Cancer Incidence in Jordan - 2012 · Cancer Incidence in Jordan - 2012 2 Comments and suggestions...

Cancer Incidence in Jordan - 2012

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The Hashemite Kingdom of Jordan

Ministry of Health

Non-Communicable Diseases Directorate

Jordan Cancer Registry


Prepared By:

Dr. Omar NimriDr. Ayoub Al-Sayaideh

Dr. Marwan Al- Zaghal

Dr. Wafa Halasa

Dr. Kamal Arqoub


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Comments and suggestions concerning the contents are encouraged and highly appreciated .Don’t hesitate to send your comments to the address below (email). You can download this report from the Ministry of Health web site www.moh.gov.jo.

Ministry of HealthNon communicable diseases DirectorateCancer Prevention DepartmentJordan Cancer RegistryTelefax:00962-6-5662067

[email protected]

وزارة ال�صحة

مديرية الأمرا�ض غري ال�صارية

ق�صم مكافحة ال�صرطان

ال�صجل الوطني لل�صرطان

تلفاك�ض: 0096265562067


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His Majesty King Abdullah II

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Foreword

With my utmost pleasure, I forward to you the 17th annual report of cancer incidence in Jordan prepared by the Jordan Cancer Registry. This registry as an ambitious goal was established, and developed over the last 20 years under the auspices of the Ministry of Health. The report provides comprehensive information about the trends and characteristics of cancer in Jordan.I have every confidence that the Jordan Cancer Registry will continue to develop and to help Jordan intensify its efforts to decrease the huge burden of cancer as one of the major NCDs especially in a developing country with limited resources; mainly after various programs of the primary health care services had successfully controlled and eradicated most of communicable diseases.The functions of the Jordan cancer registry cover a wide scope of activities including collection, filtering, coding and analysis of all newly diagnosed cancer cases, as well as dissemination of informative data to oncologists, scientists, researchers and decision makers concerned with cancer control and prevention on national and international levels. I will be proud to mention the success story of the national Jordan breast cancer program which was a fruitful result of the joint collaboration between the various public, and private health institutions, and the opportunity is rising now to develop a national colorectal cancer screening program based on the fact that, this type of cancer is the second most common cancer among Jordanians after breast cancer.It is worthy to mention that this valuable report was a result of the continuous efforts of devoted and hardworking staff at the Jordan Cancer Registry, and the continuous cooperation from other concerned health sectors.I highly appreciate these great efforts and I would like to extend my sincere thanks to everyone who helped in the development of this report, and stress as the Minister of Health that the Jordan Cancer Registry will continue to receive full support and enforcement by the Ministry of Health.

Minister of Health

Dr. Ali Hyasat


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Acknowledgment

The Jordan Cancer Registry would like to acknowledge with deep appreciation and gratitude the invaluable help and the hard work of all health care and medical professionals from the various governmental, non – governmental, universities and private facilities, and all other health sectors in the kingdom, upon whose commitment, hard work, and timely data submissions this report ultimately depends on and making this conceivable report a reality.

Our thankful gratefulness and pride to everybody of the Cancer Registry staff, Dr. Marwan Al Zaghal, Dr. Wafa Halasa for their continuous supervision of the data processing they tirelessly provide, in collect, collate and coding the data are commendable.

However, it would not have been possible without the kind support and the hard work of constantly entering the data, Mrs. Rasha Kokash, Mrs. Jameieha Al Sarway, Ms. Hala Daoud, Mr. Haytham Shqirate and last but not least our sincere thanks to Ms. Shaniaz Rahala and Dr. Ghazi Sharkas for their efforts.

We would like to extend our genuine thanks to Dr. Kamal Arqoub, tumor registrar for his efforts in cleaning and the analysis of the data.

We would like to express our gratitude towards all and every one for their kind co-operation and encouragement that help the cancer registry in completion of this report. Special thanks go to our focal personals in different hospitals and laboratories for the timely collection and compliance by providing cancer patients data to the central cancer registry. Our IT department for their continuous technical support and maintenance.

We are indebted to the National Cancer institute (NCI – USA) and the Middle East Cancer Consortium (MECC) for their constant valued support that made this reports publication possible.Director of NCD Directorate

Dr. Ayyoub As Sayaideh

Head. Cancer prevention Dept.Director – Pl. Jordan Cancer RegistryDr. Omar Nimri


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Exceptional thanks and appreciations to the directors of all public, private, military and university and other health sector hospitals as well the private laboratories listed below. Highly appreciate the efforts and the hard work of our focal points personnel’s listed below for their contribution in this report of cancer incidence in Jordan. Aiming to accretion the number of the facilities in the clinical community to report their cancer data notification to the registry, making more coverage of the kingdom and continue best quality data with best available global standards.

Name Name Hospital – Facilities1 Rufaida Nababteh Al Basheer Hospital-MOH2 Rawan Alghoul Al Basheer Hospital-MOH3 Anwar Nabil Al Basheer Hospital-MOH4 Khaled Jamal Suliemann King Hussein Cancer Center5 Mohammad Flaifel King Hussein Cancer Center6 Dr Yassin Al Tawarah Royal Medical Services7 May Ali Yassin Islamic Hospital-Private8 Dalia Musa Naser Islamic Hospital-Private9 Suad Khaleel Allam Specialty Hospital-Private10 Dena Abdel Alaal Specialty Hospital-Private11 Amani Mohammad Alsayed Prince Hamza Hospital-MOH12 May Sabra Prince Hamza Hospital-MOH13 Ruba Subhi Aletewi King Abdallah University Hospital14 Maher Sawalmeh King Abdallah University Hospital15 Lubna Abu Ghosh Al khalidi Hospital-Private16 Mohammad Al zarro Al khalidi Hospital-Private17 Suad Rashed Khlaeel Jordan University Hospital-Private18 Yusra Aljamal Jordan University Hospital-Private19 Nedal Helmi Al Salymah Arab Center Hospital-Private20 Ahlam Ali Motlaq Arab Center Hospital-Private21 Rasha Al Twait Al Afia Center-Private22 Mohammad Ababneh Prince Basma Hospital- Irbid-MOH23 Amani Metani Prince Basma Hospital- Irbid-MOH24 Sakha’a Deif Allah Batayneh Prince Basma Hospital- Irbid-MOH25 Heilda Zeyad halsah Amman Surgery Hospital-Private


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26 Soud Meslem Al Shaweesh Ma’an Hospital-MOH27 Hana Ali Abu Hatab Jordan Hospital-Private28 Isra Al dewiri Jordan Hospital-Private29 Seham Alshaim Istishari Hospital-Private30 Reem Moh. Mezher Istishari Hospital-Private31 Kefah MuneerAtwan Israa Hospital-Private32 Hanade Ahmad Al Jazzazy Al Hussein Hospital –Salt-MOH33 Tarq Al Zobaidi Ibn Al Haitham Hospital-Private34 Suleiman Khalil Al Asi Jarash Hoapital-MOH35 Kholoud Karaymeh Jabal Al Zaitoun Hospital36 Safa Momani Jordan University Hospital – IT37 Hamda Ahnmad Esmaeel Jabal Al Hussein LAB.38 Hamza Abd Al Hafeth Hasan Al Basheer Hospital LAB-MOH39 Baha’aBarham Jordan University Hospital– LAB40 Ibrahim Awad Swalha Al Bashir Hospital- IT41 Raed Jabali Ahmad Middle East LAB- Private42 Ola Hani Middle East LAB- Private43 Fatema Abd Al Mo’ate Aqel Zarqa Hospital LAB-MOH44 Fatima Hammad IT –MOH45 Abd alhakeem Saada Forensic medicine - Al Bashir Hospital


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Executive Summary

There is no doubt that cancer became an over whelming problem worldwide. In

Jordan, as well the incidence and burden of cancer are increasing. Documentation of

cancer cases helps to determine the magnitude of the problem and to provide suitable

prevention cancer programs.

This is the seventeenth 17th annual report of cancer incidence and epidemiology in

Jordan which describes cancer cases in the year 2012. The total number of new cancer

cases was 7454, of them 5013 were Jordanians (67.3%) and 2441 were non-Jordanian

(32.7%). For Jordanians the number of male was 2346 (46.8%) while in females

were 2667 (53.2%), In 2012,the number of new cases among Jordanians increased by

338 cases compared to the 2011 cases.

The number of new cancer cases diagnosed among Jordanians has increased up to

46% in the past10 years, from 3362 cases in the year 2000 to 5013 in the year 2012.

The male to female ratio was 0.88:1 in both years 2011 and 2012. The overall median

age at diagnosis was 56 (60 years for males and 53 years for females). The crude

incidence rate of all cancers among Jordanians was 78.5per100,000 (71.2for

males and 86.2for females). The Age Standardized Rate (ASR) adjusted to the world

standard population was 133.4 per 100,000 population (126.1 for males and 141.4 for

females). The Age-Standardized Rate (ASR) for all cancers combined has increased

by 7% (from 124.5 per 100,000 population in 2000 to 133.4 per 100,000 population

in 2012).

Overall, 42.7% of the cases in 2012 were diagnosed among people aged 60 years and

older, males (56.8%) were more than female (43.2%) in this particular age group.

Meanwhile; new cancer cases by age group showed that 4.3% of the cases were

below15 years old, males (55.8%) were more than female (44.2%), and 24.7%


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were in the age group 15- 44 years, and 28.0% in the age group 45-59 years in

which females predominated in this age group with ( 60.4%) over males (39.6%).

The top five cancers among Jordanians (males and females) were :breast 1008

(20.1%), colorectal 567 (11.3%),lung 371(7.4%),lymphoma 327 (6.5%),and urinary

bladder 246 (4.9%).Among Jordanian males, the top five cancer types were: lung

292 (12.4%) , colorectal 282 (12.0%), urinary bladder 217 (9.2%) , prostate

198 (8.4%), and lymphoma 177 (7.5%), while among Jordanian females , the

top five cancers were: breast 994 (37.3%), colorectal 285 (10.7%), thyroid 158

(5.9%), lymphoma 150 (5.6%) and uterus 121 (4.5%). The distribution of cancer

cases by regions showed that, 77 % of the cases were in the central region

(Amman accounted for 61.9%), 16.9% in the north region and 5.1% in the south

region .In the pediatric age group (less than 15years ) the total number of cancer

cases was 217 accounted for (4.3%) of all cancer cases in Jordan with a male to

female ratio 1.3:1. The top five cancer types in the pediatric age group were :leukemia

30%, brain and CNS 21.2%, lymphoma 14.3%, eye 6.9% and neuroblastoma 6%.

Mortality due to cancer based on the data from the JCR database showed that the most

common causes of death due to neoplasms in males were Lung (23.1%), Colorectal

(10,9%) Pancreas (6.7% ) Leukemia (6.2%) and U.Bladder (6.0%) . While in females

Breast (20.4%), Colorectal (14.6%) Lung (8.5%) , Leukemia (6.2%) and Pancreas

(5.4%).


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Table of ContentsAcknowledgementExecutive Summary List of Tables………………………………………....................……………..…………12List of Figures &Annexes ………………………………...………...……………………14Chapter One…………………………………………………………………...…………17

IntroductionJordan Population and Geography Jordan Cancer Registry (JCR) Data Collection MethodologyTrend of Cancer types of all sites 2000–2012Non Jordanians :Trend of cancer cases by year and gender - 2012

Chapter Two………………………………………………............……………………...31Cancer Incidence among Jordanians -2012Distribution of cases by Age and GenderFrequency of incident cases of Site, Age group and GenderTop ten cancers by genderTop ten cancers by age groupGeographical distribution of cancer types in Jordan

Chapter Three………………………………………………...........………......………..51Ten most common cancers among Jordanians, 2012

1-Breast2-Colo-Rectal3- Lung4- Lymphoma5- Urinary Bladder6- Leukemia7-Thyroid8- Prostate9- Brain and CNS10-Stomach

Chapter Four Pediatric Malignancies in Jordan, 2012…………..…....…..… 83Chapter Five Cancers among Non-Jordanians, 2012…………….........…...…91Chapter Six Cancer Mortality, 2012………………...............…..…..……..... 99Arabic Summary Cancer in Jordan 2012………………................................……118


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List of TablesTable1

Table2

Table3

Table4

Table5

Table6

Table7

Table8

Table9

Table10

Table11

Table12

Table13

Table14

Table15

Table16

Table17

Table18

Table19

Table20

Table21

Table22

Table23

Table24

Table25

Table26

Estimated population of the Kingdom by Age and Gender, 2012...................20

Estimated population of the Kingdom by Governorate and gender, 2012.......21

World Standard Population used for age adjustment (ASR)................................27

Basis of diagnosis of cancer cases among Jordanian,2012..............................33

Distribution of cancer cases among Jordanian according to staging, 2012........33

Percentage and ASIR of cancer by age group and gender-Jordan, 2012..............35

No. & percentage of cancer cases by primary site and gender, Jordan, 2012.....37

Frequency of Incidence cases among Jordanians by site and age (Males), 2012...38

Frequency of Incidence cases among Jordanians by site and age (Females), 2012.39

Ten most common cancers among Jordanians (both genders), 2012................40

Ten most common cancers among Jordanians (Males), 2012 ..............................40

Ten most common cancers among Jordanians (Females), 2012.........................41

Top ten cancer for the age group 0-19 years ,both genders Jordan, 2012...... 43

Top ten cancer for the age group 20-49 years , both genders 2012-Jordanian...........43

Top ten cancer for the age group 50+ years ,both genders 2012-Jordanian...............44

Percentage and ASIR of cancer cases by Governorate,regions and gender, 2012.45

Trend Frequencies of cancers among Jordanian, Males 2000-2012....................48

Trend Frequencies of cancers among Jordanian, Females 2000-2012.................49

Median age for top ten cancers among Jordanian both genders ,2012.............54

Frequency and ASIR of Breast cancer by Age-group and gender,2012.........55

Morphological Distribution for breast cancer-Jordan, 2012...............................56

Incidence and distribution of breast cancer by governorates in Jordan,2012...... 58

Frequency distribution of female breast cancer cases by age group 2000-2012 ... 59

Colo-Rectal cancer by Age-group and gender.....................................................61

Distribution of Colo-rectal cancers by topography and gender ............................63

Distribution of colorectal cancer by morphology -Jordan, 2012.....................63


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Continue – list of tablesTable27

Table28

Table29

Table30

Table31

Table32

Table33

Table34

Table35

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Table37

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Table40

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Table48

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Table50

Table51

Distribution of colorectal cancer cases by stage (SEER staging),2012.......... 64

Number and rate of colorectal cancer by governorate, Jordan 2012................64

Lung cancer by Age-group and gender.................................................................66

Hodgkin’s Disease by Age-group and gender......................................................68

Non-Hodgkin’s Lymphoma by Age-group and gender.......................................69

Bladder cancer by Age-group and gender-2012...............................................71

Leukemia by Age-group and gender 2012...........................................................73

Thyroid cancer by Age-group and gender 2012.................................................... 75

Prostate cancer by Age - group 2012......................................................................76

Brain & CNS cancer by Age-group and gender 2012..........................................79

Stomach cancer by Age-group and gender 2012..................................................81

Distribution of childhood cancers by gender and age group, Jordan, 2012........86

Distribution of childhood cancer by governorates and gender 2012....................87

Distribution of childhood cancer by age group, governorates and gender, 2012.88

Cancers among Non-Jordanians by age group & gender - 2012..........................93

Cancers among Non-Jordanians by topography and gender, 2012.....................94

Top ten cancers among Non-Jordanians Males, 2012 ..........................................95

Top ten cancers among Non-Jordanians Females, 2012.....................................96

Number and percentage of deaths due to cancer by age group and gender....100

Mortality for Top ten cancer, both gender - 2012.................................................102

Mortality for Top ten cancer, Male -2012..........................................................102

Mortality for Top ten cancer, Female -2012........................................................103

Percentage distribution of deaths due to cancer by governorates , Jordan 2012..103

Percentage distribution of male deaths due to neoplasm, Jordan 2012............104

Percentage distribution of females deaths due to neoplasm, Jordan 2012...105


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List of FiguresFigure1

Figure2

Figure3

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Figure5

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Map of The Hashemite Kingdom of Jordan……………………………........…..20

Population Pyramid, Jordan 2012………………..…...……………….………….. 21

Trend of cancer in Jordan, 1986-2012…………..................………………………...27

Trend of cancer in Jordan (Jordanian) by gender, 2003-2012………........……...28

Trend of (ASIR) of cancer in (Jordanian) by gender 2003-2012………..…….…..28

Trend of cancer in Jordan, Non Jordanian by gender 2003-2012………............…….29

Percentage distribution of cancer among Jordanians by age-group and gender, 2012. .34

Percentage gender distribution of cancer among Jordanians by age-group,2012…34

Age-Specific Incidence Rate (all sites) by age group & gender - Jordan, 2012 ……...36

Age Standardized Rate (all sites) by age group & gender-Jordan, 2012……...….…..36

ASR for Male cancers (all sites), Jordan compared with other countries...............…36

ASR for Female cancers (all sites), Jordan compared with other countries..........….36

Percentage of Top ten cancers by Age group, Males-2012….......................………..41

Percentage of Top ten cancers by Age group, Females-2012……...….......…………41

Percentage of cancers (all sites)and three main age group and gender - 2012...…42

Crude Incidence Rate by gender and governorates, Jordan, 2012…….................…….46

Crude Incidence Rate by Regions & gender, Jordan, 2012……...…......…………46

Percentage distribution of the top ten cancers by gender, Central Region, 2012........46

Percentage distribution of top ten cancer by gender, North Region, Jordan-2012.....…47

Percentage distribution of top ten cancers by gender (South Region), Jordan–2012..47

Percentage of top ten cancers among Jordanians both gender, 2012…….........…52

Number of top ten cancers among Jordanians by gender, 2012…...................……52

ASR of top ten cancers among Jordanians, both genders, 2012………...…..………53

Top ten ASR for cancers among Jordanian Males, 2012……….…....................…….53

Top ten ASR of cancers among Jordanian Females, 2012…….........…..........………..53

Breast Cancer Age-Specific Incidence rate by age group & gender 2012.........……..56

Distribution of breast cancer cases by laterality , Jordan 2012……...….......….……56


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Figure28

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Figure 35

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Figure 51

Figure 52

Figure53

Figure54

Figure55

Distribution of female breast cancer by grade–Jordanians-2012…….…..............……57

Distribution of female breast cancer by Summary Stage, 2012………..................………57

Trend of number of female breast cancer 2000-2012, Jordan……….......…………..58

Trend of ASR for female breast cancer ,2000-2012, Jordan…….……....…………..59

Colorectal cancer ASIR by age group & gender 2012, Jordan....................................61

Distribution of colorectal caner by topography.2012, Jordan……................…….…..62

Trend number of Colorectal cancer 2003-2012, Jordan………..................…………63

Trend of ASR for Colorectal cancer 2003-2012, Jordan………….....................………63

Distribution of colorectal caner by grade.2012, Jordan….…………...............…….…..64

Morphological Distribution of lung cancer-Jordan, 2012…….....………....………65

Lung cancer ASIR by Age-group and gender - 2012……………….........…………..…66

Hodgkin’s Lymphoma ASIR byAge-group and gender………............………….68

Non-Hodgkin’s Lymphoma ASIR by Age-group and gender…………..............…….69

Morphological distribution of Urinary bladder cancer 2012, Jordan…................……..70

U.Bladder cancer ASIR by Age-group and gender 2012………...………71

Morphological distribution of Leukemia -2012, Jordan…….......................………72

Leukemia ASIR by Age-group and gender 2012, Jordan…………............………..73

Morphological distribution of Thyroid cancer 2012, Jordan………........…………….74

Thyroid cancer ASIR by Age-group and gender, 2012……………………………….75

Prostate caner ASIR -2012, Jordan…….......................................……………………77

Distribution of prostate cancer by SEER summary stage -2012, Jordan ……..……77

Morphological distribution of Brain and CNS cancer -2012, Jordan…......……..78

Brain and CNS cancer ASIR by age group and gender-2012, Jordan……………..79

Morphological distribution of stomach cancer – Jordan, 2012…….......................…80

Stomach cancer ASIR by age group and gender -2012, Jordan...……....………81

Percentage of gender for pediatric cancer cases -2012, Jordan……………………...84

Percentage distribution of pediatric cancer cases by age group-2012, Jordan............85

Top ten cancers in Pediatric age group both genders, 2012, Jordan ………………. 85


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Figure56

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Figure71

Annexes :Annex(1)

Annex(2)

Top five cancer in pediatric age group by gender-2012, Jordan……………...……85

Distribution of childhood cancer by age group and site, 2012 Jordan……….......…..86

Distribution of childhood cancer by governorate and gender, 2012 - Jordan……..….87

Distribution of childhood Leukemia by age and gender, 2012-Jordan…………88

Distribution of childhood Brain & CNS by age and gender, 2012-Jordan…………..88

Distribution of childhood lymphoma by age and gender, 2012-Jordan…………….89

Distribution of childhood eye tumor by age and gender, 2012-Jordan…………….89

Distribution of childhood neuroblastoma by age and gender, 2012 - Jordan.............89

Cancer among Non-Jordanians reported in (1996–2012)…….................…….……..97

Cancer among Non-Jordanians by nationality, 2012……………......……………..97

Perecentage distribution of deaths due to cancer by gender and age group, 2012...101

Distribution of deaths due to cancer by gender , 2012 Jordanian................................101

Number of cancer cases and number of deaths due to cancer by gender, 2012......101

Percentage distribution of deaths due to cancer by governorates, 2012...104

Distribution of male deaths due to cancer by age group, 2012 Jordanian........106

Distribution of female deaths due to cancer by age group, 2012 Jordanian.........106

Jordan Cancer Registry ( JCR) Notification Form.......................................................107

Jordan Cancer Registry Data Request Application Form..................................108


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Chapter one

1 • Introduction • Population & Geography of Jordan• Jordan Cancer Registry ( JCR ) :

- Data collection- Trend of Cancer in Jordan 2003-2012


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This is the 17th annual report of the incidence of cancer in Jordan published by Jordan Cancer Registry. It comprises the data for the year 2012 and a description of trends covering the period of 1996-2012. This report aims to explore the incidence of cancer in Jordan.Cancer is one of the leading causes of morbidity and mortality in Jordan. It is the second cause of death (16.2%) after cardiovascular disease (36.7%).(mortality - 2012 report) .Many factors play role in cancer development, but it is important to mention that many types of cancers can be prevented by simple life style change ; like smoking cessation and decrease exposure to smoke as smoking is the most significant cancer risk factor that we can reduce. Smoking is responsible for not only lung cancer, but for many other types of cancer.Well-balanced diet is advantageous for many reasons: a diet rich in fruits and vegetables can reduce the risk of developing cancer and many other health related conditions. Fruits and vegetables contain antioxidants, which help in repairing damaged cells. Numerous studies showed that a diet high in animal fat increases the risk for several types of cancer, particularly colon cancer.Red meat

contains much more fat than poultry and fish, so reducing amount of red meat in diet may help to prevent cancer. A diet high in fat is a major cause of obesity, which is a risk factor for many types of cancer.Physical activity is also important factor for cancer prevention. The American Cancer Society recommends exercising 30 or more minutes, at least 5 days a week for cancer prevention. The main purpose of this report is to provide health professionals, researchers and policy-makers and others who are interested with detailed information about the most common types of cancer in Jordan and their distribution by age, gender and address . Data provided by JCR may help in promoting new researches, to assist in planning and evaluation of Cancer Control Strategies and identify priorities for public health actions.Initiation of Jordan Breast Cancer Programe (JBCP) is a good example for the utilization of Jordan cancer registry data of breast cancer epidemiology and clinical data about stage of tumor and median age at diagnosis. The availbility of cancer data at JCR is a solid data base for intiating and establishing other screening programmes.

1-1 Introduction


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Population: The estimated population of Jordan in 2012 reached 6387986, among those 3292986 were males and 3095000 were females with male: female ratio 1.06 : 1. (Department of Statistics Jordan, 2012). About 12.7 % of the population were under 5 years old, and 37.2 % were under 15 years old. Only 3.3 % of the total population were above the 65 years old age groups .The percentage of males was a little higher than females in most of the age groups of the population, except in the age group 55-59 years and 80 years and above, where the percentage of females was slightly higher than males Table (1) and figure (2) show age distribution of Jordan population, 2012(Jordanian Population Pyramid). Table (2) shows the population distribution of Jordanians by governorates and gender. The Central region (Amman, Balqa,Zarqa, and Madaba governorates) constitute (62.8%) of Jordan population with population density (249.7) Km2, compared with Northern region (Irbid,Mafraq, Jarash and Ajlun) which consitute (27.8%) with population density (55 Km2) and Southern region ( Karak, Tafiela, Ma’an and Aqaba) (9.4%) with population density (11.7 Km2).

Geography :Jordan is located in the Middle East, between Latitudes 29-33 North and between Longitude 35-39 East, extending about 500 Kilometers from North to South. It is bounded in the North by Syria, in the East by Iraq and Saudi Arabia, in the South also by Saudi Arabia, and in the West by Israel and Palestine Authority.The total area is 89.3 thousand Km2. Out of the total area, 75% is desert along the Eastern part of the country. Mountains height ranged between 1100 – 1854 meters above sea level. The Dead Sea area is the lowest location in the world and it is around 407 meter below sea level.The climate of the country as a whole is moderate, there are four seasons summer, autumn, winter and spring. The temperature ranges from 4 C in winter to 38 C in summer. Jordan is divided from the administrative point of view into three regions (Central , North, and South) and twelve governorates ( Figure 1 Map of Jordan. )

1-2 Population & Geography


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Figure (1) Map of The Hashemite Kingdom of Jordan

Table (1) Estimated population of Jordan by age group and gender , 2012

Age group Male Female Total Gender RatioNo % No % No. %0-4 417555 12.7 396067 12.8 813622 12.7 105.45-9 412379 12.5 391785 12.7 804164 12.6 105.310-14 392200 11.9 370932 12.0 763132 11.9 105.715-19 360405 10.9 339847 11.0 700252 11.0 106.020-24 350468 10.6 325586 10.5 676054 10.6 107.625-29 300740 9.1 270408 8.7 571148 8.9 111.230-34 259992 7.9 239862 7.7 499854 7.8 108.435-39 210573 6.4 194608 6.3 405181 6.3 108.240-44 155733 4.7 146905 4.7 302638 4.7 106.045-49 109387 3.3 104259 3.4 213646 3.3 104.950-54 81113 2.5 79606 2.6 160719 2.5 101.955-59 70023 2.1 72528 2.3 142551 2.2 96.560-64 65369 2.0 58376 1.9 123745 1.9 112.065-69 46522 1.4 43373 1.4 89895 1.4 107.370-74 29411 0.9 29151 0.9 58562 0.9 100.975-79 15857 0.5 14505 0.5 30362 0.5 109.380-84 7692 0.2 9284 0.3 16976 0.3 82.985+ 7567 0.2 7918 0.3 15485 0.2 95.6Total 3292986 100.0 3095000 100.0 6387986 100.0 106.4


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Figure ( 2) Population Pyramid , Jordan 2012

Table (2) Estimated Population of Jordan by Governorates (Regions) and gender , 2012

gender

GovernorateMale Female Total

Amman 1271900 1201500 2473400Zaraqa 492500 459300 951800Balqa 222200 205800 428000Madaba 82300 77400 159700Central Region 2068900 1944000 4012900Irbid 582400 554700 1137100Jarash 98600 93100 191700Ajlun 74800 72100 146900Mafraq 155600 144700 300300North Region 911400 864600 1776000Karak 126100 123000 249100Aqaba 77500 61700 139200Maan 63600 57800 121400Tafiela 45500 43900 89400South region 312700 286400 599100Total 3293000 3095000 6388000


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1-3 Jordan Cancer Registry ( JCR )

Jordan Cancer Registry (JCR) is a population-based registry established in 1996 under the jurisdiction of the Ministry of Health (MOH) by the order of His Excellency the Minister of Health. JCR is a unit of Cancer Prevention Department in the Non-communicable Disease Directorate. Cancer notification is compulsory since 1996 through a ministerial decree.JCR monitor cancer incidence in Jordan and trends over time. The aim of JCR is to provide national cancer incidence data to the public in a timely and accurate manner. JCR also provide a data for clinical and epidemiological research. The cancer registry plays a central role in all aspects of cancer control not only for the population covered but also for other populations with which results can be compared.The systematic collection, recording and analysis of data relating to cancer enables interpretation of clinical and pathological characteristics of cancer, cancer incidence, mortality, for various population and sub- groups. It also opens the way for epidemiological researches about the causes of cancer, and effects of interventions in prevention and early diagnosis, provided that patients can be

identified and linked to data base systems as mortality data and data base in other hospitals In many countries, the cancer registry has proved to be an important tool for public health surveillance, including the planning and evaluation of health services.

VisionTo meet the highest attainable international standards in cancer registration, surveillance and control.

MissionTo register all cancer cases reported in various health institution in Jordan and to avail the data and /or information gathered for policy development and support in cancer research, treatment, control ,prevention, and surveillance.

Objectives of JCRTo define the size of cancer problem and pattern of cancer occurrence in Jordan. To provide data on cancer for epidemiological and clinical studies. To make data of cancer incidence and prevalence available for use by health planners and professionals in order to plan for cancer prevention, control and management in a cost effective manner.


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1-4-1 Methodology:For Jordanian all malignant and in-situ cases diagnosed from 1st Jan- 31 Dec.2012 were notified and registered to JCR, and for non-Jordanians all cancer patients that treated in our hospitals during this year were notified to our registry. There are two methods of data collection :1. Active method Data was collected and abstracted by a trained registry staff through regular visits to all hospitals distributed all over the country. The JCR strives for full access to cancer data from all governmental hospitals, private hospitals, Royal Medical Services and University hospitals as well as clinics and laboratories throughout the Kingdom. Cancer data are abstracted by JCR trained staff (Cancer Tumor Registrar) from patients’ medical records, based on clinical and/or histopathological diagnosis.2. Passive methodtrained focal points medical staff, abstract cancer data from patients files, complete a standardized form and forward it to the Jordan Cancer Registry. The data abstracted: includes personal identification (name, ID number, gender, age), demographic information (address, telephone number, nationality), and tumor details (diagnosis date, primary site, histology, behavior, grade, stage, basis of diagnosis).

Sources of information This Registry collect the most important data about cancer patients and ensure that it is complete and of high quality. Notifications of cancer derived from many sources, such as: Hospital admissions and medical records departments from all public ,private military and university hospitals all over Jordan (hospital discharge report) through international classification of disease and operation ICD-9 or 10 morbidity and mortality coding system. Histopathology report in all these hospitals.Hospital based Registry such as King Hussein Cancer Center (KHCC). Histopathology laboratories: cytology, hematology in public and private histopathology laboratories as Med-lab, Ennab lab and others. Forensic medicine records through (death certificates).

Reportable listReportable lists may range from a simple list of invasive and in-situ tumors to a complex s list that includes benign and borderline tumors.Cases with a behavior code 2 and 3 of the International Classification of Diseases for Oncology, third Edition (ICD-O-3) included in the registry.

1-4 Methodology Data management


24


ICD-O-3 Behavior Codes0 Benign1 Bordereline, benign or malignant2 Carcinoma in situ,3 Malignant, primary siteBenign (behavior code 0) or borderline (behavior code 1) these cases were collected in JCR but not entered in the Can-reg4 program and kept in special files specially those of brain and CNS. Localized basal cell and squamous cell carcinoma of non-genital skin sites (C44.0-C44.9) were included in our registry.Abstracting information is the essence of the cancer registry. The accuracy and completeness with which this function is performed determines the value of the registry. Users of cancer registry data must be confident that the abstracted information is a true representation of the patients’ demographics, diagnosis, and treatment. An abstract completed for each reportable case.

Data variables The number of assessment variables used by JCR is based on the international standard variables for all cancer registries .They are various formats that may used. JCR uses standards provided by the International Agency for Research on Cancer (IARC). They include:

• Patients details: first name, median name, last name, ID number, age/ date of birth, gender current residence (governorate). • Tumor : diagnosis date ,Basis of diagnosis, primary site /topography (ICD-O) code, histology/morphology (ICD-O) code, behavior ,grade and stage at diagnosis (SEER summary stage)• Treatments: initial and subsequent treatments surgery, radiotherapy, chemotherapy, hormonal therapy.• Sources of data: hospital/laboratory name, hospital / facility code number, name and date of abstracter.• Follow up: patient status (alive or dead) as the date of incidence, last date of contact with physician/ health care provider or if dead – date of death and cause of death.• A complete JCR abstract form is append to this report for more details.

Classification and Coding The primary site (topography) and histology (morphology) of the malignancies are identified and coded according to the International Classification of Diseases for Oncology third Edition (ICDO-3), published by the World Health Organization (WHO), 2000.


25


1-4-2 Data management (storage and retrieval)Completeness of data : JCR collects data from Al Basher hospital, the biggest governmental hospital in Jordan that treat cancer patient with separate department including radiotherapy, chemotherapy and inpatient and outpatients clinic the same on king Hussein cancer center (KHCC) and Al Basher hospital .Data is managed using server with net work computers at the registry, a local area network is established to allow staff to work on the registry data base simultaneously. In the future online system will be established for receiving abstract forms electronically from health facilities with internet access. This is intended to ease and speed up submission of abstract forms to the registry.Data is primarily managed and filtered and prepared for submission to Can Reg4 Software, which also allows statistical analysis. Abstract forms submitted from health –care facilities are kept in box files and shelved in straight numerical order in cabinets.In order to ensure good flow of data/ information between the registry and health care facilities. All cancer registrars are strictly bound by the professional code of observing confidentiality of patient

information. Information users interested in JCR data and information services are required to obtain authority for access to data from non-communicable disease directorate (NCD) director and are mutually bound to acknowledge the registry in their data usage. In order to maintain confidentiality of facility and patient information, inclusion of facility and patient identification details is restricted.Quality Assurance & Data analysis Accuracy and consistency are essential in tumor registry reporting. Quality control means assessing for completeness, accuracy, and uniformity of data at the case finding, abstracting, coding, and data processing levels.Quality control should be an ongoing process, and time should be allotted for registry personnel to carry out special quality control functions. The registry always perform quality control on data before presenting reports Every effort is made to accurately code patient and tumor information, to ensure that all data can be reviewed, linked, and consolidated, as appropriate.Before and during the phase of data entry, validation of data was done through the following : Assurance of data completeness through continuous generation of patients’ lists who have rare or invalid categories or behavior less than three to check for it .


26


Checking essential demographic data such as age, date of birth, gender, address. Patient lists were evaluated for duplicates.Internal quality checks include : random selection of some records was done systematically for double checks of data abstraction and to ensure completeness. Procedures for review include visual review, computerized data edits, and hospital queries. JCR staff performed quality assurance tasks upon receipt of abstracts from each reporting institution. Periodic review procedures also include re- abstracting of cases and case finding studies. The reporting facility is required to resolve incomplete, incorrect, or inconsistent data upon JCR query.The computer software program used for data entry and incidence tables output is CanReg 4.31, which developed by the International Agency for Research on Cancer, (IARC) Lyon, France, this software has a duplicate entry checking facility.Validity checks are performed for consistency between items: site/histology, gender/site and age/site/histology combinations by CanReg4. Epi-info and other statistical programmers were used for further analysis by the JCR staff as SPSS.Frequencies for most of the variables collected are presented in this report mainly primary site of cancer, age group, gender, governorate and regions, tables and graphs for cancer cases for Jordanian and non-

Jordanian and pediatric malignancy and top ten cancer for both genders presented, tables and graphs from literature presented for comparison of the rates to other countries .also one chapter for mortality due to cancer presented in the last chapter to identify most common deaths due to cancer by gender and governorates.World standard population is used for calculation of standard rates, to facilitate national and international comparisons (Table 3).

ConfidentialityTo ensure the protection and confidentiality of the identifying information collected by the JCR staff , Procedure Manual contains, among other things:1. Procedures to safeguard and secure the registry database and printed data generated from the database containing identifying information2. Procedures to destroy (e.g., by shredding) all printed materials containing identifying information when such materials are to be disposed of.3. Procedures to make certain and ensure that all persons with access to JCR identifying information have signed a written statement acknowledging their responsibility to maintain confidentiality and subjecting them to penalties for violation of confidentiality requirements.


27


Table (3) World Standard Population used for Age Adjustment

Age (Years) Count Age (Years) Count0- 4 120,000 50- 54 50,0005-9 100,000 55- 59 40,00010-14 90,000 60- 64 40,00015- 19 90,000 65- 69 30,00020- 24 80,000 70- 74 20,00025- 29 80,000 75- 79 10,00030- 34 60,000 80- 84 5,00035- 39 60,000 85+ 5,00040- 44 60,000 Total 1,000,00045- 49 60,000

1-5 Trend of cancers of all sites ( Jordanian, Non Jordanian)Figure (3) shows the trend of cancer cases in Jordan during the period 1986 – 2012, which shows that prior to the establishment of Jordan Cancer Registry ( JCR) in 1996, the reported cancer cases were presented as a Hospital – Based Registry which is mainly from Albasheer hospital after JCR establishment from1996 the reported cancer

cases were collected from all over the country as Population- Based Cancer Registry. It shows the number of reported malignancies according to the years of incidence in the years 1980 to 2011.The number of registered cases markedly increase when the Registry was transformed from Hospital – Based to Population –Based Registry.

Figure (3) Trend of cancer in Jordan, 1986-2012


28


Figures (4,5 ) shows the number of reported cases to JCR by gender and also crude incidence rate for Jordanian from the year 2003 to 2012 (ten years period) by gender.These figures shows that there is slight increase in the number of incident cases and

crude incidence in Jordanian for both males and females .The number of Jordanian males increase from 2194 in 2011 to 2346 in 2012 while in females the number increase from 2481in 2011 to 2667 in 2012.

Figure (4) Trend of cancer for Jordanian by gender,2003-2012

Figure (5) Trend of Crude incidence rate of cancer in (Jordanian) by gender2003-2012


29


Figure (6) shows the trend number of cases for non Jordanian apparnetly the number of cancer cases increased in both males and females for the year 2012.

Figure (6) Trend of cancer for Non Jordanian by gender 2003-2012

31


Chapter twoCancer Incidence in Jordan -2012, Jordanian

2 • Distribution of cases by basis of diagnosis and summary stage

• Frequency of incident cases by site andage group & gender

• Top ten cancers by age group & gender • Geographical distribution of cancer in Jordan • Top ten cancers by regions


32


In the17th annual report for the year 2012, we explored the number of new incident cases among Jordanians and Non-Jordanians (Resident or Non-residents) referred from neighboring and other countries for diagnosis and treatment in Jordan. Malignant and in situ behavior are reportable to our registry, while benign and borderline malignancy are not reportable in this registry. In 2012, the registry received around 12000 different notification forms, JCR forms, self-designed abstracted forms from all hospitals including governmental, private ,military and universities hospitals and also histopathology reports and lists of names from histopathology laboratories and forensic medicine. There are more than 60 sources for cancer notification to JCR covering all sectors in Jordan, with average of 2-3 notifications per one case. After checking, filtering all forms received we update data and exclude: duplicate and registered cases

(prevalent cases after checking the case and ensure that it is not multi-primary case) depending on multi-primary standard rules. Benign and borderline forms and histopathology report received were kept separately in special files in the registry.Total number of new cancer cases registered to JCR in 2012 were (7454) compared with (6971) in 2011 with increase of (7%). The number of Jordanian was 5013 patients compared with 4675 in 2011 while for non-Jordanian the number registered in 2012 was 2441 compared with 2296 in 2011.About 106 (2.1%) of cases were insitu behavior (not invasive) and the remaining (97.9%) were invasive cancer .There were 150 cases with multi primary tumors constituted about (2%) of cases in both Jordanian and non-Jordanian. Multi-primary tumors in Jordanian were( 130) cases (1.7%).

The following tables (4) and (5) show distribution of cases by basis of diagnosis and summary stage of the cases, it shows that the basis of diagnosis of cancer cases among Jordanian; clearly most of the cases were diagnosed by taking biopsy from primary site (94.9%), and (2.5%) of the cases were diagnosed by clinical and clinical investigation, and only 0.6% were diagnosed by death certificate only (DCO).

Table (5) shows distribution of cancer cases diagnosed in 2012among Jordanian distributed by SEER summary stage: insitu stage (2.1%), 32.5% were localized, regional was 32.5% while about 27.9% were advanced stage (distant metastasis).On the other hand in (20.5%) of the cases the stage was not recorded in the forms received.

2.1 Distribution of cases by basis of diagnosis and summary stage :


33


Table ( 4 ) Basis of diagnosis of cancer cases among Jordanians , 2012

Basis of diagnosis Frequency ( %)

Histology of primary site 4757 94.9

Clinical & clinical investigation/ ultrasound 123 2.5

Cytology/Hematology 92 1.8

Death Certificate Only ( DCO) 29 0.6

Histology of metastases 5 0.1

Laboratory test 2 0.0

Unknown 5 0.1

Total 5013 100.0

Table ( 5 ) Stage distribution of incident cases among Jordanians according to SEER *Staging , 2012

SEER Summary Staging Frequency ( %)

In situ 106 2.1

Localized 1628 32.5

Regional 854 17.0

Distant Metastasis 1399 27.9

Not Known 1026 20.5

Total 5013 100.0

*SEER : Surveillance , Epidemiology and End Results


34


A total of (5013) new cases of cancer were recorded among Jordanian population for the year 2012,of these, (2346) cases (46.7%) were males and (2667) were females cases (53.3%).Male to female ratio is 0.88:1 the same ratio in the year 2011.Distribution of cancer cases by age group shows that 42.7% of the cases occurred in the age group 60 years and above, with

males higher (56.8%) than females (43.2%) in this age group. While 46% the cases were in the age group 30-59 years ,and females predominate (61.9%) over males (38.1%) , this is mostly due to high incidence of breast cancer in this age group. In child hood period 0-14 years males were higher (55.8%) than females (44.2%), as shown in Figures (7) and (8).

2.2 Distribution of cases by Age group and gender:

Figure (7) Percentage distribution of cancer among Jordanians by age-group and gender , 2012

Figure (8) Percentage gender distribution of cancer among Jordanians by age group -2012


35


The overall median age at diagnosis was 56 years with considerable variation according to the cancer site and gender (60 years for males and 53 years for females). In 2012, the crude incidence rate of all cancers among Jordanians was 78.5 per 100,000 population (71.2 for males and 86.2 for females). The age-standardized rate (ASR) adjusted to the World Standard Population was (133.4) per 100,000 population (126.1 per 100,000 for males

and (141.4) per 100,000 for females)compared with 2011 ASR was128.1 (for males 121.1 for females) 135.6 /100,000 population). For all cancer the number of cases increased with age in both males and females as shown in table (6) the same also is seen for age specific incidence rate (ASIR) which increased with age for both males and females as shown in figure (9).

Table (6) Number and ASIR of cancer cases by age group and gender –Jordan ,2012

Age group Male Female TotalN ASIR N ASIR N ASIR

0-4 54 12.9 47 11.9 101 12.45-9 31 7.5 21 5.4 52 6.5

10-14 36 9.2 28 7.5 64 8.415-19 42 11.7 50 14.7 92 13.120-24 44 12.6 70 21.5 114 16.925-29 56 18.6 72 26.6 128 22.430-34 99 38.1 127 52.9 226 45.235-39 93 44.2 179 92.0 272 67.140-44 139 89.3 266 181.1 405 133.845-49 164 149.9 281 269.5 445 208.350-54 195 240.4 294 369.3 489 304.355-59 198 282.8 274 377.8 472 331.160-64 249 380.9 264 452.2 513 414.665-69 300 644.9 260 599.5 560 622.970-79 307 1043.8 201 689.5 508 867.575-79 199 1255.0 128 882.5 327 1077.080-84 94 1222.0 67 721.7 161 948.485+ 41 541.8 32 404.1 73 471.4

Unknown 5 - 6 - 11 - Total 2346 71.2 2667 86.2 5013 78.5


36

Cancer Incidence in Jordan - 2012Figure (9) ASIR for cancer cases by age group and gender –Jordanian ,2012

Figure (12) ASR of cancer of Jordan compared with other countries-Females

Figure (10) ASR for cancer cases by age group and gender –Jordanian ,2012

Figure (11) ASR of cancer of Jordan compared with other countries-Males


37

Cancer Incidence in Jordan - 2012Table (7) Number & percantage of new cancer cases by primary site & gender - Jordan, 2012

Primary Site Male Female TotalN % N % N %

All Sites 2346 100.0 2667 100.0 5013 100.0Lip 18 0.8 6 0.2 24 0.5Tongue 17 0.7 4 0.1 21 0.4Mouth 5 0.2 10 0.4 15 0.3Salivary glands 11 0.5 9 0.3 20 0.4Pharynx 29 1.2 17 0.6 46 0.9Oesophagus 17 0.7 7 0.3 24 0.5Stomach 86 3.7 50 1.9 136 2.7Small intestine 12 0.5 11 0.4 23 0.5Colon 181 7.7 191 7.2 372 7.4Rectum 101 4.3 94 3.5 195 3.9Liver, Biliary Passages 56 2.4 36 1.3 92 1.8Pancreas 75 3.2 51 1.9 126 2.5Other & Unspecified Digestive 13 0.6 12 0.4 25 0.5Larynx 89 3.8 10 0.4 99 2.0Trachea,Bronchus,Lung 292 12.4 79 3.0 371 7.4Other Thoracic organs 11 0.5 10 0.4 21 0.4Bone 26 1.1 21 0.8 47 0.9Melanoma of Skin 4 0.2 8 0.3 12 0.2Other Skin 132 5.6 78 2.9 210 4.2Connective,Soft tissue 33 1.4 27 1.0 60 1.2Breast 14 0.6 994 37.3 1008 20.1Cervix Uteri 0 0.0 50 1.9 50 1.0Corpus Uteri, unspecified 0 0.0 121 4.5 121 2.4Ovary 0 0.0 87 3.3 87 1.7Other reproductive Female 0 0.0 20 0.7 20 0.4Prostate 198 8.4 0 0.0 198 3.9Testis 59 2.5 0 0.0 59 1.2Other reproductive Male 2 0.1 0 0.0 2 0.0Kidney 85 3.6 48 1.8 133 2.7Urinary Bladder 217 9.2 29 1.1 246 4.9Eye 13 0.6 14 0.5 27 0.5Brain, Nervous system 101 4.3 66 2.5 167 3.3Thyroid 45 1.9 158 5.9 203 4.0Other Endocrine 9 0.4 12 0.4 21 0.4Hodgkin disease 49 2.1 60 2.2 109 2.2Non-Hodgkin lymphoma 128 5.5 90 3.4 218 4.3Lymphoid Leukemia 59 2.5 37 1.4 96 1.9Myeloid Leukemia 61 2.6 71 2.7 132 2.6Leukemia unspecified. 9 0.4 6 0.2 15 0.3Other bone marrow disorders 22 0.9 6 0.2 28 0.6Multiple Myeloma 30 1.3 28 1.0 58 1.2Other & unspecified 6 0.3 7 0.3 13 0.3Primary site unknown 31 1.3 32 1.2 63 1.3


38

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40


The following tables are of top ten cancers in Jordan for the year 2012 , in both genders (Males & Females).

Table (11) Ten most common cancers among Jordanians, Males, 2012

Site Frequency Percent1 Lung 292 12.42 Colorectal 282 12.03 Urinary Bladder 217 9.24 Prostate 198 8.45 Lymphoma 177 7.56 Leukemia 129 5.57 Brain, Nervous system 101 4.38 Larynx 89 3.89 Stomach 86 3.7

10 Kidney 85 3.6N.B: The total of the top Ten male cancers accounted 1656 ( 70.6%)

2.3 Top ten cancers in both genders, Age group & primary site, Jordanian -2012

Table (10 ) Ten most common cancers among Jordanians both genders, 2012

Rank Cancer No %1 Breast 1008 20.12 Colorectal 567 11.33 Lung 371 7.44 Lymphoma 327 6.55 U.Bladder 246 4.96 Leukemia 243 4.87 Thyroid 203 4.08 Prostate 198 3.99 Brain,CNS 167 3.310 Stomach 136 2.7

N.B: The total of the top Ten cancers accounted 3466 ( 69.1%)


41


Table (12) Ten most common cancers among Jordanian Females , 2012

Rank Cancer No %1 Breast 994 37.3

2 Colorectal 285 10.7

3 Thyroid 158 5.9

4 Lymphoma 150 5.6

5 Uterus 121 4.5

6 Leukemia 114 4.3

7 Ovary 87 3.3

8 Lung 79 3.0

9 Brain, Nervous system 66 2.5

10 Pancreas 51 1.9N.B: The total of the top ten female cancers accounted 2105(78.9%)Figure ( 13 ) Percentage distribution of Top ten cancers by age group, Males-2012

Figure (14) Percentage distribution of Top ten cancers by age group, Females-2012


42


The percentage distribution of cancer cases by age group shows that most of the cases occur in the age group 50 years and more (62%) while in 20-49 years (31.8%) and only (6.2% ) in the age group 0-19 years. Distribution of cases by gender with variation of the number of cases by gender ;the percent of males cancer by age group is 7%, 25.4% and 67.6% in the age groups 0-19, 20-49 years and 50 years and more while in females it is 5.5%,37.4% and 57.1%respectively.Cancer is slightly higher in males in the age group 0-19 years and 50 years and above while it is markedly higher in female in the age group 20-49 years (25.4%) vs (37.4%) % in this age group while in 50 years and more it is slightly higher in males than female (67.6%) vs (57.1%). As shown in figure (15 ). Tables from (13-15 ) show the top ten cancers for males and females, shows that the most common cancer for these three main categories of age

group shows that; leukemia , lymphoma , brain and CNS were predominate cancers in the age group 0-19 years in both genderes accounted for more than two third of the cases in this age group, while breast cancer is markedly the commonest (45.6%) in female in the age group 20-49 years followed by thyroid cancer 10.8% in this age group and colorectal cancer (7.3%),. For males the commonest cancer in the age group 20-49 years were colorectal cancer(11.9%), testis (8.2%), leukemia (7.6%) and lung (7.2%). For the age group 50 years and above lung(15.6%), colorectal cancer (13.1%)and prostate cancer (12.3%) were the commonest in this age group in males while in females in this age group breast was still the commonest (35.5%) followed by colorectal cancer (13.6%) then uterus (6.4%). Lymphomas was the only type of cancer that present in the top ten cancer in these three main categories of age group and in both genders.

2-4 Percentage distribution of cancer and top ten cancer for three main categories of age group (0-19,20-49 years and 50 years and above).

Figure ( 15 ) Percentage distribution of cancer cases by age group and genders -2012


43


Table (13) Top ten cancer for the age group 0-19 years, both genders , 2012

Male FemaleSite No. % Site No. %

Leukemia 47 28.8 Leukemia 37 25.3Brain,CNS 33 20.2 Hodgkin disease 22 15.1NHL 15 9.2 Brain.CNS 19 13.0Hodgkin disease 14 8.6 Bone 11 7.5Bone 13 8.0 Kidney 10 6.8Testis 8 4.9 Ovary 8 5.5Eye 7 4.3 Eye 8 5.5Connective tissue 5 3.1 Connective tissue 6 4.1Endocrine 5 3.1 Endocrine 6 4.1Kidney 3 1.8 Colorectal 5 3.4Others 13 8.0 Others 14 9.6

Total 163 100.0 Total 146 100.0

Table (14 ) Top ten cancer for the age group 20-49 years ,both genders , 2012

Male Female

Site No. % Site No. %Colorectal 71 11.9 Breast 454 45.6Testis 49 8.2 Thyroid 107 10.8Leukemia 45 7.6 Colorectal 73 7.3Lung 43 7.2 NHL 40 4.0NHL 43 7.2 Leukemia 34 3.4U.Bladder 32 5.4 Ovary 33 3.3Brain,CNS 31 5.2 Cervix 27 2.7Thyroid 28 4.7 Brain,CNS 27 2.7Hodgkin disease 27 4.5 Hodgkin disease 27 2.7Skin 25 4.2 Uterus 23 2.3Others 201 33.8 Others 150 15.1

Total 595 100.0 Total 995 100.0


44


Distribution of the numbers and rates of cancer cases by governorates and regions in 2012 is shown in table (16). Amman, the capital reported (61.9 %) of all cases followed by Irbid (12.6 %), Zarqa (9.2 %) and Balqa(4%) meanwhile only (0.7 %) was reported from Tafila, and (0.9%) was reported from Ajloun. Regarding the median age at diagnosis in governorates and regions the highest median age at diagnosis in cancer was seen in Amman and Madaba governorates (57) years and the lowest was in Ajloun

(46) years and Karak (48) years.For males also Amman and Irbid showed the highest median age at diagnosis of cancer(61) years followed by Maan (59) years, and the lowest was seen in Jarash (45) years and Tafiela (51.5) years. In females the highest median age was seen in Madaba (57) years and Amman 54 years, while the lowest median age was seen in Ajlun governorate (38.5) years followed by Aqaba (47) years and Karak (47.5) years. Regarding the crude cancer incidence rate per 100,000 population by governorates.

2-5 Geographical distribution of cancer in Jordan , 2012 by gov-ernorate and regions

Table (15) Top ten cancer for the age group 50+ years ,both genders, 2012

Male FemaleSite No. % Site No. %

Lung 247 15.6 Breast 540 35.5Colorectal 208 13.1 Colorectal 206 13.6Prostate 194 12.3 Uterous 98 6.4U.Bladder 185 11.7 Lung 71 4.7Skin 104 6.6 Skin 61 4.0NHL 69 4.4 Thyroid 49 3.2Larynx 70 4.4 NHL 47 3.1Stomach 67 4.2 Pancreas 46 3.0Kidney 59 3.7 Ovary 46 3.0Pancreas 56 3.5 Leukemia 43 2.8Others 324 20.5 Others 313 20.6

Total 1583 100.0 Total 1520 100.0


45


Amman showed the highest rate (125.5) per 100,000 population and the lowest was in Mafraq (31.6) /100,000 population followed by Ajloun (32) and Tafiela (38) per 100,000 population.; The incidence rate of cancer in the Central region was (96.2) per 100,000 population while it was (47.8) per 100,000 population in the North region and (42.7) per 100,000 population in the South region. Figures (16-17) show the crude incidence

rate in governorate and regions by gender. Figures (18-20) show the top ten types of cancer by gender and the regions of Jordan (Central,Northern,and Southern regions). Tables ( 17-18) show the Trend number of Cancers among Jordanian by primary site and gender (Males, female) from 2000-2012.

Table ( 16) Crude rates and percentages of cases by genders, governorates and regions,2012

GovernorateMale Female Total

N CR N CR N CR %Amman 1455 114.4 1648 137.2 3103 125.5 61.9Zarka 216 43.9 243 52.9 459 48.2 9.2Balqa 89 40.1 110 53.4 199 46.5 4.0Madaba 45 54.7 55 71.1 100 62.6 2.0Central Region 1805 87.2 2056 105.8 3861 96.2 77.0Irbid 309 53.1 323 58.2 632 55.6 12.6Jarash 36 36.5 39 41.9 75 39.1 1.5Ajloun 25 33.4 22 30.5 47 32.0 0.9Mafraq 39 25.1 56 38.7 95 31.6 1.9North Region 409 44.9 440 50.9 849 47.8 16.9Karak 35 27.8 68 55.3 103 41.3 2.1Aqaba 32 41.3 31 50.2 63 45.3 1.3Maan 27 42.5 29 50.2 56 46.1 1.1Tafiela 17 37.4 17 38.7 34 38.0 0.7South Region 111 35.5 145 50.6 256 42.7 5.1Outside 11 - 22 - 33 - 0.7Unknown 10 - 4 - 14 - 0.2

Total 2346 71.2 2667 86.2 5013 78.5 100.0


46


Figure (16 ) Crude incidence rate of cancer by governorate and gender Jordan -2012

Figure ( 17) Crude incidence rate of cancer by regions and gender, Jordan -2012

Figure ( 18 ) Percentage distribution of top ten cancers by gender, Central Region, Jordan , 2012


47


Figure (19) Percentage distribution of top ten cancers by gender, North Region, Jordan , 2012

Figure ( 20) Percentage distribution of top ten cancers cancer by gender, South Region, Jordan , 2012


48


Table ( 17 ) Trend of Cancer among Jordanian Males, 2000-2012

Year

Primary site

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Lip 5 6 9 8 2 13 11 18 13 10 5 8 18Tongue 7 8 7 6 2 8 7 9 6 7 6 5 17Mouth 23 11 20 17 9 26 19 14 16 20 15 17 16pharynx 25 21 27 22 15 20 26 34 37 24 29 41 29Esophagus 20 16 16 7 14 15 17 14 10 18 18 15 17Stomach 82 84 106 76 78 67 79 96 95 68 90 81 86Small intestine 10 11 7 8 14 11 12 8 9 9 12 11 12Colon 94 110 122 140 149 130 167 189 210 178 223 169 181Rectum 81 53 81 64 70 73 80 91 119 112 109 109 101Liver 31 35 37 56 45 39 59 37 52 52 60 39 56Pancreas 23 30 22 17 19 26 31 35 50 34 57 49 75Other &Unspecified Digestive 0 1 0 1 1 10 0 1 0 7 17 6 13Larynx 58 76 60 52 62 68 87 72 86 88 74 79 89Bronchus, lung 198 208 168 171 166 194 256 243 297 256 311 279 292Other thoracic organs 17 11 20 24 14 34 19 4 22 14 27 16 11Bone 31 28 31 25 37 32 32 27 33 30 27 22 26Connective tissue 28 23 13 27 24 27 22 14 27 35 31 34 33Melanoma of Skin 7 7 7 3 10 6 6 11 7 2 7 4 4Non-Melanoma 114 116 109 124 112 104 123 139 156 169 116 129 132Breast 4 5 12 25 6 10 16 9 9 16 10 17 14Prostate 123 151 143 149 147 139 133 158 163 179 218 169 198Testis 34 37 33 32 21 41 31 47 44 50 52 54 59Other male genital 2 1 0 2 1 0 1 0 0 3 2 2 2Kidney etc. 32 42 53 44 48 48 53 55 63 60 54 61 85U.Bladder 129 158 169 149 146 147 177 157 171 184 186 171 217Eye 5 13 7 11 6 11 14 9 12 7 8 9 13Brain, nervous system 95 83 87 78 97 90 85 82 89 100 106 108 101Thyroid 29 28 38 33 26 23 31 31 37 39 39 37 45Other endocrine 5 3 5 4 6 0 4 3 16 11 3 9 9Hodgkin’s disease 60 62 57 46 49 54 71 80 65 68 65 71 49Non-Hodgkin lymphoma 80 88 59 68 75 50 109 113 115 128 120 120 128Lymphoid leukemia 24 18 24 26 25 120 76 51 78 78 53 65 59Myeloid leukemia 55 125 50 31 44 60 70 50 53 73 60 60 61Leukemia unspecified 62 3 76 77 103 28 14 21 21 38 14 3 9Multiple Myeloma 20 19 24 21 24 28 30 33 43 56 45 54 30Other and unspecified 20 22 35 35 32 21 22 34 15 11 31 25 28Primary site unknown 44 27 26 64 60 45 57 59 35 46 44 46 31All Sites 1677 1740 1760 1743 1763 1818 2047 2048 2274 2280 2330 2194 2346


49


Table ( 18 ) Trend of Cancer among Jordanian Females, 2000-2012

Year

Primary site

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Lip 4 3 3 5 3 3 6 5 1 7 1 3 6Tongue 1 4 4 4 1 6 5 3 2 4 10 5 4Mouth 14 16 16 10 5 15 14 15 14 14 16 6 19Pharynx 9 11 11 13 9 11 18 9 22 13 6 17 17Esophagus 5 7 10 5 11 4 12 9 9 5 11 11 7Stomach 50 35 47 46 38 45 64 55 73 77 62 49 50Small intestine 5 7 9 8 6 7 4 8 7 8 7 9 11Colon 99 100 111 103 113 107 125 169 145 173 149 152 191Rectum 72 50 67 50 50 61 68 73 74 91 77 81 94Liver 31 37 44 41 36 35 27 38 57 45 53 40 36Pancreas 16 14 6 12 14 14 12 31 26 30 37 31 51Other &Unspecified Digestive 0 0 0 0 1 8 0 0 0 9 10 2 12Larynx 6 7 5 4 9 11 10 9 13 6 6 9 10Bronchus, lung 25 45 46 36 31 44 54 54 59 43 68 48 79Other thoracic organs 5 9 19 12 7 28 15 5 11 12 10 8 10Bone 16 15 32 19 20 20 23 21 14 14 22 18 21Connective tissue 12 11 19 20 19 9 10 22 27 19 28 26 27Melanoma of Skin 9 6 4 5 18 5 15 8 11 7 10 3 8Non-Melanoma 82 64 63 72 75 56 81 74 78 113 95 102 78Breast 551 566 501 551 646 674 749 817 855 926 941 935 994Cervix uteri 25 45 31 41 23 37 52 57 42 44 41 51 50Corpus Uteri 64 89 96 91 121 88 114 125 127 104 113 138 121Ovary 63 70 54 60 54 50 69 80 83 75 84 70 87Other female genital 9 9 7 11 3 6 8 10 14 23 13 13 20Kidney 28 28 27 32 19 26 27 26 25 35 41 33 48U.Bladder 25 17 30 21 21 30 18 26 27 22 23 32 29Eye 9 9 2 3 6 6 4 9 8 9 6 10 14Brain, nervous system 77 57 44 48 65 60 53 60 65 72 62 67 66Thyroid 77 71 98 91 93 103 125 107 109 140 136 145 158Other endocrine 5 8 8 6 3 1 10 9 7 8 5 4 12Hodgkin›s disease 48 51 57 31 32 37 59 55 46 79 67 53 60Non-Hodgkin lymphoma 54 40 48 42 50 34 84 90 107 110 130 100 90Lymphoid leukemia 17 10 8 19 21 71 51 45 35 33 40 42 37Myeloid leukemia 51 85 47 46 38 56 53 56 45 50 40 49 71Leukemia unspecified 43 0 44 69 70 18 11 15 14 31 11 7 6Multiple Myeloma 20 22 15 21 23 21 31 34 24 26 28 38 28Other and unspecified 19 28 29 35 24 17 19 13 16 12 38 34 13Primary site unknown 39 26 8 51 46 36 51 42 39 29 38 40 32All Sites 1685 1672 1670 1735 1828 1860 2151 2284 2332 2518 2519 2481 2667

51


3Chapter threeTop ten cancers among Jordanian Population 2012


52


3.1 Percentages and age standardized rate (ASR) for top ten cancer in Jordan, 2012This chapter explores the epidemiology of top ten cancers in both genders for Jordanians in the year 2012. The rank order of the top ten cancers by percent of cases, is shown in figure (21 ) .

Figure (21) Percentage of top ten cancers among Jordanians both genders, 2012

Figure (22 ) Numbers of top ten cancers among Jordanian by genders , 2012

Distribution of top ten cancers in Jordan 2012 by gender: there are some cancers that are more common in female than male: clearly breast and Thyroid, on the other hand lung, urinary bladder, lymphoma, leukemia brain and CNS were more common in males than females ,while colorectal cancer is almost equal in both genderes

,as shown in figure (22) .Age standardized rate for both genders and top ten cancer by ASR, the following figures (23-25) shows the highest ASR for both males and females. Table (19) presents the median age for all top ten cancer for males and females.


53


Figure (23) ASR of top ten cancers among Jordanian,Both gender ,2012

Figure (24) ASR of top ten cancers among Jordanian,Male ,2012

Figure ( 25) ASR of top ten cancers among Jordanian,Females, 2012


54


Table (19) Median age (years) at diagnosis for top ten cancers by genders, 2012

Gender

Primary SiteMale Female Total

Breast 54 51 51Colorectal

Colon

Rectum

62

63

58

60

60

60

61

61

59Lung 65 67 66NHL

Hodgkin Lymphoma

51

30

51

23

51

24U.Bladder 66 70 66Leukemia 30 38 33Thyroid 46 40 41Prostate 71 - 71Brain, CNS 43 35 41Stomach 60 61 60

1.Breast Cancer ( C50 )In the year 2012 there were 1008 cases of breast cancer in both genders accounting for 20.1% of all newly diagnosed cancer cases (including 43 cases which were in situ behavior) compared with 23 cases in 2011, of total breast cases 994 occurred in females and 14 cases in males with female to male ratio 71:1 compared to 55:1in 2011. Breast cancer is the commonest cancer in females accounted for 37.3 % of the cancers in females. The median age at diagnosis of breast cancer in females was 51 years, ranging from 20 years to 91 years, While in males the median age was 54 years. About 30.9 % of the cases were in the age group

40-49 years . While 26 % of the cases were in the age group between 50-59 years. About 14.7% were under 40 years ,and only 28.4% of the cases were above the age of 60 years. The crude incidence rate for female breast cancer was (32.1) per100,000 female population, compared to (30.9) per 100,000 in 2011 .The highest age-specific incidence rate in female ( 200.6) per 100,000 was found at the age-group 65-69 years followed by 195.3 per 100,000 in the age group60-64 years. Table (20 ) and figure (26) The Age Standardized Rate( ASR ) for female breast cancer was (53.9)/100,000 compared with (51.3) per 100,000 female population in 2011 .

3.2 Top ten cancers by site.


55


Ductal carcinoma was the most frequent morphological type (77.6%) and (6.8)% were lobular carcinoma, while the mucinous carcinoma accounted1.3% table (21).(47.3%) of female breast cancer cases occurred in the right breast , while the left breast was affected in (47 %) of the cases, only (2.1% ) of the cases were bilateral, meanwhile laterality was not mentioned in (3.6% ) of registry records figure (27).The grade of tumors (42.6%) of the cases

were of moderate differentiation, (28.8%)were poorly differentiated and (23.5%) of the cases the differentiation was not recorded figure (28).Staging of breast cancer figure (29) showed that (4.3%) of the cases were in situ and (27.8%) were localized and (37.9%) were regionally staged and (11.7%) were staged as a distant metastasis.

Table (20) Frequency and ASIR of breast cancer by age-group and gender-2012

Age Group Male Female TotalNo. ASIR No. ASIR No ASIR*

0-4 0 0.0 0 0.0 0 0.05-9 0 0.0 0 0.0 0 0.010-14 0 0.0 0 0.0 0 0.015-19 0 0.0 0 0.0 0 0.020-24 1 0.3 5 1.5 6 0.925-29 1 0.3 15 5.5 16 2.830-34 0 0.0 47 19.6 47 9.435-39 0 0.0 80 41.1 80 19.740-44 1 0.6 151 102.8 152 50.245-49 2 1.8 156 149.6 158 74.050-54 2 2.5 140 175.9 142 88.455-59 1 1.4 118 162.7 119 83.560-64 2 3.1 114 195.3 116 93.765-69 3 6.4 87 200.6 90 100.170-74 0 0.0 42 144.1 42 71.775-79 1 6.3 26 179.2 27 88.980-84 0 0.0 7 75.4 7 41.285+ 0 0.0 6 75.8 6 38.7Unknown 0 0 0 0 0 0Total 14 0.4 994 32.1 1008 15.8


56


Figure ( 26) ASIR of breast cancer by age-group and gender-2012.Jordanian

Figure (27) Distribution of breast cancer cases by laterality, 2012- Jordan

Table (21) Distribution of Female breast cancer by Morphology Jordanian -2012

Morphology N %Ductal Carcinoma 771 77.6Lobular carcinoma 68 6.8Carcinoma NOS 60 6.0Mixed type of cancer 7 0.7Malignant tumor NOS 12 1.2Mucinous Carcinoma 13 1.3Inflammatry carcinoma 3 0.3Others 60 6.0Total 994 100.0


57


Figure (28) Distribution of female breast cancer cases by grade, Jordanian- 2012

Figure (29) Distribution of female breast cancer cases by summary stage , 2012

Distribution of female breast cancer cases by governorate showed that the highest rate was (51.5/100,000) in Amman city, while the lowest rate was in Tafiela( 6.8/100,000).Meanwhile the distribution of the cases by

regions (40.3/100,000) was in the central region compared to (16.7)/100,000 in the northern region and (19.2/100,000) in southern region as shown in table (22 )


58


Table (22) Distribution, crude rate and percentage of female breast cancer by governorates and regions, Jordan 2012

Governorate Frequency Crude incidence Rate Percent

Amman 619 51.5 62.3Zarka 106 23.1 10.7Madaba 19 24.5 1.9Balqa 39 19.0 3.9Central Region 783 40.3 78.8Irbid 112 20.2 11.3Jarash 13 14.0 1.3Ajloun 9 12.5 .9Mafraq 10 6.9 1.0North region 144 16.7 14.5Karak 26 21.1 2.6Maan 10 17.3 1.0Tafiela 3 6.8 .3Aqaba 16 25.9 1.6South region 55 19.2 5.5Unknown 12 - 1.2Total 994 32.1 100.0

The following figures 30-31 shows trend of number of cases ,ASR of female breast cancer cases from 2000-2012 , table (23)

shows the trend of frequency distribution of female breast cancer by age group from 2000-2012.

Figure ( 30) Trend numbers of female breast cancer cases 2000-2012.


59


Figure (31) Trend of Age Standardized Rate (ASR) of female breast cancer , 2000-2012

Table( 23) Frequency distribution of female breast cancer cases by age group 2000-2012 Year Age group

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

0-4 0 0 0 0 0 0 0 0 0 0 0 0 05-9 0 0 0 0 0 0 0 0 0 0 0 0 010-14 0 0 0 0 0 0 0 0 0 0 0 0 015-19 0 0 0 0 0 0 0 0 0 1 0 0 020-24 4 1 0 7 3 4 1 3 1 0 2 6 525-29 11 14 12 8 14 16 8 15 18 13 19 18 1530-34 36 26 43 30 43 38 40 44 38 46 53 47 4735-39 51 69 51 59 80 62 84 69 79 89 91 93 8040-44 64 75 62 86 91 110 101 129 125 129 156 128 15145-49 80 70 73 87 96 102 111 126 133 134 148 158 15650-54 76 88 78 64 80 87 79 92 112 117 110 122 14055-59 68 85 61 80 86 86 93 96 93 100 95 103 11860-64 66 57 35 61 71 73 86 80 104 120 112 112 11465-69 43 37 49 38 39 47 75 60 56 72 75 70 8770-74 25 25 19 19 19 28 37 51 53 46 50 33 4275-79 27 8 12 6 17 12 20 27 23 33 28 27 2680-84 0 6 3 2 6 4 9 10 10 16 21 11 785+ 0 5 5 4 1 3 1 6 7 9 5 6 6Unknown 0 0 0 0 0 2 0 1 3 1 2 1 0Total 551 566 503 551 646 674 749 817 855 926 967 935 994


60


2. Colo - Rectal cancer ( C18-C21 ) In 2012, there were 567 colo-rectal cancer cases, accounted for (11.3%) of all newly diagnosed cases among Jordanians .it ranked the second among all new cancers in both males and females. It accounted to (12%) of male cancers with 282 cases and (10.7%) of female cancers with 285 cases. Male to female ratio was 0.9 : 1 compared with 1.2:1 in 2011.The median age at diagnosis was 61 years (for both genders), for the colon in males it was (63 yrs) and (60 yrs) for females. Meanwhile the age for the rectal cancer was (58 yrs) for males and (60 yrs) for females.The crude incidence rate in both genders was (8.9 /100,000 population), it was slightly higher in females with (9.2/100,000) compared to males (8.6/100,000). The highest (ASIR) for both genders was found in the age group80-84 years (135.5/100,000) and the highest ASIR in males was found in the age group 80-84 years and above (156.0 /100.000), while in females the highest ASIR was in the ag group 70-74 year (147.5/100,000). The overall Age-Standardized Incidence Rate ( ASR ) was 16.3/100,000. ( ASR for males was 15.9/ 100,000 and for females 16.6/ 100,000 ). Table (24) shows the distribution of colo-rectal cancer cases by age-group and gender and figure (32) shows the age-specific

incidence rates of colo-rectal cancers.Figure (34) shows the trend of number of cases of CRC and figure (35) shows the trend of ASR for colorectal cancer during 2003-2012.Distribution of cases by topography of the cancer shows that the rectal cancer is the most common site 22.6% followed by sigmoid colon 21.7% and rectosigmoid 9.9 % cecal cancer 7.9% ,while colon unknown specific site «not otherwise specified « (NOS ) was 12.3% table (25) and figure (33 ) .Histopathologically it was found that (81.1%) of all colorectal cancers were adenocarcinomas, (5.1%) were mucinous carcinoma, (3.5%) of the cases were of carcinoma NOS, table (26 ).Table (27) shows the distribution of colorectal cancer cases by stage of tumor according to summary stage, it was found that about 27.7% of cases were diagnosed as localized 27.0% were regional stage,and about 21.2% were diagnosed as distant metastasis.Figure (36) shows the distrbution of CRC cases by grade, 60.3 % of the cases were moderate differniation and 10.9% of poor diffenentiation.Table (28) shows the distrbution of CRC cases by govrenorates 63.1% of the cases were in Amman followed by Irbid 13.1%.


61


Table (24 ) Colorectal Cancer number and ASIR by age-group and gender-2012

Age Group (Years)

Male Female TotalNo. ASIR No. ASIR No ASIR

0-4 0 0.0 0 0.0 0 0.05-9 0 0.0 0 0.0 0 0.010-14 1 0.3 1 0.3 2 0.315-19 1 0.3 4 1.2 5 0.720-24 1 0.3 3 0.9 4 0.625-29 4 1.3 3 1.1 7 1.230-34 10 3.8 5 2.1 15 3.035-39 15 7.1 12 6.2 27 6.740-44 17 10.9 30 20.4 47 15.545-49 24 21.9 20 19.2 44 20.650-54 26 32.1 34 42.7 60 37.355-59 25 35.7 26 35.8 51 35.860-64 37 56.6 36 61.7 73 59.065-69 44 94.6 37 85.3 81 90.170-74 34 115.6 43 147.5 77 131.575-79 23 145.0 16 110.3 39 128.580-84 12 156.0 11 118.5 23 135.585+ 7 92.5 3 37.9 10 64.6Unknown 1 1 2Total 282 8.6 285 9.2 567 8.9

Figure (32) Colorectal cancer Age Specific Incidence rate by age group & gender, 2012


62


Table (25 )Distribution of Colo-Rectal cancer by topography sub site and gender, 2012

gender

TopographyMale Female Total %

Cecum 21 24 45 7.9Appendix 6 10 16 2.8Ascending colon 17 16 33 5.8Hepatic flexure of colon 12 4 16 2.8Transverse colon 8 12 20 3.5Splenic flexure of colon 7 5 12 2.1Descending colon 10 20 30 5.3Sigmoid colon 65 58 123 21.7Overlapping Colon 3 4 7 1.2Colon. NOS 32 38 70 12.3Rectosigmoid Junction 31 25 56 9.9Rectum. Nos 63 65 128 22.6Anus and anal canal 7 4 11 1.9Total 282 285 567 100.0

Figure (33) Distribution of Colorectal cancer by topography ,Jordan -2012


63


Figure ( 34 ) Trend of number of colorectal cancer 2002-2012. Jordan

Figure ( 35 ) Trend of ASR for colorectal cancer 2003-2012. Jordan

Table (26) Distribution of Colorectal cancer cases by morphology 2012

Morphology M F T %

Adeno carcinoma 226 234 460 81.1

Mucinous carcinoma 12 17 29 5.1

Carcinoma NOS 12 8 20 3.5

Malignant tumor 4 2 6 1.1

Carcionoid tumour 9 7 16 2.8

signet ring carcinoma 5 3 8 1.4

Others 14 14 28 4.9

Total 282 285 567 100.0


64


Figure (36) Distribution of colorectal cancer cases by grade -2012, Jordan

Table (27) Distribution of colorectal cancer cases by Summary stage -2012, JordanSummary

StageColon Rectum Colorectal

N % N % N %InSitu 8 2.2 4 2.1 12 2.1Localized 117 31.5 40 20.5 157 27.7Regional 85 22.8 68 34.9 153 27.0Distant 80 21.5 40 20.5 120 21.2Unknown 82 22.0 43 22.1 125 22.0Total 372 100.0 195 100.0 567 100.0

Table (28) distribution number & percentage of colorectal cancer and rate by governorates ,Jordan 2012

Governorate N % RateAmman 358 63.1 14.5Zarka 59 10.4 6.2Madaba 13 2.3 8.1Balqa 18 3.2 4.2Central Region 448 79.0 11.2Irbid 74 13.1 6.5Jarash 9 1.6 4.7Ajloun 6 1.1 4.1Mafraq 11 1.9 3.7North region 100 17.6 5.6Karak 5 .9 2.0Maan 3 .5 2.5Tafiela 3 .5 3.4Aqaba 2 .4 1.4South region 13 2.3 2.2out side 6 1.1 Total 567 100.0 8.9


65


3-Lung Cancer (C34 )

Figure (37) Morphological Distribution of lung cancer -2012, Jordan

T h e r e w e r e 3 7 1 c a s e s o f l ung c a n c e r a c counting for (7.4 %) of all newly diagnosed cancer cases in 2012 compared with 327 cases in 2011. lung cancer affected 292 (78.7%) males and 79 (21.3%) females with a male to female ratio of 3.7:1. Lung cancer ranked the first among all males cancers (12.4%) and 8th among females cancers (3%). The crude incidence rate was 5.8 /100.000 (for males 8.9, and for females 2.6). The highest Age-Specific Incidence Rate was seen in the age group between 75-79 years for both genders (144.9) per 100,000 population (for males 201.8, for females 82.7).

The overall median age at diagnosis was 66 years, the median age at diagnosis was 65 years for males and 67 years for females. The overall ASR was (11.5/100,000) (for males the ASR was 17.6/100,000 and for females it was 5.1/100,000) . Table (29) and figure (38) show distribution and age- specific incidence rates for lung cancer Regarding the four major histological types; small cell carcinoma accounted for (9.5%), Non small cell carcinoma accounted for (67.8%): adenocarcinoma was (30.4%), the squamous cell carcinomas (20.6%), and the Non-small cell carcinoma NOS was (16.8%), figure ( 37 ) .


66


Table ( 29 ) Lung Cancer ASIR by Age-group and gender-2012

Age Group


0-4 1 0.2 0 0.0 1 0.15-9 0 0.0 0 0.0 0 0.010-14 0 0.0 0 0.0 0 0.015-19 1 0.3 0 0.0 1 0.120-24 1 0.3 0 0.0 1 0.125-29 0 0.0 0 0.0 0 0.030-34 1 0.4 1 0.4 2 0.435-39 6 2.8 1 0.5 7 1.740-44 13 8.3 1 0.7 14 4.645-49 22 20.1 5 4.8 27 12.650-54 22 27.1 6 7.5 28 17.455-59 31 44.3 6 8.3 37 26.060-64 44 67.3 13 22.3 57 46.165-69 49 105.3 13 30.0 62 69.070-74 59 200.6 15 51.5 74 126.475-79 32 201.8 12 82.7 44 144.980-84 8 104.0 5 53.9 13 76.685+ 2 26.4 1 12.6 3 19.4Total 292 8.9 79 2.6 371 5.8

Figure (38) ASIR for lung cancer by age group and gender 2012, Jordan


67


4- Lymphomas (C81-C82, C96)

In 2012 there were a total of 327 cases of

lymphoma (Hodgkin and Non Hodgkin

lymphoma) accounting for (6.5%) of all

cancer cases. Lymphoma ranked 4th among

all newly diagnosed cancer cases in both

genders, ranked 5th in males (7.5%) and 4th

in females (5.6%) for the year 2012 .

Lymphoma was of two types according

to originating site :nodal ( that originated

from lymph node) which counted 239/327

(73.1%) while the other 88 cases (26.9%)

were extra nodal, mainly stomach 24 (7.3%)

patients , skin 12 cases (3.7%) ,bone marrow

6 (1.8%) ,and others site (14.1% ).

Lymphoma occur more in male (54.1%) than

female (45.9%) with male to female ratio

1.2:1. Another morphological classification of

lymphoma into two types: Hodgkin and Non-

Hodgkin lymphoma; Hodgkin lymphoma the

number of cases was (109/327) accounting

for 33.3% of all cases of lymphoma ; It

is relatively common among adolescents

and young adults, it is higher in female

(55.1%) than male (44.9 %) Male: Female

ratio 0.81:1.

Median age for both genders is 24

years (males 30 years and 23 years in

females) Non-Hodgkin lymphoma (NHL) ;

218 cases which accounted for (64%) of all

lymphomas (218/327).It is relatively more

frequent in males (58.7%) than in females

(41.3%), with a male to female ratio of 1.4:1,

it is more commonly occurring in older age

than Hodgkin’s disease ,median age for both

genders was (51) years .

Age specific incidence rate (ASIR) for

Hodgkin lymphoma was 1.7/100,000

(1.5 in male,1.9 in females),while ASIR

for NHL was 3.4/100,000 (3.9 in males,

2.9 in females). Age specific incidence

rate (ASIR) for Hodgkin lymphoma was

1.7/100,000 (1.5 in male,1.9 in females),

while ASIR for NHL was 3.4/100,000

(3.9 in males, 2.9 in females).

Table (30) and figure (39) show the

distribution and Age-Specific Incidence Rates

for Hodgkin’s Lymphoma. Table (31) and

figure (40) shows the distribution and Age-

Specific Incidence Rates for Non- Hodgkin’s

lymphoma.


68


Table ( 30 ) Hodgkin lymphoma number and ASIR by age-group and gender-2012

Age Group


0-4 2 0.5 1 0.3 3 0.45-9 3 0.7 1 0.3 4 0.510-14 3 0.8 5 1.3 8 1.015-19 6 1.7 15 4.4 21 3.020-24 6 1.7 13 4.0 19 2.825-29 4 1.3 5 1.8 9 1.630-34 9 3.5 6 2.5 15 3.035-39 3 1.4 1 0.5 4 1.040-44 3 1.9 0 0.0 3 1.045-49 2 1.8 2 1.9 4 1.950-54 4 4.9 5 6.3 9 5.655-59 2 2.9 1 1.4 3 2.160-64 1 1.5 1 1.7 2 1.665-69 0 0.0 0 0.0 0 0.070-74 1 3.4 1 3.4 2 3.475-79 0 0.0 0 0.0 0 0.080-84 0 0.0 1 10.8 1 5.985+ 0 0.0 0 0.0 0 0.0Unknown 0 0.0 2 0.1 2 0.0Total 49 1.5 60 1.9 109 1.7

Figure (39) Age-Specific Incidence Rate (ASIR) by age group & gender ( Hodgkin’s disease), 2012


69


Table (31) Non Hodgkin lymphoma number and ASIR by age-group and gender-2012

Age Group


0-4 2 0.5 1 0.3 3 0.45-9 6 1.5 1 0.3 7 0.910-14 5 1.3 1 0.3 6 0.815-19 2 0.6 0 0.0 2 0.320-24 2 0.6 3 0.9 5 0.725-29 4 1.3 6 2.2 10 1.830-34 9 3.5 6 2.5 15 3.035-39 11 5.2 6 3.1 17 4.240-44 7 4.5 7 4.8 14 4.645-49 10 9.1 12 11.5 22 10.350-54 14 17.3 5 6.3 19 11.855-59 5 7.1 11 15.2 16 11.260-64 11 16.8 8 13.7 19 15.465-69 18 38.7 6 13.8 24 26.770-74 11 37.4 7 24.0 18 30.775-79 5 31.5 5 34.5 10 32.980-84 4 52.0 5 53.9 9 53.085+ 1 13.2 0 0.0 1 6.5Unknown 1 - 0 - 1 -Total 128 3.9 90 2.9 218 3.4

Figure (40) Age-Specific Incidence Rate (ASIR) by age group & gender ( NHL), 2012


70


5. Urinary bladder (C67) There were (246) cancer cases of urinary bladder accounting for (4.9%) of all newly diagnosed cancers. Bladder cancer ranked third in males 217 (9.2%) of all male cancers, regarding the gender distribution; males 217 (88.8%) and 29 females (11.2%) with a male to female ratio of 7.5:1 compared to 5: 1 in 2011.It is far more frequent in males than in females. Over all crude incidence rate for U.Bladder cancer was 3.9/100,000 (for males 6.6 and for females 0.9/100,000). The highest ASIR was seen in the age group 75-79 years (108.7/100,000), (for

males also it was the highest (170.3) and for females 41.4),the highest ASIR in females was in the age group 80-84 years (43.1/100,000).The median age at diagnosis (both genders) was 66 years (males 66 years, females 70 years).Over all ASR for urinary bladder cancer was 7.4/100,000 ( males 13, females 1.7 /100,000). Morphology of bladder cancer, papillary transitional cell carcinoma was the commonest type (52%), transitional cell carcinoma (39%), carcinoma (NOS) (4%) and others (4%) figure (41). Table (32) and figure (42) show the distribution and age-specific incidence rates for bladder cancer.

Figure (41 ) Morphological distribution of U.Bladder cancer , Jordan-2012


71


Table ( 32) Urinary Bladder cancer number and ASIR by age group and gender,2012

Age Group


0-4 0 0.0 0 0.0 0 0.05-9 0 0.0 0 0.0 0 0.010-14 0 0.0 0 0.0 0 0.015-19 0 0.0 0 0.0 0 0.020-24 0 0.0 0 0.0 0 0.025-29 2 0.7 0 0.0 2 0.430-34 4 1.5 1 0.4 5 1.035-39 7 3.3 1 0.5 8 2.040-44 10 6.4 2 1.4 12 4.045-49 9 8.2 1 1.0 10 4.750-54 16 19.7 4 5.0 20 12.455-59 21 30.0 3 4.1 24 16.860-64 25 38.2 1 1.7 26 21.065-69 38 81.7 1 2.3 39 43.470-74 41 139.4 3 10.3 44 75.175-79 27 170.3 6 41.4 33 108.780-84 11 143.0 4 43.1 15 88.485+ 6 79.3 2 25.3 8 51.7Unknown 0 0.0 0 0.0 0 0.0Total 217 6.6 29 0.9 246 3.9

Figure (42 ) U.Bladder cancer Age Specific Incidence Rate by age group & gender , 2012


72


6. Leukemia (C91-92,C95)There were (243) cases of leukemia, of them (129) in males (5.5%) and 114 in females (4.3%) of all female cancers, leukemia was more common in males than females; (53.1%) males (46.9%) females with a male to female ratio of 1.1: 1. compared to 1:3 in 2011.Leukemia commonly affects younger age group for both males and females with median age 33 years (30 years in males ,38 years in females).There was big differences of median age by different morphological type of leukemia as in lymphoid leukemia it was 13.5years, in myeloid leukemia 44 years while in Leukemia NOS the median age at diagnosis was 36 years. The most common types of leukemia in all age groups and both genders was myeloid Leukemia

(132/243) (54.3%). Lymphatic Leukemia accounted for (96/243) (39.5%) of all types of leukemia ,other types includes Leukemia (Not otherwise classified) (NOS) (6.2%).Leukemia is common in pediatric age group 0-14 years it constituted about (65/243) (26.7)% of total cases of leukemia. 77% of them were lymphatic leukemia and 23% were myeloid leukemia. Age specific incidence rate ASIR for leukemia was 3.8/100,000 population (3.9 in males, 3.7 in females). Overall ASR was 5.0 /100,000. ASR for males and females (5.0/100.000). Figure (43 ) shows the distribution of cases of leukemia by morphological sub types.Table (33) and figure (44) show the distribution and Age- Specific Incidence Rates for leukemia of all types.

Figure (43) Distribution of Leukemia by morphological subtypes-2012


73


Table (33) Leukemia number and ASIR by age-group and gender-2012, Jordan

Age Group


0-4 16 3.8 16 4.0 32 3.95-9 10 2.4 5 1.3 15 1.910-14 9 2.3 9 2.4 18 2.415-19 12 3.3 7 2.1 19 2.720-24 9 2.6 8 2.5 17 2.525-29 7 2.3 3 1.1 10 1.830-34 8 3.1 6 2.5 14 2.835-39 10 4.7 6 3.1 16 3.940-44 5 3.2 5 3.4 10 3.345-49 6 5.5 6 5.8 12 5.650-54 5 6.2 6 7.5 11 6.855-59 2 2.9 5 6.9 7 4.960-64 5 7.6 7 12.0 12 9.765-69 5 10.7 7 16.1 12 13.370-74 10 34.0 7 24.0 17 29.075-79 4 25.2 5 34.5 9 29.680-84 6 78.0 5 53.9 11 64.885+ 0 0.0 1 12.6 1 6.5Total 129 3.9 114 3.7 243 3.8

Figure ( 44 ) ASIR of Leukemia cases by gender and age group, 2012-Jordan


74


7-Thyroid Cancer (C73)There were 203 thyroid cancer cases accounting for 4.0% of all newly diagnosed cancers cases. It ranked the 3rd among female cancers .Thyroid cancer is one of the few tumors which is by far more frequent in females than in males. It affected 158 ( 5.9%) of all female cancers and 45 (1.7%) of all male cancers , female to male ratio 3.5:1. About 48.4% of thyroid cancer in females affected women below 40 years. Median age at diagnosis for both genders was 41 years, (for males

46 and females 40 years).The distribution of thyroid cancer by histopathological type was as follow : papillary carcinoma 70%, follicular carcinoma 10% , papillary carcinoma follicular variant 6% figure ( 45).Crude incidence rate for thyroid cancer was 3.2 /100,000 population (1.4 males , 5.1females). The over all ASR for thyroid cancer was 4.3/100,000 (2.0 males , and 6.7 females). Table (34) and figure (46) shows the distribution of numbers and Age - Specific Incidence rates for thyroid cancer by gender.

Figure (45 ) Morphological distribution of thyroid carcinoma ,2012-Jordan


75


Table ( 34 ) Thyroid cancer number and ASIR by age-group and gender-2012, Jordan

Age Group


0-4 0 0.0 0 0.0 0 0.05-9 0 0.0 0 0.0 0 0.010-14 0 0.0 0 0.0 0 0.015-19 0 0.0 2 0.6 2 0.320-24 2 0.6 12 3.7 14 2.125-29 5 1.7 15 5.5 20 3.530-34 8 3.1 24 10.0 32 6.435-39 4 1.9 25 12.8 29 7.240-44 3 1.9 21 14.3 24 7.945-49 6 5.5 10 9.6 16 7.550-54 8 9.9 10 12.6 18 11.255-59 3 4.3 14 19.3 17 11.960-64 2 3.1 11 18.8 13 10.565-69 2 4.3 7 16.1 9 10.070-74 1 3.4 5 17.2 6 10.275-79 1 6.3 1 6.9 2 6.680-84 0 0.0 1 10.8 1 5.985+ 0 0.0 0 0.0 0 0.0Total 45 1.4 158 5.1 203 3.2

Figure ( 46) Thyroid cancer Age Specific Incidence Rate by age group &gender, 2012


76


8-Prostate Cancer (C61) There were 198 cases of prostate cancer accounting for 3.9% of all cancer cases. It ranked the 4th among males cancers (8.4%) Prostate cancer was more common in the age 60 years and above ( 88.8%) of cases were found at this age-group. The highest age specific incidence rate was in the age group 75-79 years ( 258.6/100,000). Clearly the incidence of prostate cancer increased steadily with increasing age. The median

age at diagnosis was 71years .The crude incidence rate was 6.0/100,000 while ASR was 12.7/100,000, The majority of the morphology of prostate cancer was adenocarcinomas ( 93.2%).Table (35) and figure (47) show the distribution and Age- Specific Incidence rate for prostate cancer.Tumor staging showed 41% of the cases were localized and 26% were in advanced stage (distant metastasis) figure (48).

Table (35) ASIR and number of Prostate cancer by age group, 2012

Age Group MaleNo. ASIR

0- 4 0 0.05- 9 0 0.010- 14 0 0.015- 19 0 0.020- 24 0 0.025- 29 0 0.030- 34 0 0.035- 39 0 0.040- 44 0 0.045- 49 4 3.750- 54 4 4.955- 59 14 20.060- 64 18 27.565- 69 44 94.670- 74 50 170.075- 79 41 258.680- 84 14 182.085+ 9 118.9Total 198 6.0

ASIR : Age specific incidence rate


77


Figure (47) prostate cancer Age Specific Incidence Rate, Male population 2012, Jordan

Figure (48) Distribution of Prosate cancer cases by SEER summary stage, 2012, Jordan


78


9-Cancers of the Brain & CNS (C71-C72)Cancers of the central nervous system sites include the brain, cerebellum, brain stem, meninges, spinal cord, and other nervous sites. There were 167 cases accounting for 3.3% of all newly diagnosed malignant cancers 2012. These cancers ranked the 7th in males affected 101 males ( 4.9%) , and the 9th in females 66 (2.5%) with male to female ratio of 1.5: 1.These tumors were relatively rare among adults above 65 years old, but more common among children and adolescents , 65.8% of the cases occurred in the age group below 50 years .Median age at diagnosis was 41 years (males 43 years , and 35 years for females)The morphology of brain tumors, (33.5%)

of brain tumors were of glioblastoma type followed by glioma (14.4%) then astrocytoma (15.6%) and meduloblastoma (12%) figure (49 ) .The basis of diagnosis showed 19.8% of brain tumors were diagnosed clinically and clinical investigation procedures and 77.8% were diagnosed by biopsy of primary lesion and only 3 (1.8%) cases were diagnosed by death certificate only (DCO) The crude incidence rate was 2.6 /100,000 population (3.1 males, 2.1 females). The over all ASR for brain & CNS tumors was 3.6/100,000 (4.4 males,2.7 females).Table (36) and figure (50) show distribution and Age-Specific Incidence Rates for brain & nervous system tumors.

Figure (49) Morphological distribution of brain & CNS tumors , 2012-Jordan


79


Table ( 36 ) Brain & CNS number and ASIR by age-group and gender-2012, Jordan

Age Group


0-4 13 3.1 8 2.0 21 2.65-9 6 1.5 6 1.5 12 1.510-14 11 2.8 2 0.5 13 1.715-19 3 0.8 3 0.9 6 0.920-24 2 0.6 3 0.9 5 0.725-29 1 0.3 8 3.0 9 1.630-34 4 1.5 2 0.8 6 1.235-39 2 0.9 6 3.1 8 2.040-44 13 8.3 3 2.0 16 5.345-49 9 8.2 5 4.8 14 6.650-54 7 8.6 2 2.5 9 5.655-59 8 11.4 7 9.7 15 10.560-64 10 15.3 1 1.7 11 8.965-69 4 8.6 6 13.8 10 11.170-74 6 20.4 2 6.9 8 13.775-79 1 6.3 2 13.8 3 9.980-84 0 0.0 0 0.0 0 0.085+ 1 13.2 0 0.0 1 6.5Total 101 3.1 66 2.1 167 2.6

Figure ( 50 ) Brain and CNS cancers Age Specific Incidence Rate by age group & gender,2012


80


10-Stomach Cancer (C16)There were 136 cases of stomach cancer

among Jordanians, accounting for 2.7% of

all newly diagnosed cancer cases. It affected

86 males (3.7%) and 50 females (1.9%).

Stomach cancer occurred more frequently in

males than in females, with a male to female

ratio of 1.7: 1. Crude incidence rate was

2.1 /100,000 (2.6/ 100,000 for males, and

1.6/100,000 for females) .The highest age

specific incidence rate (35.3) per 100,000

population was observed in the age

80- 84 years ,in males also it included the

highest 52/100.000 and while the highest

in females 37.9/100.000 was observed in

the age-group 85 years and above.

The overall ASR for stomach cancer

was 3.9/100,000 (4.9/100,000 for males

and 2.9/ 100,000 for females). The over all

median age at diagnosis was 60 years (60

years for males and 61 years for females).

The most predominant histological type

of stomach cancer was adenocarcinoma

57.4%. , followed by signet cell carcinoma

(19.9 %) figure (51). Table ( 37 ) and figure

(52) show distribution and age - specific

incidence rates for stomach cancer.

Figure (51) Morphological distribution of Stomach cancer , 2012-Jordan


81


Table ( 37 ) ASIR and number of Stomach cancer by age group&gender,2012

gender

Age group

Males Females Total

No. ASIR* No. ASIR* No ASIR*

0-4 0 0.0 0 0.0 0 0.05-9 0 0.0 0 0.0 0 0.010-14 0 0.0 0 0.0 0 0.015-19 0 0.0 0 0.0 0 0.020-24 0 0.0 0 0.0 0 0.025-29 1 0.3 0 0.0 1 0.230-34 1 0.4 5 2.1 6 1.235-39 3 1.4 2 1.0 5 1.240-44 6 3.9 0 0.0 6 2.045-49 7 6.4 5 4.8 12 5.650-54 8 9.9 7 8.8 15 9.355-59 16 22.8 4 5.5 20 14.060-64 14 21.4 6 10.3 20 16.265-69 8 17.2 9 20.8 17 18.970-74 9 30.6 5 17.2 14 23.975-79 7 44.1 2 13.8 9 29.680-84 4 52.0 2 21.5 6 35.385+ 1 13.2 3 37.9 4 25.8

Unknown 1 0.0 0 0.0 1 0.0Total 86 2.6 50 1.6 136 2.1

Figure ( 52 ) Stomach cancer -Age Specific Incidence Rate by Age group and gender, 2012

83


4Chapter fourPediatric Malignancies in Jordan, 2012


84


Cancers among Jordanians under 15 years, 2012

Figure (53 ) Percentage of gender of pediatric cancer 2012,Jordan

There were (217) child at the age-group 0-14 years diagnosed with new cancer in Jordan this constitutes about (4.3%) of all registered malignant tumors in the year 2012 compared with 207 (4.4%) for the year 2011. The distribution of cases by gender shows that it is higher in males 121 (55.8%) than females 96 (44.2%) figure (53) .The Male to female ratio is 1.3:1. The crude incidence rate for all cancers in this age group was (93) per million (101per million for boys and 84.6 per million for girls). Mean age at diagnosis was (6.1) years. The median age for pediatric cancer was 5 years. 46.8% of registered cases were under the age of five years ; followed by the age group10 -14 years (29.6%) and 5-9 years (24.1%) figure (54).It is clearly noticed that cancer in pediatric group was higher in males than females for the

following cancers (Leukemia , lymphomas, Brain & CNS) while for eye cancer and neuroblastoma it was relatively higher in females than males as shown in figure (56). Table (38) and figure (57) shows the distribution of cancers cases by different age group as Leukemia and brain and CNS were most common in the age group 0-4 years meanwhile lymphoma and bone tumors were more frequent in the age group 10-14 years.Table (39) and figure (58) show the distribution of pediatric cancer cases by governorate where Amman was the highest 57.6% followed by Zarka governorate 11.1%. Figures (59-63) show the distribution of numbers and percentage of top ten cancers among Jordanian in both genderes and different age group and top five cancers in males & females.


85


Figure (54 ) Percentage distribution of pediatric cancer by age group -2012,Jordan

Figure (55 ) Top ten cancers in Pediatric ( both genders),2012, Jordan

Figure (56) Top Five Cancers in Pediatric by gender,2012 - Jordan


86


Table ( 38) Distribution of childhood cancers by age group, Jordan, 2012

Age groupSite 0-4 year 5-9 year 10-14 year Total %

Leukemia 32 15 18 65 30.0

Brain &CNS 21 12 13 46 21.2

Lymphoma 6 11 14 31 14.3

Eye 11 4 0 15 6.9

Neuroblastoma 12 1 0 13 6.0

Kidney 8 1 2 11 5.1

Bone 1 5 5 11 5.1

Soft tissue 3 2 2 7 3.2

Ovary 0 0 3 3 1.4

Testis 1 0 1 2 0.9

Others 6 1 6 13 6.0Total 101 52 64 217 100.0

Figure (57) Distribution of childhood cancer by age group and Site of tumor, 2012


87


Table (39) Distribution of childhood cancer by governorates and gender-2012

Governorate Male Female Total %Amman 71 54 125 57.5Zarka 15 9 24 11.1Balqa 3 10 13 6.0Madaba 4 1 5 2.3Central region 93 74 167 77.0Irbid 11 9 20 9.3Mafraq 1 4 5 2.3Jarash 5 1 6 2.8Ajloun 2 3 5 2.3North region 19 17 36 16.7Karak 2 2 4 1.9Maan 3 0 3 1.4Tafiela 2 1 3 1.4Aqaba 2 2 4 1.9South region 9 5 14 6.5Total 120 96 217 100.0

Figure (58) Distribution of childhood cancer by governorates and gender-2012


88


Table (40) Distribution of childhood cancer by Age group, governorates and gender, 2012

Governorate 0-4 5-9 10-14 TotalM F M F M F M F T

Amman 33 27 13 11 25 16 71 54 125Zarka 6 5 4 1 5 3 15 9 24Balqa 1 6 0 1 2 3 3 10 13Madaba 3 0 1 0 0 1 4 1 5Central region 43 38 18 13 31 23 92 74 166Irbid 4 5 6 3 1 1 11 9 20Mafraq 1 0 0 1 0 3 1 4 5Jarash 2 1 3 0 0 0 5 1 6Ajloun 0 0 1 3 1 0 2 3 5North region 7 6 10 7 2 4 19 17 36Karak 2 1 0 1 0 0 2 2 4Aqaba 0 2 1 0 1 0 2 2 4Maan 2 0 1 0 0 0 3 0 3Tafiela 0 0 1 0 1 1 2 1 3South region 4 3 3 1 2 1 9 5 14Total 54 47 31 21 35 28 121 96 217

Figure (60) Distribution of childhood Brain &CNS by age and gender-2012

Figure (59) Distribution of childhood Leukemia by age and gender- 2012


89


Figure (61) Distribution of childhood Lymphoma by age and gender-2012

Figure (62) Distribution of Eye tumor (retinoblastoma) by age and gender-2012

Figure (63) Distribution of Childhood Neuroblastoma tumor by age and gender-2012

91


5Chapter fiveCancer among Non- Jordanians, 2012

• Distribution by age group & gender• Distribution of cases by primary site• Top ten cancers by gender• Distribution of cases by nationality


92


Cancer among Non-Jordanians, 2012The total number of cancer cases among Non-Jordanians was 2441 accounting for (32.7%) of all cancers reported and registered in JCR for 2012, of these, 2405 cases were invasive cancer and 36 (1.4%) cases were in situ compared with 2296 Non Jordanian cancer cases registered in 2011 with an increase of (6%).The distribution of cases by gender shows that: males were 1262 (51.7%) while females were 1179 (47.3%). Males to female’s ratio of (1.1: 1).The median age at diagnosis among non-Jordanians was 53 years, ( 55 years for males and 51years for females). The highest percent was in the age group 60- 64 years (10.5%) (for males 11.6% and for females 9.3%), followed by the age group 45-49 years (10%) (for females 13.2% and for males 7%) Table (41). There were (137) cases below the age 15 years which accounted for (5.6%) of all Non –Jordanians registered in the year 2012,of them 83 males (6.6%) of male cancers ,and 54 females (4.6%) of female cancers.Table (41) shows the distribution and the percentages of cancers among Non- Jordanians by age group and gender.

Table (42) shows the distribution of cancer cases by primary site and gender. Tables (43) and (44) show the top ten cancer in 2012 for male and female among Non-Jordanian. Figure (64 ) shows the trend number of cancers among Non-Jordanians reported to Jordan Cancer Registry during the years 1996 – 2012 by gender. Figure ( 65) shows the number of cancers among Non-Jordanians reported to JCR during the year 2012 by nationality.


93


Table (41) Cancers among Non-Jordanians by age group and gender- 2012

gender

Age group

Males Females Total

N % N % N %

0- 4 35 2.8 25 2.1 60 2.55- 9 19 1.5 15 1.3 34 1.410- 14 29 2.3 14 1.2 43 1.815- 19 36 2.9 13 1.1 49 2.020- 24 46 3.6 22 1.9 68 2.825- 29 38 3.0 45 3.8 83 3.430- 34 52 4.1 56 4.7 108 4.435- 39 60 4.8 98 8.3 158 6.540- 44 96 7.6 113 9.6 209 8.645- 49 88 7.0 156 13.2 244 10.050- 54 112 8.9 115 9.8 227 9.355- 59 100 7.9 126 10.7 226 9.360- 64 146 11.6 110 9.3 256 10.565- 69 138 10.9 105 8.9 243 10.070- 74 120 9.5 83 7.0 203 8.375- 79 82 6.5 46 3.9 128 5.280- 84 37 2.9 21 1.8 58 2.485+ 27 2.1 13 1.1 40 1.6Unknown 1 0.1 3 0.3 4 0.2Total 1262 100.0 1179 100.0 2441 100.0


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Table (42) Cancers among Non-Jordanians by primary site & gender- 2012

Gender

Primary Site

Males Females TotalN % N % N %

All Site 1262 100.0 1179 100.0 2441 100.0Lips 4 0.3 1 0.1 5 0.2Tongue 10 0.8 7 0.6 17 0.7Mouth 15 1.2 12 1.0 27 1.1Pharynx 35 2.8 13 1.1 48 2.0Esophagus 14 1.1 15 1.3 29 1.2Stomach 54 4.3 37 3.1 91 3.7Small Intestine 8 0.6 2 0.2 10 0.4Colon 71 5.6 59 5.0 130 5.3Rectum 48 3.8 39 3.3 87 3.6Liver &Biliary Passage 42 3.3 36 3.1 78 3.2Pancreas 28 2.2 15 1.3 43 1.8Other & Unspecified Digestive 9 0.7 2 0.2 11 0.5Larynx 46 3.6 4 0.3 50 2.0Lung 109 8.6 33 2.8 142 5.8Other & Unspecified Respiratory 20 1.6 3 0.3 23 0.9Bone 28 2.2 18 1.5 46 1.9Connective Tissue 16 1.3 15 1.3 31 1.3Skin other and melanoma 28 2.2 19 1.6 47 1.9Breast 14 1.1 386 32.7 400 16.4Cervix Uteri 0 0.0 25 2.1 25 1.0Corpus Uteri Unspecified 0 0.0 46 3.9 46 1.9Ovary 0 0.0 47 4.0 47 1.9Other Reproductive Female 0 0.0 10 0.8 10 0.4Prostate 102 8.1 0 0.0 102 4.2Testis 15 1.2 0 0.0 15 0.6Other Reproductive Male 1 0.1 0 0.0 1 0.0Kidney & Other Urinary 52 4.1 29 2.5 81 3.3U.Bladder 97 7.7 19 1.6 116 4.8Eye 10 0.8 16 1.4 26 1.1Brain &CNS 80 6.3 34 2.9 114 4.7Thyroid 39 3.1 96 8.1 135 5.5Other Endocrine 8 0.6 3 0.3 11 0.5Leukemia 70 5.5 40 3.4 110 4.5Hodgkin›s Disease 35 2.8 21 1.8 56 2.3Non- Hodgkin›s 90 7.1 46 3.9 136 5.6Multiple Myeloma 27 2.1 10 0.8 37 1.5All Others & Unspecified 8 0.6 6 0.5 14 0.6Primary Site Unknown 29 2.3 15 1.3 44 1.8


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Table (43) Top ten cancers among Non-Jordanians (Males), 2012

Rank Primary site N %

1 Colorectal 119 9.4

2 Lung 109 8.6

3 Prostate 102 8.1

4 U.Bladder 97 7.7

5 Non- Hodgkin’s 90 7.1

6 Brain &CNS 80 6.3

7 Leukemia 70 5.5

8 Stomach 54 4.3

9 Kidney 52 4.1

10 Larynx 46 3.6

11 Others 443 35.1

Total 1262 100


96


Table (44 ) Top ten cancers among Non-Jordanians (Females), 2012

Rank Primary site N %

1 Breast 386 32.7

2 Thyroid 96 8.1

3 Colorectal 98 8.3

4 Uterus 46 3.9

5 Ovary 46 3.9

6 Non- Hodgkin’s 46 3.9

7 Leukemia 40 3.4

8 Stomach 37 3.1

9 Liver &Biliary 36 3.1

10 Brain &CNS 34 2.9

11 Others 313 26.5

Total 1179 100


97


Figure ( 65) Distribution of cancer among Non-Jordanians by nationality, 2012

Figure (64) Trend of number of cancers among Non-Jordanians by gender reported in (1996 – 2012)


98



99


6Chapter sixCancer mortality 2012

Jordan cancer registry dataMortality data 2012


100


Cancer Mortality, 2012

Table (45) Distribution of deaths due to cancer by age group and gender, 2012Age group Male Female Total Percent

0-4 17 11 28 1.65-9 5 1 6 0.310-14 7 9 16 0.915-19 12 12 24 1.420-24 10 14 24 1.425-29 11 12 23 1.330-34 23 26 49 2.835-39 26 39 65 3.840-44 48 46 94 5.545-49 68 73 141 8.250-54 77 79 156 9.155-59 96 75 171 9.960-64 104 78 182 10.665-69 125 102 227 13.270-79 140 81 221 12.875-79 101 60 161 9.380-84 53 34 87 5.085+ 26 22 48 2.8Total 949 774 1723 100.0

This chapter explores mortality data due to cancer in Jordan for the year 2012This is divided into two parts: A: Mortality data from Jordan cancer registry follow up for cancer the cases that were diagnosed in the year 2012 and follow up data till the end of 2014 Source of data : from JCR abstract form ; date of last visit and whether the patient alive or dead more over linkage of our data with civil registration database.Number of deaths :1723 patientsB: Mortality data from annual report of mortality section – Non communicable disease Directorate in ministry of health for the year 2012

Source of data: death certificate form to all patients from all hospitals governmental private, and university hospitals and forensic medicine all over Jordan were sent to this section, and all data collected to deaths from all causes and in this part, deathes due to neoplasm was selected and analyzed.Number of deaths due to neoplasm 2651 patientsA: JCR mortality data Deaths frequencies due to cancer for both genders and age group were shown in table(45) and figures (66-68). While table 46-48 show the top ten causes of cancer mortality for both genders.


101


Figure (66) Perecentage distribution of deaths due to cancer by age group and gender , Jordanian-2012

Figure (67 ) Distribution of deaths due to cancer by gender, 2012, Jordan

Figure (68 ) Number of cases and number of deaths due to cancer by gender,2012, Jordan


102


Table ( 46 ) Mortality for Top ten cancers, both gender -2012

Primary site No. %Lung 285 16.5Breast 160 9.3Colorectal 214 12.4Pancreas 106 6.2Brain and CNS 87 5.0Stomach 80 4.6Leukemia 109 6.3U bladder 65 3.8NHL 63 3.7Liver 62 3.6Others 492 28.6Total 1723 100.0

Table (47 ) Mortality due to cancer Top ten cancers (Males), 2012

Rank Primary site N %1 Lung 219 23.12 Colorectal 103 10.93 Pancreas 64 6.74 Leukemia 59 6.25 U bladder 57 6.06 Brain &CNS 56 5.97 Stomach 50 5.38 Prostate 49 5.29 Liver 42 4.410 NHL 36 3.811 Others 214 22.6

Total 949 100


103


Table (48 ) Mortality due to cancer Top ten cancers (Females), 2012

Rank Primary site N %1 Breast 158 20.42 Colorectal 113 14.63 Lung 66 8.54 Leukemia 48 6.25 Pancreas 42 5.46 Ovary 39 5.07 Uterus 34 4.48 Brain &CNS 31 4.09 Stomach 30 3.910 NHL 27 3.511 Others 186 24.0

Total 774 100

Table ( 49) and figure (69 ) Show percent of deaths distribution by governorate-2012.Most of cancer deaths occurred in Amman governorate (57.7%) followed by Irbid (12.8%) and Zarqa (10.1%) , the lowest death percent was reported from Tafiela (0.9%)

Table (49 ) Percentage distribution of deaths due to cancer by governorates, Jordan 2012

Governorate No of death %Amman 994 57.7Zarka 174 10.1Balqa 87 5.0Madaba 47 2.7Central Region 1302 75.6Irbid 221 12.8Jarash 30 1.7Ajloun 19 1.1Mafraq 40 2.3North Region 310 18.0Karak 39 2.3Tafeila 16 0.9Maan 22 1.3Aqaba 24 1.4South Region 101 5.9Outside 10 0.6Total 1723 100.0


104


Figure (69 ) Percentage distribution of deaths due to cancer by governorates,2012

The next few tables and figures are based on mortality data obtained from the mortality department, NCD -MOH. Tables (50) and (51) shows the frequency and percentage of male and female cancer deaths in the year 2012.While figures (70 ) and (71 ) shows the males and females cancer deaths by age-groups -2012.

Table (50) Distribution of male deaths due to Neoplasm, Jordan, 2012Cause of death Frequancy Percent

Lung 353 24.58Colorectal 160 11.14Leukemia 124 8.64Prostate 111 7.73Pancreas 77 5.36NHL 75 5.22Stomach 71 4.94Bladder 68 4.74lip, oral cavity and pharynx 59 4.11Liver 52 3.62Others 101 7.03Unknown 185 12.88Total 1436 100

Mortality data, 2012 report


105


Table (51) Distribution of female deaths due to Neoplasm, Jordan, 2012Cause of death Frequancy Percent

Breast 298 24.53

Colorectal 154 12.67

Leukaemia 87 7.16

Lung 85 7.00

Uterus and cervix 62 5.10

Stomach 56 4.61

Ovary 51 4.20

Pancreas 46 3.79

CNS 44 3.62

NHL 42 3.46

Others 91 7.49

Unknown 199 16.38

Total 1215 100


106


Figure (70) Distribution of male deaths due to Neoplasm by age group, Jordan, 2012

Figure (71) Distribution of Female deaths due to Neoplasm by age group, Jor-dan, 2012


107


Annex (1 ) Jordan Cancer Registry Form

Email: [email protected] Fax: 06-5656489 Tel: 06-5662067


108


Annex (2) Jordan Cancer Registry Data Request Application Form

Ministry of Health – NCDD - Jordan Cancer Registry (JCR)Amman-Ph.962 6 5662067

Data Request Format

Name : ..........................................................................................................................................................................................Address : ......................................................................................................................................................................................Institution : ..................................................................................................................................................................................Phone No : ........................... Fax No : .................... Email :...........................................

Required data :(Specify ,Time Period ,Site,Histology,Region,etc…….)

Data Required For :(Presentation / conference/ publication/clinical, epidemiological study, Commercial Need.......)

Collaborators and Co-authors( If Present ):

Avowal Declaration :

l hereby, supplicant of the above data affirm that the data given to me from the National Jordan Cancer Registry- JCR- will be treated with extreme confidentiality concerning patient’s identity, l also confirm that the data given to me will not be presented or published by me or any of my collaborators as an original work but rather can be used in my presentation and/or publication with acknowledgement to the JCR .also confirm to provide copy of my work and feed-back to the JCR soon after.

Requester’s Signature:………………….. Date Submitted ………….………………………………….

For administrative use only :

Request: / Approved : ………………………Not Approved…………………………………..................................…………………..Director of Jordan Cancer Registry………………………..….....Sign………...…………………................................……………...Director of Non-Communicable Disease Directorate…………………………..Sign……………….................................………...Date:…………………………….


109


Definitions of TermsIncidenceA cancer incidence rate is the number

of new cancers of a specific site/type

occurring in a specified population

during a year, usually expressed as

the number of cancers per 100,000

populations at risk.

That is, Incidence rate = (New cancers / Population) × 100,000

The numerator of the incidence rate

is the number of new cancers; the

denominator is the size of the population.

The number of new cancers may include

multiple primary cancers occurring in

one patient. The primary site reported is

the site of origin and not the metastatic

site.

PrevalencePrevalence is defined as the number or

percent of people alive on a certain date

in a population who previously had a

diagnosis of the disease. It includes new

(incidence) and pre-existing cases and

is a function of both past incidence and

survival. Information on prevalence can

be used for health planning, resource

allocation, and an estimate of cancer

survivorship.

Crude incidence rate (CR)The number of new cancer cases

(incidence cases) observed in the

population during a defined period ,

divided by the number of population

at risk in the same period .It is usually

expressed per 100,000 .

Age-Specific Incidence Rate (ASIR)The number of cancer cases occurring

during a specific period in a population

of a specific age group and gender,

divided by the number of mid-year

population of that age group and gender

multiplying by 100,000.

AR= Ni / Pix 100,000Ni-Number of new cancer cases

occurring in the ith age group

Pi – person –years at risk in the ith age

group


110


Age-Standardized Rate (ASR)An age-adjusted rate is a weighted

average of the age-specific rates,

where the weights are the proportions

of persons in the corresponding age

groups of a standard population. The

potential confounding effect of age is

reduced when comparing age-adjusted

rates computed using the same standard

population.

The most frequently used standard

population is the world standard

populations. The calculated incidence

is known as the world standardized

incidence rate. The rate is expressed per

100.000 populations.

RankThis measure reflects the importance of a

specific cancer site relative to other sites,

in terms of the number of registrations.

Ranking illustrates the most and least

frequent cancer sites in a population

according to their frequency.

SurvivalCancer survival statistics are typically

expressed as the proportion of patients

alive at some point subsequent to the

diagnosis of their cancer. Relative

survival is an estimate of the percentage

of patients who would be expected

to survive the effects of their cancer.

Observed survival is the actual

percentage of patients still alive at some

specified time after diagnosis of cancer

MortalityA cancer mortality rate is the number

of deaths, with cancer as the underlying

cause of death, occurring in a specified

population during a year. Cancer

mortality is usually expressed as the

number of deaths due to cancer per

100,000 population. That is,

Mortality Rate = (Cancer Deaths / Population) × 100,000

The numerator of the mortality rate is

the number of deaths; the denominator

is the size of the population. The

population used depends on the rate to


111


be calculated. For cancer sites that occur

in only one gender, the gender-specific

population (e.g., females for cervical

cancer) is used. The mortality rate can

be computed for a given cancer site or

for all cancers combined.

ICD-O-3The World Health Organization’s

International Classification of Diseases

for Oncology, 3rd Edition has been the

standard coding system for neoplasm

for over 25 years. The coding system

includes a four character code for primary

site, a four-digit numeric code for cell

type, one-digit code for behavior and a

one-digit code for tumor aggressiveness

(grade).


112


معدل اال�سابة للجن�سني لكل 100.000 من ال�سكان ح�سب املحافظات

حمافظات اقليم الو�سط :

عمان 118.1

الزرقاء 52.2

البلقاء 61.9

مادبا 64.0

2- حمافظات اقليم ال�سمال :

اربد 45.0

املفرق 23.8

جر�ش 36.8

عجلون 29.2

3- حمافظات اقليم اجلنوب :

الكرك 52.5

الطفيلة 37.7

معان 50.5

العقبة 36.0

حمافظات اقليم الو�سط :

عمان 125.5

الزرقاء 48.2

البلقاء 46.5

مادبا 62.6


اربد 55.6

املفرق 31.6

جر�ش 39.1

عجلون 32.0


الكرك 41.3

الطفيلة 38.0

معان 46.1

العقبة 45.3

العام 2012العام 2011املوؤ�صر


113


ال�سرطانات اخلم�ش االكرث �سيوعا بني االناث االردنيات

الثدي 941 37.4 %

القولون وامل�ستقيم 226 9.0 %

الغدة الدرقية 136 5.4 %

الليمفاوية )بنوعيه( 130 5.2 %

الرحم 127 %5.4

الثدي 994 37.3 %

القولون وامل�ستقيم 285 10.7 %

الغدة الدرقية 158 5.9 %

الليمفاوية )بنوعيه( 150 %5.6

الرحم 121 %4.5207217اجمايل احلاالت بني االطفال االردنيني للذكور واالناث

121121اجمايل احلاالت بني االطفال الذكور

8696اجمايل احلاالت بني االطفال االناث-

توزيع حاالت ال�سرطان االكرث �سيوعا بني االطفال

�سرطانات الدم %28.5

الدماغ واالع�ساب 20.3 %

الليمفاوية )بنوعيه( %15.5

الكليه %6.8

العظم %5.8

�سرطانات الدم %30

الدماغ واالع�ساب %21.2 الليمفاوية )بنوعيه( %14.3

العني %6.9

Neuroblastoma6%

التوزيع الن�سبي حلاالت ال�سرطان بني االردنيني ح�سب املحافظات

حمافظات اقليم الو�سط : -1

عمان %61.1

الزرقاء %10.4

البلقاء %5.5

مادبا 2.1 %


اربد %10.7

املفرق %1.5

جر�ش %1.5

عجلون %0.9


الكرك 2.7 %

الطفيلة 0.7 %

معان 1.3 %

العقبة 1.0 %

حمافظات اقليم الو�سط : -2

عمان %61.9

الزرقاء %9.2

البلقاء %4.0

مادبا 2.0 %


اربد %12.6

املفرق %1.9

جر�ش %1.5

عجلون %0.9


الكرك 2.1 %

الطفيلة 0.7 %

معان 1.1 %

العقبة 1.3 %



114


جدول يبني مقارنة اح�صائيات وبع�ض موؤ�صرات ال�صرطان للعام 2011 والعام 2012


69717454اجمايل احلاالت امل�سجلة

46755013اجمايل احلاالت بني االردنيني

22962441اجمايل احلاالت بني غري االردنيني

21942346اجمايل احلاالت بني الذكور االردنيني

24812667اجمايل احلاالت بني االناث االردنيات

5656متو�سط العمر عند الت�سخي�ش للجن�سني

6060متو�سط العمر عند الت�سخي�ش للذكور

5253متو�سط العمر عند الت�سخي�ش لالناث

74.878.5معدل اال�سابة اخلام للجن�سني ) لكل 100.000( من ال�سكان

68.171.2معدل اال�سابة اخلام للذكور لكل ) 100.000 ( من الذكور

81.986.2معدل اال�سابة اخلام لالناث لكل ) 100.000 ( من االناث

128.1133.4معدل اال�سابة املعاير عمريا للجن�سني لكل )100.000 ( من ال�سكان

121.1126.1معدل اال�سابة املعاير عمريا للذكورلكل )100.000 ( من الذكور

135.6141.4معدل اال�سابة املعاير عمريا لالناث لكل )100.000 ( من االناث

8993معدل االإ�سابة اخلام لالأطفال للجن�سني لكل مليون

101101معدل االإ�سابة اخلام لالأطفال للذكورلكل مليون

7684.6معدل االإ�سابة اخلام لالأطفال لالناث لكل مليون

ال�سرطانات اخلم�ش االكرث �سيوعا بني الذكور

الرئة 279 %12.7

القولون وامل�ستقيم 274 %12.5

املثانة 171 7.8 %

الربو�ستات 169 %7.7

�سرطان الدم 128 5.8 %

الرئة 292 %12.4

القولون وامل�ستقيم282 %12.0

املثانة 217 9.2 %

الربو�ستات 198 %8.4

الليمفوما 177 %7.5


115


من احلاالت . حوايل )46.8% ( من احلاالت امل�سجله

من �سرطانات االطفال هي الطفال دون �سن 5 �سنوات .

�سن دون لالطفال �سيوعا ال�سرطانات اكرث وكانت

15 �سنه ( هي كالتايل:

�سرطان الدم :30 %، �سرطان الدماغ واالأع�ساب 21.2

العني �سرطان ثم ،% 14.3 الليمفاوية ال�سرطانات %

بن�سبة 6.9% ثم Neuroblastoma بن�سبة %6.

معدالت االإ�سابة بال�سرطان لعام 2012

* املعدل اخلام لالإ�سابة بال�سرطان للبالغني للجن�سني

بلغ )78.5 ( لكل)مائة اإلف( من ال�سكان ) للذكور

71.2 ولالإناث )86.2 ( لكل مائة الف من ال�سكان.

من األ��ف مائة لكل عمريا املعاير االإ�سابة معدل *

133.4)ل��ل��ذك��ور126.1واالن��اث للجن�سني ال�سكان

.)141.4(

بلغ 93) لكل * معدل االإ�سابة اخلام لالأطفال فقد

مليون طفل ( 101 للذكور و 84.6 لالناث .

التوزيع الن�سبي حلاالت ال�سرطان ح�سب املحافظات:

الزرقاء ، عمان %61.9 : )%77( الو�سط حمافظات

9.2% البلقاء 4 % ثم مادبا 2 % .

، % 12.6 :ارب��د )%16.9( ال��س��م��ال حم��اف��ظ��ات

املفرق1.9% ، عجلون 0.9 % ثم جر�ش 1.5 %

2.1%العقبة الكرك : )%5.1( اجلنوب. حمافظات

1.3 % معان 1.1 % الطفيلة %0.7.

م��ع��دل احل��دوث اخل��ام حل��االت ال��س��رط��ان ح�سب

املحافظات لكل 100.000 :

الزرقاء : عمان 125.5، الو�سط )96.2( حمافظات

48.2 مادبا 62.6 ، البلقاء 46.5

حمافظات ال�سمال)47.8( : اربد 55.6 ، جر�ش 39.1

عجلون 32.0 و املفرق : 31.6

حمافظات اجلنوب )42.7( : الكرك 41.3 ، الطفيله

38.0، العقبة 45.3 ثم معان46.1.


116


يف العلمية االأوراق من العديد ال�سجل قدم االأردن. يف

املومترات املحلية والدوليةوقد اأ�سبحت قاعدة البيانات

الباحثني م��ن العديد مق�سد ال�سجل ل��دى املرتاكمة

الإجراء الدرا�سات والبحوث العلمية.

اأهم اإح�سائيات التقرير ال�سنوي ال�سابع ع�سر لعام2012

من الت�سخي�ش تاريخ على اعتمادًا احلاالت جتميع مت

بلغ ،2012/12/31 ت��اري��خ 2012/1/1ح��ت��ى ت��اري��خ

جمموع احلاالت امل�سجلة )7454 ( حالة منها)5013(

عدداحلاالت. اإجمايل من %67.3 ن�سبته ما اردنيني

عدد وبلغ . 2011 العام يف حالة )6971( مع مقارنة

)%46.8( )2346 ( االأردن��ي��ني ال��ذك��ور بني احل��االت

اإجمايل احلاالت واالإناث 2667)53.2%( يف حني بلغ

بني غري االأردنيني للعام 2012)2441( حالة ما ن�سبته

)32.7% ( من جمموع احلاالت.

االأردن��ي��ن ب��ن �سيوعاً االأك��رث اخلم�س ال�سرطانات

للجن�سن :

اإجمايل بلغ حيث االأول��ى املرتبة الثدي �سرطان احتل

%20.1 ن�سبته ما حالة )1008( ب امل�سجلة احل��االت

اإجمايل بلغ حيث وامل�ستقيم القولون �سرطانات تالها

الرئه �سرطان ثم %11.3 ن�سبته ما )567( احل��االت

الليمفاويه الغدد �سرطانات ثم )371( حاله )%7.4(

املثانه �سرطان ثم )%6.5( ن�سبته ما حاله )327(

)246( بن�سبة )%4.9( .

الذكور بن �سيوعاً االأك��رث اخلم�س ال�سرطانات *

كانت على النحو التايل:

ثم )%12.4( بن�سبة ح��ال��ه )292( ال��رئ��ة �س�رطان

�سرطان ، )%12 ( حاله )282( وامل�ستقيم القولون

الربو�ستات �سرطان ، بن�سبة)%9.2( )217( املثانة

)198( بن�سبة )8.4 %( ثم �سرطانات الغدد الليمفاويه

.)% 7.5( 177

االإن��اث االأك��رث �سيوعاً بن ال�سرطانات اخلم�س *

كانت على النحو التايل :

�سرطان الثدي )994( حالة بن�سبة )37.3 %(، القولون

الغدة %(،�سرطانات 10.7( )285(بن�سبة وامل�ستقيم

الغدد �سرطانات ثم بن�سبة )%5.9( )158( الدرقية

الليمفاويه )150( بن�سبة )5.6%( ثم �سرطان الرحم

)121( بن�سبة )4.5%( من جمموع �سرطانات االإناث.

* يف حن بلغ جمموع �سرطانات االأطفال لالأعمار

من % 4.3 بن�سبة ح��ال��ة( 217( �سنة 15 م��ن ا�سغر

الذكور بن منها)121( , الكلي ال�سرطانات جمموع

االإن��اث بن�سبة )%44.2( بن�سبة )55.8%( و ) 96( بن


117


من فهي االأردن يف ال�سرطان ح��االت ر�سد يف املتبعة

خالل الر�سد الن�سط حيث يقوم فريق من كادر ال�سجل

ذات واجلهات واملختربات امل�ست�سفيات بزيارة الوطني

يف امل�صخ�صة ال�صرطانية احل��االت وا�صتنباط العالقة

تلك االأماكن وار�سالها لل�سجل الوطني لل�سرطان.

للمعلومات وت��ن��ق��ي��ح م��راج��ع��ة عملية ت��ت��م ب��ع��د فيما

)ICD-O3( با�ستخدام الرتميز عملية و والبيانات

نظام ر�سد يف احلا�سوب اإلى اإدخ��ال احلاالت ثم ومن

با�ستعمال برنامج معد خ�سي�سًا من قبل معهد البحوث

ال�سرطانية IARC اإحدى فروع منظمة ال�سحة العاملية

اأعلى درجات الدقة واحلر�ش لتجنب WHO ويراعي

ازدواجية يف احلاالت املدخلة وذلك من خالل عدة اآليات

وم�ستويات من الرقابة الذاتية والداخلية واأي�سًا الرقابة

اخلارجية على جمريات عمل واإجنازات ال�سجل.

بعد االنتهاء من اإدخال كافة احلاالت امل�سخ�سة للفرتة

املعلومات تلك حتليل يتم )�سنة( امل��ح��ددة الزمنية

با�ستخدام برامج التحليل االإح�سائية لي�سار بعد ذلك

ال�سنوي الذي التقرير التقرير ومن ثم ن�سر اإعداد اإلى

يبني منطية وانت�سار مر�ش ال�سرطان يف االأردن حيث يبني

التقرير وجود حاالت ال�سرطان من حيث مكان االإ�سابة

والعمر واجلن�ش والتوزيع اجلغرايف.كما يتم اإعداد جزء

بال�سرطان بني واآخر خا�ش االأطفال ب�سرطانات خا�ش

اإعداد جزء خا�ش اأي�سا غري االأردنيني يف االأردن.ويتم

بالوفيات ب�سب ال�سرطان موزعة ح�سب اأنواع ال�سرطانات

والفئات العمرية واجلن�ش وكذلك التوزيع اجلغرايف .

وقد عمل ال�سجل على اإيجاد قاعدة بيانات للمر�سى ح�سب

وا�صتعمال وترميز ا�صتنباط يف املتبعة العاملية املعايري

يف املهن وجميع القرار متخذي رفد يف البيانات هذه

جمال مر�ش ال�سرطان على جميع امل�ستويات واالأ�سعدة

على ال�سجل عمل وقد وعلمية...( وتخطيط )اإداري��ة

اإ�سدار تقرير �سنوي لوجود احلاالت ال�سرطانية املكت�سفة

يف فرتة عام واحد Cancer Incidence وحفاظا على

اأعلى درجات الدقة يف جمع وترميز احلاالت ال�سرطانية

ال��دورات من العديد بعقد دوري وب�سكل ال�سجل يقوم

وا�صتنباط بجمع العاملني االرتباط ل�صباط التدريبية

ال�سجل اإن .وح��ي��ث ال�سرطان �سجالت م��ن البيانات

ال�سجالت يف وال��رواد االأوائ��ل من لل�سرطان الوطني

)Community Based Registry( يف املجتمعية

االإقليم فانه يقوم بتدريب كوادر من الدول العربية .

ال�سرطان مكافحة مديرية ال��غ��اء مت 2008 ع��ام يف

على االب��ق��اء ومت ال�سرطان مكافحة ق�سم وا�ستحدث

الى منهما كل ليتبع لل�سرطان الوطني ال�سجل وح��دة

مديرية االإمرا�ش غري ال�سارية حيث يتابع ق�سم مكافحة

من اأع��م��ال��ه لل�سرطان ال��وط��ن��ي وال�سجل ال��س��رط��ان

ت�سجيل احلاالت ال�سرطانية املكت�سفة وتطبيق ن�ساطات

ال�سرطان مكافحة جم��ال يف الوطنية اال�سرتاتيجية


118


- ق�سم مكافحة ال��س��اري��ة االأم��را��س غ��ر م��دي��ري��ة

ال�سرطان - ال�سجل الوطني لل�سرطان

خالل من ال�سرطان مر�ش ع��بء تخفيف الر�س��الة:

وبرامج �سيا�سات بتبني وذلك االإ�سابة معدالت خف�ش

الوقاية تدابري زيادة تت�سمن ال�سرطان ملكافحة وطنية

والك�سف والت�سخي�ش املبكر.

من ال��وق��ائ��ي��ة للتدابري واع��ي جمتمع نحو ال��روؤي��ا:

ال�سرطان وطرق الك�سف املبكر ومب�ساركة كافةاجلهات

الوطنية و�سواًل اإلى معدالت متدنية من االإ�سابة وبالتايل

الوفيات من هذا املر�ش.

االأه��داف :

اإعداد اإ�سرتاتيجية وخطة وطنية �ساملة ملكافحة . 1

مر�ش ال�سرطان يف اململكة.

لت�سجيل . 2 والن�سط( الذاتي ( امل�ستمر الر�سد

حاالت ال�سرطان يف اململكة اعتمادًا على املعايري العاملية.

اإعداد الربامج الوطنية ملكافحة ال�سرطان بناًء . 3

على معدالت احلدوث يف اململكة.

الك�سف . 4 اأه��م��ي��ة ح��ول ال�سحي ال��وع��ي ن�سر

والت�سخي�ش املبكر ملر�ش ال�سرطان.

اإعداد دالئل اإر�سادية وطنية للك�سف املبكر عن . 5

ال�سرطانات االأكرث �سيوعًا ) الثدي، القولون(

ال�سجل الوطني لل�سرطان:

اأن�سئ ال�سجل الوطني لل�سرطان كوحدة يف وزارة ال�سحة

مبوجب قرار وزاري وترتبط اإداريا مبعايل الوزير يف عام

ذلك قبل اخلبيث ال�سرطان حاالت كانت حيث 1996

ت�سجل من م�ست�سفى واحد يتبع لوزارة ال�سحة.بعد ذلك

وامل�سخ�سة املكت�سفة ال�سرطان حاالت جميع اأ�سبحت

واملختربات ال�سحية القطاعات كافة ومن االأردن يف

تر�سد من خالل ال�سجل الوطني لل�سرطان وذلك باإتباع

اأ�سلوب اأولها احلاالت لتلك الر�سد عملية يف اأ�سلوبني

الر�سد الذاتي حيث يتم التبليغ الذاتي عن وجود حاالت

خ�سي�سا اأع��دت ا�ستمارة تعبئة طريق عن �سرطانية

وتر�سل امل��ر��ش ح��ول البيانات م��ن جمموعة تت�سمن

مبا�سرة اإلى ال�سجل وذلك من خالل حوايل 68 �سابط

ارتباط اأكفاء مدربني وموزعني على كافة امل�صت�صفيات يف

القطاعني العام واخلا�ش وم�ست�سفيات اخلدمات الطبية

اإلى خمتربات امللكية وم�ست�سفيات اجلامعات باالإ�سافة

الثانية الطريقة ،اأم��ا اخلا�ش والقطاع العام القطاع

وبائية ال�صرطان لعام 2012

التقرير ال�صنوي ال�صابع ع�صر لل�صجل الوطني لل�صرطان


119


A.C.P

مطابع الرأي التجارية

ت�صميم:جمانه العلميمجلة


120


اململكة الأردنية الها�صمية

وزارة ال�صحة

مديرية الأمرا�ض غري ال�صارية

ال�صجل الوطني لل�صرطان

وبائيـــــة ال�صرطـــــــان لعـــــــام 2012

اإعداد:

الدكتور عمر النمري الدكتور اأيوب ال�سيايدة

الدكتور مروان الزغلالدكتور كمال عرقوب

الدكتورة وفاء هل�سه

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