Muscle invasive bladder cancer in Upper Egypt: the shift in risk factors and tumor characteristics.

BACKGROUND: In Egypt, where bilharziasis is endemic, bladder cancer is the commonest cancer in males and the 2nd in females; squamous cell carcinoma (SCC) is the commonest type found, with a peculiar mode of presentation. The aim of this study is to identify and rank the risk factors of muscle invasive bladder cancer (MIBC) in Upper Egypt and describe its specific criteria of presentation and histopathology. METHODS: This is an analytical, hospital based, case controlled study conducted in south Egypt cancer institute through comparing MIBC cases (n = 130) with age, sex and residence matched controls (n = 260) for the presence of risk factors of MIBC. Data was collected by personal interview using a well designed questionnaire. Patients' records were reviewed for histopathology and Radiologic findings. RESULTS: The risk factors of MIBC were positive family history [Adjusted odds ratio (AOR) = 7.7], exposure to pesticides [AOR = 6.2], bladder stones [AOR = 5], consanguinity [AOR = 3.9], recurrent cystitis [AOR = 3.1], bilharziasis [odds ratio (OR) = 5.8] and smoking [OR = 5.3]. SCC represented 67.6% of cases with burning micturition being the presenting symptom in 73.8%. CONCLUSION: MIBC in Upper Egypt is usually of the SCC type (although its percentage is decreasing), occurs at a younger age and presents with burning micturition rather than hematuria. Unlike the common belief, positive family history, parents' consanguinity, exposure to pesticides and chronic cystitis seem to play now more important roles than bilharziasis and smoking in the development of this disease in this area.

Pancreatic cancer mortality in Egypt: comparison to the United States pancreatic cancer mortality rates.

OBJECTIVES: Little is known about the descriptive epidemiology of pancreatic cancer in many developing countries, such as Egypt. It is believed to be rare in developing countries, but this may reflect lack of systematic cancer registration. Mortality may serve as a surrogate for incidence, since the disease is lethal. Because of availability of reliable mortality registration in Egypt, we used the national mortality data to estimate pancreatic cancer mortality in 2765 deaths from 2000 to 2004, and to gain insights into the disease incidence. METHODS: Mortality data in Egypt was obtained from the electronic national mortality records of the Ministry of Health. We calculated population-based age-specific and age-standardized pancreatic cancer mortality rates for Egypt, and compared them with the Surveillance, Epidemiology, and End Results (SEER) mortality data of the United States. RESULTS: Comparisons of age-specific mortality demonstrated higher rates in Egypt compared to the United States for subjects under age 20 years (relative risks (RR) of 7.7 and 4.2, for the age groups 0-15 and 15-20, respectively), and significantly higher rates in the United States compared to Egypt for subjects 40 years and older (RR 1.8-80.5 for the age groups of 40-45 to 75+). For the majority of age groups in Egypt and the United States, mortality in males was higher than in females. Analysis of regional distribution of pancreatic cancer mortality in Egypt showed significant variations in rates among provinces (p<0.0001) with Northern provinces having average rate that is 2.85 times the rate of Southern provinces. The highest mortality rates were observed in the Nile Delta compared to southern Egypt and the oasis. CONCLUSIONS: The findings of this study demonstrate both international and regional variation in pancreatic cancer mortality, and highlight the importance of further investigation to explore the possible factors that may contribute to the observed epidemiological patterns.

Knowledge gained after a brief CME module on breast cancer diagnosis.

BACKGROUND: In developing countries, continuing medical education (CME) is lacking and physicians' knowledge of cancer control may also be lacking. METHOD: We evaluated knowledge of 144 primary care physicians in Egypt and 50 in Tunisia regarding breast cancer (BC) and inflammatory BC (IBC) in particular. We invited the physicians to pretesting, presentation of an educational module, and post-testing. RESULTS: We found significant improvement in knowledge about risk factors for IBC and BC, importance of early detection and clinical examination, and referral of IBC cases. The variables that were independently associated with improved BC knowledge, were rural practice location, being a female physician, and greater numbers of BC patients seen in the last year. CONCLUSION. We developed and evaluated a CME module to improve BC diagnostic knowledge of primary care physicians in developing countries. The evaluation showed that physicians most lacking in this knowledge had the greatest gains. With the anticipated adoption of this module in Egypt and Tunisia, we expect to see more appropriate referrals to cancer centers. These results could guide future oncology CME for physicians in developing countries.