Cancer in the Philippines
Vol. IV Part 1 – Cancer Incidence 1998-2002
M. T. M. Redaniel, A.V. Laudico, M.R.M. Lumague,
C.A. Mapua, T. Patama, E. Pukkala
MANILA CANCER REGISTRY
DEPARTMENT OF HEALTH RIZAL CANCER REGISTRY
UNIVERSITY OF THE PHILIPPINES MANILA
SURGERY RESEARCH UNIT
PHILIPPINE CANCER SOCIETY MANILA, 2008
Cancer in the Philippines
Vol. IV Part 1 – Cancer Incidence 1998-2002
M. T. M. Redaniel, A.V. Laudico, M.R.M. Lumague,
C.A. Mapua, T. Patama, E. Pukkala
PHILIPPINE CANCER SOCIETY- MANILA CANCER REGISTRY DEPARTMENT OF HEALTH- RIZAL CANCER REGISTRY
UNIVERSITY OF THE PHILIPPINES MANILA-SURGERY RESEARCH UNIT FINNISH CANCER REGISTRY
CONTENTS
Foreword ........................................................................................................... V
I. Introduction......................................................................................................... 1
Population-based registries in Metropolitan Manila and Rizal Province................................................... 1
The Registration Areas............................................................................................................................... 2
Socio Demographic, Economic and Health Aspects................................................................................... 5
II. Methods............................................................................................................... 6 Data Collection Overview........................................................................................................................... 6
Data sources............................................................................................................................................... 6
Data Management..................................................................................................................................... 6
Quality Control........................................................................................................................................... 7
Data Analysis.............................................................................................................................................. 8
Incidence Maps.......................................................................................................................................... 9
III. Results and Discussion......................................................................................... 10 Data Description....................................................................................................................................... 10
Leading Cancer sites................................................................................................................................. 10
Overall Cancer Incidence (All Sites).......................................................................................................... 10
Oral Cavity................................................................................................................................................ 16
Stomach.................................................................................................................................................... 21
Colon......................................................................................................................................................... 25
Rectum...................................................................................................................................................... 27
Liver........................................................................................................................................................... 31
Lung........................................................................................................................................................... 35
Breast........................................................................................................................................................ 42
Cervix Uteri............................................................................................................................................... 44
Prostate.................................................................................................................................................... 46
Thyroid...................................................................................................................................................... 49
List of contributors.............................................................................................. 54
Philippine Cancer Society Board of Trustees........................................................ 55
Philippine Cancer Society-Manila Cancer Registry Staff
Department of Health – Rizal Cancer Registry Staff
Appendices......................................................................................................... 56 2000 Population Census by Area, Age Group and Sex............................................................................. 56
Annual Incidence per 100,000 by Age Group, male, Manila.................................................................... 63
Annual Incidence per 100,000 by Age Group, Female, Manila................................................................ 64
Annual Incidence per 100,000 by Age Group, Male, Rizal....................................................................... 65
Annual Incidence per 100,000 by Age Group, Female, Rizal................................................................... 66
Comparison of the Most Common Cancer Sites for Four time Periods................................................... 67
Foreword
his monograph presents the fourth volume of
the analysis of the incidence of cancer in the populations of Metropolitan Manila and Rizal
Province, in the Republic of the Philippines. The data used are again from the two population-
based cancer registries, namely the Department of Health-Rizal Cancer Registry and the
Philippine Cancer Society-Manila Cancer Registry. It covers the period from 1998 to 2002.
Cancer in the Philippines Vol.4 (CIP4) is now divided into two parts, CIP4 Part 1 –
Cancer Incidence 1998-2002, and, CIP4 Part 2 – Cancer Incidence Trends 1980-2002.
In CIP4 Part 1, as in the third volume, the incidence rates for leading cancer sites are
presented by age-group, sex and geographic subdivisions (cities/municipalities) of the
registration area. These rates are then compared with those from other populations. Also, for
the first time, incidence maps are included, provided by the Finnish Cancer Registry.
In CIP4 Part 2, a trend analysis for leading cancer sites using joinpoint regression
developed by the National Cancer Institute of the United States will be presented, and will also
include incidence maps.
The entire book was produced using personal computers and computer software, which
are widely distributed. Hence, this volume proves that the results of a cancer registry may be
summarized into a monograph illustrated by tables and figures with the aid of nothing more
complicated than a personal computer.
The production of the monograph was generously supported by the Degenerative Disease
Office – National Center for Disease Prevention and Control of the Department of Health.
T
1
The Republic of the Philippines which is located in theSoutheast Asia region, is an archipelago composed ofmore than 7,000 islands bounded by the Pacific Oceanand the South China Sea. The country is divided intothree main island groups - Luzon, Visayas andMindanao. Metropolitan Manila and Rizal Provinceare centrally located in Luzon, which is the secondlargest island, located in the northern portion of thearchipelago. The exact location of these two areas isbetween latitudes 14°18’ and 14°50’ North and betweenlongitudes 120°59’ and 121°29’ West.
Cancer in the Philippines Vol. 4 Part 1 presents anepidemiological profile of the major cancers inMetropolitan Manila and the province of Rizal for theperiod 1980-2002. Data from the two population-basedregistries, the Department of Health-Rizal CancerRegistry (DOH-RCR) and the Philippine CancerSociety-Manila Cancer Registry (PCS-MCR), wereanalyzed in detail with the age–standardized rates(ASR) for each area being compared with the ASR forall the areas combined. Comparison with rates fromother areas in the world are presented, as well asincidence maps.
1.1. Population-Based Registries inMetropolitan Manila and Rizal Province
Until 1987, the DOH-RCR and the PCS-MCR were theonly population-based cancer registries in the country.The area covered by these two registries is the mostpopulous and medically sophisticated in the country,enabling a fairly accurate view of cancer incidence tobe obtained, and providing a basis for futureepidemiological and clinical studies on cancer, as wellas valuable inputs to cancer control activities.
1.1.1. The Department of Health-Rizal CancerRegistry (DOH-RCR)
The first population-based cancer registry in the countrywas established in 1974 as one of the activities of theCommunity Cancer Control Program of the provinceof Rizal. At that time, Rizal was still composed of 26municipalities, 12 of which were subsequentlyincorporated into Metropolitan Manila in 1975.
From 1974 to 1979, data collection was entirelypassive relying on notification from physicians andhospitals. This system was highly unsatisfactory so thatactive registration was started in 1980. Researchassistants were trained in methods of cancerregistration and were assigned to abstract data fromhospitals and death certificates. In 1984, the registrystarted a cooperative effort with the Philippine CancerSociety-Manila Cancer Registry in covering 134hospitals within the National Capital Region and RizalProvince. Both registries use the same forms and thesame method of active data collection.
Since 1978, data from the Rizal Cancer Registryhave been included in Cancer Incidence in Five Continents(http://www-dep.iacr.fr). Data for 1978-1982 werepart of Volume V, 1983-1987 data in Volume VI and1993-1997 data in Volume VIII.
The DOH-RCR is located in the Rizal MedicalCenter in Pasig City. It was initially funded by the Rizalprovincial government but since 1975, funding has beena full responsibility of the Rizal Medical Center. Itspresent staff consists of a surgical oncologist who headsthe registry, two surgeons, two full-time registry clerks,and five part-time cancer registry research assistants(collaborative work with IARC and the Andres SorianoFoundation).
1.1.2. The Philippine Cancer Society-Manila CancerRegistry (PCS-MCR)
The first formal cancer registration activity in thePhilippines was started in 1959 by the PhilippineCancer Society (PCS) when it established the CentralTumor Registry of the Philippines (CTRP). The CTRPcollected data from 26 hospitals, 25 in MetropolitanManila and one located in Cebu, completely relyingon notifications from these hospitals.
The CTRP was converted into a population-basedregistry in 1983. It covered the population of fourcities included in the Metropolitan Manila area(Manila, Quezon City, Pasay City and Caloocan City)and was renamed the Philippine Cancer Society-ManilaCancer Registry.
IIntroduction
2
One of the first tasks of the PCS-MCR was aretrospective review of records covering the period of1980-1982 in all hospitals, since prior to 1983 datacollection relied solely on passive notification of cases.A review of death certificates was also accomplished.All of the smaller hospitals which were not part of theCTRP network were now included in the PCS-MCR.The DOH-RCR was also able to provide data on casesit had identified among residents of the four cities.Incidence data from the PCS-MCR have been includedin vols. VI, VII, VIII and IX of Cancer Incidence in FiveContinents.
The registry is located in the PCS building, and isfully funded by the PCS. The registry staff is composedof four part-time consultants (two surgical oncologists,one of whom heads the registr y, and twoepidemiologists), one full-time supervisor, and sixcancer registry research assistants.
1.2. The Registration Areas
The Republic of the Philippines is part of SoutheastAsia, between the Pacific Ocean and the South ChinaSea (Figures 1.2.1 & 1.2.2). The total land area
Figure 1.2.1. Location of the Republic of the Philippines. (http://go.hrw.com/atlas/norm htm/world.htm)
involved in cancer registration comprises of 1,944square kilometers. The area is in the central part ofLuzon Island, bounded by Manila Bay in the West,the province of Bulacan in the North, and the provincesof Cavite and Laguna in the southwest. To the Eastlies Quezon province. The southern border faces a largelake, the Laguna de Bay (Figures 1.2.3 & 1.2.4).
Metropolitan Manila, called the National CapitalRegion (NCR), consists of 16 cities and 1 municipalitylocated in an area of 635 square kilometers. The NCRis the major urban center of the country. The presentRizal province consists of 1 city and 13 municipalitieswith an area of 1,039 square kilometers and apopulation that is 75 percent urban (Figure 1.2.5).
The DOH-RCR covers the 26 municipalities of theoriginal province of Rizal, encompassing a land areaof 1343 km2, situated between latitudes 14°1’79" and14°45’51" North and between longitudes 120°57’59"and 121°15’10" West. Of the 12 municipalities thatwere incorporated into Metro Manila, 6 became citiesduring 1994 to 1999. Of the fourteen remainingmunicipalities of Rizal province, one (Antipolo)became a city in 1999, ten (10) are ‘urbanizing’ andonly three are rural.
3
4
5
The PCS-MCR covers the four major cities(Manila, Quezon, Pasay, Caloocan) of the NationalCapital Region (NCR) which is the major urban centerof the country. It encompasses a land area of 274.2km2 located in the southwest portion of Luzon betweenlatitudes 14° 48’23" and 14°31’15" North and betweenlongitudes 14°39’53" and 121°05’20" West. The city ofManila is the capital of the Philippines and is thecountry’s main port, the hub of commerce and tradeand the seat of cultural and intellectual activities.
1.3. Socio-demographic, Economic and HealthAspects
The population covered by the DOH-RCR, based onthe 2000 census was 5,866,920, with a male to femaleratio of 0.97:1 (Figure 1.3.1). There had been a 10.5%increase compared to the 1995 census. The populationwas predominantly young (33.10% below 15 years ofage and 2.73% over 65 years). The largest ethnic groupwas Tagalog (81.78%) while the second and thirdlargest groups were Bicol (4.30%) and Bisaya (3.07%),respectively. The following were the foreign groupsnoted: American/English (0.025%), Other Foreign(0.018%) and Chinese (0.012%). Eighty-nine percent
(89%) were Roman Catholic, 3.2% belonged to Iglesiani Cristo and 0.17% were Muslims.
The population covered by the PCS-MCR, basedon the 2000 Census of Population and Housing, was5,287,425, representing an increase of 4.1% ascompared to that in 1995. As a whole, the populationwas young, with 31.87% under 15 years of age and only2.10% over 65 (Figure 1.3.2). There were 140 differentethnic groups, the largest of which were Tagalog(69.85%), Bicol (4.27%), Ilocano (4.16%), Bisaya(3.87%) and Waray (2.81%). Among the foreign ethnicgroups, the largest were Chinese (0.59%). People ofAmerican/English ethnicity and other foreign groupscomprised 0.02% and 0.04%, respectively. RomanCatholics comprised 88.8% of the population while3.2% belonged to Iglesia ni Kristo and 0.6 % wereMuslims.
Health services in the National Capital Region andthe adjacent province of Rizal included four (4) cancerinstitutes, 168 secondary and tertiary care hospitals,43 primary care hospitals and 32 clinics of theDepartment of Health for outpatient consultations. Tenhospitals had radiotherapy facilities.
6
2.1. Data Collection Overview
Although cancer is a notifiable disease, passivecollection of cancer data from physicians and hospitalswas unsuccessful. Previous experience in the DOH-RCR showed a high degree of under-reporting. Thusdata collection shifted to an active search for cases.Registry research assistants, formerly known as cancerregistry clerks, were trained to obtain pertinent cancerdata from medical records and death certificates.
Letters and visits to hospital directors and medicalrecords officers preceded actual data gathering.
Data collection from hospitals included thefollowing activities:
1. Case finding or identification of cancer caseswho were residents of the catchment area ofthe registry. A case-finding list was preparedfor every hospital data source. These lists werelater collated and matched prior to abstracting.Pertinent information obtained by case findingwas later integrated into the hospital abstract.
2. Actual abstracting of data from the medicalrecords and completion of the hospital abstractform.
Death certificates from the office of the Local CivilRegistries were also reviewed. For death certificates,the death certificate abstract form (Appendix IV) wasfilled out for patients with cancer mentioned as theunderlying, immediate or contributory cause of deathand whose permanent address was within thecatchment area of the registry.
The registry staff also visited private oncologistsand hematologists to ensure registration completeness.
2.2. Data Sources
These included the following:
1. Records of hospitals located in theMetropolitan Manila and Rizal areas. Caseswere collected from the following data sources:
a. Medical records, both inpatient andoutpatient
b. Pathology records including surgicalpathology, cytology, hematology andautopsy reports and logbooks
c. Radiotherapy records and logsd. Radiology, ultrasound, nuclear medicine
and CT scan reports and logse. Hospital Tumor registry, if available
2. Death certificates gathered from the offices ofthe Local Civil Registrar of the municipalitiesof Metropolitan Manila and the province ofRizal.
2.3. Data Management
Data management was done as follows:
1. All documents received at registry werestamped with the proper date.
2. A summary of all cases abstracted in eachhospital (the Intake of Cases) was prepared bygiving the number of cases collected from ahospital per year and the distribution of casesper hospital by site.
3. A summary of all death certificate abstractsgathered per municipality per year (Intake ofDeaths) was likewise prepared, giving thenumber of deaths from cancer per municipalityper year and the distribution of cases by site aswell as the cases for follow-back and thehospitals where the follow-back will be made.
4. Both hospital abstract and death certificateabstracts were checked for completeness as wellas consistency. Abstracts with missing essentialdata or with inconsistencies were held in aSuspense File pending completion of data orcorrection of inconsistencies.
5. To avoid duplication, completed hospital anddeath certificate abstracts were compared withthe following:
IIMethods
7
a. The Master Patient Index File, which wasan alphabetical file of all registered cancercases, including both living and dead cases.
b. Prior to Reference Date Cases, which wasan alphabetically arranged file of casesdiagnosed prior to the reference date of theregistry.
c. The Site Index File, which was an indexfile of cases, arranged by primary site.
d. In matching the name of patients,allowance was made for errors in spelling(phonetic spelling of names or errors inspelling due to varying degrees of legibilityof handwritten records). If there was asimilarity of name, the age, sex, residenceand diagnosis were compared.
e. If the death certificate abstract was notpreviously registered, this was followedback in the hospital where the patient died,or if the patient died at home, the deathcertificate abstract was matched with thedifferent case-finding lists from thedifferent hospitals to determine if the casewas previously seen in a hospital or not.If the case could not be traced back to ahospital or to the physician who signed thedeath cer tif icate, the case was thenregistered under the “Death CertificateOnly” category (DCO).
6. Data were encoded using the IARC/IACRCanReg 4 software, which incorporated checksfor consistency and validity of codes.
2.4. Quality Control
Quality control was assessed through the followingindices:
1. Histologically Verified (HV) Percentage: Thiswas the percentage of cases whose diagnosiswas based on histological examination of tissuefrom a primary site or from a metastatic site.For leukemia, this included examination of thebone marrow. Cases based on cytology orperipheral blood smear were not considered ashistologically verified.
Cases seen in Radiotherapy Units where thebasis for diagnosis indicated were coded underthe “Clinical Only” category. However, sincemost radiotherapy unit gave irradiation onlyto histologically verified cases, (with theexception of oncological emergencies), thiswould have led to the Histologically Verified
percentage being an underestimate of the truevalue.
2. Death Certificate Only (DCO) Percentage:This is the percentage of cases where diagnosiswas based solely on information obtained froma death certificate. If this percentage was high,it reflected the degree of underreporting in theregistry.
The percentages of cases of histologically verifiedand registered from death certificates only for each timeperiod are shown in Tables 1 and 2 in the Results andDiscussion part of this paper.
2.5. Data Analysis
The computation of incidence rates was based on thenumber of new cases registered by the DOH-RCR andthe PCS-MCR for the time periods 1 January 1998 to31 December 2002.
In this fourth volume, analysis of the data included:
1. Average annual crude incidence rates per100,000 by sex and site for the period covering1998-2002.
2. Average annual age-specific incidence ratesper 100,000 by sex, site and age groups for theperiod covering 1998-2002.
3. Age-standardized rates (ASR) per 100,000carried out by the direct method using theworld standard population.
4. A detailed analysis of the most frequentmalignancies and other sites of interest,including the following: oral cavity, stomach,colon, rectum, liver, lung (bronchus), breast(female), cervix uteri, prostate, and thyroid forthe period of 1998-2002.
2.5.1. Population
The number of person-years was derived from the 2000census reported by the National Census and StatisticsOffice.
2.5.2. Geographic Subdivision
As in the previous volume, volume IV calls the differentgeographical subdivisions (cities/municipalities) bytheir proper names in order to avoid confusion withthe administrative “regions” used by the Department
8
of Health. The numbering and geographic location ofeach city/municipality are:
PCS-Manila Cancer Registry
1. City of Manila 14º36’N 120º58’E
2. Caloocan City 14º39’N 120º58’E
3. Pasay City 14º34’N 121º00’E
4. Quezon City 14º39’N 121º03’E
DOH-Rizal Cancer Registry
5. Pasig City 14º34’N 121º05’E
6. Las Piñas 14º29’N 121º59’E
7. Makati City 14º34’N 121º02’E
8. Antipolo City 14º35’N 121º10’E
9. Taguig City 14º32’N 121º04’E
10. Parañaque City 14º30’N 120º59’E
11. Marikina City 14º38’N 121º06’E
12. Muntinlupa City 14º23’N 121º03’E
13. Malabon City 14º39’N 120º57’E
14.Mandaluyong City 14º35’N 121º02’E
15.Cainta 14º29’N 121º13’E
16.Navotas 14º40’N 120º57’E
17.Taytay 14º33’N 121º08’E
18.Binangonan 14º28’N 121º11’E
19.San Mateo 14º42’N 121º07’E
20.San Juan 14º36’N 121º01’E
21.Montalban 14º44’N 121º09’E
22.Tanay 14º30’N 121º17’E
23.Angono 14º32’N 121º09’E
24.Pateros 14º33’N 121º04’E
25.Pililla 14º29’N 121º18’E
26.Morong 14º31’N 121º14’E
27.Cardona 14º29’N 121º13’E
28.Teresa 14º34’N 121º12’E
29.Baras 14º32’N 121º16’E
30.Jala-Jala 14º21’N 121º20’E
The numbering and geographic locations were used inthe production of the site-specific cancer incidencemaps (Figure 2.5.1)
9
2.5.3. Statistical Methods
For comparisons of age-adjusted incidence ratesbetween the different areas, the significance of thedifference between the incidence rate for each area, withthat for the entire Rizal and Metro Manila (overall)was tested. The method used was the Mantel-Haenszel(M-H) test. The difference in rates was significant atthe a = 0.05 when |M-H| is equal to or greater than1.96. This was indicated by an asterisk (*) in the tables.
The M-H test takes into account the possible effectof the differences in the variance of age-groups to theASR. It takes into consideration the differences in thevariance by age-groups. This means that the M-H testunderscores the variation between age-specific rates ofthe groups being compared. The formula for this isillustrated below.
2.6. Incidence Maps
The database was sent by the two registries to theFinnish Cancer Registry and consisted of annualnumber of cases by age-group in each city/municipalityfor each of the selected sites/sex, and the populationof each city/municipality and their individualgeographic locations. The ASRs were located using ametric coordinate system called Philippines Zone III.Every city/municipality was shown as a circle, thediameter of which described the order of the male orfemale populations. The size does not indicate absolutepopulation size differences.
There was a relative color scale used for showingthe ASRs with 19 colors, ranging from blue and greentints depicting low rates, to red and violet depictinghigh rates. A step change from one color level to anothercorresponds to a 10% or 1.1-fold relative change in theASR. The lower limit of the highest category istherefore always 5.07 times (1.117 ) the upper limit ofthe lowest category. The color scale is fixed so thatvalues of the ASRs can be seen. The map consists oflayers, such as area boundaries, titles, scales and circles.The maps were created using a self-developed serversidesoftware which can generate the map outlook. Thesoftware used the Mapserver module(http://umn.mapserver.ch/) to handle the map layersand produce a single image.
Additional information, such as names of cities/municipalities and asterisks, were inserted at theSurgery Research Unit of the University of thePhilippines Manila.
where:k2x = the number of cases in age group x in the second populationKx = the total number of cases in age group xm1x = the person - years in age group x in the first populationm2x = the person - years in age group x in the second populationMx = the total person - years in age group x
10
3.1. Data Description
The complete 1998-2002 incidence data for All Sites,generated through the CANREG software of theInternational Agency for Research on Cancer areincluded in Appendix II, consisting of four separateTables. The database used for the computations of thismonograph differs slightly but not significantly, becauseof continuing updating of case files by the tworegistries.
During the period between 1998 and 2002, a total of63,194 new cases were included in the two registries. Therewere 27,154 cases among males and 36,040 cases amongfemales, resulting in a male to female ratio of 1 male toevery 1.3 females. From the PCS-MCR areas, a total of33,351 cases were recorded, comprising of 14,360 malesand 18,991 females. On the other hand, in the DOH-RCR areas, 29,843 new cases were recorded, 12,794 ofwhich were males while 17,049 were females.
Table 3.1.1 shows that in DOH-RCR areas, 59percent of cases among males were histologicallyverified while 16.1 percent were registered throughdeath cer tificates (DCO). Among females, theproportions were 73.1 percent and 11.9 percent,respectively.
For the PCS-MCR areas, 64.5 percent of casesamong males were histologically verified while thisproportion was 77.9 percent among females (Table3.1.2). The proportion of cases that were identifiedthrough death certificates were 12.5 percent in malesand 7.9 percent in females.
3.2. Leading Cancer Sites
The ten most common cancer sites for the period1998-2002 are shown in Figures 3.2.1, 3.2.2 and 3.2.3.The rankings based on the proportion of cases fromthe total in comparison with the previous years areshown in Appendix III.
For both sexes, the four most common cancer siteswere Breast, Lung, Liver and Cervix, similar to 1993-1997. As compared to the previous period, Colon
cancer jumped to 5th from 6th and Thyroid cancerjumped from 7th to 6th. Rectum rose from 10th to 7thwhile Ovary remained in 8th place. Prostate is nowranked 9th and Non-Hodgkin Lymphoma 10th.
In men, the three most common cancers were thesame in comparison to the previous period. Coloncancer moved from 5th to 4th while Rectal cancer roseto 5th from 8th, Non-Hodgkin Lymphoma rose to 6thfrom 9th. Nasopharynx remained in 7th as Stomachcancer dropped from 6th to 8th. Laryngeal and Brainand nervous system cancers ranked 9th and 10th,respectively.
For women, the three most common cancer siteswere the same as that in 1998-1997 namely: Breast,Cervix, and Ovary. Thyroid cancer rose from 5th to4th while Lung cancer dropped to 5th from 4th. Colonand liver cancers remained in the 6th and 8th place,respectively. Corpus uteri rose to 7th from 9th whilerectum rose to 9th from 10th. Non-Hodgkin Lymphomais ranked 10th.
3.3. Overall Cancer Incidence (All Sites)
The overall (all sites) crude incidence rate for all theareas covered among males was 98.9 per 100,000population whereas the overall age-standardizedincidence rate was 194.1 per 100,000 population. Forfemales, the overall crude and age-specific rates were127.2 per 100,000 and 192.7 per 100,000, respectively.The crude, age-standardized and 5-year age-specificincidence rates for the different areas covered by theregistries are shown in tables and correspondingincidence maps.
For males (Table 3.3.1 & Figure 3.3.1), the PCS-MCR had an ASR of 214.9 per 100,000 population thatwas signif icantly higher than the overall ASR.Meanwhile, the DOH-RCR had an ASR of 174.8 per100,000 that was significantly lower. The DOH-RCRRizal area had an ASR that was significantly lower thanthe overall (133.6 per 100,000) while there was notenough evidence to say that the ASR for the DOH-RCR Metro Manila area was significantly lower thanthe overall.
IIIResults and Discussion
11
12
Table 3.1.1. Percentage of cases registered with histological confirmation of diagnosis (%HV) or on the basis of information only from adeath certificate (%DCO), DOH-RCR, 1998-2002.
ICD-1O Site No. of Cases % HV % DCO
Male Female Male Female Male Female
C00-C06 Oral cavity 215 219 86.5 79 7.4 12.3
C07-C08 Lip 85 73 88.2 80.8 4.7 9.6
C11 Nasopharynx 473 212 73.8 76.4 10.4 11.8
C15 Oesophagus 152 60 61.8 51.7 11.2 23.3
C16 Stomach 445 382 51.7 52 21.6 23
C18 Colon 841 797 63.5 67.8 14.1 13.3
C19-C21 Rectum 574 414 84.1 82.6 6.3 6.8
C22 Liver 1394 549 35.2 32.6 23.6 26
C25 Pancreas 270 290 39.3 35.5 25.9 23.4
C32 Larynx 308 48 78.9 72.9 6.8 14.6
C33-C34 Bronchus, lung 2844 1015 49.5 52.9 16.6 16.3
C40-C41 Bone 243 213 48.1 44.6 37 41.8
C47; C49 Connective tissue 179 167 82.7 81.4 3.9 7.2
C44 Other skin 172 206 84.9 87.9 5.8 3.4
C50 Breast 53 4852 71.7 85.1 9.4 7.4
C55 Uterus, unspecified 231 30.7 61.9
C53 Cervix uteri 1802 79.1 8.4
C58 Placenta 51 76.5 8.4
C54 Corpus uteri 629 90.5 2.2
C56 Ovary 1081 71.8 8.9
C51-C52; C57 Other female genital 68 75 5.9
C61 Prostate 976 65.7 16.4
C62 Testis 96 76 7.3
C60 Penis, etc. 38 86.8 10.5
C64 Kidney 236 171 51.7 92.4 18.6 13.5
C67 Bladder 229 100 76.9 73 5.7 9
C69 Eye 52 49 63.5 79.6 7.7 2
C70-C72 Brain, nervous system 318 244 49.1 52 25.8 20.9
C73 Thyroid 247 1001 85 89.1 4.5 3
C82-C85; C96 Non-Hodgkin lymphoma 482 377 69.3 68.4 7.7 8.8
C81 Hodgkin’s disease 64 51 75 92.2 10.9 5.9
C91 Lymphoid leukemia 231 172 84.4 86 8.2 5.2
C92 Myeloid leukemia 302 309 84.1 81 4.6 4.9
All Sites 12799 16960 59 73.1 16.1 11.9
13
Table 3.1.2. Percentage of cases registered with histological confirmation of diagnosis (%HV) or on the basis of information only from adeath certificate (%DCO), PCS-MCR, 1998-2002.
ICD-1O Site No. of Cases % HV % DCO
Male Female Male Female Male Female
C00-C06 Oral cavity 256 252 90.23 84.52 27.73 4.76
C07-C08 Lip 76 65 93.42 95.38 1.31 0
C11 Nasopharynx 525 253 75.04 76.28 4.76 1.98
C15 Oesophagus 197 61 69.03 57.37 6.59 13.11
C16 Stomach 521 462 65.64 65.15 8.83 12.34
C18 Colon 932 919 75.11 77.91 6.55 3.59
C19-C21 Rectum 652 578 85.59 86.33 2.61 2.77
C22 Liver 1553 558 24.98 26.16 28.46 26.52
C25 Pancreas 266 309 33.46 37.22 10.90 15.53
C32 Larynx 337 66 83.98 77.27 5.34 15.15
C33-C34 Bronchus, lung 3198 1180 55.97 56.44 15.32 13.98
C40-C41 Bone 240 196 47.08 51.53 45.42 43.37
C47; C49 Connective tissue 213 220 84.04 84.54 1.88 0
C44 Other skin 296 286 97.30 93.0 1.01 2.09
C50 Breast 85 5225 65.88 86.49 11.76 5.42
C55 Uterus, unspecified 200 42.5 46.5
C53 Cervix uteri 2006 90.23 3.19
C58 Placenta 66 83.33 1.51
C54 Corpus uteri 878 90.54 2.05
C56 Ovary 1153 73.11 8.32
C51-C52; C57 Other female genital 57 91.23 0
C61 Prostate 1246 69.82 10.27
C64 Kidney 316 225 65.50 61.33 18.04 20.89
C62 Testis 152 80.92 5.69
C60 Penis, etc. 49 89.8 0
C67 Bladder 279 105 85.3 80.95 1.43 2.86
C69 Eye 43 39 83.73 74.36 4.65 2.56
C70-C72 Brain, nervous system 290 259 50.69 47.10 15.86 20.07
C73 Thyroid 265 1222 90.56 93.13 6.04 0.41
C82-C85; C96 Non-Hodgkin lymphoma 609 522 79.64 76.24 4.10 2.29
C81 Hodgkin's disease 31 94 100.00 100.00 0 0
C91 Lymphoid leukemia 231 185 93.94 93.55 5.63 5.94
C92 Myeloid leukemia 282 265 94.68 95.09 4.96 4.53
C94-C95 Other and unspecified leukemias 153 170 53.59 50.00 43.79 48.82
Others 1071 921
All Sites 14364 18997 64.48 77.90 12.45 7.94
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The areas with ASRs that were significantly higherthan that of the overall were Manila, Quezon City,Parañaque, Pasig and San Juan. On the other hand,the areas with ASRs that were significantly lower thanthe overall ASR were Caloocan, Muntinlupa, Navotas,Taguig, Angono, Antipolo, Baras, Binangonan, Cainta,Cardona, Jala-jala, Montalban, Morong, Pililia, SanMateo, Tanay, and Taytay.
For females (Table 3.3.2 & Figure 3.3.2), the PCS-MCR, likewise, had a significantly higher ASR (209.5per 100,000) than the overall whereas the DOH-RCRhad a significantly lower ASR (176.5 per 100,000). TheRizal areas covered by DOH-RCR similarly exhibiteda significantly lower ASR (127.5 per 100,000) but therewas not enough evidence to say that the ASR for theDOH-RCR Metro Manila areas was significantly lowerthan the overall.
The cities/municipalities that showed significantlyhigher ASRs than the overall were Manila, QuezonCity, Mandaluyong, Parañaque, Pasig and San Juan.Conversely, those that presented significantly lower
ASRs were Caloocan, Las Piñas, Malabon, Marikina,Navotas, Taguig, Angono, Antipolo, Baras,Binangonan, Cainta, Cardona, Jala-jala, Montalban,Morong, Pililia, San Mateo, Tanay, Taytay and Teresa.
For both males and females, highly urbanized areashad higher ASRs while those less developed or withlarge less urbanized areas such as the case of Caloocan,had significantly lower ASRs.
Figure 3.3.3 shows that the all sites ASR amongmales was lowest among the Singaporean Indians. Astep higher were Malays in Singapore and residents ofthe DOH-RCR area. Higher still were the Chinese inLos Angeles (L.A.) and PCS-MCR residents.Singaporean Chinese and Filipino residents in L.A. hadsimilarly higher rates, and the Saarland population aswell as the Non-Hispanic Whites in L.A. had evenhigher ASRs. The highest ASR was observed amongthe Black population in L.A. This could indicate theinfluence of varying lifestyles not only betweendeveloped and developing countries but also betweenethnic and/or economic groups within the samegeographic area.
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Among females (Figure 3.3.4) the all sites patternwas similar, with the non-Asian populations having thehighest ASRs (Blacks and Non-Hispanic Whites in L.A.and Saarland residents), while the lowest ASR wasagain observed among the Singaporean Indians. Thissimilarity of the pattern observed in both males andfemales could indicate that the lifestyle differences that
could lead to inter-country and intra-country variationsin ASRs may affect both sexes.
3.4. Oral Cavity
This group included malignancies of the tongue, gum,floor of the mouth, buccal mucosa, hard and soft palate
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as well as malignancies of the mouth, not otherwisespecified. ICD-10 codes are C01-C06.
There were a total of 929 new oral cavity cancersrecorded between both sexes in the period covering 1998to 2002. Among these, 476 were males while 453 werefemales, resulting in a male to female ratio of 1.05.The CR for males was 1.7 while the ASR was 3.4 per100,000. For females, the CR and ASR were 1.6 and2.9, respectively.
Among males (Table 3.4.1 & Figure 3.4.1), thePCS-MCR had an ASR of 3.8 per 100,000, while theASR for DOH-RCR was 3.0 per 100,000. For both,there was not enough evidence to say that the ASRsdiffered from the overall. The ASR of Rizal Province(2.4 per 100,000) was significantly lower, while therewas not enough evidence to say the same for the ASRof the DOH-RCR Metro Manila areas (3.0 per100,000).
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The area with an ASR that was significantly higherthan that of the overall was Pasay City. On the otherhand, Antipolo had an ASR that was significantlylower than the overall. The municipalities of Jala-jalaand Morong did not have any case for this period.
For females (Table 3.4.2 & Figure 3.4.2), therewas not enough evidence to say that the ASRs of PCS-MCR (2.9 per 100,000) and DOH-RCR (2.8 per100,000) were significantly different from that of theoverall. Rizal Province exhibited a significantly lower
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ASR (2.1 per 100,000), but the same cannot be said ofthe ASR from the DOH-RCR Metro Manila area (3.0per 100,000). No individual area showed a significantlydifferent ASR than the overall. Pililia and Teresa didnot have any case of oral cancer among females forthis period.
Figure 3.4.3 shows that the highest male oralcancer rates were observed among Saarland residents,
and the Black and Non-Hispanic White residents inL.A. The lowest rates occurred in the Filipino andChinese residents in L.A. and Singapore Malays.Slightly higher ASRs were seen among SingaporeIndians and Chinese as well as Philippine residents.These rates could reflect the levels of cigarette smokingand, among the Asian populations, betel-quid chewinga couple of decades ago.
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Among females, Figure 3.4.4 shows that thedifferences were not large, and could indicate that theprevalence of cigarette smoking may have been lowercompared to males. The highest ASR was seen amongSingapore Indians and may be partly attributable tobetel-quid chewing.
3.5. Stomach
There were a total of 1,842 new cases of stomachcancer recorded in the two registries from 1998 to 2002.Of these, 985 were males while 857 were females givinga sex ratio of 1.1. The CR for males was 3.6 per 100,000whereas the ASR was 7.5 per 100,000. For females, itwas 3.0 per 100,000 (CR) and 5.3 per 100,000 (ASR).
For males, there was not enough evidence to saythat the ASR of 8.3 per 100,000 population for PCS-MCR and 6.8 per 100,000 for DOH-RCR weresignificantly higher than the overall. The ASR of RizalProvince (6.5 per 100,000) was significantly lower,while there was not enough evidence to say that theASR of the DOH-RCR Metro Manila area was alsosignificantly lower (7.0 per 100,000).
Among males (Table 3.5.1 & Figure 3.5.1),Manila and Parañaque had ASRs that weresignificantly higher than the overall. On the otherhand, the areas with ASRs that were significantly lower
than the overall ASR were Binangonan and Tanay. Nocases were reported from the municipality of Jala-jala.
For females (Table 3.5.2 & Figure 3.5.2) there wasnot enough evidence to say that the ASR of PCS-MCR(5.7 per 100,000) and that of DOH-RCR (5.0 per100,000) were significantly different than the overall.The same conclusions could be said of the ASRs fromthe DOH-RCR Metro Manila areas (5.1 per 100,000)and Rizal Province (4.7 per 100,000). Areas with asignificantly higher ASR were Manila and QuezonCity, while those with significantly lower ASRs wereCaloocan, Marikina and Taytay.
The highest ASR of male stomach cancer wasobserved among Singapore Chinese, and was twice thatamong Chinese residents in L.A. (Figure 3.5.3). Therates observed among Philippine residents were not toodifferent from the other Asian populations. There seemsto be a global trend of decreasing incidence of stomachcancer, and the rate observed among the SingaporeanChinese could be the residual effects of higher levelsof lifestyle and environmental risk factors.
Figure 3.5.4 shows that the female SingaporeanChinese also had the highest ASR but was only half ofthat observed among their male counterparts. Thelowest rates were seen among Filipinos and Non-Hispanic White residents in L.A. and Malays inSingapore. The rest had fairly comparable rates.
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3.6. Colon
Between 1998 and 2002, a total of 3,502 new cases ofcolon cancer were recorded. Among these, 1,783 caseswere males and 1,719 were females, resulting in a sexratio of 1.04. The CR among males was 6.5 per 100,000while the ASR was 13.7 per 100,000. For females, itwas 6.1 per 100,000 (CR) and 10.6 per 100,000 (ASR).
An ASR of 14.8 per 100,000 male population wasrecorded for PCS-MCR, which was significantly higherthan the overall. Meanwhile, there was not enoughevidence to say that the ASRs for the entire DOH-RCRareas (12.7 per 100,000) and the DOH-RCR MetroManila areas (14.5 per 100,000) were significantlydifferent from the overall. Nevertheless, the ASR ofRizal Province (8.2 per 100,000) was significantly lower.
Among males (Table 3.6.1 & Figure 3.6.1) theareas with ASRs that were significantly higher than
the overall were Manila, Quezon City, Mandaluyongand Parañaque. On the other hand, the areas withASRs that were significantly lower than the overallwere Caloocan, Taguig, Antipolo, Montalban, SanMateo and Tanay. No cases were reported for themunicipalities of Cardona.
Similar to that in males, the ASR of the PCS-MCR(11.5 per 100,000) for females (Table 3.6.2 & Figure3.6.2) was significantly higher than that of the overall.However, there was not enough evidence to say thatthe ASR for DOH-RCR (9.8 per 100,000) wassignificantly different from the overall. The same canbe said for the DOH-RCR Metro Manila areas (10.9per 100,000) but Rizal Province had a significantlylower ASR (6.8 per 100,000). Among the areas, Manila,Quezon City and Parañaque showed significantlyhigher ASRs than the overall. Contrastingly, those thatpresented significantly lower ASRs were Caloocan,Antipolo, Binangonan and Morong.
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The colon cancer rates among males in the DOH-RCR area and among Singapore Indians were thelowest (Figure 3.6.3). These rates were less than halfthe ASR observed among Filipino residents in L.A. TheASR in the PCS-MCR area was almost twice the ASRseen in the DOH-RCR area. The highest rates wereseen among the Black and Non-Hispanic Whiteresidents in L.A., Saarland residents and among theSingaporean Chinese. The lowest colon cancer ratesamong females were observed in both Philippineregistries and among the Singaporean Indians andMalays (Figure 3.6.4). The rate among Filipinoresidents in L.A. was only slightly higher. The highestrates were observed among the Black and Non-HispanicWhite residents in L.A., the Singaporean Chinese andamong Saarland residents. The differences in rates maybe largely attributable to lifestyle variability.
3.7. Rectum
A total of 2,243 new rectal cancer cases were identifiedfor the period between 1998 and 2002. Among these,
1,236 were males and 1,007 were females resulting in asex ratio of 1.2. The CR for males was 4.5 per 100,000while the ASR was 8.9 per 100,000. For females, theCR was 3.6 per 100,000 while the ASR was 6.0 per100,000.
In males (Table 3.7.1 & Figure 3.7.1), thecomputed ASR for PCS-MCR (9.8 per 100,000) wassignificantly higher than the overall ASR. On the otherhand, the ASR of DOH-RCR (8.0 per 100,000) wassignificantly lower. For the Metro Manila areas coveredby the DOH-RCR (8.6 per 100,000), there was nosufficient evidence to say that the ASR was significantlylower. For Rizal Province, the ASR of 6.5 per 100,000was significantly lower than the overall.
The areas with an ASR that were significantlyhigher than the overall were Manila, Quezon City andParañaque. On the other hand, the areas withsignificantly lower ASRs were Caloocan, Binangonan,and Tanay.
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The computed ASR for females (Table 3.7.2 &Figure 3.7.2) for the PCS-MCR (7.2 per 100,000) wassignificantly higher than the overall while that of DOH-RCR (4.8 per 100,000) was significantly lower. Likewise,the same conclusion could be said of the ASR for RizalProvince (3.4 per 100,000) but not for the Metro Manilaareas covered by the DOH-RCR (5.3 per 100,000).
The cities / municipalities that showed asignificantly higher ASR than the overall were Manila,Quezon City and Pasig. Conversely, those thatpresented significantly lower ASRs were Caloocan, LasPiñas, Antipolo and Taytay. There was no case reportedfor the municipality of Cardona.
The highest male rectum cancer ASRs were amongSaarland residents and the Chinese residents inSingapore (Figure 3.7.3). The lowest rates were seenamong the Philippine residents, Singaporean Indiansand Malays, and Chinese residents in L.A. Slightlyhigher rates were observed among Filipino, Black andNon-Hispanic White residents in L.A.
The ASRs among females were lower comparedto males (Figure 3.7.4). The pattern of the differences
was however quite similar. The differences (orsimilarities) between and among sexes may also beattributable to lifestyle variations.
3.8. Liver
A total of 4,090 new cases of liver cancer were recordedfrom 1998 to 2002. Among these new cases, 2,964 weremales and 1,126 were females resulting in a sex ratioof 2.6. The CR among males was 10.8 per 100,000while the ASR was 19.7 per 100,000. On the other hand,the CR was 4.0 per 100,000 and the ASR was 6.8 per100,000 for females.
For males (Table 3.8.1 & Figure 3.8.1), an ASRof 21.8 per 100,000 population was recorded for PCS-MCR, which was significantly higher than the overall.Meanwhile, for DOH-RCR, an ASR of 17.8 per100,000 was computed, a figure significantly lowerthan the overall. Likewise, the ASR of Rizal Province(19.0 per 100,000) was also significantly lower. Therewas no sufficient evidence to say that the ASR for theDOH-RCR Metro Manila areas was different from theoverall.
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Only Manila had an ASR that was significantlyhigher than the overall. On the other hand, the areaswith ASRs that were significantly lower than the overallASR were Muntinlupa, Taguig, Antipolo, Cainta andTanay.
For females (Table 3.8.2 & Figure 3.8.2), therewas not enough evidence to say that the ASRs of PCS-MCR (7.0 per 100,000) and DOH-RCR (6.6 per100,000) were significantly different than the overall.Areas in Rizal Province exhibited a significantly lowerASR (4.3 per 100,000), but the same cannot be said ofthe ASR from the DOH-RCR Metro Manila areas (7.5per 100,000).
The cities that showed a significantly higher ASRthan the overall were Manila, Parañaque and San Juan.Contrastingly, only Montalban presented a significantlylower ASR.
The ASRs for liver cancer among males (Figure3.8.3) in the DOH-RCR and PCS-MCR areas, and the
Chinese residents in both Singapore and L.A. were thehighest. The rate among Filipino residents in L.A. waslower, but still higher than those observed amongSaarland residents and Non-Hispanic Whites in L.A.
The ASRs among females were lower comparedto males (Figure 3.8.4) but the pattern of differencesbetween populations was basically similar. Thedifferences (or similarities) between and among sexesmay be largely attributable to the prevalence of hepatitisB infection, particularly chronic HBV infection.
3.9. Lung
There were a total number of 8,182 new lung cancercases during the period between 1998 and 2002. Therewere 6,012 males and 2,170 females, resulting in a sexratio of 2.8. The CR and ASR among males were 21.9per 100,000 and 47.5 per 100,000, respectively. Forfemales, the CR was 7.7 per 100,000 while the ASRwas 13.7 per 100,000.
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For males (Table 3.9.1 & Figure 3.9.1), the ASR of52 per 100,000 population for PCS-MCR was significantlyhigher than the overall. Meanwhile, for DOH-RCR, anASR of 43.4 per 100,000 was significantly lower than the
overall. Likewise, the ASR of Rizal Province (34 per100,000) was also significantly lower than the overall, butthe same could not be said for the DOH-RCR MetroManila areas (47.1 per 100,000).
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40
The areas with ASRs that were significantly higherthan the overall were Manila, Quezon City and San Juan.On the other hand, the areas with ASRs that weresignificantly lower than the overall ASR were Caloocan,San Juan, Antipolo, Binangonan, Cainta, Cardona, Jala-jala, Montalban, Morong, Pililia, and Tanay.
For females (Table 3.9.2 & Figure 3.9.2) ,compared to the overall ASR, there was no sufficientevidence to say that the ASR of PCS-MCR (14.7 per100,000) and DOH-RCR (12.7 per 100,000) weresignificantly different from the overall. The sameconclusion could be said of the ASR from the DOH-RCR Metro Manila areas (14.0 per 100,000). However,the ASR for Rizal Province (9.1 per 100,000) wassignificantly lower than the overall.
The cities/municipalities that showed asignificantly higher ASR than the overall were Manila,Quezon City and Parañaque. Contrastingly, those that
presented a significantly lower ASR were Caloocan,Pateros, Binangonan, Cainta, Cardona, Morong, SanMateo and Taytay.
The highest male lung cancer ASRs were observedamong Black residents in L.A. and among Saarlandresidents (Figure 3.9.3). The lowest rate was seenamong the Malays in Singapore. A range ofintermediate rates could be observed among the otherpopulations. The rate observed in the PCS-MCR areawas higher than that of Filipino residents in L.A.
The rates among females were lower but the patternwas essentially similar (Figure 3.9.4). The rate observedamong female Filipino residents in L.A. was slightlyhigher than that observed among Philippine residents.The differences (or similarities) between and amongthe sexes may be largely attributable to the prevalenceof cigarette smoking and the level of exposure tosecondhand smoke.
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3.10. Breast
Breast cancer was the most frequent type of canceramong females in the Philippines. There were a totalof 10,083 new cases registered among females during1998 to 2002. The CR was 35.6 per 100,000 while theASR was 52.2 per 100,000. The incidence rates variedfrom 12.7 per 100,000 in Baras, Rizal to 75.9 per100,000 in San Juan.
The ASR of PCS-MCR (56.1 per 100,000) wassignificantly higher than that of the overall (Table3.10.1 & Figure 3.10.1). DOH-RCR on the other hand,had a significantly lower ASR (48.6 per 100,000) thanthat of the overall. The DOH-RCR Metro Manila areashad a significantly higher ASR (54.7 per 100,000) whileRizal Province exhibited a significantly lower ASR(32.3 per 100,000).
The cities/municipalities that showed a significantlyhigher ASR than the overall were Manila, Quezon City,Makati, Mandaluyong, Parañaque, Pasig and San Juan.Contrastingly, those that presented significantly lowerASRs were Caloocan, Malabon, Navotas, Taguig,Angono, Antipolo, Baras, Binangonan, Cardona, Jala-jala, Montalban, Morong, Pililia, San Mateo, Tanay,Taytay and Teresa.
The breast cancer ASRs observed among women inthe PCS-MCR area, Singaporean Chinese and Chineseresidents in L.A. were similar (Figure 3.10.2).Interestingly, the rate among female Filipino residents inL.A. was almost double, and higher than those observedamong Black residents in L.A. and in Saarland. Thehighest rate was seen among the Non-Hispanic Whiteresidents in L.A. The differences (or similarities) betweenpopulations could be largely attributable to variations inreproductive behavior and lifestyle.
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3.11. Cervix Uteri
For cancer of the cervix uteri, a total of 3,842 newcases were diagnosed between 1998 and 2002. The CRwas 13.6 per 100,000 whereas the ASR was 18.7 per100,000.
The ASR of 20.1 per 100,000 in PCS-MCR wassignificantly higher than that of the overall (Table3.11.1 & Figure 3.11.1). Conversely, DOH-RCR hada significantly lower ASR (17.4 per 100,000) than thatof the overall. Likewise, the Province of Rizalexhibited a significantly lower ASR (13.3 per 100,000).
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For the DOH-RCR Metro Manila areas, there was notenough evidence to say that the ASR (17.4 per 100,000)was significantly lower than the overall.
The cities/municipalities that showed asignificantly higher ASR than the overall were Manila,Pasay, Makati, and Pasig. Contrastingly, those thatpresented a significantly lower ASR were Caloocan,Marikina, Taguig, Antipolo, Binangonan, Cardona,Montalban, Morong and Taytay.
Compared to other countries, the ASRs of cervicalcancer cases among female residents in the Philippineswere the highest (Figure 3.11.2). The lowest rate wasobserved among Chinese residents in L.A. The ASRsof Philippine residents were more than double of whatwas observed among Filipino residents in L.A. Thedifferences (or similarities) between populations canbe largely attributed to the varying prevalence of
chronic cervical HPV infection, and safe sex practices.To a certain extent, prevention resulting from screeningmay also have played a role.
3.12. Prostate
For cancer of the prostate, a total of 2,219 new caseswere diagnosed between 1998 and 2002. The CR was8.1 per 100,000 whereas the ASR was 21.9 per 100,000.
For PCS-MCR, the ASR of 25.2 per 100,000 wassignificantly higher than the overall while the ASR ofDOH-RCR of 18.7 per 100,000 was significantly lower(Table 3.12.1 & Figure 3.12.1). Similarly, RizalProvince exhibited a significantly lower ASR (12.4 per100,000). For the DOH-RCR Metro Manila areas, therewas not enough evidence to say that the ASR (21.2 per100,000) was significantly different from the overall.
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The cities/municipalities that showed asignificantly higher ASR than the overall were Manila,Quezon City, and Parañaque. Contrastingly, those that
presented significantly lower ASRs were Caloocan,Taguig, Antipolo, Binangonan, Montalban, Morong,Pililia, San Mateo, Tanay and Taytay.
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The highest rate was observed in the Blackpopulation in L.A. (Figure 3.12.2), while the lowestrates were seen among the Philippine and Singaporeanpopulations. There was a wide range of intermediaterates observed in the other populations. Differences inthe hormonal milieu that could have been brought aboutby lifestyle variations may be partly responsible for thedifferences in risk.
3.13. Thyroid
There were a total of 2,730 new cases of thyroid cancersrecorded in the two registries from 1998 to 2002. Ofthese, 514 were males while 2,216 were females,resulting in a sex ratio of 1 male for every 4 females.The CR for males was 1.9 per 100,000 whereas the ASRwas 2.9 per 100,000. For females it was 7.8 per 100,000(CR) and 10 per 100,000 (ASR).
For males (Table 3.13.1 & Figure 3.13.1), therewas not enough evidence to say that an ASR of 3.0 per100,000 for PCS-MCR and an ASR of 2.8 per 100,000for DOH-RCR were significantly different from theoverall. The ASR of Rizal Province (1.6 per 100,000)was significantly lower, while there was not enoughevidence to say that the ASR of the DOH-RCR MetroManila areas (3.2 per 100,000) was also significantlyhigher than the overall.
Only Manila had an ASR that was significantlyhigher than the overall. On the other hand, Navotasand Binangonan had ASRs that were significantly lower
than the overall ASR. No cases were reported for themunicipalities of Baras, Jala-jala, Morong, Tanay andTeresa.
For females (Table 3.13.2 & Figure 3.13.2), theASRs of PCS-MCR (11.3 per 100,000) and DOH-RCR(8.8 per 100,000) were significantly different from theoverall. The ASR of Rizal Province (7.0 per 100,000)was significantly lower but there was not enoughevidence to say the same for the ASR of the DOH-RCR Metro Manila areas (9.5 per 100,000).
The cities/municipalities that showed significantlyhigher ASRs than the overall were Manila, Quezon Cityand Pasig. Contrastingly, those that presented asignificantly lower ASR were Caloocan, Navotas,Binangonan, Montalban, San Mateo and Tanay. Therewas no case recorded in Jala-jala during this period.
Figure 3.13.3 shows that the ASRs of male thyroidcancer were low, the highest being those among Filipinoand Non-Hispanic White residents in L.A. The ratesamong Philippine residents were also higher than thoseseen in the other populations.
Figure 3.14.4 shows that the ASRs in females werepractically triple those in males. The highest rate wasobserved among female Filipino residents in L.A.,whose rates were among the highest in the world. Whiledietary and genetic factors had been implicated, thehigher rates observed among women and in somepopulations still has to be adequately investigated.
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Contributors
Maria Theresa M. Redaniel holds a Master of Science in Epidemiology (PublicHealth) from the University of the Philippines Manila. Her association with the PhilippineCancer Society-Manila Cancer Registry started with her Masteral thesis which was onpopulation-based survival of cervical cancer, and has subsequently co-authored severalpublications with the registry. She is currently working for a Doctor of Science in theHumanities at the Ruprecht-Karls-Universitat Heidelberg under Professor Herman Brenner.Tere’s doctoral thesis will be on the recent trends, up-to-date estimates and thedeterminants of cancer survival in a Philippine urban population, using the period analysismethodology.
Adriano V. Laudico is a surgical oncologist, and recently retired Professor of Surgeryat the University of the Philippines Manila. He was the former head of the Departmentof Health-Rizal Cancer Registry, and currently heads The Philippine Cancer Society-Manila Cancer Registry. He was a Past President of the Philippine College of Surgeons,and the Founding President of the Surgical Oncology Society of the Philippines. Yagowas also a Short Term Consultant on Cancer of the World Health Organization WesternPacific Region to several countries in Southeast Asia and the Pacific.
Maria Rica Mirasol-Lumague is a general surgeon, and is the current head ofthe Department of Health - Rizal Cancer Registry. Rica is also the Acting Training Officerof Rizal Medical Center, where she also supervises the Tumor Clinic. She underwenttraining on cancer registration methods and cancer epidemiology at the InternationalAgency for Research on Cancer in Lyon, France.
Cynthia A. Mapua holds a Master of Science in Epidemiology from the College ofPublic Health, University of the Philippines Manila, and is at present working for aDoctor of Public Health in Epidemiology at the same institution. Her association withthe Philippine Cancer Society - Manila Cancer Registry began with her Masteral thesiswhich was on population-based survival of breast cancer. Cyndi had undergone trainingon cancer registration methods and cancer epidemiology at the International Agencyfor Research on Cancer in Lyon, France. Cyndi is currently a Scientist/Epidemiologist atthe Bioinformatics Department, Research and Biotechnology Division, St. Luke’s MedicalCenter.
Toni Patama holds a degree of Master of Science (Environmental Sciences) from theUniversity of Kuopio and specializes on geographical information systems and spatialepidemiology. Toni is currently an Assistant Researcher at the Finnish Cancer Registry.
Eero Pukkala obtained his M.A. from the University of Helsinki, and his Ph.D. fromthe University of Tampere. He is currently Director of Statistics and an epidemiologist atthe Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research,Helsinki. He is also a Professor of Public Health and Epidemiology at Tampere School ofPublic Health, University of Tampere. Eero is responsible for the European Unioninternational post-graduate education network “Spreading of Excellence in Cancer ControlUsing Population-based Registries and Biobanks.”
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Philippine Cancer Society Board of Trustees
Chairman Dr. Roberto M. PaternoVice Chairman Antonio Ma. GuerreroPresident Dr. George G. EufemioVice President Dr. Ernesto O. DomingoTreasurer Dr. Don M. FerryAssistant Treasurer Tomas V. ApacibleDr. Conrado Llanes Lorenzo, Jr.Dr. Francisco G. DizonAmbassador Albert F. del RosarioDr. Alberto D. RoxasDr. Jose S. SandejasDr. Corazon A. NgelangelCecilia Lim-LazaroUndersecretary Enrique D. PerezDr. Antonio H. Villalon
Philippine Cancer Society-Manila Cancer Registry
Luzviminda M. TuranoEllen Nora S. Mesina
Zolia F. BautistaMelinda S. Visoria
Siony P. AlcosLydia T. Navarro
Glenda Q. PalomaresBlessa M. Huerto
Department of Health - Rizal Cancer Registry
Wilma M. GrafiloElena DC. Marquez
Maria Teresa M. MedesJosephine R. Isla
Portia E. De GuzmanArlene T. Sasot
The publication of this monograph was generouslysupported by the Degenerative Disease Office-
National Center for Disease Prevention andControl of the Department of Health, under
Dr. Yolanda E. OliverosThe preparation of the manuscript was assisted by some of the staff of the SurgeryResearch Unit of the University of the Philippines Manila, namely Madonna R. Balbacaland Francisco G. Valenzuela who put the map inserts.
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