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Journal of Cancer Epidemiology logoLink to Journal of Cancer Epidemiology
. 2014 Sep 21;2014:437971. doi: 10.1155/2014/437971

Cancer Incidence in Egypt: Results of the National Population-Based Cancer Registry Program

Amal S Ibrahim 1,*, Hussein M Khaled 2, Nabiel NH Mikhail 3, Hoda Baraka 4, Hossam Kamel 2
PMCID: PMC4189936  PMID: 25328522

Abstract

Background. This paper aims to present cancer incidence rates at national and regional level of Egypt, based upon results of National Cancer Registry Program (NCRP). Methods. NCRP stratified Egypt into 3 geographical strata: lower, middle, and upper. One governorate represented each region. Abstractors collected data from medical records of cancer centers, national tertiary care institutions, Health Insurance Organization, Government-Subsidized Treatment Program, and death records. Data entry was online. Incidence rates were calculated at a regional and a national level. Future projection up to 2050 was also calculated. Results. Age-standardized incidence rates per 100,000 were 166.6 (both sexes), 175.9 (males), and 157.0 (females). Commonest sites were liver (23.8%), breast (15.4%), and bladder (6.9%) (both sexes): liver (33.6%) and bladder (10.7%) among men, and breast (32.0%) and liver (13.5%) among women. By 2050, a 3-fold increase in incident cancer relative to 2013 was estimated. Conclusion. These data are the only available cancer rates at national and regional levels of Egypt. The pattern of cancer indicated the increased burden of liver cancer. Breast cancer occupied the second rank. Study of rates of individual sites of cancer might help in giving clues for preventive programs.

1. Introduction

Egypt was completely lacking incidence rates at national level until the results given in the current report were obtained. Available statistics were proportions derived from single or multicenter hospital registries that could not be used for calculation of incidence rates [1–7]. The only published incidence rates are those from a cancer registry in one district in Nile delta (Gharbiah governorate). The last internal reports of this registry are for 2002 [8, 9]. Incidence rates up to 2007 were published in Volumes IX and X of Cancer Incidence in Five Continents [10, 11], date of end of registry activities due to failure of sustainability. The published crude and age-standardized incidence rates from that registry are 96.5 and 132.6/100,000 males and 97.3 and 122.1/100,000 females. The commonest sites of cancer in males are liver (18.7%), bladder (12.7%), non-Hodgkin's lymphoma (11.0%) and trachea, bronchus, and lung (8.2%). The 4 sites represent 50.6% of all cancer in males. The commonest sites in females are breast (38.8%), non-Hodgkin's lymphoma (8.5%), liver (4.6%), and ovary (4.5%); all together represent 56.4% of cancer in females. There is no mention of rates of both sexes together. Studies are published using these Gharbiah data up to 2007 and are limited to specific sites of cancer mainly breast [12–15], gastrointestinal [16–18], hematopoietic [19], bladder [20], and gynecological cancers [21]. None of these geographically-limited studies and published rates could be considered as representative of Egypt, being based on results of one registry in a single delta governorate and do not have an impact on understanding the current situation of cancer at the national level.

The National Cancer Registry Program (NCRP) was established in 2008 and became the only source for cancer incidence in the country [22]. The main objective of the current publication is to present the incidence rates of cancer in Egypt in 2008–2011 based upon data of the National Cancer Registry Program of Egypt with estimated incidence of the disease up to 2050.

2. Materials and Methods

For registration purposes, Egypt was stratified into 3 geographical strata (regions), namely, Lower Egypt (north of Cairo), Middle Egypt (south of Cairo), and Upper Egypt (further south, reaching the southern frontier of the country). The current report covered three districts (governorate), each representing one of the 3 regions, namely, Damietta (Nile delta), Minya (Middle Egypt), and Aswan (Upper Egypt) (Figure 1). A population-based registry was established in each of the 3 governorates, located in the Ministry of Health Cancer Center.

Figure 1.

Figure 1

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Map of Egypt showing the location of the 5 peripheral registries of the national network of population-based cancer registries National Cancer Institute, Cairo, and South Egypt Cancer Institute, Assiut.

Trained medical doctors in the 3 registries abstracted records from their cancer centers and regularly visited establishments that dealt with cancer within the governorate for active data collection from medical records. Other sources of data were major tertiary centers on the national level as the National Cancer Institute of Cairo University, Pediatric Oncology Hospital in Cairo, and South Egypt Cancer Institute of Assiut University. Data managers in these institutions reported incident cancer cases among residents of the 3 governorates that were diagnosed/treated in these institutions. Health Insurance Organization and the Government-Subsidized Treatment Program periodically supplied their data. Death registers in local health directorates were regularly checked for cancer deaths from the 3 governorates.

A web-based software was developed for online data entry, validity checks, and data analysis. The database was centralized in the Ministry of Communication and Information Technology server (Figure 2) with backups in the Ministry of Health and the National Cancer Institute. Computer checks were achieved using DEPedits Conversion and Check Programs for Cancer Registries software [23]. Duplicates were eliminated using the National Identification Number and a clean database was achieved ready for analysis. Registration covered all invasive cancers (behavior code/3), in situ breast cancer (topography code C50._ and behavior code/2), in situ urinary bladder cancer (topography code C67._ and behavior code/2), and borderline tumors of the brain (topography code C71._ and behavior code/1) [24].

Figure 2.

Figure 2

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The NCRP Web Based System (3-Tier Architecture).

For the current report, we used data from Aswan (2008), Minya (2009), and Damietta (2009–2011) to represent the 3 geographical strata of Egypt (Table 1). Crude, age-specific, and world population age-standardized incidence rates were calculated and expressed/100,000 population. Statistics were published at the level of the 3-character ICD-10 codes [10]. The format of IARC publication: “Cancer Incidence in Five Continents, Vol. X” [11], was used for grouping of ICD codes. Statistics for all sites of cancer were expressed twice, with and without nonmelanoma skin cancer (C44). Confidence intervals were calculated following SEER methodology [25].

Table 1.

Population parameters of the 3 regions of Egypt and corresponding registries used in the current report to calculate regional and national incidence rates.

Region characteristics Upper Egypt Middle Egypt Lower Egypt
Regional Registry Aswan Minia Damietta
Registration period 2008 2009 2009–2011
Registry Population 1,074,131 4,426,528 3,586,056∗∗
Region population∗ 4,645,449 16,161,200 30,342,291
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*Based upon 2006 census.

**Person years during the registration period.

We developed a model to use incidence data of the population-based registries of the 3 regions (Lower, Middle, and Upper Egypt) to get incidence rates for the entire country. The first step was to apply the age-specific incidence rates of each registry to the population of the stratum it represented to get the number per gender of incident cases in different age groups and for all ages together in this region using data of Egypt last census [26]. Then, we used these statistics to estimate the crude and age specific incidence rates (ASIR) of cancer in the 3 regions together, considered to be representative of the entire country. These rates were applied to the total population of Egypt to get number of incident cancers and crude rate and ASR (world) at national. This procedure was applied for each cancer site and for all sites together per gender. For projections up to 2050, the ASIRs were applied to the projected population of the corresponding year to get the number of patients/age group. Crude and ASR (world) could then be obtained. Steps of calculations are detailed in the Appendix.

3. Results

3.1. National Incidence Rates and Proportions

The crude incidence rates on the national level for all sites excluding nonmelanoma skin cancer (C44) were 113.1/100,000 (both sexes), 115.7/100,000 (males), and 110.3/100,000 (females). The age-standardized rates (world) were 166.6/100,000 (both sexes), 175.9/100,000 (males), and 157.0/100,000 (females) as shown in Table 2. Proportions, crude, age standardized incidence rates and detailed age-specific rates of cancer sites according to ICD-10 format are shown in Tables 3 and 4 for individual sites of cancer and for all sites together by gender. The age-specific rates are represented graphically in Figure 3 for all cancers and Figures 4, 5, and 6 for breast, liver, and bladder cancer as examples of some of the more frequent cancer sites.

Table 2.

Incidence rates of Cancer in Egypt (/100,000 populations) classified by region and sex for all cancer sites with and without nonmelanoma skin cancer (C44).

  Males Females All Male : female ratio
  Crude rate ASR Crude rate ASR Crude rate ASR Crude rate ASR
  (95% CI) (95% CI) (95% CI) (95% CI) (95% CI) (95% CI)
All sites                
(i) Upper Egypt 97.1 142.8 116.9 167.1 107.0 155.0 0.8 : 1 0.9 : 1
(89.1–105.8) (133.1–153.2) (108.1–126.5) (156.5–178.4) (101.0–113.3) (147.7–162.6)
(ii) Middle Egypt 109.7 170.0 95.9 132.1 102.9 151.1 1.1 : 1 1.3 : 1
(105.4–114.1) (164.7–175.5) (91.1–100.2) (127.4–137.0) (100.0–106.0) (147.5–154.8)
(iii) Lower Egypt 138.5 191.8 131.7 173.3 135.2 182.6 1.1 : 1 1.1 : 1
(133.2–144.0) (185.6–198.2) (126.5–137.2) (167.3–179.6) (131.4–139.1) (178.2–187.1)
(iv) Calculated rates of Egypt 117.3 178.5 111.7 159.1 114.5 169.0 1.1 : 1 1.1 : 1
(116.0–118.6) (176.9–180.2) (110.4–113.0) (157.6–160.7) (113.6–115.5) (167.9–170.2)
All sites (excluding nonmelanoma skin cancer C44)                
(i) Upper Egypt 96.0 141.0 115.1 163.9 105.5 152.5 0.8 : 1 0.9 : 1
(88.1–1104.6) (131.4–151.4) (106.3–124.5) (153.4–175.1) (99.5–111.8) (145.5–160.1)
(ii) Middle Egypt 108.0 167.2 94.9 130.7 101.6 149.0 1.1 : 1 1.3 : 1
(103.8–112.3) (162.0–172.6) (90.9–99.1) (126.0–135.6) 98.7–104.6) (145.5–152.6)
(iii) Lower Egypt 136.7 189.1 130.1 170.9 133.5 180.0 1.1 : 1 1.1 : 1
(131.5–142.2) (182.9–195.5) (124.8–135.5) (164.9–177.1) (129.7–137.3) (175.7–184.4)
(iv) Calculated rates of Egypt 115.7 175.9 110.3 157.0 113.1 166.6 1 : 1 1.1 : 1
(114.4–117.0) (174.3–177.5) (109.0–111.6) (155.4–158.5) (112.2–114.0) (165.5–167.8)
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Table 3.

Calculated age-specific incidence rates, crude rates, and ASR (World), males, Egypt 2008–2011.

Site 0–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75+ Crude rate ASR %
Lip — — — — — — 0.5 — 0.3 — 0.8 1.4 0.6 1.8 8.7 1.5 0.3 0.4 0.23%
Tongue — — — — — — — — 0.3 1.4 1.3 3.1 1.9 1.8 — 2.2 0.3 0.5 0.27%
Mouth — — — 0.1 — — 0.2 0.5 0.8 1.5 2.5 4.6 0.6 2.6 1.4 — 0.5 0.6 0.41%
Salivary glands — — 0.1 — 0.1 — — 0.2 — — 0.7 1.4 2.0 2.6 4.5 5.2 0.3 0.5 0.25%
Tonsil — — — — — — — — 0.3 — — — — — — — — — 0.01%
Other oropharynx — — — — 0.1 — — — — — 0.4 0.6 — 0.8 2.8 — 0.1 0.1 0.07%
Nasopharynx — — — — 0.3 — — 0.2 — — 3.4 0.4 — 3.6 — 5.2 0.3 0.4 0.26%
Hypopharynx — — — 0.1 — — — — 0.3 — 0.9 1.4 0.6 — 1.4 1.5 0.2 0.2 0.13%
Pharynx unspec. — — — — — — 0.2 — — 1.0 — — — — — 1.5 0.1 0.1 0.07%
Esophagus — — — — 0.3 0.2 0.3 — 1.4 1.8 6.1 4.1 11.2 10.8 24.4 14.7 1.4 2.3 1.20%
Stomach — 0.1 0.1 — 0.3 0.2 0.7 0.5 2.0 2.6 5.0 6.0 11.9 6.4 21.5 14.1 1.5 2.3 1.26%
Small intestine 0.1 — — — — — 0.5 0.5 0.6 0.3 0.4 1.4 — 0.8 — 1.5 0.2 0.3 0.17%
Colon — — — 0.1 0.3 0.7 2.1 2.5 1.9 6.5 14.2 11.0 19.8 18.9 31.5 32.6 3.1 4.7 2.63%
Rectum — — — 0.1 0.7 1.2 0.7 1.2 2.2 2.0 3.4 4.1 3.4 2.6 8.7 1.5 1.0 1.3 0.84%
Anus — — — — 0.3 — 0.5 0.5 0.6 0.6 — 2.1 2.0 1.0 — — 0.3 0.3 0.24%
Liver 0.3 0.4 0.4 0.2 0.3 1.3 1.4 6.1 21.2 76.3 174.2 258.7 323.1 313.8 327.1 363.5 39.5 61.8 33.63%
Gallbladder and so forth — — — — — 0.4 — 0.5 0.6 0.6 1.0 1.0 5.9 1.0 4.7 7.4 0.5 0.7 0.40%
Pancreas — — — — — — 1.3 0.2 2.5 7.7 9.0 14.9 25.3 26.4 12.7 19.3 2.7 4.2 2.31%
Nose, sinuses and so forth — 0.1 — — — — — 0.5 0.3 — 1.2 — — — 1.4 8.2 0.2 0.3 0.17%
Larynx — — — — — — 0.2 — 2.1 2.6 6.6 6.8 18.2 11.0 23.2 32.5 1.9 3.1 1.58%
Trachea, Bronchus, Lung 0.1 — 0.1 0.4 0.8 1.2 1.2 3.0 3.8 12.5 19.3 39.1 49.0 49.3 73.9 76.1 6.7 10.4 5.69%
Other Thoracic organs 0.3 — — 0.1 0.2 0.2 — — 0.6 1.2 2.8 3.5 3.2 7.1 9.8 8.9 0.8 1.2 0.65%
Bone 0.1 1.2 1.4 0.7 1.8 0.8 1.0 1.0 1.4 2.0 4.2 3.7 13.9 8.6 8.4 15.6 1.9 2.5 1.62%
Melanoma of skin — — — — 0.1 0.2 — — 0.6 — — 0.4 — 1.8 2.8 — 0.1 0.2 0.11%
Other skin 0.6 — 0.1 — 0.3 0.4 0.5 0.5 1.1 0.6 3.2 4.5 14.0 14.2 18.5 30.4 1.6 2.6 1.35%
Mesothelioma — — — — — — — — — 0.8 0.5 1.4 — 0.8 — — 0.1 0.2 0.10%
Kaposi sarcoma — — — — — — 0.2 — — — 1.1 — 1.3 0.8 1.4 — 0.1 0.2 0.10%
Connective, Soft tissue 0.3 0.1 0.1 0.6 1.1 2.0 1.3 1.3 3.1 3.5 3.6 8.3 4.6 6.1 18.8 2.2 1.7 2.2 1.47%
Breast — — — — — 0.4 — 0.3 2.2 0.3 2.5 3.1 3.4 3.6 2.8 5.9 0.6 0.9 0.51%
Penis — — — — — — — — — — — — — — — — — — 0.00%
Prostate — — — — — 0.2 0.3 — 0.3 1.3 4.1 11.2 24.6 47.5 90.3 216.5 5.0 9.3 4.27%
Testis — 0.1 — — 1.1 1.2 0.7 1.5 0.6 0.6 0.4 0.4 0.6 — 1.4 2.2 0.5 0.5 0.43%
Other male genital — — — — — — — — — — 0.4 — — 0.8 1.4 — — 0.1 0.04%
Kidney 1.2 0.1 — — — 0.2 0.2 0.5 0.5 3.4 6.9 9.8 7.9 16.9 14.1 22.3 1.8 2.7 1.53%
Renal pelvis — — — — 0.1 — — 0.2 0.6 0.3 0.4 1.9 2.0 1.8 2.8 4.4 0.3 0.4 0.25%
Ureter — — — — — — — — — — — — — — 1.4 3.0 — 0.1 0.04%
Bladder 0.1 0.1 — 0.3 0.1 1.2 1.7 2.2 4.0 9.2 28.7 68.4 97.2 128.6 194.8 205.6 12.6 21.1 10.71%
Other urinary organs — — — — — — — — — — — — 0.6 — — — — — 0.01%
Eye 0.5 0.3 — — — — — — — 0.4 0.4 1.8 0.6 — — — 0.2 0.2 0.16%
Brain, Nervous tissue 2.9 3.0 1.8 1.7 1.5 3.3 4.2 6.8 7.3 7.3 15.5 14.5 27.2 30.4 46.7 91.4 6.4 9.0 5.48%
Thyroid — — — — 0.2 0.8 1.2 1.9 1.1 3.2 4.5 4.3 6.6 8.7 3.0 — 1.1 1.5 0.95%
Adrenal gland 0.3 0.1 — — — — — — — — — 0.6 — 0.8 1.4 — 0.1 0.1 0.08%
Other endocrine 0.5 — 0.1 — 0.3 — — 0.5 0.3 1.0 0.4 1.3 0.6 — 2.8 — 0.3 0.4 0.25%
Hodgkin disease 0.5 1.7 1.7 1.5 1.5 1.4 — 0.2 1.7 2.5 2.0 1.4 5.3 6.1 2.8 1.5 1.5 1.7 1.29%
Non-Hodgkin lymphoma 1.1 1.2 1.5 1.0 2.2 2.5 2.1 3.6 5.8 16.6 24.4 36.0 33.8 29.5 38.1 28.8 6.4 8.8 5.48%
Immunoproliferative dis. — — — — — — — — — — — — — — — — — — 0.00%
Multiple myeloma — — — — — — 0.5 0.5 1.1 0.4 3.1 3.9 8.0 0.8 2.8 2.9 0.6 0.9 0.53%
Lymphoid leukemia 3.9 2.2 0.7 0.2 1.4 — 0.7 1.5 1.1 1.8 1.5 5.0 6.0 8.9 5.6 — 1.8 2.1 1.50%
Myeloid Leukemia 0.8 0.4 0.3 0.8 1.0 0.4 1.1 0.7 1.4 1.8 4.2 3.3 3.4 2.6 4.5 1.5 1.1 1.3 0.96%
Leukemia unspec. 1.0 1.2 1.1 0.6 2.1 2.2 1.7 0.5 2.1 4.7 1.8 6.0 8.0 3.5 7.3 20.8 2.1 2.6 1.80%
Other & unspecified 2.4 2.8 0.9 1.7 1.3 1.8 3.3 3.1 6.1 15.0 22.9 25.2 44.9 54.7 64.7 83.6 7.6 11.2 6.52%
All sites Total 17.1 15.4 10.5 10.5 20.1 23.9 30.6 42.8 83.8 195.4 389.6 582.4 793.5 840.2 1096.1 1335.6 117.3 178.5 100.00%
All sites but C44# 16.6 15.4 10.4 10.5 19.8 23.5 30.0 42.4 82.7 194.9 386.4 577.9 779.5 826.0 1077.5 1305.3 115.7 175.9 98.65%
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#Incidence rates do not include nonmelanoma skin cancer.

Table 4.

Calculated age-specific incidence rates, crude rates, and ASR (World), females, Egypt 2008–2011.

Site 0–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75+ Crude rate ASR %
Lip — — — — — — — — 0.3 1.4 0.8 0.5 1.6 0.8 1.3 4.7 0.2 0.4 0.21%
Tongue — — — — — 0.5 — — — 0.4 0.4 1.2 0.7 — — 15.4 0.3 0.5 0.26%
Mouth — 0.1 0.1 — — — — — 0.3 1.0 0.8 0.5 1.4 2.9 6.1 2.7 0.3 0.5 0.28%
Salivary glands — — 0.3 — — — — — — 0.7 — 2.9 0.7 2.9 — — 0.2 0.3 0.18%
Tonsil — — — — — — — — — — — — — 2.2 — 1.4 — 0.1 0.04%
Other oropharynx — — — — — — — — — 0.3 — 0.7 — 0.8 — — — 0.1 0.04%
Nasopharynx 0.1 — 0.1 — — — — — — — — — 1.6 — — — 0.1 0.1 0.06%
Hypopharynx — — — — — 0.2 — 0.4 0.3 1.0 0.9 0.5 — 1.1 — — 0.2 0.2 0.16%
Pharynx unspec. — — — — — 0.2 — — — — — — — — — — — — 0.01%
Esophagus — — — — — 0.2 — — 2.0 1.3 0.8 3.7 11.1 10.6 9.2 5.4 0.9 1.5 0.79%
Stomach — 0.1 — — — — 2.0 1.4 3.1 5.1 5.7 5.1 9.7 16.3 18.7 14.8 1.8 2.7 1.65%
Small intestine — — — — — — — 0.4 — 1.9 1.7 — 1.4 5.2 4.8 — 0.4 0.5 0.32%
Colon — — — — 0.5 0.5 1.0 2.4 2.9 7.9 9.4 7.9 10.4 25.2 16.2 29.4 2.5 3.8 2.28%
Rectum — — — — 0.1 1.1 1.2 0.7 1.9 1.7 1.9 2.9 3.0 3.9 4.4 5.4 0.8 1.1 0.72%
Anus — — — — — 0.2 — — 0.3 — 0.5 — 1.6 — 1.3 — 0.1 0.1 0.09%
Liver 1.0 — 0.5 — — 0.9 2.0 3.3 12.5 25.2 43.2 89.3 129.3 143.9 167.9 150.4 15.1 24.4 13.54%
Gallbladder and so forth — — — — 0.3 — 0.5 0.5 0.3 1.3 2.5 3.3 2.2 3.7 6.9 6.0 0.6 0.9 0.55%
Pancreas — — — — — 0.4 — 0.5 0.6 3.0 3.4 8.6 9.0 18.7 24.4 19.5 1.6 2.6 1.41%
Nose, sinuses and so forth 0.1 — — — — — — — 0.3 0.7 1.2 1.2 5.4 — — — 0.3 0.4 0.23%
Larynx — — — — — — — — 0.3 1.0 2.0 — 3.0 — 3.0 2.1 0.3 0.4 0.23%
Trachea, Bronchus, Lung 0.7 — 0.1 0.1 0.5 2.0 1.0 1.5 1.7 6.9 12.3 11.7 15.1 11.3 35.9 38.0 3.0 4.5 2.70%
Other Thoracic organs — — — — — — — — 0.8 1.7 1.6 2.6 1.6 3.0 1.3 10.7 0.5 0.7 0.42%
Bone 0.7 0.1 1.1 2.0 1.4 0.7 0.7 2.2 0.9 2.3 6.5 6.7 12.0 4.5 2.6 16.9 2.0 2.5 1.80%
Melanoma of skin — — — — — — — — 0.6 — — — — 2.2 4.4 — 0.1 0.2 0.10%
Other skin 0.3 — — 0.2 — 0.4 0.5 — 2.0 2.7 1.2 8.6 10.4 14.0 14.9 11.8 1.4 2.2 1.24%
Mesothelioma — — — — — — — — — — 1.2 0.5 3.0 1.1 4.8 — 0.2 0.3 0.17%
Kaposi sarcoma — — — — — — — — — — — — — 0.8 — — — — 0.01%
Connective, Soft tissue 1.2 0.3 0.7 0.4 1.5 2.1 1.7 1.2 2.0 2.0 2.9 2.4 6.2 3.9 3.1 13.4 1.6 1.9 1.42%
Breast — — — — 3.1 9.5 29.2 49.0 86.0 106.2 136.0 172.9 177.4 166.3 138.7 148.6 35.8 48.8 32.04%
Vulva 0.1 — 0.1 — — — — — — 0.3 — 1.0 — 0.8 — 1.4 0.1 0.1 0.09%
Vagina — — — — — — — — — — — 1.0 3.0 3.3 — 1.4 0.2 0.3 0.14%
Cervix Uteri — — — — — 0.2 0.2 — 0.6 3.6 6.5 9.1 8.3 10.5 1— 9.4 1.3 2.0 1.17%
Corpus Uteri — — — — — — 0.5 0.2 0.6 1.3 0.7 8.1 4.3 3.0 3.0 12.1 0.7 1.1 0.62%
Uterus unspec. — — — 0.5 1.2 0.4 0.7 0.5 1.8 1.6 11.1 9.5 21.5 20.4 31.4 21.2 2.5 3.9 2.27%
Ovary — — 0.5 0.4 0.8 1.5 1.5 3.3 8.7 17.2 20.3 24.0 19.6 17.2 2— 26.3 4.6 6.3 4.12%
Other female genital — — — — — — — 0.3 — — — — — — 1.3 2.1 0.1 0.1 0.05%
Placenta — — — — — 0.4 — — — — — — — — — — — — 0.03%
Kidney 1.5 0.1 — — — 0.5 0.8 0.5 0.6 2.9 2.3 1.0 10.4 10.7 1.3 7.3 1.1 1.6 0.97%
Renal pelvis — 0.3 — — — 0.6 — 0.2 — 0.7 0.4 0.5 1.6 0.8 — — 0.2 0.3 0.19%
Ureter — — — — — — — — — — — — — — — — — — 0.00%
Bladder 0.1 — — 0.2 — 0.2 — 0.7 0.8 5.3 8.2 18.6 20.2 37.8 43.6 53.9 3.3 5.5 2.96%
Other urinary organs — — — — — — — — — — — — — 2.2 — — — 0.1 0.03%
Eye 0.1 0.3 — — — — 0.5 — — — — 1.2 0.7 0.8 — 1.4 0.2 0.2 0.14%
Brain, Nervous tissue 3.3 2.1 1.9 0.8 2.9 0.7 4.5 6.5 6.6 9.5 11.3 12.1 31.4 26.3 33.1 72.2 5.8 8.0 5.18%
Thyroid — — — — 2.7 2.8 10.2 7.2 6.4 9.7 10.2 11.0 9.0 2.6 10.4 14.2 3.7 4.3 3.28%
Adrenal gland 1.5 0.1 — — — — — — — — — 1.2 — — — 1.4 0.2 0.3 0.20%
Other endocrine — 0.1 — 0.1 0.1 0.3 — 0.5 0.3 0.3 0.4 1.0 0.7 0.8 — — 0.2 0.2 0.19%
Hodgkin disease — 0.6 0.4 1.9 1.3 0.4 1.2 0.7 0.6 0.4 — 1.2 3.8 — — — 0.8 0.8 0.70%
Non-Hodgkin lymphoma 0.9 0.7 — 1.1 0.8 1.2 1.7 3.3 3.8 8.6 16.0 23.4 24.1 16.8 31.3 36.7 4.2 6.1 3.80%
Immunoproliferative dis. — — — — — — — — — — — — — — — — — — 0.00%
Multiple myeloma — — — — — — — — 0.6 1.4 0.8 1.2 2.3 4.4 6.1 2.7 0.4 0.6 0.34%
Lymphoid leukemia 2.0 0.7 0.9 0.4 0.5 — 0.7 0.7 1.4 1.0 2.7 1.7 2.8 3.9 4.4 — 1.0 1.2 0.93%
Myeloid Leukemia 0.5 0.3 0.7 0.2 1.5 1.5 1.4 1.0 0.9 0.7 4.0 3.1 6.8 7.5 — 4.9 1.3 1.6 1.14%
Leukemia unspec. 0.4 0.7 0.7 1.3 0.9 1.7 1.5 0.7 1.4 2.7 3.3 5.5 6.1 8.3 7.4 14.8 1.7 2.2 1.55%
Other & unspecified 1.4 0.9 1.9 1.7 2.4 3.9 4.6 5.5 9.6 12.5 23.8 37.3 39.9 42.1 42.6 70.5 7.7 10.8 6.93%
All sites Total 16.1 7.8 10.1 11.4 22.4 34.9 69.7 95.2 163.7 255.3 359.1 506.5 633.7 665.8 715.9 850.5 111.7 159.1 100.00%
All sites but C44# 15.8 7.8 10.1 11.2 22.4 34.6 69.3 95.2 161.6 252.5 357.9 497.8 623.3 651.8 701.0 838.7 110.3 157.0 98.76%
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#Incidence rates do not include nonmelanoma skin cancer.

Figure 3.

Figure 3

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Calculated age specific incidence rates for Egypt 2008–2011.

Figure 4.

Figure 4

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Calculated age specific incidence rates for liver cancer in Egypt 2008–2011.

Figure 5.

Figure 5

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Calculated age specific incidence rates for breast cancer in Egypt 2008–2011.

Figure 6.

Figure 6

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Calculated age specific incidence rates for urinary bladder cancer in Egypt 2008–2011.

Table 5 depicts the proportions and rates of the most frequent cancer sites by gender. There was predominance of liver, breast, and bladder cancer that represented approximately 46% of all cancers. Liver and bladder cancers represented approximately 44% of cancer in males. In females, breast and liver cancer occupied the top ranks accounting for around 45% of all cancers.

Table 5.

The most frequent cancers in Egypt estimated using the results of the National Population-Based Registry Program of Egypt 2008–2011.

  Site % Crude rate ASR
Males Liver 33.63 39.5 61.8
Bladder 10.71 12.6 21.1
Lung# 5.69 6.7 10.4
Non-Hodgkin lymphoma 5.48 6.4 8.8
Brain## 5.48 6.4 8.8
Prostate 4.27 5.0 9.3
Females Breast 32.04 35.8 48.8
Liver 13.54 15.1 24.4
Brain## 5.18 5.8 8.0
Ovary 4.12 4.6 6.3
Non-Hodgkin lymphoma 3.80 4.2 6.1
Thyroid 3.28 3.7 4.3
Both Sexes Liver 23.81 27.5 43.6
Breast 15.41 17.8 24.3
Bladder 6.94 8.0 13.5
Brain## 5.29 6.1 8.5
Non-Hodgkin lymphoma 4.64 5.4 7.5
Lung# 4.22 4.9 7.5
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#Includes trachea, bronchus, and lung tumors.

##Includes brain and nervous system tumors.

3.2. Frequencies and Incidence Rates/Geographical Strata

The frequencies of individual sites of cancer and their incidence rates by geographical stratum and sex are detailed in Tables 6 and 7. Table 8 depicts the most common sites of cancer that accounted for approximately 3/4 of cases. For the 2 sexes together, the top 2 ranks in the 3 regions were liver and breast cancer. The proportions and ASR of liver cancer were highest in Lower Egypt (29.6% and 56.8/100,000), less in Middle, and least in Upper Egypt (8.2% and 13.1/100,000).

Table 6.

Incidence rates/100,000 population of individual cancer sites in Lower, Middle, and Upper Egypt: males.

Primary site Lower Egypt Middle Egypt Upper Egypt
2009–2011 2009 2008
Crude ASR % Crude ASR % Crude ASR %
Lip 0.4 0.4 0.28% 0.3 0.5 0.24% 0.4 0.6 0.38%
Tongue 0.3 0.3 0.20% 0.2 0.4 0.20% 1.1 1.5 1.15%
Mouth 0.2 0.3 0.16% 0.8 1.1 0.73% 1.3 1.9 1.34%
Salivary glands 0.3 0.4 0.20% 0.4 0.5 0.36% 0.6 0.9 0.57%
Tonsil 0.0 0.0 0.00% 0.0 0.1 0.04% 0.0 0.0 0.00%
Other oropharynx 0.0 0.0 0.00% 0.2 0.3 0.20% 0.2 0.3 0.19%
Nasopharynx 0.5 0.5 0.35% 0.1 0.1 0.12% 0.6 1.0 0.57%
Hypopharynx 0.0 0.0 0.00% 0.3 0.5 0.28% 0.6 0.9 0.57%
Pharynx unspec. 0.1 0.1 0.04% 0.1 0.1 0.08% 0.2 0.3 0.19%
Esophagus 1.0 1.3 0.71% 1.8 3.0 1.61% 3.9 5.5 4.01%
Stomach 1.4 2.0 0.98% 1.7 2.5 1.53% 2.4 3.8 2.48%
Small intestine 0.1 0.1 0.04% 0.5 0.6 0.44% 0.2 0.2 0.19%
Colon 4.0 5.4 2.91% 2.3 3.7 2.10% 2.4 3.7 2.48%
Rectum 0.9 1.1 0.67% 1.2 1.6 1.13% 0.7 1.1 0.76%
Anus 0.4 0.4 0.28% 0.2 0.2 0.16% 0.4 0.5 0.38%
Liver 57.8 81 41.71% 22.4 37.6 20.42% 11.5 17.5 11.83%
Gallbladder and so forth 0.5 0.5 0.39% 0.4 0.7 0.32% 1.3 2.2 1.34%
Pancreas 3.2 4.4 2.28% 2.1 3.5 1.94% 3.5 5.4 3.63%
Nose, sinuses and so forth 0.1 0.1 0.04% 0.4 0.6 0.32% 0.6 0.9 0.57%
Larynx 0.8 1.3 0.59% 3.3 5.7 3.03% 3.9 6.0 4.01%
Trachea, Bronchus, Lung 7.6 10.1 5.47% 6.3 10.8 5.77% 7.4 11.5 7.63%
Other Thoracic organs 1.0 1.3 0.71% 0.8 1.2 0.69% 0.6 0.8 0.57%
Bone 1.9 2.4 1.34% 2.3 3.4 2.10% 1.5 1.9 1.53%
Melanoma of skin 0.2 0.2 0.12% 0.1 0.1 0.12% 0.0 0.0 0.00%
Other skin 1.8 2.7 1.30% 1.7 2.8 1.53% 1.1 1.8 1.15%
Mesothelioma 0.0 0.0 0.00% 0.3 0.4 0.24% 0.4 0.6 0.38%
Kaposi sarcoma 0.1 0.1 0.08% 0.2 0.3 0.16% 0.0 0.0 0.00%
Connective, Soft tissue 2.5 2.6 1.77% 0.5 0.8 0.48% 3.0 3.8 3.05%
Breast 0.7 0.8 0.47% 0.4 0.6 0.32% 1.1 1.8 1.15%
Penis 0.0 0.0 0.00% 0.0 0.0 0.00% 0.0 0.0 0.00%
Prostate 6.7 11.7 4.84% 2.9 5.2 2.66% 5.7 9.2 5.92%
Testis 0.5 0.4 0.35% 0.5 0.7 0.48% 0.4 0.5 0.38%
Other male genital 0.0 0.0 0.00% 0.1 0.2 0.12% 0.0 0.0 0.00%
Kidney 2.2 3.2 1.61% 1.7 2.5 1.53% 0.9 1.3 0.95%
Renal pelvis 0.2 0.3 0.12% 0.5 0.8 0.48% 0.4 0.5 0.38%
Ureter 0.1 0.1 0.04% 0.0 0.1 0.04% 0.0 0.0 0.00%
Bladder 12.2 19 8.82% 15.6 26.4 14.25% 12.2 19.3 12.60%
Other urinary organs 0.0 0.0 0.00% 0.0 0.0 0.00% 0.2 0.3 0.19%
Eye 0.1 0.2 0.08% 0.3 0.4 0.24% 0.7 0.6 0.76%
Brain, Nervous tissue 6.2 8.1 4.49% 8.0 12.5 7.26% 5.2 6.7 5.34%
Thyroid 1.3 1.5 0.91% 1.2 1.7 1.05% 0.7 1.1 0.76%
Adrenal gland 0.0 0.0 0.00% 0.1 0.2 0.12% 0.6 0.8 0.57%
Other endocrine 0.1 0.1 0.08% 0.6 0.8 0.56% 0.4 0.4 0.38%
Hodgkin disease 1.6 1.8 1.18% 1.7 2.0 1.53% 1.5 1.5 1.53%
Non-Hodgkin lymphoma 8.3 10.3 6.03% 5.2 7.6 4.76% 2.8 4.2 2.86%
Immunoproliferative dis. 0.0 0.0 0.00% 0.0 0.0 0.00% 0.0 0.0 0.00%
Multiple myeloma 0.7 0.9 0.51% 0.7 1.1 0.61% 0.2 0.3 0.19%
Lymphoid leukemia 1.7 2.2 1.22% 1.8 2.3 1.61% 3.0 3.1 3.05%
Myeloid Leukemia 0.9 1.0 0.63% 1.6 1.8 1.45% 1.9 2.5 1.91%
Leukemia unspec. 2.4 3.1 1.73% 2.0 2.6 1.86% 1.1 1.1 1.15%
Other & unspecified 5.9 8.3 4.25% 13.9 17.6 12.67% 8.7 13 8.97%
All sites Total 138.5 191.8 100.00% 109.7 170 100.00% 97.1 142.8 100.00%
All sites but C44# 136.7 189.1 98.70% 108 167.2 98.47% 96 141 98.85%
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#Incidence rates do not include nonmelanoma skin cancer.

Table 7.

Incidence rates/100,000 population of individual cancer sites in Lower, Middle, and Upper Egypt: females.

Primary site Lower Egypt Middle Egypt Upper Egypt
2009–2011 2009 2008
Crude ASR % Crude ASR % Crude ASR %
Lip 0.3 0.4 0.26% 0.2 0.4 0.24% 0.0 0.0 0.00%
Tongue 0.3 0.5 0.26% 0.3 0.5 0.34% 0.2 0.2 0.16%
Mouth 0.1 0.2 0.09% 0.5 0.8 0.53% 0.9 1.5 0.80%
Salivary glands 0.2 0.2 0.13% 0.3 0.4 0.29% 0.2 0.4 0.16%
Tonsil 0.1 0.1 0.04% 0.0 0.1 0.05% 0.0 0.0 0.00%
Other oropharynx 0.0 0.0 0.00% 0.1 0.1 0.10% 0.2 0.3 0.16%
Nasopharynx 0.1 0.1 0.04% 0.0 0 0.05% 0.2 0.2 0.16%
Hypopharynx 0.0 0.0 0.00% 0.4 0.4 0.38% 0.6 0.9 0.48%
Pharynx unspec. 0.0 0.0 0.00% 0.0 0.0 0.05% 0.0 0.0 0.00%
Esophagus 0.9 1.2 0.65% 1.2 1.9 1.25% 1.1 1.6 0.96%
Stomach 2.3 3.2 1.73% 1.2 1.8 1.25% 1.9 3.1 1.60%
Small intestine 0.3 0.5 0.22% 0.4 0.6 0.43% 0.6 0.9 0.48%
Colon 3.0 4.2 2.30% 2.2 3.2 2.31% 2.4 3.5 2.08%
Rectum 0.9 1.0 0.65% 1.0 1.2 1.01% 0.7 1.3 0.64%
Anus 0.1 0.1 0.04% 0.1 0.2 0.14% 0.2 0.3 0.16%
Liver 21.6 32.6 16.37% 8.6 13.7 8.95% 6.0 8.7 5.12%
Gallbladder and so forth 0.5 0.5 0.35% 0.6 0.9 0.58% 1.9 3.1 1.60%
Pancreas 2.1 3.2 1.60% 0.9 1.4 0.91% 1.7 2.3 1.44%
Nose, sinuses and so forth 0.3 0.5 0.26% 0.1 0.2 0.14% 0.2 0.2 0.16%
Larynx 0.2 0.3 0.17% 0.3 0.4 0.29% 0.4 0.7 0.32%
Trachea, Bronchus, Lung 3.7 5.3 2.82% 2.2 3.1 2.26% 2.4 3.8 2.08%
Other Thoracic organs 0.6 0.8 0.43% 0.5 0.7 0.48% 0.0 0.0 0.00%
Bone 2.0 2.3 1.52% 1.8 2.4 1.92% 3.4 4.4 2.88%
Melanoma of skin 0.2 0.3 0.17% 0.0 0.1 0.05% 0.0 0.0 0.00%
Other skin 1.7 2.4 1.26% 1.0 1.5 1.06% 1.9 3.1 1.60%
Mesothelioma 0.3 0.3 0.22% 0.2 0.3 0.24% 0.4 0.7 0.32%
Kaposi sarcoma 0.0 0.0 0.00% 0.0 0.1 0.05% 0.0 0.0 0.00%
Connective, Soft tissue 2.3 2.6 1.78% 0.4 0.6 0.38% 1.9 2.2 1.60%
Breast 43.8 53 33.22% 25.8 35.6 26.84% 45.3 64.5 38.72%
Vulva 0.0 0.0 0.00% 0.3 0.4 0.34% 0.0 0.0 0.00%
Vagina 0.1 0.2 0.09% 0.1 0.2 0.14% 0.6 1.0 0.48%
Cervix Uteri 1.7 2.4 1.26% 1.0 1.5 1.06% 0.6 0.9 0.48%
Corpus Uteri 0.6 0.9 0.43% 0.6 0.9 0.67% 1.7 2.9 1.44%
Uterus unspec. 3.7 5.3 2.77% 1.0 1.3 1.06% 2.4 3.8 2.08%
Ovary 5.1 6.4 3.90% 3.6 5.0 3.75% 7.1 10.2 6.08%
Other female genital 0.0 0.0 0.00% 0.0 0.1 0.05% 0.4 0.6 0.32%
Placenta 0.0 0.0 0.00% 0.0 0.0 0.05% 0.2 0.2 0.16%
Kidney 1.1 1.6 0.87% 1.2 1.8 1.25% 0.7 1.1 0.64%
Renal pelvis 0.2 0.3 0.17% 0.2 0.3 0.19% 0.2 0.2 0.16%
Ureter 0.0 0.0 0.00% 0.0 0.0 0.00% 0.0 0.0 0.00%
Bladder 3.7 5.9 2.77% 3.1 4.9 3.27% 3.6 5.7 3.04%
Other urinary organs 0.1 0.1 0.04% 0.0 0.0 0.00% 0.0 0.0 0.00%
Eye 0.1 0.1 0.04% 0.3 0.5 0.34% 0.2 0.2 0.16%
Brain, Nervous tissue 5.8 7.4 4.42% 7.4 11.1 7.70% 2.4 2.9 2.08%
Thyroid 5.1 5.4 3.90% 1.6 2.1 1.64% 3.6 4.2 3.04%
Adrenal gland 0.2 0.3 0.17% 0.2 0.3 0.24% 0.2 0.2 0.16%
Other endocrine 0.1 0.0 0.04% 0.5 0.7 0.53% 0.2 0.2 0.16%
Hodgkin disease 1.0 0.7 0.74% 1.0 1.0 1.01% 0.9 0.9 0.80%
Non-Hodgkin lymphoma 5.4 6.7 4.11% 4.2 5.8 4.43% 2.6 3.8 2.24%
Immunoproliferative dis. 0.0 0.0 0.00% 0.0 0.0 0.00% 0.0 0.0 0.00%
Multiple myeloma 0.7 0.9 0.52% 0.1 0.3 0.14% 0.2 0.0 0.16%
Lymphoid leukemia 1.0 1.1 0.74% 1.2 1.6 1.25% 1.5 1.6 1.28%
Myeloid Leukemia 0.9 1.1 0.65% 1.7 2.0 1.78% 2.2 3.3 1.92%
Leukemia unspec. 1.8 2.4 1.34% 1.6 2.0 1.68% 1.9 2.3 1.60%
Other & unspecified 5.9 8.2 4.46% 14.3 15.5 14.86% 9.2 12.9 7.84%
All sites Total 131.7 173.3 100.00% 95.9 132.1 100.00% 116.9 167.1 100.00%
All sites but C44# 130.1 170.9 98.74% 94.9 130.7 98.94% 115.1 163.9 98.40%
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#Incidence rates do not include nonmelanoma skin cancer.

Table 8.

Proportions and incidence rates of the most frequently observed cancers in the 3 regions of Egypt.

  Lower Egypt Middle Egypt Upper Egypt
  2009–2011 2009 2008
  Site % Crude rate ASR Site % Crude rate ASR Site % Crude rate ASR
Males Liver 41.7 57.8 81.0 Liver 20.4 22.4 37.6 Bladder 12.6 12.2 19.3
Bladder 8.8 12.2 19.0 Bladder 14.2 15.6 26.4 Liver 11.8 11.5 17.5
NHL 6.0 8.3 10.3 Brain# 7.3 8.0 12.5 Lung## 7.6 7.4 11.5
Lung## 5.5 7.6 10.1 Lung## 5.8 6.3 10.8 Leukemia 6.1 6.0 6.7
Prostate 4.8 6.7 11.7 Leukemia 4.9 5.4 6.7 Prostate 5.9 5.7 9.2
Females Breast 33.2 43.8 53.0 Breast 26.8 25.8 35.6 Breast 38.7 45.3 64.5
Liver 16.4 21.6 32.6 Liver 8.9 8.6 13.7 Ovary 6.1 7.1 10.2
Brain# 4.4 5.8 7.4 Brain# 7.7 7.4 11.1 Liver 5.1 6.0 8.7
NHL 4.1 5.4 6.7 Leukemia 4.7 4.5 5.6 Leukemia 4.8 5.6 7.2
Thyroid 3.9 5.1 5.4 NHL 4.4 4.2 5.8 Uterus 3.5 4.1 6.7
Both Sexes Liver 29.6 40.1 56.8 Liver 15.2 15.6 25.7 Breast 21.6 23.1 33.2
Breast 16.1 21.7 26.9 Breast 12.4 12.8 18.1 Liver 8.2 8.8 13.1
Bladder 5.9 8.0 12.5 Bladder 9.2 9.5 15.7 Bladder 7.4 7.9 12.5
NHL 5.1 6.9 8.5 Brain# 7.5 7.7 11.8 Leukemia 5.4 5.7 7.0
Brain# 4.5 6.0 7.8 Leukemia 4.8 4.9 6.2 Lung## 4.6 4.9 7.7
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#Includes brain and nervous system tumors.

##Includes trachea, bronchus and lung tumors.

Among males in the 3 regions, liver and bladder cancer occupied the top 2 ranks. The proportion and ASR of liver cancer were highest in Lower Egypt (41.7% and 81.0/100,000) and lowest in Upper Egypt (11.8% and 17.5/100,000). Cancer of the lung occupied the third or fourth ranks representing 5–7% of cancers and Non-Hodgkin lymphoma was among the 5 most common cancers in Lower Egypt only having a proportion of 6.0% and ASR 10.3/100,000.

Among females, the pattern in the 3 regions was dominated by the high frequency of breast cancer and liver cancer. Proportion of liver cancer was highest in Lower Egypt (16.4%), less in Middle Egypt, and lowest in Upper Egypt (8.9% and 5.1% resp.).

3.3. Estimated Number of Incident Cancer Cases 2013–2050

During the period 2013–2050, population of Egypt is expected to increase to approximately 160% the 2013 population size. Applying the current age-specific incidence rates to successive populations would lead to a progressive increase in number of incident cases from 114,985 in 2013 to 331,169 in 2050, approximately 290% of 2013 incidence (Table 9 and Figure 7). This increase reflected both population growth and demographic change mainly due to ageing of population. Population growth alone would increase the number of incident cases by 55.2% in 2015. This fraction progressively decreased to become 32.8% in 2050. The fraction due to ageing gradually increased to reach 67.2% in 2050 (Figure 8).

Table 9.

Estimated number of cancer cases, Egypt 2013–2050.

  2013 2015 2020 2025 2050
  Males Females Total Males Females Total Males Females Total Males Females Total Males Females Total
Lip 135 126 262 146 135 281 178 164 342 206 202 408 438 427 866
Tongue 155 175 330 164 185 349 186 231 417 219 296 515 417 763 1180
Mouth 228 163 391 243 178 420 275 216 491 314 261 575 544 528 1071
Salivary glands 147 108 255 158 117 275 189 130 319 222 153 375 495 265 760
Tonsil 6 31 37 6 33 40 9 41 50 11 54 65 13 129 142
Other oropharynx 42 25 67 45 28 73 54 30 85 63 37 100 132 65 198
Nasopharynx 145 32 178 154 34 188 171 40 211 207 42 249 428 68 496
Hypopharynx 72 80 152 76 85 161 88 96 184 102 111 213 200 173 372
Pharynx unspec. 35 7 42 36 7 43 42 7 48 55 7 62 94 8 102
Oesophagus 699 485 1184 746 525 1271 897 644 1542 1065 762 1827 2249 1504 3752
Stomach 726 969 1695 772 1045 1816 922 1249 2171 1080 1484 2565 2185 2877 5062
Small intestine 98 179 277 106 194 300 120 229 349 134 274 408 223 507 730
Colon 1522 1339 2862 1618 1437 3055 1893 1715 3608 2225 2063 4287 4465 4120 8585
Rectum 464 406 871 490 432 922 568 502 1070 645 584 1230 1097 1052 2149
Anus 133 50 183 142 53 195 162 65 227 178 71 249 291 127 418
Liver 19646 8345 27991 20932 9043 29975 24420 10900 35320 28580 12933 41513 59047 26425 85471
Gallbladder and so forth 235 324 559 248 350 598 297 413 710 348 488 835 715 967 1682
Pancreas 1350 876 2226 1440 957 2397 1676 1160 2836 1961 1405 3366 3912 2971 6883
Nose, sinuses and so forth 98 136 234 104 144 247 124 170 294 154 186 340 340 322 661
Larynx 933 134 1067 993 142 1136 1194 173 1367 1428 201 1629 3094 395 3489
Trachea, Bronchus, Lung 3304 1586 4890 3530 1703 5233 4168 2031 6198 4889 2404 7293 10176 4895 15071
Other Thoracic organs 368 260 628 393 277 670 464 335 798 551 415 966 1149 897 2046
Bone 889 957 1846 935 1011 1946 1068 1174 2242 1216 1330 2546 2212 2401 4613
Melanoma of skin 60 59 119 66 66 132 82 84 166 95 105 200 181 207 388
Other skin 797 749 1547 853 813 1666 1018 973 1990 1205 1160 2365 2641 2306 4947
Mesothelioma 55 106 161 58 116 174 65 143 207 76 161 238 135 321 456
Kaposi sarcoma 60 8 68 63 9 72 72 10 82 81 13 95 159 28 187
Connective, Soft tissue 801 751 1552 846 787 1633 981 901 1882 1113 1026 2139 1924 1796 3720
Breast 287 17905 18192 306 19105 19411 362 22320 22682 422 25793 26215 807 45243 46050
Vulva 0 52 52 0 56 56 0 63 63 0 76 76 0 146 146
Vagina 0 95 95 0 103 103 0 126 126 0 147 147 0 305 305
Cervix Uteri 0 701 701 0 752 752 0 882 882 0 1039 1039 0 2039 2039
Corpus Uteri 0 392 392 0 426 426 0 502 502 0 600 600 0 1256 1256
Uterus unspec. 0 1353 1353 0 1456 1456 0 1758 1758 0 2055 2055 0 4143 4143
Ovary 0 2288 2288 0 2434 2434 0 2830 2830 0 3311 3311 0 5957 5957
Other female genital 0 30 30 0 34 34 0 44 44 0 55 55 0 134 134
Placenta 0 14 14 0 14 14 0 14 14 0 15 15 0 18 18
Penis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Prostate 2544 0 2544 2747 0 2747 3398 0 3398 4295 0 4295 10785 0 10785
Testis 229 0 229 240 0 240 266 0 266 291 0 291 425 0 425
Other male genital 21 0 21 22 0 22 28 0 28 33 0 33 73 0 73
Kidney 877 561 1438 934 594 1528 1080 693 1774 1274 801 2076 2628 1487 4115
Renal pelvis 141 99 240 152 103 255 183 115 297 214 126 341 446 196 642
Ureter 22 0 22 24 0 24 31 0 31 41 0 41 111 0 111
Bladder 6362 1872 8234 6852 2038 8891 8228 2481 10709 9746 3016 12762 21783 6554 28337
Other urinary organs 8 21 29 8 23 31 10 27 37 11 35 46 22 72 94
Eye 89 82 171 92 87 180 98 96 194 104 108 212 160 195 355
Brain, Nervous tissue 3072 2933 6004 3256 3133 6389 3779 3721 7500 4390 4351 8740 8439 8450 16888
Thyroid 547 1759 2306 582 1867 2448 661 2106 2767 748 2363 3111 1298 3814 5113
Adrenal gland 43 105 149 46 109 155 52 113 166 57 121 178 102 180 282
Other endocrine 129 95 224 136 100 236 156 114 269 174 125 300 273 188 462
Hodgkin disease 647 321 968 673 336 1008 751 371 1123 837 397 1234 1245 527 1772
Non-Hodgkin lymphoma 3053 2188 5241 3223 2345 5568 3689 2755 6444 4240 3202 7442 7749 6135 13884
Immunoproliferative dis. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Multiple myeloma 316 200 516 334 218 552 386 264 650 432 321 753 819 644 1463
Lymphoid leukaemia 801 471 1272 841 493 1335 926 551 1477 1000 603 1604 1535 896 2431
Myeloid Leukaemia 511 614 1125 534 642 1176 595 727 1323 666 810 1476 1054 1358 2412
Leukemia unspec. 965 842 1807 1005 891 1896 1131 1027 2157 1295 1188 2483 2226 2169 4395
Other & unspecified 3692 3965 7657 3921 4232 8153 4573 4971 9543 5358 5793 11151 10582 11026 21607
All sites Total 57558 57426 114985 61288 61495 122783 71759 72496 144255 84045 84679 168723 171494 159675 331169
All sites but C44# 56761 56677 113438 60435 60683 121117 70742 71523 142265 82840 83519 166358 168854 157369 326223
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#Numbers do not include nonmelanoma skin cancer.

Figure 7.

Figure 7

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Estimated number of cases in Egypt (2013–2050).

Figure 8.

Figure 8

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Estimated number of cases in Egypt (2013–2050) and causes of the increase in cases.

4. Discussion

When the National Cancer Registry Program of Egypt was designed, there had been a number of challenges that were addressed. One of the most important challenges was design of a sample that could be representative of such a big country. Other challenges included complete capture of incident cancer cases among residents of selected governorates and best guarantee of quality of data and sustainability of the program to avoid going through survey-like data collection that need to be repeated, a methodology that proved to be inappropriate [27].

Dealing with population-based registration, the word national might be confusing. Actually, and with the exception of very few examples mainly old registries like that of Denmark and registries in small countries like Singapore, complete national coverage is not accomplished [27, 28]. The US is an example of a huge country with 18 population-based registries spread over the states without a central national registry [29]. Recently, national incidence rates of Turkey were published based on results of 8 geographically spread peripheral registries [30].

With this in mind, Egypt was geographically stratified for registration purposes into 3 regions: Lower Egypt, to the north of Cairo, and Middle, and Upper Egypt to the south. Three governorates were selected from the 3 regions representing 20.9% of the total population of Egypt. The greater Cairo, including the capital city, and Alexandria, the second capital (approximately 18 million population), were not included in the program due to difficulty in data collection and coverage of a population that daily migrates in and out of these 2 regions. Other regions that were not covered were frontier governorates; namely Matrooh, New Valley, Red Sea, and Sinai, together representing 3.3% of total population [26]. This exclusion was due to logistic reasons being mainly inhabited by nomads or internal migrants working in the tourist industry.

To ensure complete coverage of incident cancer patients in the selected governorates, data were actively collected from medical records of oncology centers within the governorates and from national referral centers like National Cancer Institute in Cairo. Registration covered health-insured patients and patients treated on government-subsidized treatment program would minimize under registration considered a point of strength of the registry. Also, regular check of death registers helped to decrease the possibility of under registration. Death certificate only cases (DCO) accounted for almost 8% of cases which could be considered an acceptable level for a newly established registry [28].

One of the elements that contributed to the National Cancer Registry Program of Egypt was the use of a unique national identification number for duplicate elimination to prevent over registration, which is a serious threat to population-based registries [7, 28]. A major concern during the development of a cancer registry especially population-based, is its sustainability. An alternative that was applied in Europe and the US was to conduct successive cancer surveys as with the US Health Interview and Examination surveys. Evaluation of these surveys was negative and this method was not recommended [28]. The main reason for lack of sustainability is unavailability of needed funding and lack of collaboration of treating physicians [28]. From the very beginning, the national cancer registry was planned to be a national program and not a project with start and end dates. During all stages of its development it was gradually incorporated within the infrastructure of the health system to gradually become part of everyday routine work [31]. Quality of data was assured through computer validation and regular manual checks on the peripheral and central levels.

We also developed a mathematical model to apply the regional age-specific incidence rates to the corresponding population structure to get national estimates of all cancers and for individual cancer sites for any specified year. Mathematical modeling is a common practice used to estimate national rates from statistics of regional registries. Recently, a model was developed for china to get national rates based upon regional registries [32]. The advantage of our Egyptian model was use of Egyptian national population-based data without importing data of adjacent countries [33].

Nonetheless, the program has its points of weakness. The data should be carefully interpreted in view of the short initial phase of registration that would be of better accuracy on successive years [28]. Furthermore, some private patients that are not covered by the Government-Subsidized Treatment Program might escape registration. This would be assumed to be a small proportion. With the rising cost of cancer treatment, most patients would seek government financial support which is a constriction right.

The results given in the current report are the first ever published incidence rates on a national and regional level for Egypt derived from a population-based cancer registry program. These incidence rates would replace the proportions that have always been derived from hospital-based results [1–5]. The results were those of Damietta (Lower Egypt), Minya (Middle Egypt), and Aswan (Upper Egypt). Damietta was selected to represent the Nile delta instead of Gharbiah registry that stopped its activities before establishment of the NCRP and needed some time to be restructured to join the program. Results of these governorates were used to compute regional rates that were used to get a national estimate based upon age-specific incidence rates and population structure.

The estimated incidence rates showed differences between the 3 regions that were mainly in the incidence of liver and bladder cancers. Among males, the proportion of incident liver cancer was highest in Lower Egypt (41.7%) and next in Middle Egypt (20.4%) and lowest in Upper Egypt (11.8%). Bladder cancer ranked next to liver cancer in Lower Egypt (8.8%). In Middle Egypt, the proportion was 14.2%, still lower than liver cancer. In Upper Egypt, liver cancer was still the most common cancer, with a small difference from bladder cancer (12.6%). These differences could be attributed to the high prevalence of hepatitis C viral infection (HCV), which is one of the highest prevalence rates worldwide [34, 35]. The distribution of liver cancer in the 3 regions followed the distribution of HCV, which is more frequent in Nile delta with decreasing prevalence going south [34]. The main risk factor for bladder cancer in Egypt was urinary Schistosomiasis which was more frequent in Upper Egypt and its prevalence decreased when going north [34]. Despite control of Schistosomiasis, its effect on bladder cancer needs time to disappear. Another difference between the 3 regions was the proportion of non-Hodgkin lymphoma that was distributed in a pattern similar to that of liver cancer [36, 37].

Among females, the pattern in Lower, Middle, and Upper Egypt was dominated by the high frequency of breast cancer (33.8%, 26.8% and 38.7% resp.) and liver cancer (16.4%, 8.9% and 5.1% resp.). This pattern of liver cancer was similar to that of males with similar relation to the prevalence of HCV. Other differences in site distribution between the 3 regions will be detailed in a separate publication [38].

The national age standardized incidence rates for all cancers in Egypt, excluding nonmelanoma skin cancer, were 175.9/100,000 for males, 157.0/100,000 for females, and 166.6/100,000 for both sexes. The age-standardized rates were intermediate between the rates of more and less developed countries [33, 39, 40]. For both sexes, the rates for all cancers excluding nonmelanoma skin cancer were 268.3/100,000 for more developed countries and 147.7/100,000 for less developed countries compared to 166.6/100,000 in Egypt. For males, the age-standardized rates were 308.7/100,000 for more developed countries and 163.0/100,000 for less developed countries compared to 175.9/100,000 in Egypt. The rates of females were 240.6/100,000 in more developed countries and 135.8/100,000 in less developed countries compared to 157.0/100,000 for Egypt.

The model used in our study revealed the seriousness of the liver cancer that ranked first among cancers in males (33.6%) and next to breast cancer. Among females the proportion of breast cancer was 32.0% followed by liver cancer (13.5%). The high prevalence of HCV especially genotype IV would explain this high incidence [34, 35]. The age-standardized rates for liver cancer for both genders were 5.4/100,000 in more developed countries, 12.0/100,000 in less developed countries compared to 43.6/100,000 in Egypt. Among males the rates were 8.6/100,000 in more developed countries, 17.8/100,000 in less developed countries compared to 61.8/100,000 in Egypt. Among females, the rates were 2.7/100,000 (more developed), 6.6/100,000 (less developed), and 24.4/100,000 (Egypt).

Incidence rate of bladder cancer that ranked next to liver cancer in males was also high. The age-standardized rates are 16.9/100,000 (more developed) and 5.3/100,000 (less developed) compared to 21.1/100,000 in Egypt. Breast cancer was the most frequent cancer among females. The age-standardized rates are 74.1/100,000 (more developed), 31.3/100,000 (less developed), and 48.8/100,000 (Egypt). Analysis of individual sites of cancers will be detailed in a separate publication [38].

Applying the model over successive years for the projected populations showed an increase in number of incident cases from approximately 115,000 patients in 2013 to more than 331,000 in 2050, almost 3-fold increase. The fraction of increase due to population growth gradually decreased over the years with a corresponding increase in the fraction due to demographic transition with ageing of the population. The cancer problem in Egypt would thus be expected to continue simply due to the inevitable ageing of the population with better standards of health care (Table 10).

Table 10.

Estimated cancer incidence in the period 2013–2050 and causes of increase.

  2013 2015 2020 2025 2050
Estimated population 85294388 (100%) 88487396 (103.7%) 96260017 (112.9%) 103742157 (121.6%) 137872522 (161.6%)
Number of cases#1 114985 122783 (106.8%) 144255 (125.5%) 168723 (146.7%) 331169 (288.0%)
Increased cases from 2013#2   7798 (6.8%) 29270 (25.5%) 53738 (46.7%) 216184 (188.0%)
Increased cases due to population growth#3   4303 14783 24869 70880
Increased cases due to population structure change#4   3494 14487 28869 145304
% Increase due to population growth#5   55.20% 50.50% 46.28% 32.79%
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N.B.

#1Number of expected cases depending on 2013 rates of incidence.

#2Number of increased cases from 2013 number of cases.

#3Number of increased cases (from 2013) that is attributed to increase in population number (population growth).

#4Number of increased cases (from 2013) that is attributed to change in population structure (aging of population) and not to population growth.

#5Percent of increased number of cases (from 2013) that can be attributed to population growth only (not due to change in population structure).

Rates estimated by the model developed for the study were based on certain assumptions that should be considered in interpretation of results. These assumptions were: (a) constant age-specific rates during the study period; (b) populations of Greater Cairo and Alexandria would be considered a mosaic of the 3 registration regions and would affect the number of incident cases, and not rates; and (c) exclusion of frontier governorates (3.3% of total population of Egypt) that need special studies to get reliable cancer statistics.

5. Conclusion

These results are the first ever published incidence rates for Egypt on a national and regional level and clearly demonstrated the seriousness of the cancer problem of Egypt with age-adjusted incidence rates approaching those of the more developed countries. Liver cancer is a serious if not the most serious cancer problem in Egypt. Nonetheless, these rates should be carefully interpreted being based on a short initial phase of registration and a mathematical model that used regional incidence rates.

Acknowledgments

The authors acknowledge the important role played by staff of the Ministry of Communication and Information technology specially Dr. Hesham El Deeb engineers El-Sayed Abdelwahid and Mohamed Hamid who were actively behind success of the registry. The dedication of data managers who supervised peripheral registries' activities during the initial phase of registration, namely, Drs. Amir Bishara (Aswan), Hassan Afifi (Minya), Tarek Heikal (Damietta), and Professor Nelly Alieldin (National Cancer Institute, Cairo University) is also acknowledged. Furthermore, this work would have not been accomplished without the remarkable effort of abstractors, coders, and supporting staff in participating registries.

List of Abbreviations

ASIR:

Age specific incidence rate

ASR:

Age standardized rate

DCO:

Death certificate only

HCV:

Hepatitis C virus

IARC:

International Agency for Research on Cancer

ICD-10:

International Statistical Classification of Diseases and related health problems, 10th revision

NCRP:

National Cancer Registry Program of Egypt

NHL:

Non-Hodgkin Lymphoma

SEER:

Surveillance, Epidemiology, and End Results Program.

Appendix

Statistical Formulas Used in the Analysis

Step 1 (calculation of regional and national incident cases for census year 2006/sex). —

(1) Number of incident cancer cases C in age group x/region i where r is incidence rate and w is population size:

Cxi=rxig∗wxig. (A.1)

(2) Total incident cases in region i: C i = ∑C xi.

(3) Total incident cases in the 3 regions G: C G = ∑C i where I = 1–3.

(4) Incident cases in total Egypt M:

CM=∑CG∗(WM/WG) where  W  is  2006  population. (A.2)

(5) Calculation of national age specific incidence rates r xM = ∑C xi/W xi for the 3 regions.

Step 2 (calculation of regional and national incident cases for a given year/sex). —

The same procedure was followed applying r xM calculated above to the population of the year under study.

Step 3 (future projections). —

For estimation of incident cancer in a specific year till 2050, the national age specific incidence rates by sex were applied to the corresponding population structure [41]. This estimated number would be due to population growth and demographic change with aging of the population. The fraction due to population growth could be calculated using corresponding population sizes. The remainder of increase in number would be due mainly to demographic change.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

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