- Email: [email protected]
Increased oesophageal cancer mortality rate in Iran
Arab Journal of Gastroenterology 13 (2012) 82–84
Contents lists available at SciVerse ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Short Communication
Increased oesophageal cancer mortality rate in Iran Mohamad Amin Pourhoseingholi a,⇑, Zeinab Fazeli a, Bijan Moghimi-Dehkordi a, Mohsen Vahedi b, Asma Pourhoseingholi a, Azadeh Safaee a, Sarah Ashtari a, Mohammad Reza Zali a a b
Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
a r t i c l e
i n f o
Article history: Received 10 July 2011 Accepted 11 June 2012
Keywords: Oesophageal cancer Mortality Age standardised Burden Iran
a b s t r a c t Background and study aims: The aim of this study is to present the mortality trends of oesophageal cancer (EC) in the Iranian population, to provide updated information regarding time trends for this cancer. Patients and methods: We analysed the national death statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004. EC [International Classification of Diseases (ICD-9); C15] were expressed as the annual mortality rates/100 000, overall, by sex and by age group (<15, 15–49 and P50 years of age) and age standardised rate (ASR). Results: The age standardised mortality rate of EC increased dramatically during the study period. EC mortality was higher for males and the mortality rate also increased with age. Conclusion: This study provides a comprehensive projection for the burden of death due to EC, indicating that the trend of EC mortality dramatically increased in the recent decade. Ó 2012 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
Introduction Gastrointestinal (GI) cancers are the most frequent cancers among Iranian males and rank second to breast cancer among females [1]. Oesophageal cancer (EC) is one of the most common cancers worldwide [2]. Survival rates are very low [3] and advanced EC carries an overall poor prognosis with most patients presenting with incurable disease [4]. Statistics reveal that males are more vulnerable to the disease than females [5]; however, in the very high incidence area of EC, the male to female ratio is close to 1 [6]. The main histopathologic types of EC cancer are squamous cell carcinoma (SCC) and adenocarcinoma (AC) and the dominant histological type worldwide is SCC [7]. The incidence and mortality rates show a wide geographical variation with differences between high- and low-risk areas [2,8]. Some world areas have a higher incidence than others such as China, Iran, India, Japan and the region around the Caspian sea [9]. Apart from the eastern part of the Caspian littoral area of Iran which has the highest incidence of EC in the world, other parts of the country have variable rates, ranging from 3 to more than 15 cases per 100 000 population, but rates have decreased sharply in the high incidence areas [1]. The World Health Organization (WHO) has encouraged its member states to introduce systems of mortality registration involving medical certification for cause of death. The National ⇑ Corresponding author. Tel.: +98 21 22 43 25 15. E-mail address: [email protected] (M.A. Pourhoseingholi).
Organization for Civil Registration (NOCR) and the Ministry of Health and Medical Education (MOH&ME) established death registration systems in Iran. Between 1966 and 1995, mortality data based on cemetery records were collected in a sample of 24 cities. In 1995, the system was redesigned to cover the entire country [10]. Although the information on mortality of EC has been studied in some developed countries, data from developing countries such as Iran are still scanty. The aim of this study was to present the mortality trends of EC in Iranian population during a period of almost a decade, using published death statistic by MOH&ME to provide updated information regarding time trends for this cancer.
Patients and methods The national mortality statistics reported by the MOH&ME from 1995 to 2000 (registered death statistics for the Iranian population at the Information Technology and Statistic Management Center, MOH&ME) and from 2001 to 2004 (published by MOH&ME) [11– 13] stratified by age group, sex and cause of death (coded according to the 9th revision of the International Classification of Diseases [ICD-9]) are included in this analysis. EC [ICD-9; C15] were expressed as the annual mortality rates/100 000, overall, by sex and by age group (<15, 15–49 and P50 years of age) and age standardised rate (ASR). The populations of Iran in 1995–2004 were estimated, using the census from 1996 conducted by the Statistics Centre of Iran and its estimation according to population growth rate for years before and after national census [14].
1687-1979/$ - see front matter Ó 2012 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajg.2012.06.008
83
M.A. Pourhoseingholi et al. / Arab Journal of Gastroenterology 13 (2012) 82–84
Results All death records due to EC from 1995 to 2004 are included in this study. The age standardised mortality rate of EC increased dramatically during these years from 0.71 to 3.35 per 100 000 (Fig. 1 and Table 1); however, a slight decreasing trend was observed from 2002 to 2004. Moreover, the EC mortality rate was higher for males (Table 1 and Fig. 2) and older age (Table 2 and Fig. 3). In the male group, it seems that there was a stable trend for EC mortality (3.92 per 100 000 in 2003 and 3.93 per 100 000 in 2004) in contrast to the female group in which, a drop was observed from 2002 to 2004 (3.13 per 100 000 in 2002 and 2.74 per 100 000 in 2004). Besides, the mortality increased with age increase (Table 2 and Fig. 3) and the trend levelled off from 2002 to 2004.
Table 1 Age specific rate (per 100 000) for oesophageal cancer mortality stratified by sex group. Year
Male
Female
Total
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
0.73 1.70 1.61 1.61 2.36 2.55 2.39 4.28 3.92 3.93
0.68 1.10 1.11 1.30 1.59 1.78 1.81 3.13 3.22 2.74
0.71 1.41 1.36 1.46 1.98 2.18 2.10 3.71 3.58 3.35
4.5 Male
4
Discussion Mortality Rate
3.5
Female
3 2.5 2 1.5 1 0.5 0
04
20
2
03 20
0 20
0
01
20
0 20
99
19
8
9 19
6
97
19
9 19
95
19
This study provides a comprehensive projection for burden of death due to EC based on the mortality registry system for Iran, indicating that the trend of EC mortality dramatically increased in the recent decade. EC mortality in France and Italy (from the WHO Mortality Database) has continuously decreased through recent decades. On the other hand, ASR mortality due to EC in the UK and USA has gradually increased since 1960 [15]. EC incidence and mortality rates for African-Americans continue to be higher than the rates for Caucasians. However, incidence and mortality of EC have significantly decreased among African-Americans since the early 1980s, whereas with Caucasians, it has slightly increased [16] and now USA has reached a plateau [15]. A study in China revealed that incidence and mortality rates for EC are decreasing due to an unplanned success of prevention, such as changes in population dietary patterns and food preservation methods [17]. In Japan, the ASR mortality of EC constantly decreased according to the WHO Mortality Database [15]. Our study showed that EC mortality was higher for males. Males tend to have higher EC mortality compared with females in Western countries too [15] and statistics indicated that EC affected males more than females [5]. Age-specific mortality indicated an increasing rate of EC mortality as age increases. Age is a risk factor for EC [18] and there were similar increasing trends for all age groups in other countries for EC deaths [15]. Our study indicated a low mortality rate for population under 15 years of age. Although EC is very rare in children, the Iranian Annual National Cancer Registration Report revealed that the incidence of EC for people under 20 years of age is 0.09 per 100 000 in males and 0.55 per 100 000 in females [19]. There-
Fig. 2. Trends of oesophageal cancer mortality during the period 1995–2004 by sex groups (age standardised rate per 100 000).
Table 2 Age standardised rate (per 100 000) for oesophageal cancer mortality stratified by sex group. Year
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
<15 Years
15–49 Years
P50 Years
Male
Female
Male
Female
Male
Female
0.02 0.04 0.01 0.05 0.04 0.08 0.03 0.02 0.01 0.02
0.00 0.08 0.04 0.05 0.09 0.06 0.03 0.02 0.00 0.02
0.06 0.25 0.20 0.23 0.38 0.35 0.29 0.60 0.50 0.49
0.09 0.14 0.11 0.21 0.28 0.25 0.20 0.47 0.46 0.46
3.48 7.85 7.52 7.42 10.8 11.76 11.19 19.88 18.38 18.43
3.19 5.01 5.20 5.90 7.10 8.20 8.49 14.46 14.96 12.54
4 3.5
Mortality Rate
3 2.5 2 1.5 1 0.5 0
4
03
0 20
20
02 20
01
00
8
99
20
20
19
9 19
6
97
19
9 19
95
19
Fig. 1. Trends of oesophageal cancer mortality during the period 1995–2004 (age standardised rate per 100 000).
fore, this burden of mortality due to EC is expectable for age less than 15 years. EC is a deadly cancer with high mortality. The prognosis is quite poor, because most patients present with advanced disease. Therefore, the overall 5-year survival rate is less than 20%, with most patients dying within the first year of diagnosis [3,20]. Tobacco and alcohol are the risk factors for EC in the world [21,22]. A Japanese study speculated that alcohol-related EC mortality rates have been increasing in Japanese men replacing non-alcohol-related EC deaths [23] but in Iran it seems that patterns of food and nutrient consumption (including drinking hot tea) and also socioeconomic status are playing the main role in the high risk area of Iran, which revealed higher incidence of EC for low social levels [24–26]. Although the study revealed interesting facts about mortality of EC during the study decade in Iran, the results must be interpreted after the reader considers that: the coverage and quality of death registration have increased in our country during the study period
84
M.A. Pourhoseingholi et al. / Arab Journal of Gastroenterology 13 (2012) 82–84
Age
20 18 16 14 12
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
References
<15
15-50
0.01 0.06 0.02 0.05 0.07 0.07 0.03 0.02 0.01 0.02
0.07 0.19 0.16 0.22 0.33 0.3 0.25 0.53 0.48 0.48
10 8
>50 3.34 6.47 6.39 6.68 9 10.05 9.86 17.22 16.71 15.55
<15 15-50 >50
6 4 2 0
Fig. 3. Age-specific rate (per 100 000) for oesophageal cancer mortality during the period 1995–2004.
and observed that increased mortality rates for EC may be probably due to better national registration; however the underestimation of mortality for cancers in Iran due to poor registry is still a problem [13]. Low general awareness about the symptoms of EC and delay in diagnosis of EC due to the lack of a national comprehensive system for early detection of this cancer lead to diagnosis of EC in older ages and the subsequent higher mortality rates of EC. Hence, conducting a programme to increase the general awareness of known and probable risk factors of EC may be helpful to reduce EC incidence, especially in the high incidence area of Iran and reduce its mortality in future decades. Conflict of interest The authors declared that there was no conflict of interest. Acknowledgement This study was sponsored by a Grant from the Research Center for Gastrointestinal and Liver Disease (RCGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
[1] Mosavi Jarrahi A, Mohagheghi MA. Epidemiology of esophageal cancer in the high-risk population of Iran. Asian Pac J Cancer Prev 2006;7(3):375–80. [2] Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin 2005;55(2):74–108. [3] Polednak AP. Trends in survival for both histologic types of esophageal cancer in US surveillance, epidemiology and end results areas. Int J Cancer 2003;105(1):98–100. [4] Qureshi I, Shende M, Luketich JD. Surgical palliation for Barrett’s esophagus cancer. Surg Oncol Clin N Am 2009;18(3):547–60. [5] Seitz JF, Dahan L, Jacob J, et al. Esophagus cancer. Gastroenterol Clin Biol 2006;30(Spec. No. 2). 2S5-2S15. [6] Schottenfeld C, Fraumeni JF. Cancer epidemiology and prevention. In: Schottenfeld D, Fraumeni Jr JF, editors. 3rd ed. New York USA: Oxford University Press; 2006. [7] Engel LS, Chow WH, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst 2003;95(18):1404–13. [8] Ferlay I, Bray F, Pisani P. GLOBOCAN 2002. cancer incidence, mortality and prevalence worldwide. Lyon: IARC Press; 2002. 2004. [9] Kleihues P, Stewart BW. World cancer report. Lyon: IARC Press–WHO; 2003. [10] Khosravi A, Taylor R, Naghavi M, et al. Mortality in the Islamic Republic of Iran, 1964–2004. Bull World Health Organ 2007;85(8):607–14. [11] Naghavi M. Death report from 18 provinces in Iran. 1st ed. Tehran, Iran: Ministry of Health and Medical Education; 2003. [12] Naghavi M. Death report from 23 provinces in Iran. 1st ed. Tehran, Iran: Ministry of Health and Medical Education; 2003. [13] Naghavi M. Death report from 29 provinces in Iran. 1st ed. Tehran, Iran: Ministry of Health and Medical Education; 2003. [14] National Statistics Center, Online Publications at:. [15] Qiu D, Kaneko S. Comparison of esophageal cancer mortality in five countries: France, Italy, Japan, UK and USA from the WHO mortality database (1960– 2000). Jpn J Clin Oncol 2005;35(9):564–7. [16] National Cancer Institute. Incidence and mortality rate trends. A snapshot of esophageal cancer. National Cancer Institute; 2006. [17] Ke L. Mortality and incidence trends from esophagus cancer in selected geographic areas of China circa 1970–90. Int J Cancer 2002;102(3):271–4. [18] Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med 2003;349(23):2241–52. [19] Iranian annual of national cancer registration report. Islamic Republic of Iran: Ministry of Health and Medical Education, Health Deputy; 2006–2007. [20] Sant M, Aareleid T, Berrino F, et al. EUROCARE-3: survival of cancer patients diagnosed 1990–94-results and commentary. Ann Oncol 2003;14(Suppl. 5). v61–118. [21] IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum 2004;83:1–1438. [22] Corrao G, Bagnardi V, Zambon A, et al. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med 2004;38(5):613. 2004;38(5):613–9. [23] Parrish KM, Higuchi S, Lucas LJ. Increased alcohol-related oesophageal cancer mortality rates in Japanese men. Int J Epidemiol 1993;22(4):600–5. [24] Islami F, Kamangar F, Nasrollahzadeh D, et al. Oesophageal cancer in Golestan Province, a high-incidence area in northern Iran – a review. Eur J Cancer 2009;45(18):3156–65. [25] Islami F, Kamangar F, Nasrollahzadeh D, et al. Socio-economic status and oesophageal cancer: results from a population-based case-control study in a high-risk area. Int J Epidemiol 2009;38(4):978–88. [26] Islami F, Pourshams A, Nasrollahzadeh D, et al. Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: Population based casecontrol study. BMJ (Clinical research Ed.);338:b929.
Contents lists available at SciVerse ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Short Communication
Increased oesophageal cancer mortality rate in Iran Mohamad Amin Pourhoseingholi a,⇑, Zeinab Fazeli a, Bijan Moghimi-Dehkordi a, Mohsen Vahedi b, Asma Pourhoseingholi a, Azadeh Safaee a, Sarah Ashtari a, Mohammad Reza Zali a a b
Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
a r t i c l e
i n f o
Article history: Received 10 July 2011 Accepted 11 June 2012
Keywords: Oesophageal cancer Mortality Age standardised Burden Iran
a b s t r a c t Background and study aims: The aim of this study is to present the mortality trends of oesophageal cancer (EC) in the Iranian population, to provide updated information regarding time trends for this cancer. Patients and methods: We analysed the national death statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004. EC [International Classification of Diseases (ICD-9); C15] were expressed as the annual mortality rates/100 000, overall, by sex and by age group (<15, 15–49 and P50 years of age) and age standardised rate (ASR). Results: The age standardised mortality rate of EC increased dramatically during the study period. EC mortality was higher for males and the mortality rate also increased with age. Conclusion: This study provides a comprehensive projection for the burden of death due to EC, indicating that the trend of EC mortality dramatically increased in the recent decade. Ó 2012 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved.
Introduction Gastrointestinal (GI) cancers are the most frequent cancers among Iranian males and rank second to breast cancer among females [1]. Oesophageal cancer (EC) is one of the most common cancers worldwide [2]. Survival rates are very low [3] and advanced EC carries an overall poor prognosis with most patients presenting with incurable disease [4]. Statistics reveal that males are more vulnerable to the disease than females [5]; however, in the very high incidence area of EC, the male to female ratio is close to 1 [6]. The main histopathologic types of EC cancer are squamous cell carcinoma (SCC) and adenocarcinoma (AC) and the dominant histological type worldwide is SCC [7]. The incidence and mortality rates show a wide geographical variation with differences between high- and low-risk areas [2,8]. Some world areas have a higher incidence than others such as China, Iran, India, Japan and the region around the Caspian sea [9]. Apart from the eastern part of the Caspian littoral area of Iran which has the highest incidence of EC in the world, other parts of the country have variable rates, ranging from 3 to more than 15 cases per 100 000 population, but rates have decreased sharply in the high incidence areas [1]. The World Health Organization (WHO) has encouraged its member states to introduce systems of mortality registration involving medical certification for cause of death. The National ⇑ Corresponding author. Tel.: +98 21 22 43 25 15. E-mail address: [email protected] (M.A. Pourhoseingholi).
Organization for Civil Registration (NOCR) and the Ministry of Health and Medical Education (MOH&ME) established death registration systems in Iran. Between 1966 and 1995, mortality data based on cemetery records were collected in a sample of 24 cities. In 1995, the system was redesigned to cover the entire country [10]. Although the information on mortality of EC has been studied in some developed countries, data from developing countries such as Iran are still scanty. The aim of this study was to present the mortality trends of EC in Iranian population during a period of almost a decade, using published death statistic by MOH&ME to provide updated information regarding time trends for this cancer.
Patients and methods The national mortality statistics reported by the MOH&ME from 1995 to 2000 (registered death statistics for the Iranian population at the Information Technology and Statistic Management Center, MOH&ME) and from 2001 to 2004 (published by MOH&ME) [11– 13] stratified by age group, sex and cause of death (coded according to the 9th revision of the International Classification of Diseases [ICD-9]) are included in this analysis. EC [ICD-9; C15] were expressed as the annual mortality rates/100 000, overall, by sex and by age group (<15, 15–49 and P50 years of age) and age standardised rate (ASR). The populations of Iran in 1995–2004 were estimated, using the census from 1996 conducted by the Statistics Centre of Iran and its estimation according to population growth rate for years before and after national census [14].
1687-1979/$ - see front matter Ó 2012 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajg.2012.06.008
83
M.A. Pourhoseingholi et al. / Arab Journal of Gastroenterology 13 (2012) 82–84
Results All death records due to EC from 1995 to 2004 are included in this study. The age standardised mortality rate of EC increased dramatically during these years from 0.71 to 3.35 per 100 000 (Fig. 1 and Table 1); however, a slight decreasing trend was observed from 2002 to 2004. Moreover, the EC mortality rate was higher for males (Table 1 and Fig. 2) and older age (Table 2 and Fig. 3). In the male group, it seems that there was a stable trend for EC mortality (3.92 per 100 000 in 2003 and 3.93 per 100 000 in 2004) in contrast to the female group in which, a drop was observed from 2002 to 2004 (3.13 per 100 000 in 2002 and 2.74 per 100 000 in 2004). Besides, the mortality increased with age increase (Table 2 and Fig. 3) and the trend levelled off from 2002 to 2004.
Table 1 Age specific rate (per 100 000) for oesophageal cancer mortality stratified by sex group. Year
Male
Female
Total
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
0.73 1.70 1.61 1.61 2.36 2.55 2.39 4.28 3.92 3.93
0.68 1.10 1.11 1.30 1.59 1.78 1.81 3.13 3.22 2.74
0.71 1.41 1.36 1.46 1.98 2.18 2.10 3.71 3.58 3.35
4.5 Male
4
Discussion Mortality Rate
3.5
Female
3 2.5 2 1.5 1 0.5 0
04
20
2
03 20
0 20
0
01
20
0 20
99
19
8
9 19
6
97
19
9 19
95
19
This study provides a comprehensive projection for burden of death due to EC based on the mortality registry system for Iran, indicating that the trend of EC mortality dramatically increased in the recent decade. EC mortality in France and Italy (from the WHO Mortality Database) has continuously decreased through recent decades. On the other hand, ASR mortality due to EC in the UK and USA has gradually increased since 1960 [15]. EC incidence and mortality rates for African-Americans continue to be higher than the rates for Caucasians. However, incidence and mortality of EC have significantly decreased among African-Americans since the early 1980s, whereas with Caucasians, it has slightly increased [16] and now USA has reached a plateau [15]. A study in China revealed that incidence and mortality rates for EC are decreasing due to an unplanned success of prevention, such as changes in population dietary patterns and food preservation methods [17]. In Japan, the ASR mortality of EC constantly decreased according to the WHO Mortality Database [15]. Our study showed that EC mortality was higher for males. Males tend to have higher EC mortality compared with females in Western countries too [15] and statistics indicated that EC affected males more than females [5]. Age-specific mortality indicated an increasing rate of EC mortality as age increases. Age is a risk factor for EC [18] and there were similar increasing trends for all age groups in other countries for EC deaths [15]. Our study indicated a low mortality rate for population under 15 years of age. Although EC is very rare in children, the Iranian Annual National Cancer Registration Report revealed that the incidence of EC for people under 20 years of age is 0.09 per 100 000 in males and 0.55 per 100 000 in females [19]. There-
Fig. 2. Trends of oesophageal cancer mortality during the period 1995–2004 by sex groups (age standardised rate per 100 000).
Table 2 Age standardised rate (per 100 000) for oesophageal cancer mortality stratified by sex group. Year
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
<15 Years
15–49 Years
P50 Years
Male
Female
Male
Female
Male
Female
0.02 0.04 0.01 0.05 0.04 0.08 0.03 0.02 0.01 0.02
0.00 0.08 0.04 0.05 0.09 0.06 0.03 0.02 0.00 0.02
0.06 0.25 0.20 0.23 0.38 0.35 0.29 0.60 0.50 0.49
0.09 0.14 0.11 0.21 0.28 0.25 0.20 0.47 0.46 0.46
3.48 7.85 7.52 7.42 10.8 11.76 11.19 19.88 18.38 18.43
3.19 5.01 5.20 5.90 7.10 8.20 8.49 14.46 14.96 12.54
4 3.5
Mortality Rate
3 2.5 2 1.5 1 0.5 0
4
03
0 20
20
02 20
01
00
8
99
20
20
19
9 19
6
97
19
9 19
95
19
Fig. 1. Trends of oesophageal cancer mortality during the period 1995–2004 (age standardised rate per 100 000).
fore, this burden of mortality due to EC is expectable for age less than 15 years. EC is a deadly cancer with high mortality. The prognosis is quite poor, because most patients present with advanced disease. Therefore, the overall 5-year survival rate is less than 20%, with most patients dying within the first year of diagnosis [3,20]. Tobacco and alcohol are the risk factors for EC in the world [21,22]. A Japanese study speculated that alcohol-related EC mortality rates have been increasing in Japanese men replacing non-alcohol-related EC deaths [23] but in Iran it seems that patterns of food and nutrient consumption (including drinking hot tea) and also socioeconomic status are playing the main role in the high risk area of Iran, which revealed higher incidence of EC for low social levels [24–26]. Although the study revealed interesting facts about mortality of EC during the study decade in Iran, the results must be interpreted after the reader considers that: the coverage and quality of death registration have increased in our country during the study period
84
M.A. Pourhoseingholi et al. / Arab Journal of Gastroenterology 13 (2012) 82–84
Age
20 18 16 14 12
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
References
<15
15-50
0.01 0.06 0.02 0.05 0.07 0.07 0.03 0.02 0.01 0.02
0.07 0.19 0.16 0.22 0.33 0.3 0.25 0.53 0.48 0.48
10 8
>50 3.34 6.47 6.39 6.68 9 10.05 9.86 17.22 16.71 15.55
<15 15-50 >50
6 4 2 0
Fig. 3. Age-specific rate (per 100 000) for oesophageal cancer mortality during the period 1995–2004.
and observed that increased mortality rates for EC may be probably due to better national registration; however the underestimation of mortality for cancers in Iran due to poor registry is still a problem [13]. Low general awareness about the symptoms of EC and delay in diagnosis of EC due to the lack of a national comprehensive system for early detection of this cancer lead to diagnosis of EC in older ages and the subsequent higher mortality rates of EC. Hence, conducting a programme to increase the general awareness of known and probable risk factors of EC may be helpful to reduce EC incidence, especially in the high incidence area of Iran and reduce its mortality in future decades. Conflict of interest The authors declared that there was no conflict of interest. Acknowledgement This study was sponsored by a Grant from the Research Center for Gastrointestinal and Liver Disease (RCGLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
[1] Mosavi Jarrahi A, Mohagheghi MA. Epidemiology of esophageal cancer in the high-risk population of Iran. Asian Pac J Cancer Prev 2006;7(3):375–80. [2] Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin 2005;55(2):74–108. [3] Polednak AP. Trends in survival for both histologic types of esophageal cancer in US surveillance, epidemiology and end results areas. Int J Cancer 2003;105(1):98–100. [4] Qureshi I, Shende M, Luketich JD. Surgical palliation for Barrett’s esophagus cancer. Surg Oncol Clin N Am 2009;18(3):547–60. [5] Seitz JF, Dahan L, Jacob J, et al. Esophagus cancer. Gastroenterol Clin Biol 2006;30(Spec. No. 2). 2S5-2S15. [6] Schottenfeld C, Fraumeni JF. Cancer epidemiology and prevention. In: Schottenfeld D, Fraumeni Jr JF, editors. 3rd ed. New York USA: Oxford University Press; 2006. [7] Engel LS, Chow WH, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst 2003;95(18):1404–13. [8] Ferlay I, Bray F, Pisani P. GLOBOCAN 2002. cancer incidence, mortality and prevalence worldwide. Lyon: IARC Press; 2002. 2004. [9] Kleihues P, Stewart BW. World cancer report. Lyon: IARC Press–WHO; 2003. [10] Khosravi A, Taylor R, Naghavi M, et al. Mortality in the Islamic Republic of Iran, 1964–2004. Bull World Health Organ 2007;85(8):607–14. [11] Naghavi M. Death report from 18 provinces in Iran. 1st ed. Tehran, Iran: Ministry of Health and Medical Education; 2003. [12] Naghavi M. Death report from 23 provinces in Iran. 1st ed. Tehran, Iran: Ministry of Health and Medical Education; 2003. [13] Naghavi M. Death report from 29 provinces in Iran. 1st ed. Tehran, Iran: Ministry of Health and Medical Education; 2003. [14] National Statistics Center, Online Publications at: