Current and future cancer burden in Saudi Arabia: meeting the challenge

Despite the low cancer incidence in Saudi Arabia, the country must be ready to face the challenge of a foreseeable increase in cancer burden mainly attributed to the growth and aging of the population. We designed this study to estimate the future cancer burden and to highlight the demands on prospective healthcare resources. Cancer statistics in Saudi Arabia from 2000 to 2004 were examined. The Joinpoint regression program was used to identify changes in secular trends, while the GLOBOCAN 2002 software projected future burden. Considering current trends and the growth and aging of the population, we projected the future burden. In 2004, the age-standardized rate [ASR] for incidence for all cancer sites, excluding basal and squamous skin cancer, was 57.2 per 100000 [55.8 and 59.1 per in males and females, respectively]. ASR trends showed a statistically significant increase in the annual percent change [ARC] for both males and females, which was greatest from 2003 to 2004 [4.93% and 2.64%, respectively]. By the year 2020 and 2030, there would be an approximately 6- and 10-fold rise among males as compared with the burden in 2004. The corresponding numbers for females would be 5- and 8-fold, respectively. The highest cancer burden would be expected for middle-aged and elderly Saudis. In countries currently experiencing low cancer rates, the future cancer burden could increase considerably and place enormous demands on healthcare resources. The present study may provide an impetus to examine the future all or site-specific cancer burden, particularly in developing countries

Genito-urinary cancer in Saudi Arabia

The incidence of Genito-urinary cancer GUC in the Kingdom of Saudi Arabia KSA increases with age and is 5-fold higher in men than in women. Genito-urinary cancer accounts for only 9.2% of all cancers in KSA, while the rate in the United States of America USA is as high as 24.1%. An epidemiological search on GUC in KSA revealed a relatively low incidence compared to developed countries. This is more evident in prostatic cancer, which is 50 times lower than in the USA. The most common GUC in KSA is bladder, followed by the prostate, kidney, and testicular cancer. Penile cancer is extremely rare. Genito-urinary cancer is not among the 10 most common cancer in KSA, however, bladder cancer ranking tenth. Reviewing the National Cancer Registry data in addition to the available literature on GUC in KSA for the past 50-years showed the changing pattern of this disease over time

Intravesical immunotherapy for superficial bladder cancer

To compare and evaluate the efficacy and tolerance of intravesical instillation of Bacillus Calmette-Guerin [BCG] and interferon alpha-2b immunotherapy for superficial transitional cell carcinoma [TCC] of the urinary bladder. Thirty-five patients with superficial TCC of the urinary bladder, primary and recurrent tumors, stage Ta, T1, and grade 1 and 2, were prospectively enrolled for intravesical immunotherapy at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1992 and December 2000. The treatment regimes used were either 120 mg of BCG weekly for 6 weeks followed by a 2nd 6 week course given only on first tumor recurrence, or 50 million i.u. of interferon alpha-2b weekly for 3 months, bi-weekly for the next 3 months and monthly for 6 months. Twenty-two patients received BCG and 13 received interferon alpha-2b. Adequate blood counts, renal and hepatic function profiles, and informed consent were required. Cystoscopy was repeated every 3 months for the first 2 years, then 6 monthly for another 2 years and then yearly. The follow-up period ranged from 9-96 months [median 31.33 months]. Twenty patients attended the follow-up and were evaluable in the BCG group and 13 in the interferon alpha-2b group. In the BCG versus interferon alpha-2b group, the rates of complete response were 80% and 41.6%, partial response were 5% and 33.3%, and progression were 15% and 8.3%. Mild side effects occurred in 5 patients and all of them completed their treatments. There was only one cancer related death in each group after 6 and 7 years of starting the treatment. Bacillus Calmette-Guerin was confirmed as a more effective intravesical immunotherapy for superficial TCC of the urinary bladder as compared to interferon alpha-2b. Both agents' treatments are well tolerated