Cancer Incidence in Middle East
The National Cancer Institute (NCI), part of the National Institutes of Health, today released Cancer Incidence in Four Member Countries (Cyprus, Egypt, Israel and Jordan) of the Middle East Cancer Consortium (MECC) Compared with U.S. SEER. The monograph compiles information on cancer incidence between 1996 and 2001, drawn from cancer registries in four member countries as part of the Joint Cancer Registration Project of the Middle East Cancer Consortium (MECC).
The MECC's primary goal is to reduce the incidence and impact of cancer in the Middle East through collaborative research. It was established in 1996 with an official agreement among the Ministries of Health of Cyprus, Egypt, Israel, Jordan, and the Palestinian Authority.
MECC Executive Director, Michael Silbermann, D.M.D., Ph.D., states in the monograph's preface, "Prior to the agreement, most of the countries in the consortium had only recently begun to establish population-based registries. By accelerating and strengthening this process, the Joint Cancer Registration Project very quickly became the flagship of MECC's activities in the region."
"MECC represents one of the few cooperative efforts in the Middle East that has managed to continue uninterrupted through the challenging times in the region," said Joe Harford, Ph.D., Director of NCI's Office of International Affairs and the primary liaison to MECC. "The new monograph comes at the 10th anniversary of the signing of the ministerial agreement forming MECC. It is our hope that the publication of these data and the interesting questions that they raise will stimulate research that will benefit not only the people of the Middle East but will also deepen our understanding of cancer to the benefit of all."
The monograph includes information on interpretation of the data, including the study population, how data were collected, and the strengths and limitations of the data. For comparative purposes, tables show cancer incidence rates from both the MECC registry regions and the Surveillance, Epidemiology, and End Results (SEER) registry program in the United States. SEER, an NCI program, is an authoritative source of information on cancer incidence and survival in the United States and is considered the standard for quality among cancer registries around the world.
"This project represents a decade of hard work and collaboration between scientists from each of these countries and is a model for international scientific collaboration in troubled regions of the world," said Laurence Freedman, Ph.D., director, Biostatistics Unit, Gertner Institute for Epidemiology, Sheba Medical Center, lead author and chair of the MECC's Steering Committee for Joint Cancer Registration.
Major findings in this monograph include the following:
- Jordanians had the lowest overall incidence of cancer, while the United States SEER population and Israeli Jews had substantially higher overall cancer incidence rates than in the other MECC populations. Cypriots, Israeli Arabs, and Egyptians had intermediate cancer incidence rates.
- While overall lung cancer incidence was much lower in the MECC populations than in the U.S. SEER population, the rates were comparable to U.S. SEER rates in Israeli Arab men younger than 60, who are known to have high tobacco consumption.
- Israeli Jews had colorectal cancer rates higher than the U.S. SEER population and more than twice as high as the other MECC populations. This finding calls for further investigation of genetic and dietary/environmental factors among these populations.
- Liver cancer incidence rates in Egyptians were five to seven times as high as those of the other MECC populations, and more than three times the U.S. SEER population. This may be related to the higher prevalence of hepatitis B and C in the population or to contamination of food by aflatoxin, a toxin produced by many species of fungi.
- Egyptians and Israeli Jews had rates of non-Hodgkin lymphoma higher than in the U.S. SEER population and considerably higher than in the other MECC populations. Further studies of risk factors for this malignancy are needed in this region of the world.
- Breast cancer incidence was high in Israeli Jews, comparable to the U.S. population. The other MECC countries had much lower rates. The rates of breast cancer among women under 55 years of age were higher in Israeli Jews than in the U.S. population, which may be related to the genetic mutations in the BRCA genes known to be more prevalent among Ashkenazi women.
- The incidence of esophageal cancer in the MECC countries was among the lowest in the world, which may be related to the relatively low consumption of alcohol in the region. This finding calls for further study, as there is a high prevalence of smoking in most MECC countries, which tends to increase esophageal cancer rates.
- Childhood cancer (under 15 years) was higher overall in the Cyprus population than in the U.S. SEER population and the other MECC populations. The Cypriots reported high rates of childhood leukemia and central nervous system malignancies, while the incidence of childhood lymphoma was particularly high among Egyptians, compared with the other MECC populations.
- Rates of urinary bladder cancer were very high among Egyptians and Israeli Jews, higher than the U.S. SEER population. Egypt's high rate may be partly explained by previously high rates of schistosomiasis, a parasitic disease caused by infection with schistosome blood flukes that damage the bladder, which is a known risk factor for urinary bladder squamous cell carcinoma.
Three additional registries