Prevalence of lung cancer in Isfahan Province, Iran

Journal of the Egyptian National Cancer Institute 30 (2018) 57–59

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Prevalence of lung cancer in Isfahan Province, Iran Zahra Tolou_Ghamari Isfahan Kidney Transplantation Research Center, Isfahan Alzahra Research Centers, Isfahan University of Medical Sciences, Isfahan, Iran

a r t i c l e

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Article history: Received 24 January 2018 Received in revised form 6 March 2018 Accepted 7 March 2018

Keywords: Cancer Prevalence Iran Lung Respiratory

a b s t r a c t Objective: To describe for the first time period prevalence (PP) and incidence rate (Ir) for patients with lung cancer in Isfahan Province/Iran. Design: Data associated to the Surveillance, Epidemiology, and End Results; (SEER) was collected from the Isfahan Cancer Registry from March 2011 to March 2015. Lung cancer was distinguished by the related established topography code. PP and Ir were calculated and expressed per 100,000 persons. Results: In all, 548 females and 1399 males were identified. For the total population the PP was calculated as 39.1 (distinguished as: 30.7 for bronchus and lung, 7.9 for larynx and 0.5 for trachea). This value corresponded to a PP of 55.3 for males and 22.3 for females (p < 0.001). Irs versus mortality rates were calculated for each year, i.e. 2011–2012, 2012–2013, 2013–2014, and 2014–2015, as 9.3 vs 6.3, 10.1 vs 6.6, 9.9 vs 6.3, 9.6 vs 6.4, respectively. The mean (SD, range) age of the patients was 65.8 (14.7, 1–103) years. In relation to the age of study population, lung cancer occurred in 94% of patients aged between 40 and 90 years. Conclusion: The PP for lung cancer in male population was 2.5 times higher than females. There was a 3.2% increase in the Irs over the study period. To facilitate early diagnosis for better management associated to pharmacotherapy or surgical care, our findings emphasized the advantage of further research and greater effort toward environmental, job related exposure, genetic and geographical factors in Isfahan Province/Iran. Ó 2018 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction Previous publications identified lung cancer as the second most common cancer in both genders. In the United States for 2017 there were new cases of 222,500 and deaths of 155,870 cases of lung cancer. In 2008, six million new cases of respiratory system cancer or 12.7% of the total cancer incidence were identified. In 2009, African Americans had the highest incidence rates of 69 per 100,000, whereas Hispanics had the lowest rate of 30 per 100,000. The estimated death related to lung cancer in the United States ranged around 85% that caused by cigarette smoking [1–5]. Due to emission of a particle upon decay, inhaled radon can also have a carcinogenic effect on the lung [6]. Occupational exposures to dusts and asbestos and family history of cancer were mentioned as other causes of lung cancer [7]. In a chronic process there are encompassing changes in genetic, cellular and local tissue. The alteration of usual cells to preneoplastic cells to definite malicious cells contains variations that include DNA tribulations, hereditary and epigenetic alterations. Exposure to various carcinogens alters

Peer review under responsibility of The National Cancer Institute, Cairo University. E-mail address: [email protected]

normal cells long before clinically detectable invasive malignant tumors occur [8,9]. Howlader et al. reported that the 1-year relative survival rate for lung cancer increased from 35% in 1975–79 to 42% in 1988–2008. The overall 5-year survival rate for lung cancer of all stages was reported as 16.8% in 2004 [10]. In malignant pleural mesothelioma patients who underwent surgical treatment, there are several prognostic indices to predict overall survival. The regimen, predictive survival, histology or phase index presented moderate discrimination for those received chemotherapy and best supportive care [11]. Mokarian et al. reported that the rate of cancer is increasing rapidly in Isfahan province [12]. Therefore the aim of this study was to determine the epidemiologic characteristic of lung cancer in Isfahan Province/Iran. Material and methods Ethical approval The study was conducted at the Isfahan Kidney Transplantation Research Centre (IKTRC) and was approved by the Institutional Review Board (No. 295115). Lung cancer data from March 2011 to March 2015 were obtained from the Isfahan Cancer Registry,

https://doi.org/10.1016/j.jnci.2018.03.001 1110-0362/Ó 2018 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Z. Tolou_Ghamari / Journal of the Egyptian National Cancer Institute 30 (2018) 57–59

located at the Isfahan Deputy of Health. The Isfahan Cancer Programme is intended to record all cancer cases in the Isfahan. The management arm of the programme is the deputy of research in the Isfahan University of Medical Sciences. Data analysis The cancer sites studied were defined according to the International Classification of Diseases (ICD-O; third edition). Lung cancer was distinguished by the related topography code such as cancer of larynx (C32), cancer of trachea (C33), bronchus and lung (C34). Collected coded data were linked using the de-identified patients’ name and surname. In the next step, the code for each patient, father’s name, age, gender, pathology report and its’ date, topography code were recorded in Excel.

Fig. 1. Distribution of age in population studied.

Statistical analysis Microsoft Excel was used to arrange raw data before being inputted into the Statistical Package for Social Science (SPSSÒ version 20; IBM Corp., Armonk NY, USA) for analysis. Age, as a continuous variable, was expressed as mean ± standard deviation (SD). Variables such as gender, alive/dead, year of report were expressed by frequency and percentage. In order to examine the differences between PP with gender the t-test was used. The total population for Isfahan City was obtained from the Isfahan/Programme and Budget Management Organization. PP was calculated as the proportion of the total cases over the period of the years 2011– 2015/to population at risk during the same time period  100,00 0. The Ir was calculated by dividing new cases of cancer during a given time period/to the population at risk during the same time period  100,000 [13].

Fig. 2. Period prevalence for lung, larynx and trachea.

Results Demographic and epidemiology characteristic of patients with lung cancer are shown in Table 1. There were 1947 recorded cases, in which 72% were males. With a minimum of 1 and a maximum of 103, the mean age ± standard deviation was 65.8 ± 14.1 years old. Fig. 1 shows distribution of age in population studied (Fig. 1). Age related to respiratory system cancers in 94% defined at the age between 40 and 90 years old of life. Approximately 2% of respiratory cancers were diagnosed in patients between age under 30 years; 3% between 30 and 40 years; 8% between 40 and 50 years; 19% between 50 and 60 years; 23% between 60 and 70 years; 27% between 70 and 80 years and 18% at 80 years and older. The PP was significantly different between males and females (chi-squared test; P < 0.001). With a total PP of 39.1 per 100,000 persons, the prevalence in males (55.3 per 100,000) was 2.5times than that in females (22.3 per 100,000 persons). Fig. 2 shows PP for related sites as, 30.7 for bronchus and lung, 7.9 for larynx and 0.5 for trachea (Fig. 2). Out of total reported cases 65% were related to deceased population. Among dead population, age in 72% was between 60 and 90 years. Fig. 3 shows the total incidence vs mortality incidence for lung cancer between the years 2011–2015 (Fig. 3). The Ir for the related

Fig. 3. Total incidence vs mortality incidence.

years of study was 9.4, 10.1, 9.9 and 9.7 per 100,000 persons, respectively. There was 1275 recorded deaths (65%) included 405 females and 870 males. The estimated mortality Irs, were as: 6.3 (2011–2012), 6.6 (2012–2013), 6.3 (2013–2014) and 6.4 (2014– 2015) per 100,000 persons, correspondingly.

Table 1 Demographic and Epidemiological Characteristics in patients with lung cancer. Population studied

Number

ELC

ED

Age (Min–Max)

PP

Ir 2011–2012

Ir 2012–2013

Ir 2013–2014

Ir 2014–2015

Total Females Males

1947 548 1399

672 143 529

1275 405 870

65.8 (1–103) 65.9 (17–103) 65.7 (1–99)

39.1 22.3 55.3

9.4 5.4 13.2

10.1 5.5 14.5

9.9 6.1 13.8

9.7 5.4 13.8

Z. Tolou_Ghamari / Journal of the Egyptian National Cancer Institute 30 (2018) 57–59

Discussion Historically diagnosis of lung cancer backed to the early 1400s. Due to conflicts for its control, prevention and management strategy it is likely to remain as the world’s leading cause of cancerrelated disease burden [14]. Previous publication mentioned that cancer can be reflected an age-related disease because the incidence of most cancers increases with age, rising more rapidly beginning in midlife [10]. In this study out of total population with lung cancer (n = 1947), age in 94% was ranged from 40 to 90 years old. The reported age from this study associated to some part of life-time incidences was in conflict with published data by Ridge et al. as they reported 0.2% of diagnosed lung cancers between age 20 and 34 years vs 2% diagnosed between age under 30 years (from this study); 1.5% between 35 and 44 years vs 3% between 30 and 40 years (from this study) and 8.3% at 85 years and older vs18% at 80 years and older (from this study) [2]. White et al. reported that, age for most adults, is unpredictably related to avoidable chronic situations, exposures, and modifiable risk behaviors that are causally connected to cancer [10]. Ridge et al. reported a median age of 71 years for cancer of lung and bronchus [2], but in our study with a median age of 67 years there was a tendency of lung cancer toward younger society in Isfahan Province/Iran. Moreover in their study no cases were diagnosed in patients younger than 20 years [2], but in this study, 14 patients were diagnosed between the age of 1 and 20 years. In this study PP in males was 2.5-times higher than females (55.3 versus 22.3; p < 0.001). Hosseini M, et al., studied 242 patients with lung cancer between October 2002 and November 2005. In their study 74% of total patients were males [15]. Vardanjani et al. studied incidence numbers of lung cancer between the years 2003–2009. According to their results, percentage of female lung cancer patients within 5 years from diagnosis was 32.4%, and male: female ratio was 2.01 [16]. Associated to alteration in incidence from 2011 to 2015, there was a 3.2% increase in our study. This is in agreement with previous publications, that mentioned increases of lung cancer incidence along with the development, so that the cancer incidence is more in developed countries rather than less developed countries [15–18]. In our study mortality of lung cancer among total reported population in Isfahan Province, Iran was around 65%. Pakzad et al. studied a total of 1,033,881 incidences in Asian countries in 2012 in which 71.1% were males and 28.9% were females. Sex ratio was 2.5 and there was reported death of 936,051 comprised of 71.5% in men and 28.5% in women [19]. Conclusion The PP associated to lung cancer with a value of 39.1 per 100,000 persons, confirmed 2.5 times higher rate of incidence in males when compared to females. The incidence rate with a value of 9.4 related to year 2011–2012 to a value of 9.6 related to year 2014–2015 showed a 3.2% increase. These findings emphasized that a greater effort should be made for early diagnosis, as management in earlier stage proved to be more curable. Therefore for pre-

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dictive health care outcome toward population of patients with lung cancer, further research associated to; 1) individual targeted pharmacotherapy 2) specific challenge for surgical strategy and 3) environmental factors recommended. Conflict of interest None. Acknowledgements Thanx to head of Urology department Professor Hamid Mazdak, head of Isfahan Kidney Transplantation Research Center Professor Mehrdad Mohamadi, Head of Alzahra Research Centers Professor Massieh Sabouri and Isfahan University of Medical Sciences. Ethical Code No. 295115 appreciated. References [1] Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med 2011;32(4):605–44. [2] Ridge CA, McErlean AM, Ginsberg MS. Epidemiology of lung cancer. Semin Intervent Radiol 2013;30(2):93–8. [3] Wong MCS, Lao XQ, Ho KF, Goggins WB, Tse SLA. Incidence and mortality of lung cancer: global trends and association with socioeconomic status. Sci Rep 2017;7(1):14300. [4] Shopland DR. Tobacco use and its contribution to early cancer mortality with a special emphasis on cigarette smoking. Environ Health Perspect 1995;103 (Suppl. 8):131–42. [5] Hecht SS, Carmella SG, Murphy SE, Akerkar S, Brunnemann KD, Hoffmann D. A tobacco-specific lung carcinogen in the urine of men exposed to cigarette smoke. N Engl J Med 1993;329(21):1543–6. [6] Barros-Dios JM, Barreiro MA, Ruano-Ravina A, Figueiras A. Exposure to residential radon and lung cancer in Spain: a population-based case-control study. Am J Epidemiol 2002;156(6):548–55. [7] Spitz MR, Etzel CJ, Dong Q, Amos CI, Wei Q, Wu X, et al. An expanded risk prediction model for lung cancer. Cancer Prevent Res (Phila) 2008;1(4):250–4. [8] Kelley MJ, McCrory DC. Prevention of lung cancer: summary of published evidence. Chest 2003;123(Suppl. 1):50S–9S. [9] Hjelmborg J, Korhonen T, Holst K, Skytthe A, Pukkala E, Kutschke J, et al. Lung cancer, genetic predisposition and smoking: the Nordic Twin Study of Cancer. Thorax 2017;72(11):1021–7. [10] White MC, Holman DM, Boehm JE, Peipins LA, Grossman M, Henley SJ. Age and cancer risk: a potentially modifiable relationship. Am J Prevent Med 2014;46(3 Suppl. 1):S7–15. [11] Kataoka Y, Yamamoto Y, Otsuki T, Kaku S, Maehashi-Wada N, Fukuma S, et al. External validation of prognostic indices for overall survival of malignant pleural mesothelioma. Lung Cancer 2017;113:88–92. [12] Mokarian F, Ramezani MA, Heydari K, Tabatabaeian M, Tavazohi H. Epidemiology and trend of cancer in Isfahan 2005–2010. J Res Med Sci 2011;16(9):1228–33. [13] Mazdak H, Tolou_Ghamari Z. Preliminary study of prevalence for bladder cancer in Isfahan Province, Iran. Arab J Urol 2018. https://www.journals. elsevier.com/arab-journal-of-urology/recent-articles [in press]. [14] Rubin SA. Lung cancer: past, present, and future. J Thorac Imaging 1991;7 (1):1–8. [15] Hosseini M, Seyed Alinaghi SA, Adimi Naghan P, Karimi S, Bahadori M, Khodadad K, et al. A clinicopathologic study of lung cancer cases in iran. Tanaffos 2009;8(3):28–36. [16] Vardanjani MH, Zeinali M, Radmerikhi S, Hadipour M. Lung cancer prevalence in Iran by histologic subtypes. Adv Biomed Res 2017;6:111. [17] Alberg AJ, Samet JM. Epidemiology of lung cancer. Chest 2003;123(1 Suppl):21S–49S. [18] Youlden DR, Cramb SM, Baade PD. The International Epidemiology of Lung Cancer: geographical distribution and secular trends. J Thorac Oncol 2008;3:819–31. [19] Pakzad R, Mohammadian-Hafshejani A, Ghoncheh M, Iraj Pakzad I, Salehiniya H. The incidence and mortality of lung cancer and their relationship to development in Asia. Transl Lung Cancer Res 2015;4(6):763–74.