Primary Liver Cancer in Golestan Province, Northeastern Iran: 13-Year Experience of Golestan Population-Based Cancer Registry (GPCR).

BACKGROUND: Liver cancer (LC) is among the most common and fatal cancers worldwide. A four-fold increasing trend is reported for LC age-standardized mortality rate (ASMR) in Iran within 1990-2015. In the present study, we aimed to report the incidence rate of LC during the 13-year establishment of the Golestan population-based cancer registry (GPCR). METHODS: Age-standardized incidence rate (ASIR) per 100000 person-years was calculated using CanReg5 software. The Joint point regression analysis was used to assess the temporal trends in incidence rate of LC. RESULTS: During the study period, GPCR registered 575 of LC cases, of which 373 (64.9%) were men and 297 (51.6%) lived in rural areas. The mean (SD) age of LC in men and women were 60.3 (17.2) and 58.0 (17.1), respectively. The ASIR of LC was significantly higher in men than women (4.7 vs. 2.6; P value<0.01) and a minimal increasing trend in LC incidence was observed in both sexes. The incidence rate of LC was significantly higher in rural areas compared to the urbans (3.91 vs. 3.40; P value=0.04). In the last 13 years, rural population had a significant increasing trend in ASIR of LC (average annual percent change [AAPC]=7.85, P value=0.005). CONCLUSION: LC was more prevalent in men among both urban and rural populations. The results showed a significant increasing trend in rural areas that requires Golestan health care system to take action in controlling the burden of LC in rural areas.

Building a Cancer Biobank in a Low-Resource Setting in Northern Iran: the Golestan Cancer Biobank.

BACKGROUND: We aim to present the development and the initial results of the Golestan Cancer Biobank (GoCB), in a low resource setting in northern Iran. METHODS: The GoCB protocol and its standard operation procedures (SOP) were developed according to internationally accepted standards and protocols with some modifications considering the limited resources in our setting. The main biological samples collected by the GoCB include blood sample, urine sample, fresh endoscopy tissue sample, fresh surgical tissue sample and formalin fixed paraffin embedded (FFPE) tissue sample. The GoCB collects patients' demographic data, tumor characteristics as well as data on risk factors. We developed a specific GoCB software for management of patient data and biological sample information. The GoCB dataset is annually linked with the Golestan cancer registry dataset to add complementary data (e.g., survival data). RESULTS: The GoCB started collection of data and biological samples in December 2016. By November 2020, a total number of 1217 cancer patients participated in the GoCB. The majority of the GoCB participants (n = 942, 77%) were those with gastrointestinal and breast cancers. Data on risk factors were successfully collected in 684 (56.2%) of the participants. Overall, 3563 samples were collected from the GoCB participants and 730 samples were used in 7 national and international research projects. CONCLUSION: We considered specific strategies to overcome major limitations, especially budget shortage, in the development and maintenance of a cancer-specific biological repositories in our setting. The GoCB may be considered as a model for the development of biobank in low- and middle-income countries (LMICs).

Recent cancer incidence trends and short-term predictions in Golestan, Iran 2004-2025.

BACKGROUND: We examine recent trends in the major cancers occurring in the Golestan province, a high-risk region for upper gastrointestinal cancers in Northern Iran, and provide short-term cancer predictions of the future cancer burden. METHODS: New cancer cases diagnosed in Golestan 2004-2016 were obtained from the Golestan population-based cancer registry (GPCR) database, and age-standardized rates by cancer site, year and sex calculated per 100,000 person-years. Using IARC's DepPred package we fitted time-linear age-period models to the available GPCR data to predict the cancer incidence burden in the year 2025. We calculated the contribution of demographic changes versus changes in risk to the overall changes in incidence from 2016 to 2025. RESULTS: The number of new cancer cases (excluding non-melanoma skin cancers) in 2025 is predicted to increase by 61.3% from 2678 cases in 2016 to 4319 cases. While a 17.6% reduction in the number of esophageal cancer cases is predicted by 2025, the number of new cases for each of the remaining major cancers is predicted to increase over the next decade, including cancers of the stomach (a 36.1% increase from 2016 to 2025), colorectum (56.2%), lung (67.8%), female breast (93.2%), prostate (101.8%) and leukemia (96.1%). The changes in the population structure and risk contributed 37.8% and 23.5% respectively, to the overall increase in incidence. CONCLUSION: Other than for the major upper gastrointestinal cancer types, the incidence rates of common cancers observed in the province are on the rise, reinforcing the need for continuous surveillance, as well as the design and implementation of effective cancer control programs.

Descriptive Epidemiology of Lymphoma in Northern Iran: Results from the Golestan Registry 2004-2013.

BACKGROUND: There is currently little known about the epidemiology of lymphomas in Iran. The aim of this paper is to describe the geographic and time variations in incidence rates of lymphomas in the Golestan province between 2004 and 2013. METHODS: The Golestan Population-based Cancer Registry (GPCR) routinely registers primary cancer patients from all sources (e.g. pathology centers, hospitals, etc.) throughout the Golestan province. We obtained data on newly-diagnosed lymphomas in Golestan during 2004-2013 from the GPCR dataset. Crude rates and age standardized incidence (ASR) rates (per 100000) of lymphomas were estimated, joinpoint regression was used to quantify incidence trends and average annual percent changes (AAPCs) were calculated. RESULTS: In total, 898 new cases of lymphoma were registered in the GPCR during 2004-2013. The ASR of Hodgkin lymphoma (HL) was 1.5 and 1.1 in males and females, respectively, while corresponding non-Hodgkin lymphoma (NHL) rates were greater, at 6.5 and 3.4 in males and females, respectively. Our results indicated a significant difference in the trends of HL between males (AAPC = -3.2) and females (AAPC = 3.6, P value = 0.001). The incidence rates of lymphoma were considerably higher in the urban population (ASR = 7.3) compared to those residing in rural areas (ASR = 5.3, P value = 0.054). We also found higher incidence rates for both HL and NHL in the western parts of the Golestan province. CONCLUSION: The incidence rates of lymphoma in the Golestan province are relatively high and vary geographically, with a higher incidence observed in the western area. Such differences may reflect unknown lifestyle and environmental determinants linked to ethnic susceptibility differing between the two areas.

Increasing trends of lung cancer in Golestan province, Northern Iran (2004-2016).

INTRODUCTION: We aimed to present the time trends and geographical distribution of lung cancer in Golestan province, a high-risk area for pulmonary tuberculosis (TB) in Northern Iran (2004-2016). METHODS: Data on incident primary lung cancers were obtained from the Golestan population-based cancer registry. The data were analyzed by CanReg-5 software to calculate the age-standardized incidence rates (ASRs). We used Joinpoint software for time trend analysis. Average annual percent changes were calculated. The contribution of population aging, population growth and risk to the overall changes in incidence of lung cancer were determined using partitioning analysis. RESULTS: Overall, 1829 cases of lung cancer were registered by the GPCR during 2004-2016, of which 1274 (69.7%, ASR in 2016 = 21.3) were men and 555 (30.3%, ASR in 2016 = 11.4) were women. The results of Joinpoint regression suggested a significant increasing trend in incidence of lung cancer in Golestan province during 2004 and 2016 (AAPC = 3.74; p-value = 0.01) with more prominent increasing in rural population (AAPC = 4.93; p-value<0.01). The number of new cases of lung cancer increased by 131.6% (from 98 in 2004 to 227 in 2016), of which 34.1%, 22.3% and 75.3% were due to population size, population aging and risk, respectively. Hot points of lung cancer were found in western parts of the Golestan. CONCLUSION: With high incidence rates and increasing trends of lung cancer, further studies are warranted to clarify the role of TB and other risk factors on its burden in this population.

Epidemiology of Head and Neck Cancers in Northern Iran: A 10-Year Trend Study From Golestan Province.

BACKGROUND: Golestan province, in Northern Iran, is a high-risk area for esophageal squamous cell carcinoma (SCC). SCC is also the most common histological type of cancers of the head and neck region including cancers of oral cavity, oropharynx, hypopharynx and larynx. We aimed to present the incidence rate of head and neck SCC (HNSCC) in Golestan province during 2004 and 2013. METHODS: Data on HNSCC were obtained from Golestan population-based cancer registry (GPCR). Quality control and data analysis were performed using CanReg software. Age standardized incidence rates (ASRs) were calculated using the world standard population. The ASRs were presented per 100000 person-years for different genders, residence places and years. RESULTS: During the 10-year period from 2004-2013, 434 cases of HNSCC were registered. 327 (75.3%) of these cases were male, 51.2% (222 cases) lived in urban areas and 351 (80.9%) of the total HNSCCs occurred in the larynx. Overall, the ASR of HNSCCs in Golestan province was 4.8. The ASR of HNSCCs was more than two-fold higher in male (6.6) than female (3.0). Our results showed an increasing trend in ASR of larynx cancer during the study period both in male and female. CONCLUSION: We found relatively high rates of larynx cancer in Golestan province. Our results also showed higher rates of HNSCC in males and urban population. Considering common risk factors between HNSCCs and esophageal cancer, further studies are needed to clarify different aspects of HNSCCs (including epidemiology and risk factors) in this high-risk population.

Building cancer registries in a lower resource setting: The 10-year experience of Golestan, Northern Iran.

INTRODUCTION: The Golestan population-based cancer registry (GPCR) was established in Golestan province, Northern Iran, within the Asian belt with predominance of upper-gastrointestinal cancers. We aimed to present the experiences of the registry in a resource-limited setting over the 10 years since its inception (2004-2013). METHODS: The GPCR was established as a research project to enable sustainable funding. A clear plan was developed for use of the GPCR data. New primary cancers were registered based on international standards, indices of data quality were routinely assessed and age-standardized incidence rates (ASR) per 100,000 person-years calculated using IARC's CanReg-5 software. RESULTS: Overall, 19807 new cancer cases were registered during the study period, an average of 1981 cases per annum, with overall ASR of 175.0 and 142.4 in males and females, respectively. The GPCR data suggested gastrointestinal and breast cancers as the most common malignancies in Golestan province. We observed increasing incidence rates of breast and colorectal cancers but declining trends of esophageal cancer. Overall, indices of data quality were within acceptable ranges. CONCLUSIONS: The GPCR data have been included in IARC's Cancer Incidence in Five Continents series, were used in 21 research projects, and published as 30 research papers. The key ingredients for the successful establishment and maintenance of the GPCR included sustainable sources of funding, a clear action plan for the use of data as well as stakeholder cooperation across all areas of the registration. The GPCR may be considered as a model for planning population-based cancer registries in lesser-resourced settings.