Cancer epidemiology in Lebanon

The main obstacle facing cancer preventive strategies worldwide is a lack of well conducted epidemiological studies to guide local and international efforts for disease control. In Lebanon, long due political strain has added yet another obstacle to the development of methodologies aiming to collect data on cancer epidemiology. However, through several efforts dated from the 1960s the picture is becoming clearer. We herein review the outcome of all such efforts and their interpretation as a guide for future preventive strategies

Long-term outcome of adult acute lymphoblastic leukemia in Lebanon: a single institution experience from the American university of Beirut

The most important studies about outcome of acute leukemia come from developed countries, whereas most of the patients with this disease are in developing countries. We report predictive and prognostic factors in patients with acute lymphoblastic leukemia [ALL] in a tertiary care center in a developing country. We retrospectively reviewed the records of adult patients with acute leukemia who were referred to the American University of Beirut Medical Center between 1996 and early 2006. Of 105 patients, 36 [34%] patients were diagnosed with ALL, and included 19 [53%] males and 17 [47%] females with a median age of 34 years [range, 14-79 years]. Induction chemotherapy with curative intent was administered to 34 [94%] patients. Twenty-seven patients received intrathecal chemotherapy as prophylaxis [n=24] or as treatment for CNS disease [n=3]. Twenty-eight patients [82%] achieved complete remission [CR] after induction chemotherapy. The median overall survival [OS] time was 22 months and the five-year OS for ALL patients was 38%. The median disease-free survival [DFS] time was 12 months, while the five-year DFS was 38%. Multivariate analysis showed that age <40 years, WBC <30x10[9]/L, achievement of CR after first induction, and CNS prophylaxis were predictive factors for OS and DFS. Despite limitations and the relatively low socioeconomic status of the Lebanese population, OS [38%] and DFS [38%] are quite similar to international data. Trends toward a higher CR and DFS in adults are due to intensified consolidation chemotherapy, the use of stem cell transplantation, and improvements in supportive care

Docetaxel and irinotecan as first-line chemotherapy in patients with advanced non-small-cell lung cancer: a pilot study

The aim of this study is to evaluate the activity and toxicity of the combination docetaxel and irinotecan as first-line therapy for advanced non-small-cell lung cancer [NSCLC]. Twenty-two chemotherapy-naive patients with stage IIIB with pleural effusion or stage IV NSCLC received irinotecan 50 mg/m[2] on days 1, 8, and 15, and docetaxel 50 mg/m[2] on day 2, every 28 days until disease progression. Median follow-up was 10 months [range: 2-28 months]. The overall response rate was 36.4% [8/22 patients; 95% confidence interval: 16.8-56.0], with no complete responses. Median time to disease progression was 5 months [range: 1-24 months] and median overall survival was 10 months [range: 2-28]. Grade 3-4 diarrhea was observed in 2 patients [9.1%]. Grade 3-4 neutropenia occurred in 2 patients [9.1%]: 1 episode of febrile neutropenia in one patient, and 1 death due to neutropenic sepsis in another patient. One patient received transfusion for grade 4 anemia. Irinotecan showed a moderate response rate and overall survival of clinical interest. Diarrhea was the main toxicity. This regimen may be suitable for patients unable to tolerate cisplatin-based therapy, for elderly and/or for patients with poor performance status, and should be investigated in a larger trial

Age Distribution of breast cancer in Lebanon: increased percentages and age adjusted incidence rates of younger-aged groups at presentation

Background: Breast cancer is the most common cancer in Lebanese women. Lebanon has no national cancer registry and the American University of Beirut Medical Center [AUBMC] is one of the largest hospitals in Lebanon and has a fully operational cancer registry. Earlier studies showed that it sees about one third of all cancer cases in Lebanon. Methods: All female breast cancer patients recorded at AUBMC between 1983 and 2000 were evaluated. We used the sex-specific age distribution of 1995 Lebanese Population and Housing Survey to estimate the age-specific incidence of breast cancer in Lebanon. The results were calculated as number and proportion of cases, 10-year age-specific incidence rates, crude rates and age standardized rates [ASR] per 100,000 population. The ASR per 100,000 population was estimated by the direct method with the use of the World Standard Population. Results Between 1983 and 2000, there were a total of 16421 cancers of which 8007 were in women. There were 2673 female breast cancers, averaging 148 cases per year [Range 94-202]. Almost half of cases [9.1%] were in women below the age of fifty. The mean age was 49.8 years +/- 13.9 years. Ten-year age groups distribution showed that 4.7% were below 30 years of age, 16.1% were 30-39 years, 28.3% were 40-49 years, 26.3% were 50-59 years, 16.9% were 60-69 years, 6.1% were 70-79 years and 1.6% were 80 years of age or older. Twenty-two patients [0.9%] had their age missing in the records. Overall ASR was 30.6, for a crude rate of 27.7. Age adjusted incidence rate-had its peak in women aged 50-59, followed by women 40-49 then 60-69 with values of 96.3, 79.9 and 77.4 per 100,000 respectively. We also noted 19 male breast cancer cases corresponding to 0.7% of the 2692 combined total. Conclusions: The percentage of women with breast cancer in Lebanon seen at AUBMC in pre-menopausal and younger-aged groups is higher than those reported from western countries. Our results emphasize the need to search for possible environmental, lifestyle and/or genetic risk factors in Lebanon.Our study also shows the importance of implementing early detection and screening programs which, along with high quality mammography and medical care, can have a positive impact on survival, especially in younger-aged women