Despite decreasing trends, the Kurdistan province is still considered as one of the regions with high incidence of gastric cancer in Iran.

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Abstract​

Background:​

There are no studies on the trend of gastric cancer (GC) incidence in Kurdistan, a province in the west of Iran. We aimed to estimate the trend, age-standardized incidence rate (ASR), and annual percentage change (APC) of GC in this province during 2001–2014.

Materials and Methods:​

The data of newly diagnosed GC patients were obtained from the regional Cancer Registering Database. The ASRs were calculated per 100,000 population during 2001–2014. Direct standardization and 95% confidence intervals (CI) were calculated by an efficient method. The temporary changes in ASRs were determined based on the APC by the joinpoint regression model.

Results:​

Overall, 2225 newly diagnosed GC patients were identified. The ASRs ranged from 13.5 (95% CI: 10.4–17.3) to 29.0 (95% CI: 24.5–34.0). The highest ASRs were related to the men and women lived in Divandareh as 32.26 and 13.66, respectively. The respective APC value of GC incidence in women demonstrated a nonsignificant increase during 2001–2008 and a nonsignificant decrease during 2008–2014 (P = 0.1). Accordingly, the incidence of GC in men increased during 2001–2004 (P = 0.1) and decreased during 2004–2014 (P = 0.001).

Conclusion:​

The incidence of GC showed nonsignificant and significant decreasing trends in women and men in Kurdistan province, respectively. Despite such decreasing trends, the Kurdistan province is still considered as one of the regions with high incidence of GC in Iran. Therefore, it is necessary to implement screening programs in the province to early diagnose GC.

Keywords: Incidence, Iran, joinpoint, Kurdistan, stomach neoplasms, trends

 

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INTRODUCTION​

Gastric cancer (GC) is a multifactorial neoplasm; its development is affected by both environmental and genetic determinants.[1] GC constitutes the fifth common neoplasm following lung, breast, colorectal, and prostate cancers and the third most common cause of cancer-related mortality worldwide.[2,3] In Southeast Asia, GC constitutes the most common etiology of cancer.[1] In 2015, around 1.3 million new GC cases had been diagnosed worldwide leaving behind 819,000 deaths.[4] GC has also caused 17.4 million disabilities as 98% of them contributed as the lost years of life, delivering the highest ratio among all cancers.[4]

More than 70% of GC new cases are diagnosed in developing countries.[2] The incidence of GC in Iran has been higher than other countries in the west of Asia. This higher rate has been attributed to factors such as obesity, genetic determinants, nutritional habits, and lifestyle.[5,6,7,8] A relationship has also been suggested between air pollution and GC development in men.[9] Nevertheless, the disability-adjusted life years trend of GC in Iran showed a 38% decrease from 1990 to 2010.[10]

There are some studies on the trend of GC incidence in Iran and the world. However, to establish preventive measures and policies, there is a need for performing the trend analyses in local level. This is important as the risk factors of GC may vary in different regions of a country. According to the annual reporting of Ministry of Health of Iran, the incidence of GC was high in this province, and this province was identified as one of the high-risk provinces of Iran. In addition, lifestyle factors of Iranian population were changed during decades, including nutrition factors related to the GC. Therefore, there was a need to know the pattern of change of GC in parallel with the mentioned changes. On the other hand, in other regions of Iran, the traditional methods were applied to investigate the trend of cancer, but in this study, we were applied a new approach to estimate the trend of GC.

As there were no studies on the incidence rate and trend of GC in Kurdistan, a western province of Iran, here, we aimed to estimate the trend, age-standardized incidence rate (ASR), and annual percentage change (APC) of GC incidence using the archives of the regional Cancer Registering Database from 2001 to 2014. For this purpose, we applied joinpoint regression statistical software which is used to develop simple joinpoint models for cancer incidence trend.

 

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MATERIALS AND METHODS​

Study population​

Kurdistan is a province located in the western region of Iran and constitutes eight counties. The majority of the residents of this province are farmers and ranchers. In the national census in 2016, the overall population of this province was estimated as 1,600,000 with 71% of them lived in urban areas.
In this study, all the patients newly diagnosed with GC (the International Classification of Diseases 10 code of 16) during 2001–2014 were included. In our province, local pathology clinics, laboratories, and hospitals regularly report that all the new cases of cancer are to a regional cancer registry center affiliated with the Health Deputy of Kurdistan University of Medical Sciences.[11] In the case of migration of patients to other regions for diagnosis, follow–up, and treatment, these cases are still monitored by or regional cancer registry center.
After gathering the intended information, the duplicates were identified (based on comparing information such as national code, first and last names, sex, age, and address) and removed by independently reviewing the records by two of the authors (RM and AN). Finally, 2229 unique cases of GC were identified from whom four patients with unknown age were excluded from the final analysis.
The characteristics of local population that used for calculating of intended incidence rates were interpolated from the population data provided by the Iranian Health Ministry.[12] These indices included the annual birth and death rates by individual gender and age groups.
We also recorded the age, year of diagnosis, as well as patient's gender. The age spectrum of 30–80-year-old was divided into 10-year intervals including <30, 30–39, 40–49, 50–59, 60–69, 70–79, and >80-year-old categories.

 

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View attachment 204215

High incidence of stomach cancer with relatively low prevalence of h pylori in Kurdistan

 

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High incidence of stomach cancer with relatively low prevalence of h pylori in Kurdistan

 

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Probably because they eat something raw. Like caviar.