Cancer Epidemiology in EGYPT

The Real Magnitude Of The Problem

Emad Shash, M.Sc.Ass. Lecturer of Medical Oncology

National Cancer Institute, Cairo UniversityE: emad.shash@oncologyclinic.org

W: www.nci.cu.edu.eg

Egypt

• Population Census is carried out by the Government every 10 years.

• The 1st : 1882 – 6.7 million

• 2006: Last Census – 72.5 million at a growth rate of 37 % over 1996 figure.

• Egypt’s population till 1st of May 2008 reached 78.7 million

51%49%

Male/Female

Males Females

Egypt State Information Service

www2.sis.gov.eg

Egypt Administrative Plan

• Egypt is divided into 29 governorates, 217 Cities and 4617 Villages

• Geographical regions:

1- Upper Egypt

2- Metropolitan Cairo &

Central Egypt

3- The Delta

4- The Canal Zone and Sinai

5- Alexandria and Matrouh

6- North CoastEgypt State Information Service

www2.sis.gov.eg

Egypt State Information Service

www2.sis.gov.eg

11%

9%

6%

3%

3%

6%

0%4%

2%

1%1%

1%

7%

7%

6%

5%

7%

6%

5%

5%

4%2%

1%

0%0%

0% 0%

Egypt Population 2006 Census

Cairo

Giza

Kalyoubia

Bani Souef

Fayoum

Alexandria

Matrouh

Kafr El Sheikh

Demita

Port Said

Ismailyia

Suez

Dakhlia

Sharkyia

Gharbeya

Mounefya

Behira

Menya

Assuit

Sohag

29 %

National Cancer Institute

www.nci.cu.edu.eg

The Largest Comprehensive Cancer Center In the Middle East

National Cancer Institute

• The Original National Cancer Institute including its hospital 270 beds was built in the sixties and started operating in 1969.

• Today Hospital capacity: 532 beds– 369 beds free of charge

– 163 beds for national insurance and privatepatients

Total NCI New Patients 2002-2009

www.nci.cu.edu.eg

Percentage by Geographical Area

www.nci.cu.edu.eg

Percentage of New Patients based on Financial deals

2003-2009

www.nci.cu.edu.eg

Total NCI Number of Follow Up Visits

2003-2009

www.nci.cu.edu.eg

Total NCI Number of Inpatients 2003-2009

www.nci.cu.edu.eg

Medical Oncology Department

• In patient unit (Currently):

60 bed (Solid and Hematological Malignancies)

• Out-patient unit:

New cases and follow up (6 days / week)

• Day care unit:

CTX, Blood component therapy

Numbers of patients served

• Average number of patients seen in o.p. daily 300

• Average number of o.p. treatment given daily 120

• Average inpatient stay: 12 days for solid tumorsand 34 days for hematological malignancies.

Staff of the department

Rank of staff Number

Professors emeriti 2

Professors 11

Ass. Professors 5

Lecturers 16

Ass. Lecturers

Residents & Fellows

Total

18

15

67

NCI Statistical Data

Most Common Sites in Males 2002-2004

0 5 10 15 20

Larynx

Skin

Soft tissue

Colorectal

Lung

Leukemia

Lymphoma

Liver

Bladder

Percent of cases

2004

2003

2002

www.nci.cu.edu.eg

Most Common Sites in Females 2002-2004

0 10 20 30 40 50

Thyroid

Soft tissue

Cervix

Ovary

Liver

Colorectal

Bladder

Leukemia

Lymphoma

Breast

Percent of cases

2004

2003

2002

www.nci.cu.edu.eg

Most Common Sites ,Gender Combined2002-2004

0 5 10 15 20 25

Skin

Lung

Soft tissue

Colorectal

Leukemia

Liver

Lymphoma

Bladder

Breast

Percent of cases

2004

2003

2002

www.nci.cu.edu.eg

Cancer of Urinary Bladder AmongMen & Women, 2002-2007

www.nci.cu.edu.eg

Changing Pattern of Bladder Cancer Type

NCI 1975-2002

www.nci.cu.edu.eg

Liver Cancer AmongMen &Women, 2002-2007

www.nci.cu.edu.eg

Is cancer a problem in Egypt?

• More than 50% of the new cancer cases in the world occur in developing countries

• Cancer is already a significant health problem in many developing countries.

• Burden of the problem will increase:

- Better Diagnosis

- More exposure to Risk Factors

- Increased Life Expectancy

Magnitude is Not Accurately Known!!

• Until 1970, when the NCI of Cairo University startedto function, there were no specialized cancercentres.

• In 1975, the first MoH cancer centre was establishedin the Northern part of Egypt (Tanta Cancer Centre).

• During the last 2-3 decades, (7) MoH cancer centreswere established all over the country to avoid theneed of long distance travel.

• Available statistics were Hospital-based

Gharbiah Population Based Registry

Egypt State Information Service

www2.sis.gov.eg

11%

9%

6%

3%

3%

6%

0%4%

2%

1%1%

1%

7%

7%

6%

5%

7%

6%

5%

5%

4%2%

1%

0%0%

0% 0%

Egypt Population 2006 Census

Cairo

Giza

Kalyoubia

Bani Souef

Fayoum

Alexandria

Matrouh

Kafr El Sheikh

Demita

Port Said

Ismailyia

Suez

Dakhlia

Sharkyia

Gharbeya

Mounefya

Behira

Menya

Assuit

Sohag

40 %

Cancer Profile

Male Cases, NCI Registry 2002Male Cases, Gharbiah Population

Registery 2002

Cancer Profile

Female Cases, NCI Registry 2002Female Cases, Gharbiah Population

Registery 2002

Currently operational

Cancer Registries

• Alexandria Cancer Registry: Hospital Based.

• NCI registry: Hospital Based, biggest series.

• Gharbiah Population Registry: Delta Region.

• Cancer Registry for MOH Cancer Centres: Multi centre, hospital based .

Incomplete Coverage

Almost impossible in 76 million population

Not to Have

National Cancer Registry

Egypt National Cancer Registry

• Population-based cancer registry

• Aswan, Menia, Sinai and Matrouh

• Linkage with Gharbiah data

• NCI central registry

• Establishment of National estimates

Conclusion

• For a better estimate of the Magnitude of the problem; National Cancer Registry is a Must.

• Out reach programs for better awareness and better identification of the non diagnosed ones.

• Health education (Schools, high schools and colleges).

• Mass Media effect by better projection of the problem

(Risk Factors, Early Detection …..).