gastro-esophageal malignancies in Northern Iran research project: impact on the health research and health care systems of Iran

The Gastro-Esophageal Malignancies in Northern Iran [GEMINI] research project is an example of recent progress in health research in Iran. The original aim of this project was to identify etiologic factors and prevention measures for upper gastrointestinal cancers in Northern provinces of Iran, but its achievements have gone much beyond this initial goal. GEMINI consists of several projects including cancer registries, pilot studies, case-control studies, and the Golestan Cohort Study. GEMINI has been conducted through extensive collaborations between the Digestive Disease Research Center of Tehran University of Medical Sciences with other domestic and international health organizations. The achievements of GEMINI include producing new knowledge, introducing new research methods, developing and expanding health research and health care infrastructures, investing in human resources, and increasing the awareness and knowledge of policy makers and officials at all levels about the importance of chronic diseases in Iran's health priorities. The success of GEMINI reveals the feasibility of large-scale health research studies in developing countries and serves as a successful model not only for health research in Iran, but also for similar research studies in other developing nations

Cancer incidence in golestan province: report of an ongoing population-based cancer registry in Iran between 2004 and 2008

Golestan Province, at the western end of the Asian esophageal cancer [EC] belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry [GPCR]. The GPCR collected data from newly diagnosed [incident] cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer [IARC]. Age-standardized incidence rates [ASR] of cancers were calculated using the 2000 world standard population. From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean [SD] age was 55.5 [18.6] years, and 54% were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach [ASR:30.7], esophagus [24.3], and lung [15.4] were the most common cancers in males. In females, breast cancer [ASR:26.9] was followed by malignancies of the esophagus [19.1] and stomach [12.4]. The diagnosis of cancer was based on histopatho-logical reports in 71% and on death certificate only in 9% of cases. The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase

Esophageal cancer in Iran: a review

Esophageal cancer is the second and third most common malignancy in Iranian males and females, respectively, claiming lives of approximately 5800 Iranians each year. Squamous cell carcinoma [SCC] is presently the most common type accounting for about 90% of all esophageal cancers in Iran. Recent studies have shown that there is a gradual increase in the incidence of adenocarcinoma of the distal esophagus along with gastric cardia adenocarcinoma. Thirty-five years ago, the age standardizied rate [ASR] of esophageal SCC in the city of Gonbad [Golestan Province, northeast of Iran] was found to be one of the highest rates for any single cancer that had been reported worldwide [ASR >100/10[5]/year]. Recent studies have shown that the incidence of SCC in Gonbad has declined to less than half of what it was in the past. This decline in the incidence of esophageal SCC parallels an improvement in the socioeconomic situation of people living in this region. According to recent cancer registry data in Iran there is still an obvious intracountry variability between the incidence of esophageal cancer in the south with an ASR of 3 for males and 2 for females in Kerman and 43 and 36 in the northeastern province of Golestan. The reasons for this very high rate of SCC in northeastern Iran have been the subject of several studies during the past 35 years. According to results of these studies the suspected risk factors are: low intake of fruits and vegetables, drinking hot tea, consumption of opium products and tobacco, H.pylori infection in the stomach, using unhealthy drinking water from cisterns and genetic susceptibility. The main suspected mutagens are polycyclic aromatic hydrocarbons [PAH] and N-nitroso compounds. In order to embark primary and secondary prevention of this fatal cancer, further prospective studies are presently underway in the region. The Golestan esophageal cancer cohort study which follows of 50,000 subjects is on going. We expect simple and feasible evidence based preventive strategies to be implemented in the future according to the results of this study

Five common cancers in Iran

Iran as a developing nation is in epidemiological transition from communicable to non-communicable diseases. Although, cancer is the third cause of death in Iran, it's mortality are on the rise during recent decades. This mini-review was carried out to provide a general viewpoint on common cancers incidence in Iran and to explain incidental differences that may help us to establish early detection programs and investigate population risk factors. A detailed Pub Med, Scopus and Google scholar search were made from 2000 to 2009. The basic inclusion criteria were all relevant studies focused on cancer epidemiological data from Iran. Overall age-standard incidence rate per 100,000 population according to primary site is 110.43 in males and 98.23 in females. The five most common cancers [except skin cancer] are stomach, esophagus, colon-rectum, bladder and leukemia in males, and in females are breast, esophagus, stomach, colon-rectum and cervix uteri. The incidence rates of gastrointestinal cancers are high in Iran [it is one of the known areas with a high incidence of Gl cancers]. Breast cancer mainly affects Iranian women about a decade earlier than Western countries and younger cases are affected by an increasing rate of colorectal cancer in Iran, near the Western rates