Cancer registry and pattern in Saudi Arabia

Shouki Bazarbashi, MBBS

King Faisal Specialist Hospital and Research center

The Saudi Cancer Registry

• Commenced reporting cancer cases from 01 January 1994.

• Is presently under the umbrella of the Saudi Health Counsel (CHS)

• Active case finding and registration

• Publishes annual report on cancer incidence in Saudi Arabia

• Last report 2015

• www.chs.gov.sa

Administrative regions

Total Healthcare Facilities data collected from

Administrative region Number of facilities

Central region 114

Eastern region 89

Madinah& Northern region 64

Southern region 58

Western region 88

Total 413

Crude incidence rate(CIR)

Age standardized rate (ASR)

Population pyramids evolution

1996 2015 USA

World standard population

Doll, et al. 1996

0 2000 4000 6000 8000 10000 12000 14000

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

75-79

80-84

85+

Incidence

Top 10 cancers KSA, 2015

SCR annual report

Top 10 cancers KSA, 2015

USABreast

Prostate

Lung

Colorectal

Corpus uteri

Melanoma

Bladder

Non-Hodgkins lymphoma

Kidney and renal pelvis

Thyroid

Saudi Arabia

www.gis.cdc.gov

Minor changes over the years

2005 2008 2010 2011 2015

Top 10 cancers by gender in KSA, 2015

Top 10 cancers by gender in adults, KSA, 2015

GLOBOCAN 2012

Comparison of ASR for Saudi Males with Selected Countries

GLOBOCAN 2012

Comparison of ASR for Saudi Females with Selected Countries

Cancer is more common in males world wide

Males Females

GLOBOCAN 2018

Incidence of common cancers- Males

6.6

4.64.8

5.4

5.9

43.8

2.6 2.6 2.52.2

0

1

2

3

4

5

6

7

colon rectum lung prostate NHL liver bladder kidney stomach thyroid pancrease

per 100,000

per 100,000

Incidence of common cancers- Females

24.3

5.8

3.34.5

5.94.1

2.81.7 1.3

0

5

10

15

20

25

30

breast thyroid colon rectum uterus NHL Ovary stomach lung

per 100,000

per 100,000

Do we have a more frequent cancer?

1

10

100

1000

Breast colonRectal males Thyroid female liver male NHL male

24.3

11.2

5.8

4

5.9

124.8

43

21.5

13

22

KSA USA

Incidence according to region: 2015

Cancers in the highest incidence region - 2015

Riyadh Eastern province Jouf

Cancers in the lowest incidence region-2015

Aseer Baha Jazan

Trends

Number of Cancer Cases KSA

0

2000

4000

6000

8000

10000

12000

14000

94 96 982000

2002

2004

2006

2008

2010

2012

2014

SCR reports

Saudi Arabian Population

0

5000000

10000000

15000000

20000000

25000000

1994

1996

1998

2000

2002

2004

2006

2009

2011

2013

2015

SCR reports

ASR according to year/100,000

0

20

40

60

80

100

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

male

female

Breast Cancer: Age specific rates* ( KSA vs USA)

Age groups KSA USA

20-24 1 1.5

25-29 6.2 7.9

30-34 16.7 26

35-39 27.3 59.9

40-44 46 120.7

*Per 100,000• SEER data base 2007, SCR report 2007

24% of KSA pts below 35 years

15% of USA pts below 35 years

Colorectal cancer: Age Specific Rate* KSA vs USAMales, colon only

Age group KSA USA

20-24 0.6 0.5

25-29 0.7 1.2

30-34 1.1 2.6

35-39 2.5 4.9

40-44 3 9.2

45-49 8 17.2

50-54 7.3 36.2

55-60 15.9 57

* Per 100,000.- SEER data base 2000-2008, SCR 2007 annual report

12.5% vs 7.1%Below age 40 years

1994 2015

Stage presentation: Breast cancer

15.00%

38%

38.60%

8.20%distant

localized

reginal

unknown

16.00%

28%

49.00%

7.00%distant

localized

reginal

unknown

Survival in cancer patients in Saudi Arabia

Breast survival: all stages(776 pts)

Colorectal cancer: all stagesN=539

Colorectal: according to genderMales: 356

No Driving Theory

Quality of SCR data

• Consistency

Quality of SCR data

• Consistency

• Low cancer incidence: completeness of case finding

Cancer incidence in the GCC

Breast cancer comparison with other nations

Quality of SCR data

• Consistency

• Low cancer incidence: completeness of case finding

• Abstract/re-abstract projects: none

Quality of SCR data

• Consistency

• Low cancer incidence: completeness of case finding

• Abstract/re-abstract projects: none

• No section on data quality control in the annual report

Quality of SCR data

• Consistency

• Low cancer incidence: completeness of case finding

• Abstract/re-abstract projects: none

• No section on data quality control in the annual report

• Histological confirmation: 95.5% ( high)

Quality of SCR data

• Consistency

• Low cancer incidence: completeness of case finding

• Abstract/re-abstract projects: none

• No section on data quality control in the annual report

• Histological confirmation: 95.5% ( high)

• Death certificate only 1.4% ( low)

Quality of SCR data

• Consistency

• Low cancer incidence: completeness of case finding

• Abstract/re-abstract projects: none

• No section on data quality control in the annual report

• Histological confirmation: 95.5% ( high)

• Death certificate only 1.4% ( low)

• No mortality data, Need updated survival data

What have we learned?

• Our cancer incidence is low

• Maybe we are missing some cases

• Our priorities are different from others

• Saudi females have higher incidence than male: non-driving theory!

• We have regional variation; a call for research look

• We have no mortality data

• National survival data calls for improvement

• There is plenty of improvement to be done for SCR

Thank you