers by gender, North Region, Jordan , 2012
Figure ( 20) Percentage distribution of top ten cancers cancer by gender, South Region, Jordan , 2012
47
Cancer Incidence in Jordan - 2012 Table ( 17 ) Trend of Cancer among Jordanian Males, 2000-2012 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Primary site Lip
5
6
9
8
2
13
11
18
13
10
5
8
18
Mouth
23
11
20
17
9
26
19
14
16
20
15
17
16
Esophagus
20
16
16
7
14
15
17
14
10
18
18
15
Tongue pharynx
Stomach
Small intestine Colon
Rectum Liver
Pancreas
Other &Unspecified Digestive Larynx
7
8
25
21
82
84
94
31
10
81
23 0
58
7
2
8
140
149
130
167
189
210
178
223
169
181
35
37
56
45
39
59
37
52
52
60
39
56
53
30 1
76
81
22 0
60
64
17 1
52
70
19 1
62
11
73
26
10
68
12
80
31 0
87
8
91
35 1
72
9
119 50 0
86
9
112 34 7
88
90
12
109 57
17
74
41
17
122
14
68
29
5
110
8
95
24
6
78
96
37
7
76
79
34
6
106
67
26
9
15
7
20
7
22
11
27
6
81 11
109 49 6
79
29
17
86
12
101 75
13
89
Bronchus, lung
198
208
168
171
166
194
256
243
297
256
311
279
292
Bone
31
28
31
25
37
32
32
27
33
30
27
22
26
7
7
6
11
4
4
Other thoracic organs Connective tissue
Melanoma of Skin
17
28
11
23
20
13 7
24
27 3
14
24
10
34
27 6
19
22
4
14
22
27 7
14
35 2
27
31 7
16
34
11
33
Non-Melanoma
114
116
109
124
112
104
123
139
156
169
116
129
132
Prostate
123
151
143
149
147
139
133
158
163
179
218
169
198
2
1
0
2
1
0
1
0
0
3
2
2
2
Breast Testis
Other male genital Kidney etc.
4
34
32
5
37
42
12
33
53
25
32
44
6
21
48
10
41
48
16
31
53
9
47
55
9
44
63
16
50
60
10
52
54
17
54
61
14
59
85
U.Bladder
129
158
169
149
146
147
177
157
171
184
186
171
217
Brain, nervous system
95
83
87
78
97
90
85
82
89
100
106
108
101
Other endocrine
5
3
5
4
6
16
11
3
9
9
Eye
Thyroid
5
29
13
28
7
38
11
33
6
11
31
31
37
71
80
65
0
62
57
46
49
54
Lymphoid leukemia
24
18
24
26
25
120
77
103
28
35
32
Myeloid leukemia
Leukemia unspecified Multiple Myeloma
Other and unspecified
Primary site unknown All Sites
48
88
55
125
20
19
44
27
62
20
1677
3
22
1740
59
50
76
24
35
26
1760
68
31
21
64
1743
12
23
60
80
9
26
Hodgkin’s disease
Non-Hodgkin lymphoma
14
75
44
24
60
1763
4
3
7
39
68
8
39
65
9
37
71
13
45
49
50
109
113
115
128
120
120
128
60
70
50
53
73
60
60
61
28
21
45
1818
76
14
30
22
57
2047
51
21
33
34
59
2048
78
21
43
15
35
2274
78
38
56 11
46
2280
53
14
65 3
59 9
45
54
30
44
46
31
31
2330
25
2194
28
2346
Cancer Incidence in Jordan - 2012 Table ( 18 ) Trend of Cancer among Jordanian Females, 2000-2012 Year Primary site Lip
Tongue
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 4
1
3
4
3
4
1
11
13
9
14
16
16
Esophagus
5
7
10
9
11
3
4
Mouth
Pharynx
5
10 5
3
6
5
15
11
4
6
5
5
3
14
15
12
9
11
18
1
2
7
4
1
3
6
6
19
11
7
10
14
14
16
9
5
11
9
22
13
5
6
17
4
17
Stomach
50
35
47
46
38
45
64
55
73
77
62
49
50
Colon
99
100
111
103
113
107
125
169
145
173
149
152
191
31
37
44
41
36
35
27
38
57
45
53
40
36
0
0
Small intestine
Rectum
Liver
5
72
7
50
Pancreas
16
14
Larynx
6
7
Other &Unspecified Digestive
0
Bronchus, lung
25
45
Bone
16
15
9
6
Other thoracic organs
5
Connective tissue
12
Non-Melanoma
82
Melanoma of Skin
9
9
67
8
50
6
50
7
61
4
68
8
73
7
74
8
91
6
12
14
14
12
31
26
30
5
4
9
11
10
9
13
6
46
19
32
0
8
36
31
19
20
20
18
5
12
11
19
20
64
63
72
4
1
5
7
19
75
44
28 9
56
0
0
0
54
54
59
23
21
14
8
11
15
5
10
22
81
74
15
11
7
77
9
81
37
31
6
9
94
51
9
10
43
68
48
79
14
22
18
21
7
10
3
12
27
19
78
113
10
28
95
2
11
8
12
10
10
26
27
102
78
8
Breast
551
566
501
551
646
674
749
817
855
926
941
935
994
Corpus Uteri
64
89
96
91
121
88
114
125
127
104
113
138
121
13
20
32
29
Cervix uteri
25
45
31
41
Ovary
63
70
54
60
Kidney
28
28
27
32
Other female genital
9
9
7
11
23
37
54
50
19
26
3
6
52
69 8
27
57
80 10
26
42
83
14
25
44
75 23
35
41
84
13
41
U.Bladder
25
17
30
21
21
30
18
26
27
22
23
Brain, nervous system
77
57
44
48
65
60
53
60
65
72
62
Other endocrine
5
8
8
6
3
Eye
Thyroid
Hodgkin›s disease
Non-Hodgkin lymphoma
Lymphoid leukemia
Myeloid leukemia
Leukemia unspecified
Multiple Myeloma
Other and unspecified
Primary site unknown
All Sites
9
77
48
54
9
71
51
2
98
57
40
48
51
85
47
20
22
17
43
19
39
10 0
28
26
8
44
15
29 8
3
91
31
42
19
46
69
21
35
51
6
6
4
9
8
9
51
70
33
50
87
48
6
10
14
67
66
93
103
125
107
109
140
136
145
158
32
37
59
55
46
79
67
53
60
50
21
38
70
23
24
46
1
34
71
10
84
51
56
53
21
31
18
17
36
11
19
51
9
7
8
5
4
12
90
107
110
130
100
90
56
45
50
40
49
71
26
28
38
28
40
32
45
15
34
13
42
35
14
24
16
39
33
31
12
29
40 11
38
38
42 7
34
1685 1672 1670 1735 1828 1860 2151 2284 2332 2518 2519 2481
37 6
13
2667
49
Cancer Incidence in Jordan - 2012
3
Chapter three
Top ten cancers among Jordanian Population 2012
51
Cancer Incidence in Jordan - 2012 3.1 Percentages and age standardized rate (ASR) for top ten cancer in Jordan, 2012 This chapter explores the epidemiology of top ten cancers in both genders for Jordanians in the year 2012. The rank order of the top ten cancers by percent of cases, is shown in figure (21 ) .
Figure (21) Percentage of top ten cancers among Jordanians both genders, 2012
Distribution of top ten cancers in Jordan 2012 by gender: there are some cancers that are more common in female than male: clearly breast and Thyroid, on the other hand lung, urinary bladder, lymphoma, leukemia brain and CNS were more common in males than females ,while colorectal cancer is almost equal in both genderes
,as shown in figure (22) .Age standardized rate for both genders and top ten cancer by ASR, the following figures (23-25) shows the highest ASR for both males and females. Table (19) presents the median age for all top ten cancer for males and females.
Figure (22 ) Numbers of top ten cancers among Jordanian by genders , 2012
52
Cancer Incidence in Jordan - 2012 Figure (23) ASR of top ten cancers among Jordanian,Both gender ,2012
Figure (24) ASR of top ten cancers among Jordanian,Male ,2012
Figure ( 25) ASR of top ten cancers among Jordanian,Females, 2012
53
Cancer Incidence in Jordan - 2012 Table (19) Median age (years) at diagnosis for top ten cancers by genders, 2012 Gender
Male
Female
Total
54 62
51 60
51 61
Colon
63
60
61
Rectum Lung NHL
58 65 51
60 67 51
59 66 51
Hodgkin Lymphoma U.Bladder Leukemia Thyroid Prostate Brain, CNS Stomach
30 66 30 46 71 43 60
23 70 38 40 35 61
24 66 33 41 71 41 60
Primary Site Breast Colorectal
3.2 Top ten cancers by site. 1.Breast Cancer ( C50 )
In the year 2012 there were 1008 cases of breast cancer in both genders accounting for 20.1% of all newly diagnosed cancer cases (including 43 cases which were in situ behavior) compared with 23 cases in 2011, of total breast cases 994 occurred in females and 14 cases in males with female to male ratio 71:1 compared to 55:1in 2011. Breast cancer is the commonest cancer in females accounted for 37.3 % of the cancers in females. The median age at diagnosis of breast cancer in females was 51 years, ranging from 20 years to 91 years, While in males the median age was 54 years. About 30.9 % of the cases were in the age group
54
40-49 years . While 26 % of the cases were in the age group between 50-59 years. About 14.7% were under 40 years ,and only 28.4% of the cases were above the age of 60 years. The crude incidence rate for female breast cancer was (32.1) per100,000 female population, compared to (30.9) per 100,000 in 2011 . The highest age-specific incidence rate in female ( 200.6) per 100,000 was found at the age-group 65-69 years followed by 195.3 per 100,000 in the age group60-64 years. Table (20 ) and figure (26) The Age Standardized Rate( ASR ) for female breast cancer was (53.9)/100,000 compared with (51.3) per 100,000 female population in 2011 .
Cancer Incidence in Jordan - 2012 Ductal carcinoma was the most frequent morphological type (77.6%) and (6.8)% were lobular carcinoma, while the mucinous carcinoma accounted1.3% table (21). (47.3%) of female breast cancer cases occurred in the right breast , while the left breast was affected in (47 %) of the cases, only (2.1% ) of the cases were bilateral, meanwhile laterality was not mentioned in (3.6% ) of registry records figure (27). The grade of tumors (42.6%) of the cases
were of moderate differentiation, (28.8%) were poorly differentiated and (23.5%) of the cases the differentiation was not recorded figure (28). Staging of breast cancer figure (29) showed that (4.3%) of the cases were in situ and (27.8%) were localized and (37.9%) were regionally staged and (11.7%) were staged as a distant metastasis.
Table (20) Frequency and ASIR of breast cancer by age-group and gender-2012 Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Unknown Total
No. 0 0 0 0 1 1 0 0 1 2 2 1 2 3 0 1 0 0 0 14
Male
ASIR 0.0 0.0 0.0 0.0 0.3 0.3 0.0 0.0 0.6 1.8 2.5 1.4 3.1 6.4 0.0 6.3 0.0 0.0 0 0.4
No. 0 0 0 0 5 15 47 80 151 156 140 118 114 87 42 26 7 6 0 994
Female
ASIR 0.0 0.0 0.0 0.0 1.5 5.5 19.6 41.1 102.8 149.6 175.9 162.7 195.3 200.6 144.1 179.2 75.4 75.8 0 32.1
No 0 0 0 0 6 16 47 80 152 158 142 119 116 90 42 27 7 6 0 1008
Total
ASIR* 0.0 0.0 0.0 0.0 0.9 2.8 9.4 19.7 50.2 74.0 88.4 83.5 93.7 100.1 71.7 88.9 41.2 38.7 0 15.8
55
Cancer Incidence in Jordan - 2012 Figure ( 26) ASIR of breast cancer by age-group and gender-2012.Jordanian
Figure (27) Distribution of breast cancer cases by laterality, 2012- Jordan
Table (21) Distribution of Female breast cancer by Morphology Jordanian -2012 Morphology
N
%
Ductal Carcinoma
771
77.6
Carcinoma NOS
60
6.0
Lobular carcinoma Mixed type of cancer
68 7
Malignant tumor NOS
12
Inflammatry carcinoma
3
Mucinous Carcinoma Others Total
56
13 60
994
6.8
0.7
1.2 1.3 0.3
6.0
100.0
Cancer Incidence in Jordan - 2012 Figure (28) Distribution of female breast cancer cases by grade, Jordanian- 2012
Figure (29) Distribution of female breast cancer cases by summary stage , 2012
Distribution of female breast cancer cases by governorate showed that the highest rate was (51.5/100,000) in Amman city, while the lowest rate was in Tafiela( 6.8/100,000). Meanwhile the distribution of the cases by
regions (40.3/100,000) was in the central region compared to (16.7)/100,000 in the northern region and (19.2/100,000) in southern region as shown in table (22 )
57
Cancer Incidence in Jordan - 2012 Table (22) Distribution, crude rate and percentage of female breast cancer by governorates and regions, Jordan 2012 Governorate Amman Zarka Madaba Balqa Central Region Irbid Jarash Ajloun Mafraq North region Karak Maan Tafiela Aqaba South region Unknown Total
Frequency 619 106 19 39 783 112 13 9 10 144 26 10 3 16 55 12 994
The following figures 30-31 shows trend of number of cases ,ASR of female breast cancer cases from 2000-2012 , table (23)
Crude incidence Rate 51.5 23.1 24.5 19.0 40.3 20.2 14.0 12.5 6.9 16.7 21.1 17.3 6.8 25.9 19.2 32.1
Percent 62.3 10.7 1.9 3.9 78.8 11.3 1.3 .9 1.0 14.5 2.6 1.0 .3 1.6 5.5 1.2 100.0
shows the trend of frequency distribution of female breast cancer by age group from 2000-2012.
Figure ( 30) Trend numbers of female breast cancer cases 2000-2012.
58
Cancer Incidence in Jordan - 2012 Figure (31) Trend of Age Standardized Rate (ASR) of female breast cancer , 2000-2012
Table( 23) Frequency distribution of female breast cancer cases by age group 2000-2012 Year Age group 0-4
5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Unknown Total
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0 0 0 0 4 11 36 51 64 80 76 68 66 43 25 27 0 0 0 551
0 0 0 0 1 14 26 69 75 70 88 85 57 37 25 8 6 5 0 566
0 0 0 0 0 12 43 51 62 73 78 61 35 49 19 12 3 5 0 503
0 0 0 0 7 8 30 59 86 87 64 80 61 38 19 6 2 4 0 551
0 0 0 0 3 14 43 80 91 96 80 86 71 39 19 17 6 1 0 646
0 0 0 0 4 16 38 62 110 102 87 86 73 47 28 12 4 3 2 674
0 0 0 0 1 8 40 84 101 111 79 93 86 75 37 20 9 1 0 749
0 0 0 0 3 15 44 69 129 126 92 96 80 60 51 27 10 6 1 817
0 0 0 0 1 18 38 79 125 133 112 93 104 56 53 23 10 7 3 855
0 0 0 1 0 13 46 89 129 134 117 100 120 72 46 33 16 9 1 926
0 0 0 0 2 19 53 91 156 148 110 95 112 75 50 28 21 5 2 967
0 0 0 0 6 18 47 93 128 158 122 103 112 70 33 27 11 6 1 935
0 0 0 0 5 15 47 80 151 156 140 118 114 87 42 26 7 6 0 994
59
Cancer Incidence in Jordan - 2012 2. Colo - Rectal cancer ( C18-C21 ) In 2012, there were 567 colo-rectal cancer cases, accounted for (11.3%) of all newly diagnosed cases among Jordanians .it ranked the second among all new cancers in both males and females. It accounted to (12%) of male cancers with 282 cases and (10.7%) of female cancers with 285 cases. Male to female ratio was 0.9 : 1 compared with 1.2:1 in 2011. The median age at diagnosis was 61 years (for both genders), for the colon in males it was (63 yrs) and (60 yrs) for females. Meanwhile the age for the rectal cancer was (58 yrs) for males and (60 yrs) for females. The crude incidence rate in both genders was (8.9 /100,000 population), it was slightly higher in females with (9.2/100,000) compared to males (8.6/100,000). The highest (ASIR) for both genders was found in the age group80-84 years (135.5/100,000) and the highest ASIR in males was found in the age group 80-84 years and above (156.0 /100.000), while in females the highest ASIR was in the ag group 70-74 year (147.5/100,000). The overall Age-Standardized Incidence Rate ( ASR ) was 16.3/100,000. ( ASR for males was 15.9/ 100,000 and for females 16.6/ 100,000 ). Table (24) shows the distribution of colorectal cancer cases by age-group and gender and figure (32) shows the age-specific
60
incidence rates of colo-rectal cancers. Figure (34) shows the trend of number of cases of CRC and figure (35) shows the trend of ASR for colorectal cancer during 2003-2012. Distribution of cases by topography of the cancer shows that the rectal cancer is the most common site 22.6% followed by sigmoid colon 21.7% and rectosigmoid 9.9 % cecal cancer 7.9% ,while colon unknown specific site «not otherwise specified « (NOS ) was 12.3% table (25) and figure (33 ) . Histopathologically it was found that (81.1%) of all colorectal cancers were adenocarcinomas, (5.1%) were mucinous carcinoma, (3.5%) of the cases were of carcinoma NOS, table (26 ). Table (27) shows the distribution of colorectal cancer cases by stage of tumor according to summary stage, it was found that about 27.7% of cases were diagnosed as localized 27.0% were regional stage,and about 21.2% were diagnosed as distant metastasis.Figure (36) shows the distrbution of CRC cases by grade, 60.3 % of the cases were moderate differniation and 10.9% of poor diffenentiation.Table (28) shows the distrbution of CRC cases by govrenorates 63.1% of the cases were in Amman followed by Irbid 13.1%.
Cancer Incidence in Jordan - 2012 Table (24 ) Colorectal Cancer number and ASIR by age-group and gender-2012 Age Group (Years) 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Unknown Total
No. 0 0 1 1 1 4 10 15 17 24 26 25 37 44 34 23 12 7 1 282
Male
ASIR 0.0 0.0 0.3 0.3 0.3 1.3 3.8 7.1 10.9 21.9 32.1 35.7 56.6 94.6 115.6 145.0 156.0 92.5 8.6
Female No. ASIR 0 0.0 0 0.0 1 0.3 4 1.2 3 0.9 3 1.1 5 2.1 12 6.2 30 20.4 20 19.2 34 42.7 26 35.8 36 61.7 37 85.3 43 147.5 16 110.3 11 118.5 3 37.9 1 285 9.2
No 0 0 2 5 4 7 15 27 47 44 60 51 73 81 77 39 23 10 2 567
Total
ASIR 0.0 0.0 0.3 0.7 0.6 1.2 3.0 6.7 15.5 20.6 37.3 35.8 59.0 90.1 131.5 128.5 135.5 64.6 8.9
Figure (32) Colorectal cancer Age Specific Incidence rate by age group & gender, 2012
61
Cancer Incidence in Jordan - 2012 Table (25 )Distribution of Colo-Rectal cancer by topography sub site and gender, 2012 gender Topography Cecum Appendix Ascending colon Hepatic flexure of colon Transverse colon Splenic flexure of colon Descending colon Sigmoid colon Overlapping Colon Colon. NOS Rectosigmoid Junction Rectum. Nos Anus and anal canal Total
Male
Female
Total
%
21 6 17 12 8 7 10 65 3 32 31 63 7 282
24 10 16 4 12 5 20 58 4 38 25 65 4 285
45 16 33 16 20 12 30 123 7 70 56 128 11 567
7.9 2.8 5.8 2.8 3.5 2.1 5.3 21.7 1.2 12.3 9.9 22.6 1.9 100.0
Figure (33) Distribution of Colorectal cancer by topography ,Jordan -2012
62
Cancer Incidence in Jordan - 2012 Figure ( 34 ) Trend of number of colorectal cancer 2002-2012. Jordan
Figure ( 35 ) Trend of ASR for colorectal cancer 2003-2012. Jordan
Table (26) Distribution of Colorectal cancer cases by morphology 2012 Morphology
M
F
T
%
Adeno carcinoma
226
234
460
81.1
Mucinous carcinoma
12
17
29
5.1
Carcinoma NOS
12
8
20
3.5
Malignant tumor
4
2
6
1.1
Carcionoid tumour
9
7
16
2.8
signet ring carcinoma
5
3
8
1.4
Others
14
14
28
4.9
Total
282
285
567
100.0
63
Cancer Incidence in Jordan - 2012 Figure (36) Distribution of colorectal cancer cases by grade -2012, Jordan
Table (27) Distribution of colorectal cancer cases by Summary stage -2012, Jordan Summary Stage InSitu Localized Regional Distant Unknown Total
N 8 117 85 80 82 372
Colon
% 2.2 31.5 22.8 21.5 22.0 100.0
N 4 40 68 40 43 195
Rectum
% 2.1 20.5 34.9 20.5 22.1 100.0
Colorectal N % 12 2.1 157 27.7 153 27.0 120 21.2 125 22.0 567 100.0
Table (28) distribution number & percentage of colorectal cancer and rate by governorates ,Jordan 2012 Governorate Amman Zarka Madaba Balqa Central Region Irbid Jarash Ajloun Mafraq North region Karak Maan Tafiela Aqaba South region out side Total
64
N 358 59 13 18 448 74 9 6 11 100 5 3 3 2 13 6 567
% 63.1 10.4 2.3 3.2 79.0 13.1 1.6 1.1 1.9 17.6 .9 .5 .5 .4 2.3 1.1 100.0
Rate 14.5 6.2 8.1 4.2 11.2 6.5 4.7 4.1 3.7 5.6 2.0 2.5 3.4 1.4 2.2 8.9
Cancer Incidence in Jordan - 2012 3-Lung Cancer (C34 ) T h e r e w e r e 3 7 1 c a s e s o f l ung c a n c e r a c counting for (7.4 %) of all newly diagnosed cancer cases in 2012 compared with 327 cases in 2011. lung cancer affected 292 (78.7%) males and 79 (21.3%) females with a male to female ratio of 3.7:1. Lung cancer ranked the first among all males cancers (12.4%) and 8th among females cancers (3%). The crude incidence rate was 5.8 /100.000 (for males 8.9, and for females 2.6). The highest Age-Specific Incidence Rate was seen in the age group between 75-79 years for both genders (144.9) per 100,000 population (for males 201.8, for females 82.7).
The overall median age at diagnosis was 66 years, the median age at diagnosis was 65 years for males and 67 years for females. The overall ASR was (11.5/100,000) (for males the ASR was 17.6/100,000 and for females it was 5.1/100,000) . Table (29) and figure (38) show distribution and agespecific incidence rates for lung cancer Regarding the four major histological types; small cell carcinoma accounted for (9.5%), Non small cell carcinoma accounted for (67.8%): adenocarcinoma was (30.4%), the squamous cell carcinomas (20.6%), and the Non-small cell carcinoma NOS was (16.8%), figure ( 37 ) .
Figure (37) Morphological Distribution of lung cancer -2012, Jordan
65
Cancer Incidence in Jordan - 2012 Table ( 29 ) Lung Cancer ASIR by Age-group and gender-2012 Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total
No. 1 0 0 1 1 0 1 6 13 22 22 31 44 49 59 32 8 2 292
Male
ASIR 0.2 0.0 0.0 0.3 0.3 0.0 0.4 2.8 8.3 20.1 27.1 44.3 67.3 105.3 200.6 201.8 104.0 26.4 8.9
No. 0 0 0 0 0 0 1 1 1 5 6 6 13 13 15 12 5 1 79
Female ASIR 0.0 0.0 0.0 0.0 0.0 0.0 0.4 0.5 0.7 4.8 7.5 8.3 22.3 30.0 51.5 82.7 53.9 12.6 2.6
No 1 0 0 1 1 0 2 7 14 27 28 37 57 62 74 44 13 3 371
Total
Figure (38) ASIR for lung cancer by age group and gender 2012, Jordan
66
ASIR 0.1 0.0 0.0 0.1 0.1 0.0 0.4 1.7 4.6 12.6 17.4 26.0 46.1 69.0 126.4 144.9 76.6 19.4 5.8
Cancer Incidence in Jordan - 2012 4- Lymphomas (C81-C82, C96)
Median age for both genders is 24
In 2012 there were a total of 327 cases of
years
lymphoma (Hodgkin and Non Hodgkin
females) Non-Hodgkin lymphoma (NHL) ;
lymphoma) accounting for (6.5%) of all
218 cases which accounted for (64%) of all
cancer cases. Lymphoma ranked 4th among
lymphomas (218/327).It is relatively more
all newly diagnosed cancer cases in both
frequent in males (58.7%) than in females
genders, ranked 5th in males (7.5%) and 4th
(41.3%), with a male to female ratio of 1.4:1,
in females (5.6%) for the year 2012 .
it is more commonly occurring in older age
Lymphoma was of two types according
than Hodgkin’s disease ,median age for both
to originating site :nodal ( that originated
genders was (51) years .
from lymph node) which counted 239/327
Age specific incidence rate (ASIR) for
(73.1%) while the other 88 cases (26.9%)
Hodgkin
were extra nodal, mainly stomach 24 (7.3%)
(1.5 in male,1.9 in females),while ASIR
patients , skin 12 cases (3.7%) ,bone marrow
for NHL was 3.4/100,000 (3.9 in males,
6 (1.8%) ,and others site (14.1% ).
2.9 in females). Age specific incidence
Lymphoma occur more in male (54.1%) than
rate (ASIR) for Hodgkin lymphoma was
female (45.9%) with male to female ratio
1.7/100,000 (1.5 in male,1.9 in females),
1.2:1. Another morphological classification of
while
lymphoma into two types: Hodgkin and Non-
(3.9 in males, 2.9 in females).
Hodgkin lymphoma; Hodgkin lymphoma the
Table (30) and
number of cases was (109/327) accounting
distribution and Age-Specific Incidence Rates
for 33.3% of all cases of lymphoma ; It
for Hodgkin’s Lymphoma. Table (31) and
is relatively common among adolescents
figure (40) shows the distribution and Age-
and young adults, it is higher in female
Specific Incidence Rates for Non- Hodgkin’s
(55.1%) than male (44.9 %) Male: Female
lymphoma.
(males 30 years and 23 years in
lymphoma
ASIR
was 1.7/100,000
for NHL was 3.4/100,000 figure (39) show
ratio 0.81:1.
67
the
Cancer Incidence in Jordan - 2012 Table ( 30 ) Hodgkin lymphoma number and ASIR by age-group and gender-2012 Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Unknown Total
No. 2 3 3 6 6 4 9 3 3 2 4 2 1 0 1 0 0 0 0 49
Male
ASIR 0.5 0.7 0.8 1.7 1.7 1.3 3.5 1.4 1.9 1.8 4.9 2.9 1.5 0.0 3.4 0.0 0.0 0.0 0.0 1.5
No. 1 1 5 15 13 5 6 1 0 2 5 1 1 0 1 0 1 0 2 60
Female ASIR 0.3 0.3 1.3 4.4 4.0 1.8 2.5 0.5 0.0 1.9 6.3 1.4 1.7 0.0 3.4 0.0 10.8 0.0 0.1 1.9
No 3 4 8 21 19 9 15 4 3 4 9 3 2 0 2 0 1 0 2 109
Total
ASIR 0.4 0.5 1.0 3.0 2.8 1.6 3.0 1.0 1.0 1.9 5.6 2.1 1.6 0.0 3.4 0.0 5.9 0.0 0.0 1.7
Figure (39) Age-Specific Incidence Rate (ASIR) by age group & gender ( Hodgkin’s disease), 2012
68
Cancer Incidence in Jordan - 2012 Table (31) Non Hodgkin lymphoma number and ASIR by age-group and gender-2012 Age Group
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Unknown Total
No. 2 6 5 2 2 4 9 11 7 10 14 5 11 18 11 5 4 1 1 128
Male
ASIR 0.5 1.5 1.3 0.6 0.6 1.3 3.5 5.2 4.5 9.1 17.3 7.1 16.8 38.7 37.4 31.5 52.0 13.2 3.9
Female No. ASIR 1 1 1 0 3 6 6 6 7 12 5 11 8 6 7 5 5 0 0 90
0.3 0.3 0.3 0.0 0.9 2.2 2.5 3.1 4.8 11.5 6.3 15.2 13.7 13.8 24.0 34.5 53.9 0.0 2.9
No
3 7 6 2 5 10 15 17 14 22 19 16 19 24 18 10 9 1 1 218
Total
ASIR 0.4 0.9 0.8 0.3 0.7 1.8 3.0 4.2 4.6 10.3 11.8 11.2 15.4 26.7 30.7 32.9 53.0 6.5 3.4
Figure (40) Age-Specific Incidence Rate (ASIR) by age group & gender ( NHL), 2012
69
Cancer Incidence in Jordan - 2012 5. Urinary bladder (C67) There were (246) cancer cases of urinary bladder accounting for (4.9%) of all newly diagnosed cancers. Bladder cancer ranked third in males 217 (9.2%) of all male cancers, regarding the gender distribution; males 217 (88.8%) and 29 females (11.2%) with a male to female ratio of 7.5:1 compared to 5: 1 in 2011. It is far more frequent in males than in females. Over all crude incidence rate for U.Bladder cancer was 3.9/100,000 (for males 6.6 and for females 0.9/100,000). The highest ASIR was seen in the age group 75-79 years (108.7/100,000), (for
males also it was the highest (170.3) and for females 41.4),the highest ASIR in females was in the age group 80-84 years (43.1/100,000).The median age at diagnosis (both genders) was 66 years (males 66 years, females 70 years).Over all ASR for urinary bladder cancer was 7.4/100,000 ( males 13, females 1.7 /100,000). Morphology of bladder cancer, papillary transitional cell carcinoma was the commonest type (52%), transitional cell carcinoma (39%), carcinoma (NOS) (4%) and others (4%) figure (41). Table (32) and figure (42) show the distribution and age-specific incidence rates for bladder cancer.
Figure (41 ) Morphological distribution of U.Bladder cancer , Jordan-2012
70
Cancer Incidence in Jordan - 2012 Table ( 32) Urinary Bladder cancer number and ASIR by age group and gender,2012 Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Unknown Total
No. 0 0 0 0 0 2 4 7 10 9 16 21 25 38 41 27 11 6 0 217
Male
ASIR 0.0 0.0 0.0 0.0 0.0 0.7 1.5 3.3 6.4 8.2 19.7 30.0 38.2 81.7 139.4 170.3 143.0 79.3 0.0 6.6
No. 0 0 0 0 0 0 1 1 2 1 4 3 1 1 3 6 4 2 0 29
Female ASIR 0.0 0.0 0.0 0.0 0.0 0.0 0.4 0.5 1.4 1.0 5.0 4.1 1.7 2.3 10.3 41.4 43.1 25.3 0.0 0.9
No 0 0 0 0 0 2 5 8 12 10 20 24 26 39 44 33 15 8 0 246
Total
ASIR 0.0 0.0 0.0 0.0 0.0 0.4 1.0 2.0 4.0 4.7 12.4 16.8 21.0 43.4 75.1 108.7 88.4 51.7 0.0 3.9
Figure (42 ) U.Bladder cancer Age Specific Incidence Rate by age group & gender , 2012
71
Cancer Incidence in Jordan - 2012 6. Leukemia (C91-92,C95)
(132/243) (54.3%). Lymphatic Leukemia
There were (243) cases of leukemia, of
accounted for (96/243) (39.5%) of all types
them (129) in males (5.5%) and 114 in
of leukemia ,other types includes Leukemia
females (4.3%) of all
cancers,
(Not otherwise classified) (NOS) (6.2%).
leukemia was more common in males
Leukemia is common in pediatric age group
than females; (53.1%) males
(46.9%)
0-14 years it constituted about (65/243)
females with a male to female ratio of
(26.7)% of total cases of leukemia. 77%
1.1: 1. compared to 1:3 in 2011.Leukemia
of them were
commonly affects younger age group for
23% were myeloid leukemia. Age specific
both
males and
incidence rate ASIR for leukemia
age
33 years (30 years in males ,38
3.8/100,000 population (3.9 in males, 3.7
years in females).There was big differences
in females). Overall ASR was 5.0 /100,000.
of median age by different morphological
ASR for males and females (5.0/100.000).
type of leukemia as in lymphoid leukemia
Figure (43 ) shows the distribution of cases
it was 13.5years, in myeloid leukemia 44
of leukemia by morphological sub types.
years while in Leukemia NOS the median
Table (33) and figure
age at diagnosis was 36 years. The most
distribution and Age- Specific Incidence
common types of leukemia in all age groups
Rates for leukemia of all types.
female
females
with median
lymphatic leukemia and
(44)
show
and both genders was myeloid Leukemia
Figure (43) Distribution of Leukemia by morphological subtypes-2012
72
was
the
Cancer Incidence in Jordan - 2012 Table (33) Leukemia number and ASIR by age-group and gender-2012, Jordan Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total
No. 16 10 9 12 9 7 8 10 5 6 5 2 5 5 10 4 6 0 129
Male
ASIR 3.8 2.4 2.3 3.3 2.6 2.3 3.1 4.7 3.2 5.5 6.2 2.9 7.6 10.7 34.0 25.2 78.0 0.0 3.9
Female No. ASIR 16 4.0 5 1.3 9 2.4 7 2.1 8 2.5 3 1.1 6 2.5 6 3.1 5 3.4 6 5.8 6 7.5 5 6.9 7 12.0 7 16.1 7 24.0 5 34.5 5 53.9 1 12.6 114 3.7
No 32 15 18 19 17 10 14 16 10 12 11 7 12 12 17 9 11 1 243
Total
ASIR 3.9 1.9 2.4 2.7 2.5 1.8 2.8 3.9 3.3 5.6 6.8 4.9 9.7 13.3 29.0 29.6 64.8 6.5 3.8
Figure ( 44 ) ASIR of Leukemia cases by gender and age group, 2012-Jordan
73
Cancer Incidence in Jordan - 2012 7-Thyroid Cancer (C73) There were 203 thyroid cancer cases accounting for 4.0% of all newly diagnosed cancers cases. It ranked the 3rd among female cancers .Thyroid cancer is one of the few tumors which is by far more frequent in females than in males. It affected 158 ( 5.9%) of all female cancers and 45 (1.7%) of all male cancers , female to male ratio 3.5:1. About 48.4% of thyroid cancer in females affected women below 40 years. Median age at diagnosis for both genders was 41 years, (for males
46 and females 40 years).The distribution of thyroid cancer by histopathological type was as follow : papillary carcinoma 70%, follicular carcinoma 10% , papillary carcinoma follicular variant 6% figure ( 45). Crude incidence rate for thyroid cancer was 3.2 /100,000 population (1.4 males , 5.1females). The over all ASR for thyroid cancer was 4.3/100,000 (2.0 males , and 6.7 females). Table (34) and figure (46) shows the distribution of numbers and Age - Specific Incidence rates for thyroid cancer by gender.
Figure (45 ) Morphological distribution of thyroid carcinoma ,2012-Jordan
74
Cancer Incidence in Jordan - 2012 Table ( 34 ) Thyroid cancer number and ASIR by age-group and gender-2012, Jordan Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total
No. 0 0 0 0 2 5 8 4 3 6 8 3 2 2 1 1 0 0 45
Male
ASIR 0.0 0.0 0.0 0.0 0.6 1.7 3.1 1.9 1.9 5.5 9.9 4.3 3.1 4.3 3.4 6.3 0.0 0.0 1.4
No. 0 0 0 2 12 15 24 25 21 10 10 14 11 7 5 1 1 0 158
Female ASIR 0.0 0.0 0.0 0.6 3.7 5.5 10.0 12.8 14.3 9.6 12.6 19.3 18.8 16.1 17.2 6.9 10.8 0.0 5.1
No 0 0 0 2 14 20 32 29 24 16 18 17 13 9 6 2 1 0 203
Total
ASIR 0.0 0.0 0.0 0.3 2.1 3.5 6.4 7.2 7.9 7.5 11.2 11.9 10.5 10.0 10.2 6.6 5.9 0.0 3.2
Figure ( 46) Thyroid cancer Age Specific Incidence Rate by age group &gender, 2012
75
Cancer Incidence in Jordan - 2012 8-Prostate Cancer (C61)
age at diagnosis was 71years .The crude
There were 198 cases of prostate cancer
incidence rate was 6.0/100,000 while
accounting for 3.9% of all cancer cases. It
ASR was 12.7/100,000, The majority of
ranked the 4th among males cancers (8.4%)
the morphology of prostate cancer was
Prostate cancer was more common in the
adenocarcinomas ( 93.2%).
age 60 years and above ( 88.8%) of cases
Table (35) and figure (47) show the
were found at this age-group. The highest
distribution and Age- Specific Incidence
age specific incidence rate was in the age
rate for prostate cancer.
group 75-79 years ( 258.6/100,000). Clearly
Tumor staging showed 41% of the cases
the incidence of prostate cancer increased
were localized and 26% were in advanced
steadily with increasing age. The median
stage (distant metastasis) figure (48).
Table (35) ASIR and number of Prostate cancer by age group, 2012 Age Group 0- 4 5- 9 10- 14 15- 19 20- 24 25- 29 30- 34 35- 39 40- 44 45- 49 50- 54 55- 59 60- 64 65- 69 70- 74 75- 79 80- 84 85+ Total
ASIR : Age specific incidence rate
76
No. 0 0 0 0 0 0 0 0 0 4 4 14 18 44 50 41 14 9 198
Male
ASIR 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.7 4.9 20.0 27.5 94.6 170.0 258.6 182.0 118.9 6.0
Cancer Incidence in Jordan - 2012 Figure (47) prostate cancer Age Specific Incidence Rate, Male population 2012, Jordan
Figure (48) Distribution of Prosate cancer cases by SEER summary stage, 2012, Jordan
77
Cancer Incidence in Jordan - 2012 9-Cancers of the Brain & CNS (C71-C72)
of brain tumors were of glioblastoma
Cancers of the central nervous system sites
astrocytoma (15.6%) and meduloblastoma
include the brain, cerebellum, brain stem,
(12%) figure (49 ) .
meninges, spinal cord, and other nervous
The basis of diagnosis showed 19.8%
sites. There were 167 cases accounting for
of brain tumors were diagnosed clinically
3.3% of all newly diagnosed malignant
and clinical investigation procedures and
cancers 2012. These cancers ranked the
77.8% were diagnosed
7th in males affected 101 males ( 4.9%) ,
primary lesion and only 3 (1.8%) cases were
and the 9th in females 66 (2.5%) with male
diagnosed by death certificate only (DCO)
to female ratio of 1.5: 1.These tumors were
The crude incidence rate was 2.6 /100,000
relatively rare among adults above 65 years
population (3.1 males, 2.1 females). The
old, but more common among children and
over all ASR for brain & CNS tumors was
adolescents , 65.8% of the cases occurred in
3.6/100,000 (4.4 males,2.7 females).
the age group below 50 years .Median age
Table (36) and figure (50) show distribution
at diagnosis was 41 years (males 43 years
and Age-Specific Incidence Rates for brain
, and 35 years for females)
& nervous system tumors.
type followed by glioma (14.4%)
by
biopsy
then
of
The morphology of brain tumors, (33.5%)
Figure (49) Morphological distribution of brain & CNS tumors , 2012-Jordan
78
Cancer Incidence in Jordan - 2012 Table ( 36 ) Brain & CNS number and ASIR by age-group and gender-2012, Jordan Age Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total
No. 13 6 11 3 2 1 4 2 13 9 7 8 10 4 6 1 0 1 101
Male
ASIR 3.1 1.5 2.8 0.8 0.6 0.3 1.5 0.9 8.3 8.2 8.6 11.4 15.3 8.6 20.4 6.3 0.0 13.2 3.1
No. 8 6 2 3 3 8 2 6 3 5 2 7 1 6 2 2 0 0 66
Female ASIR 2.0 1.5 0.5 0.9 0.9 3.0 0.8 3.1 2.0 4.8 2.5 9.7 1.7 13.8 6.9 13.8 0.0 0.0 2.1
No 21 12 13 6 5 9 6 8 16 14 9 15 11 10 8 3 0 1 167
Total
ASIR 2.6 1.5 1.7 0.9 0.7 1.6 1.2 2.0 5.3 6.6 5.6 10.5 8.9 11.1 13.7 9.9 0.0 6.5 2.6
Figure ( 50 ) Brain and CNS cancers Age Specific Incidence Rate by age group & gender,2012
79
Cancer Incidence in Jordan - 2012 10-Stomach Cancer (C16)
in females 37.9/100.000 was observed in
There were 136 cases of stomach cancer
the age-group 85 years and above.
among Jordanians, accounting for 2.7% of
The overall ASR for stomach cancer
all newly diagnosed cancer cases. It affected
was 3.9/100,000 (4.9/100,000
86 males (3.7%) and 50 females (1.9%).
and 2.9/ 100,000 for females). The over all
Stomach cancer occurred more frequently in
median age at diagnosis was 60 years (60
males than in females, with a male to female
years for males and 61 years for females).
ratio of 1.7: 1. Crude incidence rate was
The most predominant histological type
2.1 /100,000 (2.6/ 100,000 for males, and
of stomach cancer was adenocarcinoma
1.6/100,000 for females) .The highest age
57.4%. , followed by signet cell carcinoma
specific incidence rate (35.3) per 100,000
(19.9 %) figure (51). Table ( 37 ) and figure
population was
(52) show distribution and age - specific
observed
in
the age
80- 84 years ,in males also it included the
for males
incidence rates for stomach cancer.
highest 52/100.000 and while the highest
Figure (51) Morphological distribution of Stomach cancer , 2012-Jordan
80
Cancer Incidence in Jordan - 2012 Table ( 37 ) ASIR and number of Stomach cancer by age group&gender,2012 gender
Age group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Unknown Total
Males
Females
Total
No.
ASIR*
No.
ASIR*
No
ASIR*
0 0 0 0 0 1 1 3 6 7 8 16 14 8 9 7 4 1 1 86
0.0 0.0 0.0 0.0 0.0 0.3 0.4 1.4 3.9 6.4 9.9 22.8 21.4 17.2 30.6 44.1 52.0 13.2 0.0 2.6
0 0 0 0 0 0 5 2 0 5 7 4 6 9 5 2 2 3 0 50
0.0 0.0 0.0 0.0 0.0 0.0 2.1 1.0 0.0 4.8 8.8 5.5 10.3 20.8 17.2 13.8 21.5 37.9 0.0 1.6
0 0 0 0 0 1 6 5 6 12 15 20 20 17 14 9 6 4 1 136
0.0 0.0 0.0 0.0 0.0 0.2 1.2 1.2 2.0 5.6 9.3 14.0 16.2 18.9 23.9 29.6 35.3 25.8 0.0 2.1
Figure ( 52 ) Stomach cancer -Age Specific Incidence Rate by Age group and gender, 2012
81
Cancer Incidence in Jordan - 2012
4
Chapter four Pediatric Malignancies in Jordan, 2012
83
Cancer Incidence in Jordan - 2012 Cancers among Jordanians under 15 years, 2012 There were (217) child at the age-group 0-14 years diagnosed with new cancer in Jordan this constitutes about (4.3%) of all registered malignant tumors in the year 2012 compared with 207 (4.4%) for the year 2011. The distribution of cases by gender shows that it is higher in males 121 (55.8%) than females 96 (44.2%) figure (53) .The Male to female ratio is 1.3:1. The crude incidence rate for all cancers in this age group was (93) per million (101per million for boys and 84.6 per million for girls). Mean age at diagnosis was (6.1) years. The median age for pediatric cancer was 5 years. 46.8% of registered cases were under the age of five years ; followed by the age group10 -14 years (29.6%) and 5-9 years (24.1%) figure (54).It is clearly noticed that cancer in pediatric group was higher in males than females for the
following cancers (Leukemia , lymphomas, Brain & CNS) while for eye cancer and neuroblastoma it was relatively higher in females than males as shown in figure (56). Table (38) and figure (57) shows the distribution of cancers cases by different age group as Leukemia and brain and CNS were most common in the age group 0-4 years meanwhile lymphoma and bone tumors were more frequent in the age group 10-14 years. Table (39) and figure (58) show the distribution of pediatric cancer cases by governorate where Amman was the highest 57.6% followed by Zarka governorate 11.1%. Figures (59-63) show the distribution of numbers and percentage of top ten cancers among Jordanian in both genderes and different age group and top five cancers in males & females.
Figure (53 ) Percentage of gender of pediatric cancer 2012,Jordan
84
Cancer Incidence in Jordan - 2012 Figure (54 ) Percentage distribution of pediatric cancer by age group -2012,Jordan
Figure (55 ) Top ten cancers in Pediatric ( both genders),2012, Jordan
Figure (56) Top Five Cancers in Pediatric by gender,2012 - Jordan
85
Cancer Incidence in Jordan - 2012 Table ( 38) Distribution of childhood cancers by age group, Jordan, 2012 Age group Site
0-4 year
5-9 year
10-14 year
Total
%
Leukemia
32
15
18
65
30.0
Brain &CNS
21
12
13
46
21.2
Lymphoma
6
11
14
31
14.3
Eye
11
4
0
15
6.9
Neuroblastoma
12
1
0
13
6.0
Kidney
8
1
2
11
5.1
Bone
1
5
5
11
5.1
Soft tissue
3
2
2
7
3.2
Ovary
0
0
3
3
1.4
Testis
1
0
1
2
0.9
Others
6
1
6
13
6.0
Total
101
52
64
217
100.0
Figure (57) Distribution of childhood cancer by age group and Site of tumor, 2012
86
Cancer Incidence in Jordan - 2012 Table (39) Distribution of childhood cancer by governorates and gender-2012 Governorate
Amman Zarka Balqa Madaba Central region Irbid Mafraq Jarash Ajloun North region Karak Maan Tafiela Aqaba South region Total
Male 71 15 3 4 93 11 1 5 2 19 2 3 2 2 9 120
Female 54 9 10 1 74 9 4 1 3 17 2 0 1 2 5 96
Total 125 24 13 5 167 20 5 6 5 36 4 3 3 4 14 217
%
57.5 11.1 6.0 2.3 77.0 9.3 2.3 2.8 2.3 16.7 1.9 1.4 1.4 1.9 6.5 100.0
Figure (58) Distribution of childhood cancer by governorates and gender-2012
87
Cancer Incidence in Jordan - 2012 Table (40) Distribution of childhood cancer by Age group, governorates and gender, 2012 Governorate Amman Zarka Balqa Madaba Central region Irbid Mafraq Jarash Ajloun North region Karak Aqaba Maan Tafiela South region Total
M 33 6 1 3 43 4 1 2 0 7 2 0 2 0 4 54
0-4
F 27 5 6 0 38 5 0 1 0 6 1 2 0 0 3 47
M 13 4 0 1 18 6 0 3 1 10 0 1 1 1 3 31
5-9
F 11 1 1 0 13 3 1 0 3 7 1 0 0 0 1 21
10-14
M 25 5 2 0 31 1 0 0 1 2 0 1 0 1 2 35
F 16 3 3 1 23 1 3 0 0 4 0 0 0 1 1 28
M 71 15 3 4 92 11 1 5 2 19 2 2 3 2 9 121
Total F 54 9 10 1 74 9 4 1 3 17 2 2 0 1 5 96
T 125 24 13 5 166 20 5 6 5 36 4 4 3 3 14 217
Figure (59) Distribution of childhood Leukemia by age and gender- 2012
Figure (60) Distribution of childhood Brain &CNS by age and gender-2012
88
Cancer Incidence in Jordan - 2012 Figure (61) Distribution of childhood Lymphoma by age and gender-2012
Figure (62) Distribution of Eye tumor (retinoblastoma) by age and gender-2012
Figure (63) Distribution of Childhood Neuroblastoma tumor by age and gender-2012
89
Cancer Incidence in Jordan - 2012
5
Chapter five
Cancer among Non- Jordanians, 2012
• Distribution by age group & gender • Distribution of cases by primary site • Top ten cancers by gender • Distribution of cases by nationality
91
Cancer Incidence in Jordan - 2012 Cancer among Non-Jordanians, 2012 The total number of cancer cases among Non-Jordanians was 2441 accounting for (32.7%) of all cancers reported and registered in JCR for 2012, of these, 2405 cases were invasive cancer and 36 (1.4%) cases were in situ compared with 2296 Non Jordanian cancer cases registered in 2011 with an increase of (6%). The distribution of cases by gender shows that: males were 1262 (51.7%) while females were 1179 (47.3%). Males to female’s ratio of (1.1: 1).The median age at diagnosis among nonJordanians was 53 years, ( 55 years for males and 51years for females). The highest percent was in the age group 6064 years (10.5%) (for males 11.6% and for females 9.3%), followed by the age group 45-49 years (10%) (for females 13.2% and for males 7%) Table (41). There were (137) cases below the age 15 years which accounted for (5.6%) of all Non –Jordanians registered in the year 2012,of them 83 males (6.6%) of male cancers ,and 54 females (4.6%) of female cancers. Table (41) shows the distribution and the percentages of cancers among NonJordanians by age group and gender.
92
Table (42) shows the distribution of cancer cases by primary site and gender. Tables (43) and (44) show the top ten cancer in 2012 for male and female among Non-Jordanian. Figure (64 ) shows the trend number of cancers among Non-Jordanians reported to Jordan Cancer Registry during the years 1996 – 2012 by gender. Figure ( 65) shows the number of cancers among Non-Jordanians reported to JCR during the year 2012 by nationality.
Cancer Incidence in Jordan - 2012 Table (41) Cancers among Non-Jordanians by age group and gender- 2012 gender
Males
Females
Total
Age group
N
%
N
%
N
%
0- 4
35
2.8
25
2.1
60
2.5
5- 9
10- 14
15- 19
20- 24
25- 29
30- 34
35- 39
40- 44
45- 49
50- 54
55- 59
60- 64
65- 69
19
29
36
46
38
52
60
96
88
3.0
4.1
4.8
7.6
22
45
56
98
113
1.1
1.9
3.8
4.7
8.3
9.6
7.9
126
10.7
138
10.9
105
8.9
82
6.5
46
112
100
146
37
Total
3.6
13
1.2
13.2
80- 84
Unknown
2.9
14
1.3
156
120
85+
2.3
15
7.0
70- 74
75- 79
1.5
27 1
1262
8.9
11.6 9.5
2.9
115
110 83
21
2.1
13
100.0
1179
0.1
3
9.8
9.3
34
43
49
68
83
108
158
209
1.4
1.8
2.0
2.8
3.4
4.4
6.5
8.6
244
10.0
226
9.3
227
256
9.3
10.5
243
10.0
3.9
128
5.2
1.1
40
100.0
2441
7.0
1.8
0.3
203 58 4
8.3
2.4
1.6
0.2
100.0
93
Cancer Incidence in Jordan - 2012 Table (42) Cancers among Non-Jordanians by primary site & gender- 2012 Gender Primary Site All Site Lips Tongue Mouth Pharynx Esophagus Stomach Small Intestine Colon Rectum Liver &Biliary Passage Pancreas Other & Unspecified Digestive Larynx Lung Other & Unspecified Respiratory Bone Connective Tissue Skin other and melanoma Breast Cervix Uteri Corpus Uteri Unspecified Ovary Other Reproductive Female Prostate Testis Other Reproductive Male Kidney & Other Urinary U.Bladder Eye Brain &CNS Thyroid Other Endocrine Leukemia Hodgkin›s Disease Non- Hodgkin›s Multiple Myeloma All Others & Unspecified Primary Site Unknown
94
N
Males
%
N
Females
%
N
Total
%
1262 4 10 15 35 14 54 8 71 48 42 28 9 46 109
100.0 0.3 0.8 1.2 2.8 1.1 4.3 0.6 5.6 3.8 3.3 2.2 0.7 3.6 8.6
1179 1 7 12 13 15 37 2 59 39 36 15 2 4 33
100.0 0.1 0.6 1.0 1.1 1.3 3.1 0.2 5.0 3.3 3.1 1.3 0.2 0.3 2.8
2441 5 17 27 48 29 91 10 130 87 78 43 11 50 142
100.0 0.2 0.7 1.1 2.0 1.2 3.7 0.4 5.3 3.6 3.2 1.8 0.5 2.0 5.8
28 16 28 14 0 0 0 0 102 15 1 52 97 10 80 39 8 70 35 90 27 8 29
2.2 1.3 2.2 1.1 0.0 0.0 0.0 0.0 8.1 1.2 0.1 4.1 7.7 0.8 6.3 3.1 0.6 5.5 2.8 7.1 2.1 0.6 2.3
18 15 19 386 25 46 47 10 0 0 0 29 19 16 34 96 3 40 21 46 10 6 15
1.5 1.3 1.6 32.7 2.1 3.9 4.0 0.8 0.0 0.0 0.0 2.5 1.6 1.4 2.9 8.1 0.3 3.4 1.8 3.9 0.8 0.5 1.3
46 31 47 400 25 46 47 10 102 15 1 81 116 26 114 135 11 110 56 136 37 14 44
1.9 1.3 1.9 16.4 1.0 1.9 1.9 0.4 4.2 0.6 0.0 3.3 4.8 1.1 4.7 5.5 0.5 4.5 2.3 5.6 1.5 0.6 1.8
20
1.6
3
0.3
23
0.9
Cancer Incidence in Jordan - 2012 Table (43) Top ten cancers among Non-Jordanians (Males), 2012 Rank
Primary site
N
%
1
Colorectal
119
9.4
2
Lung
109
8.6
3
Prostate
102
8.1
4
U.Bladder
97
7.7
5
Non- Hodgkin’s
90
7.1
6
Brain &CNS
80
6.3
7
Leukemia
70
5.5
8
Stomach
54
4.3
9
Kidney
52
4.1
10
Larynx
46
3.6
11
Others
443
35.1
1262
100
Total
95
Cancer Incidence in Jordan - 2012 Table (44 ) Top ten cancers among Non-Jordanians (Females), 2012 Rank
Total
96
Primary site
N
%
1
Breast
386
32.7
2
Thyroid
96
8.1
3
Colorectal
98
8.3
4
Uterus
46
3.9
5
Ovary
46
3.9
6
Non- Hodgkin’s
46
3.9
7
Leukemia
40
3.4
8
Stomach
37
3.1
9
Liver &Biliary
36
3.1
10
Brain &CNS
34
2.9
11
Others
313
26.5
1179
100
Cancer Incidence in Jordan - 2012 Figure (64) Trend of number of cancers among Non-Jordanians by gender reported in (1996 – 2012)
Figure ( 65) Distribution of cancer among Non-Jordanians by nationality, 2012
97
Cancer Incidence in Jordan - 2012
98
Cancer Incidence in Jordan - 2012
6
Chapter six Cancer mortality 2012
Jordan cancer registry data Mortality data 2012
99
Cancer Incidence in Jordan - 2012 Cancer Mortality, 2012 This chapter explores mortality data due to cancer in Jordan for the year 2012 This is divided into two parts: A: Mortality data from Jordan cancer registry follow up for cancer the cases that were diagnosed in the year 2012 and follow up data till the end of 2014 Source of data : from JCR abstract form ; date of last visit and whether the patient alive or dead more over linkage of our data with civil registration database. Number of deaths :1723 patients B: Mortality data from annual report of mortality section – Non communicable disease Directorate in ministry of health for the year 2012
Source of data: death certificate form to all patients from all hospitals governmental private, and university hospitals and forensic medicine all over Jordan were sent to this section, and all data collected to deaths from all causes and in this part, deathes due to neoplasm was selected and analyzed. Number of deaths due to neoplasm 2651 patients A: JCR mortality data Deaths frequencies due to cancer for both genders and age group were shown in table(45) and figures (66-68). While table 46-48 show the top ten causes of cancer mortality for both genders.
Table (45) Distribution of deaths due to cancer by age group and gender, 2012 Age group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 75-79 80-84 85+ Total
100
Male 17 5 7 12 10 11 23 26 48 68 77 96 104 125 140 101 53 26 949
Female 11 1 9 12 14 12 26 39 46 73 79 75 78 102 81 60 34 22 774
Total 28 6 16 24 24 23 49 65 94 141 156 171 182 227 221 161 87 48 1723
Percent 1.6 0.3 0.9 1.4 1.4 1.3 2.8 3.8 5.5 8.2 9.1 9.9 10.6 13.2 12.8 9.3 5.0 2.8 100.0
Cancer Incidence in Jordan - 2012 Figure (66) Perecentage distribution of deaths due to cancer by age group and gender , Jordanian-2012
Figure (67 ) Distribution of deaths due to cancer by gender, 2012, Jordan
Figure (68 ) Number of cases and number of deaths due to cancer by gender,2012, Jordan
101
Cancer Incidence in Jordan - 2012 Table ( 46 ) Mortality for Top ten cancers, both gender -2012 Primary site
No. 285 160 214 106 87 80 109 65 63 62 492 1723
Lung Breast Colorectal Pancreas Brain and CNS Stomach Leukemia U bladder NHL Liver Others Total
% 16.5 9.3 12.4 6.2 5.0 4.6 6.3 3.8 3.7 3.6 28.6 100.0
Table (47 ) Mortality due to cancer Top ten cancers (Males), 2012 Rank 1 2 3 4 5 6 7 8 9 10 11 Total
102
Primary site Lung Colorectal Pancreas Leukemia U bladder Brain &CNS Stomach Prostate Liver NHL Others
N 219 103 64 59 57 56 50 49 42 36 214 949
% 23.1 10.9 6.7 6.2 6.0 5.9 5.3 5.2 4.4 3.8 22.6 100
Cancer Incidence in Jordan - 2012 Table (48 ) Mortality due to cancer Top ten cancers (Females), 2012 Rank 1 2 3 4 5 6 7 8 9 10 11 Total
Primary site Breast Colorectal Lung Leukemia Pancreas Ovary Uterus Brain &CNS Stomach NHL Others
N 158 113 66 48 42 39 34 31 30 27 186 774
% 20.4 14.6 8.5 6.2 5.4 5.0 4.4 4.0 3.9 3.5 24.0 100
Table ( 49) and figure (69 ) Show percent of deaths distribution by governorate-2012. Most of cancer deaths occurred in Amman governorate (57.7%) followed by Irbid (12.8%) and Zarqa (10.1%) , the lowest death percent was reported from Tafiela (0.9%)
Table (49 ) Percentage distribution of deaths due to cancer by governorates, Jordan 2012 Governorate Amman Zarka Balqa Madaba Central Region Irbid Jarash Ajloun Mafraq North Region Karak Tafeila Maan Aqaba South Region Outside Total
No of death 994 174 87 47 1302 221 30 19 40 310 39 16 22 24 101 10 1723
% 57.7 10.1 5.0 2.7 75.6 12.8 1.7 1.1 2.3 18.0 2.3 0.9 1.3 1.4 5.9 0.6 100.0
103
Cancer Incidence in Jordan - 2012 Figure (69 ) Percentage distribution of deaths due to cancer by governorates,2012
Mortality data, 2012 report The next few tables and figures are based on mortality data obtained from the mortality department, NCD -MOH. Tables (50) and (51) shows the frequency and percentage of male and female cancer deaths in the year 2012.While figures (70 ) and (71 ) shows the males and females cancer deaths by age-groups -2012.
Table (50) Distribution of male deaths due to Neoplasm, Jordan, 2012 Cause of death
Frequancy
Percent
Lung
353
24.58
Leukemia
124
8.64
Colorectal Prostate
Pancreas NHL
Stomach Bladder
lip, oral cavity and pharynx Liver
160 111 77 75 71 68 59
5.36 5.22 4.94 4.74 4.11
3.62
185
12.88
101
Total
1436
104
7.73
52
Others
Unknown
11.14
7.03 100
Cancer Incidence in Jordan - 2012 Table (51) Distribution of female deaths due to Neoplasm, Jordan, 2012 Cause of death
Frequancy
Percent
Breast
298
24.53
Colorectal
154
12.67
Leukaemia
87
7.16
Lung
85
7.00
Uterus and cervix
62
5.10
Stomach
56
4.61
Ovary
51
4.20
Pancreas
46
3.79
CNS
44
3.62
NHL
42
3.46
Others
91
7.49
Unknown
199
16.38
Total
1215
100
105
Cancer Incidence in Jordan - 2012 Figure (70) Distribution of male deaths due to Neoplasm by age group, Jordan, 2012
Figure (71) Distribution of Female deaths due to Neoplasm by age group, Jordan, 2012
106
Cancer Incidence in Jordan - 2012 Annex (1 ) Jordan Cancer Registry Form
Email:
[email protected] Fax: 06-5656489 Tel: 06-5662067
107
Cancer Incidence in Jordan - 2012 Annex (2) Jordan Cancer Registry Data Request Application Form
Ministry of Health – NCDD - Jordan Cancer Registry (JCR) Amman-Ph.962 6 5662067 Data Request Format
Name : .......................................................................................................................................................................................... Address : ...................................................................................................................................................................................... Institution : .................................................................................................................................................................................. Phone No : ........................... Fax No : .................... Email :........................................... Required data : (Specify ,Time Period ,Site,Histology,Region,etc…….)
Data Required For : (Presentation / conference/ publication/clinical, epidemiological study, Commercial Need.......)
Collaborators and Co-authors( If Present ):
Avowal Declaration : l hereby, supplicant of the above data affirm that the data given to me from the National Jordan Cancer Registry- JCRwill be treated with extreme confidentiality concerning patient’s identity, l also confirm that the data given to me will not be presented or published by me or any of my collaborators as an original work but rather can be used in my presentation and/or publication with acknowledgement to the JCR .also confirm to provide copy of my work and feed-back to the JCR soon after. Requester’s Signature:………………….. Date Submitted ………….…………………………………. For administrative use only : Request: / Approved : ………………………Not Approved…………………………………..................................………………….. Director of Jordan Cancer Registry………………………..….....Sign………...…………………................................……………... Director of Non-Communicable Disease Directorate…………………………..Sign……………….................................………... Date:…………………………….
108
Cancer Incidence in Jordan - 2012 Definitions of Terms Incidence
allocation, and an estimate of cancer
A cancer incidence rate is the number
survivorship.
of new cancers of a specific site/type occurring in a specified population during a year, usually expressed as
Crude incidence rate (CR)
the number of cancers per 100,000
The number of new cancer cases
populations at risk.
(incidence
That is, Incidence rate = (New cancers
population during a defined period ,
/ Population) × 100,000
divided by the number of population
The numerator of the incidence rate
at risk in the same period .It is usually
is the number of new cancers; the
expressed per 100,000 .
cases)
observed
in
the
denominator is the size of the population. The number of new cancers may include multiple primary cancers occurring in one patient. The primary site reported is
Age-Specific Incidence Rate (ASIR)
the site of origin and not the metastatic
The number of cancer cases occurring
site.
during a specific period in a population of a specific age group and gender, divided by the number of mid-year
Prevalence
population of that age group and gender
Prevalence is defined as the number or
multiplying by 100,000. AR= Ni / Pix 100,000
percent of people alive on a certain date in a population who previously had a
Ni-Number
of
new
cancer
cases
diagnosis of the disease. It includes new
occurring in the ith age group
(incidence) and pre-existing cases and
Pi – person –years at risk in the ith age
is a function of both past incidence and
group
survival. Information on prevalence can be used for health planning, resource
109
Cancer Incidence in Jordan - 2012
Age-Standardized Rate (ASR)
Survival
An age-adjusted rate is a weighted
Cancer survival statistics are typically
average
rates,
expressed as the proportion of patients
where the weights are the proportions
alive at some point subsequent to the
of persons in the corresponding age
diagnosis of their cancer. Relative
groups of a standard population. The
survival is an estimate of the percentage
potential confounding effect of age is
of patients who would be expected
reduced when comparing age-adjusted
to survive the effects of their cancer.
rates computed using the same standard
Observed
population.
percentage of patients still alive at some
The most frequently used standard
specified time after diagnosis of cancer
of
population
the
is
age-specific
the
world
survival
is
the
actual
standard
populations. The calculated incidence is known as the world standardized incidence rate. The rate is expressed per
Mortality
100.000 populations.
A cancer mortality rate is the number of deaths, with cancer as the underlying cause of death, occurring in a specified
Rank
population
This measure reflects the importance of a
mortality is usually expressed as the
specific cancer site relative to other sites,
number of deaths due to cancer per
in terms of the number of registrations.
100,000 population. That is,
during
a
year.
Cancer
Ranking illustrates the most and least
Mortality Rate = (Cancer Deaths /
frequent cancer sites in a population
Population) × 100,000
according to their frequency.
The numerator of the mortality rate is the number of deaths; the denominator is the size of the population. The population used depends on the rate to
110
Cancer Incidence in Jordan - 2012
be calculated. For cancer sites that occur
ICD-O-3
in only one gender, the gender-specific
The
population (e.g., females for cervical
International Classification of Diseases
cancer) is used. The mortality rate can
for Oncology, 3rd Edition has been the
be computed for a given cancer site or
standard coding system for neoplasm
for all cancers combined.
for over 25 years. The coding system
World
Health
Organization’s
includes a four character code for primary site, a four-digit numeric code for cell type, one-digit code for behavior and a one-digit code for tumor aggressiveness (grade).
111
Cancer Incidence in Jordan - 2012 امل�ؤ�شر
العام 2011
حمافظات اقليم الو�سط : عمان
118.1
العام 2012
حمافظات اقليم الو�سط : عمان
125.5
الزرقاء
52.2
الزرقاء
48.2
البلقاء
61.9
البلقاء
46.5
مادبا
64.0
مادبا
62.6
-2حمافظات اقليم ال�شمال :
-2حمافظات اقليم ال�شمال :
اربد
45.0
اربد
55.6
املفرق
23.8
املفرق
31.6
معدل اال�صابة للجن�سني لكل 100.000من ال�سكان ح�سب املحافظات جر�ش
36.8
جر�ش
39.1
عجلون
29.2
عجلون
32.0
-3حمافظات اقليم اجلنوب : الكرك الطفيلة
52.5 37.7
-3حمافظات اقليم اجلنوب : الكرك
41.3
الطفيلة
38.0
معان
50.5
معان
46.1
العقبة
36.0
العقبة
45.3
112
Cancer Incidence in Jordan - 2012 امل�ؤ�شر ال�سرطانات اخلم�س االكرث �شيوعا بني االناث االردنيات
العام 2011
% 37.4
الثدي 941
الثدي
العام 2012
% 37.3 994
القولون وامل�ستقيم % 9.0 226
القولون وامل�ستقيم % 10.7 285
% 5.4
% 5.9 158
الغدة الدرقية 136
الغدة الدرقية
الليمفاوية (بنوعيه) % 5.2 130الليمفاوية (بنوعيه) %5.6 150 اجمايل احلاالت بني االطفال االردنيني للذكور واالناث
الرحم
127
207
%5.4
الرحم
121 217
اجمايل احلاالت بني االطفال الذكور
121
121
اجمايل احلاالت بني االطفال االناث-
86
96
�سرطانات الدم الدماغ واالع�صاب توزيع حاالت ال�سرطان االكرث �شيوعا بني االطفال
الليمفاوية (بنوعيه) الكليه العظم -1
%28.5
% 20.3الدماغ واالع�صاب %15.5الليمفاوية (بنوعيه) %6.8العني
113
%30 %21.2 %14.3 %6.9
Neuroblastoma6% %5.8 حمافظات اقليم الو�سط : حمافظات اقليم الو�سط -2 : عمان
%61.9
عمان
%61.1
الزرقاء
%10.4الزرقاء
%9.2
البلقاء
%5.5
البلقاء
%4.0
مادبا
% 2.1
مادبا
% 2.0
-2حمافظات اقليم ال�شمال :
التوزيع الن�سبي حلاالت ال�سرطان بني االردنيني ح�سب املحافظات
�سرطانات الدم
%4.5
-2حمافظات اقليم ال�شمال :
اربد
%10.7
اربد
%12.6
املفرق
%1.5
املفرق
%1.9
جر�ش
%1.5
جر�ش
%1.5
عجلون
%0.9
عجلون
%0.9
-3حمافظات اقليم اجلنوب :
-3حمافظات اقليم اجلنوب :
الكرك
% 2.7
الكرك
% 2.1
الطفيلة
% 0.7
الطفيلة
% 0.7
معان
% 1.3
معان
% 1.1
العقبة
% 1.0
العقبة
% 1.3
Cancer Incidence in Jordan - 2012 جدول يبني مقارنة اح�صائيات وبع�ض م�ؤ�شرات ال�سرطان للعام 2011والعام 2012 العام 2011
العام 2012
امل�ؤ�شر اجمايل احلاالت امل�سجلة
6971
7454
اجمايل احلاالت بني االردنيني
4675
5013
اجمايل احلاالت بني غري االردنيني
2296
2441
اجمايل احلاالت بني الذكور االردنيني
2194
2346
اجمايل احلاالت بني االناث االردنيات
2481
2667
متو�سط العمر عند الت�شخي�ص للجن�سني
56
56
متو�سط العمر عند الت�شخي�ص للذكور
60
60
متو�سط العمر عند الت�شخي�ص لالناث
52
53
معدل اال�صابة اخلام للجن�سني ( لكل )100.000من ال�سكان
74.8
78.5
معدل اال�صابة اخلام للذكور لكل ( ) 100.000من الذكور
68.1
71.2
معدل اال�صابة اخلام لالناث لكل ( ) 100.000من االناث
81.9
86.2
معدل اال�صابة املعاير عمريا للجن�سني لكل ( ) 100.000من ال�سكان
128.1
133.4
معدل اال�صابة املعاير عمريا للذكورلكل ( ) 100.000من الذكور
121.1
126.1
معدل اال�صابة املعاير عمريا لالناث لكل ( ) 100.000من االناث
135.6
141.4
معدل الإ�صابة اخلام للأطفال للجن�سني لكل مليون
89
93
معدل الإ�صابة اخلام للأطفال للذكورلكل مليون
101
101
معدل الإ�صابة اخلام للأطفال لالناث لكل مليون
76
84.6
الرئة ال�سرطانات اخلم�س االكرث �شيوعا بني الذكور
279
%12.7
القولون وامل�ستقيم %12.5 274 املثانة 171
% 7.8
الرئة
292
%12.4
القولون وامل�ستقيم%12.0 282 املثانة 217
% 9.2
الربو�ستات 169
%7.7
الربو�ستات 198
%8.4
�سرطان الدم 128
% 5.8
الليمفوما 177
%7.5
114
Cancer Incidence in Jordan - 2012 من احلاالت .حوايل ( ) %46.8من احلاالت امل�سجله
%9.2البلقاء % 4ثم مادبا . % 2
من �سرطانات االطفال هي الطفال دون �سن � 5سنوات .
حم��اف�ظ��ات ال���ش�م��ال (: )%16.9ارب���د , % 12.6
وكانت اكرث ال�سرطانات �شيوعا لالطفال دون �سن
املفرق , %1.9عجلون % 0.9ثم جر�ش % 1.5
� 15سنه ) هي كالتايل:
حمافظات اجلنوب : )%5.1( .الكرك %2.1العقبة
�سرطان الدم � ،% 30:سرطان الدماغ والأع�صاب 21.2
% 1.3معان % 1.1الطفيلة .%0.7
%ال�سرطانات الليمفاوية ,% 14.3ثم �سرطان العني بن�سبة %6.9ثم Neuroblastomaبن�سبة .%6 معدالت الإ�صابة بال�سرطان لعام 2012 * املعدل اخلام للإ�صابة بال�سرطان للبالغني للجن�سني
م�ع��دل احل ��دوث اخل ��ام حل��االت ال���س��رط��ان ح�سب املحافظات لكل : 100.000
بلغ ( ) 78.5لكل(مائة �إلف) من ال�سكان ( للذكور
حمافظات الو�سط ( : )96.2عمان ,125.5الزرقاء
71.2وللإناث ( ) 86.2لكل مائة الف من ال�سكان.
48.2مادبا , 62.6البلقاء 46.5
* معدل الإ�صابة املعاير عمريا لكل مائة �أل��ف من
حمافظات ال�شمال( : )47.8اربد , 55.6جر�ش 39.1
ال�سكان للجن�سني (133.4ل �ل��ذك��ور126.1واالن��اث
عجلون 32.0و املفرق 31.6 :
(.)141.4
حمافظات اجلنوب ( : )42.7الكرك , 41.3الطفيله
* معدل الإ�صابة اخلام للأطفال فقد بلغ (93لكل مليون طفل ) 101للذكور و 84.6لالناث .
التوزيع الن�سبي حلاالت ال�سرطان ح�سب املحافظات: حمافظات الو�سط ( : )%77عمان , %61.9الزرقاء 115
,38.0العقبة 45.3ثم معان.46.1
Cancer Incidence in Jordan - 2012 يف الأردن .قدم ال�سجل العديد من الأوراق العلمية يف
( )327حاله ما ن�سبته ( )%6.5ثم �سرطان املثانه
املومترات املحلية والدوليةوقد �أ�صبحت قاعدة البيانات
( )246بن�سبة (. )%4.9
املرتاكمة ل��دى ال�سجل مق�صد العديد م��ن الباحثني لإجراء الدرا�سات والبحوث العلمية.
* ال�سرطانات اخلم�س الأك�ثر �شيوعاً بني الذكور كانت على النحو التايل: �سـرطان ال��رئ��ة ( )292ح��ال��ه بن�سبة ( )%12.4ثم
�أهم �إح�صائيات التقرير ال�سنوي ال�سابع ع�شر لعام2012 مت جتميع احلاالت اعتماد ًا على تاريخ الت�شخي�ص من
القولون وامل�ستقيم ( )282حاله ( � ، )%12سرطان
ت��اري��خ 2012/1/1ح� �ت ��ى ت��اري��خ ,2012/12/31بلغ
املثانة ( )217بن�سبة(� , )%9.2سرطان الربو�ستات
جمموع احلاالت امل�سجلة ( ) 7454حالة منها()5013
( )198بن�سبة ( )% 8.4ثم �سرطانات الغدد الليمفاويه
اردنيني ما ن�سبته %67.3من �إجمايل عدداحلاالت.
.)% 7.5( 177
مقارنة مع ( )6971حالة يف العام . 2011وبلغ عدد احل��االت بني ال��ذك��ور الأردن �ي�ين ( )%46.8( )2346
* ال�سرطانات اخلم�س الأك�ثر �شيوعاً بني الإن��اث
والإناث )%53.2(2667يف حني بلغ �إجمايل احلاالت
كانت على النحو التايل :
بني غري الأردنيني للعام )2441(2012حالة ما ن�سبته
�سرطان الثدي ( )994حالة بن�سبة ( ،)% 37.3القولون
( ) %32.7من جمموع احلاالت.
وامل�ستقيم ()285بن�سبة (�,)% 10.7سرطانات الغدة الدرقية ( )158بن�سبة ( )%5.9ثم �سرطانات الغدد
ال�سرطانات اخلم�س الأك�ث�ر �شيوعاً ب�ين الأردن �ي�ين
الليمفاويه ( )150بن�سبة ( )%5.6ثم �سرطان الرحم
للجن�سني :
( )121بن�سبة ( )%4.5من جمموع �سرطانات الإناث.
احتل �سرطان الثدي املرتبة الأول��ى حيث بلغ �إجمايل احل��االت امل�سجلة ب ( )1008حالة ما ن�سبته %20.1
* يف حني بلغ جمموع �سرطانات الأطفال للأعمار
تالها �سرطانات القولون وامل�ستقيم حيث بلغ �إجمايل
ا�صغر م��ن � 15سنة ( 217ح��ال��ة) بن�سبة % 4.3من
احل��االت ( )567ما ن�سبته %11.3ثم �سرطان الرئه
جمموع ال�سرطانات الكلي ,منها( )121بني الذكور
( )371حاله ( )%7.4ثم �سرطانات الغدد الليمفاويه
بن�سبة ( )%55.8و ( )96بني الإن��اث بن�سبة ()%44.2 116
Cancer Incidence in Jordan - 2012 املتبعة يف ر�صد ح��االت ال�سرطان يف الأردن فهي من
بالوفيات ب�سب ال�سرطان موزعة ح�سب �أنواع ال�سرطانات
خالل الر�صد الن�شط حيث يقوم فريق من كادر ال�سجل
والفئات العمرية واجلن�س وكذلك التوزيع اجلغرايف .
الوطني بزيارة امل�ست�شفيات واملختربات واجلهات ذات
وقد عمل ال�سجل على �إيجاد قاعدة بيانات للمر�ضى ح�سب
العالقة وا�ستنباط احل��االت ال�سرطانية امل�شخ�صة يف
املعايري العاملية املتبعة يف ا�ستنباط وترميز وا�ستعمال
تلك الأماكن وار�سالها لل�سجل الوطني لل�سرطان.
هذه البيانات يف رفد متخذي القرار وجميع املهن يف
فيما ب�ع��د ت�ت��م عملية م��راج �ع��ة وت�ن�ق�ي��ح للمعلومات
جمال مر�ض ال�سرطان على جميع امل�ستويات والأ�صعدة
()ICD-O3
(�إداري��ة وتخطيط وعلمية )...وقد عمل ال�سجل على
ومن ثم �إدخ��ال احلاالت �إلى نظام ر�صد يف احلا�سوب با�ستعمال برنامج معد خ�صي�ص ًا من قبل معهد البحوث
�إ�صدار تقرير �سنوي لوجود احلاالت ال�سرطانية املكت�شفة يف فرتة عام واحد Cancer Incidenceوحفاظا على
ال�سرطانية � IARCإحدى فروع منظمة ال�صحة العاملية
�أعلى درجات الدقة يف جمع وترميز احلاالت ال�سرطانية
WHOويراعي �أعلى درجات الدقة واحلر�ص لتجنب
يقوم ال�سجل وب�شكل دوري بعقد العديد من ال��دورات
ازدواجية يف احلاالت املدخلة وذلك من خالل عدة �آليات وم�ستويات من الرقابة الذاتية والداخلية و�أي�ض ًا الرقابة
التدريبية ل�ضباط االرتباط العاملني بجمع وا�ستنباط البيانات م��ن �سجالت ال�سرطان .وح�ي��ث �إن ال�سجل
اخلارجية على جمريات عمل و�إجنازات ال�سجل.
الوطني لل�سرطان من الأوائ ��ل وال ��رواد يف ال�سجالت
بعد االنتهاء من �إدخال كافة احلاالت امل�شخ�صة للفرتة
املجتمعية ( )Community Based Registryيف
الزمنية امل�ح��ددة (�سنة) يتم حتليل تلك املعلومات
الإقليم فانه يقوم بتدريب كوادر من الدول العربية .
با�ستخدام برامج التحليل الإح�صائية لي�صار بعد ذلك
يف ع��ام 2008مت ال �غ��اء مديرية مكافحة ال�سرطان
�إلى �إعداد التقرير ومن ثم ن�شر التقرير ال�سنوي الذي
وا�ستحدث ق�سم مكافحة ال�سرطان ومت االب�ق��اء على
يبني منطية وانت�شار مر�ض ال�سرطان يف الأردن حيث يبني
وح��دة ال�سجل الوطني لل�سرطان ليتبع كل منهما الى
التقرير وجود حاالت ال�سرطان من حيث مكان الإ�صابة
مديرية الإمرا�ض غري ال�سارية حيث يتابع ق�سم مكافحة
والعمر واجلن�س والتوزيع اجلغرايف.كما يتم �إعداد جزء
ال���س��رط��ان وال�سجل ال��وط�ن��ي لل�سرطان �أع�م��ال��ه من
خا�ص ب�سرطانات الأطفال و�آخر خا�ص بال�سرطان بني
ت�سجيل احلاالت ال�سرطانية املكت�شفة وتطبيق ن�شاطات
غري الأردنيني يف الأردن.ويتم �أي�ضا �إعداد جزء خا�ص
اال�سرتاتيجية الوطنية يف جم��ال مكافحة ال�سرطان
والبيانات و عملية الرتميز با�ستخدام
117
Cancer Incidence in Jordan - 2012 وبائية ال�سرطان لعام 2012 التقرير ال�سنوي ال�سابع ع�شر لل�سجل الوطني لل�سرطان م��دي��ري��ة الأم��را���ض غ�ير ال���س��اري��ة -ق�سم مكافحة
والت�شخي�ص املبكر ملر�ض ال�سرطان.
ال�سرطان -ال�سجل الوطني لل�سرطان
�5 .5إعداد دالئل �إر�شادية وطنية للك�شف املبكر عن ال�سرطانات الأكرث �شيوع ًا ( الثدي ،القولون)
الر�ســالة :تخفيف ع��بء مر�ض ال�سرطان من خالل خف�ض معدالت الإ�صابة وذلك بتبني �سيا�سات وبرامج
ال�سجل الوطني لل�سرطان:
وطنية ملكافحة ال�سرطان تت�ضمن زيادة تدابري الوقاية
�أن�شئ ال�سجل الوطني لل�سرطان كوحدة يف وزارة ال�صحة
والك�شف والت�شخي�ص املبكر.
مبوجب قرار وزاري وترتبط �إداريا مبعايل الوزير يف عام 1996حيث كانت حاالت ال�سرطان اخلبيث قبل ذلك
ال �ـ �ـ��ر�ؤي��ا :نحو جمتمع واع ��ي للتدابري ال��وق��ائ�ي��ة من
ت�سجل من م�ست�شفى واحد يتبع لوزارة ال�صحة.بعد ذلك
ال�سرطان وطرق الك�شف املبكر ومب�شاركة كافةاجلهات الوطنية و�صو ًال �إلى معدالت متدنية من الإ�صابة وبالتايل
�أ�صبحت جميع حاالت ال�سرطان املكت�شفة وامل�شخ�صة يف الأردن ومن كافة القطاعات ال�صحية واملختربات
الوفيات من هذا املر�ض.
تر�صد من خالل ال�سجل الوطني لل�سرطان وذلك ب�إتباع �أ�سلوبني يف عملية الر�صد لتلك احلاالت �أولها �أ�سلوب
الأهـــداف : �1 .1إعداد �إ�سرتاتيجية وخطة وطنية �شاملة ملكافحة
الر�صد الذاتي حيث يتم التبليغ الذاتي عن وجود حاالت �سرطانية عن طريق تعبئة ا�ستمارة �أع��دت خ�صي�صا
مر�ض ال�سرطان يف اململكة.
تت�ضمن جمموعة م��ن البيانات ح��ول امل��ر���ض وتر�سل
2 .2الر�صد امل�ستمر ( الذاتي والن�شط) لت�سجيل حاالت ال�سرطان يف اململكة اعتماد ًا على املعايري العاملية.
مبا�شرة �إلى ال�سجل وذلك من خالل حوايل � 68ضابط ارتباط �أكفاء مدربني وموزعني على كافة امل�ست�شفيات يف
�3 .3إعداد الربامج الوطنية ملكافحة ال�سرطان بنا ًء على معدالت احلدوث يف اململكة.
امللكية وم�ست�شفيات اجلامعات بالإ�ضافة �إلى خمتربات
4 .4ن�شر ال��وع��ي ال�صحي ح��ول �أه �م �ي��ة الك�شف
القطاع العام والقطاع اخلا�ص �,أم��ا الطريقة الثانية
القطاعني العام واخلا�ص وم�ست�شفيات اخلدمات الطبية
118
Cancer Incidence in Jordan - 2012
A.C.P ﺠﺎﺭﻳﺔ ﻣﻄﺎﺑﻊ ﺍﻟﺮﺃﻱ ﺍﻟﺘ
ﻣﺠﻠﺔ ت�صميم:جمانه العلمي
119
Cancer Incidence in Jordan - 2012
اململكة الأردنية الها�شمية وزارة ال�صحة مديرية الأمرا�ض غري ال�سارية ال�سجل الوطني لل�سرطان
وبائيـــــة ال�سرطـــــــان لعـــــــام 2012 �إعداد:
الدكتور �أيوب ال�سيايدة
الدكتور عمر النمري
الدكتور كمال عرقوب
الدكتور مروان الزغل
الدكتورة وفاء هل�سه 120
