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Variable Incidence ofVariable Incidence of Stomach Cancer in MoroccoLearning Opportunities & Challenges in International Cancer
Epidemiology
Brittney Smith MPHBrittney Smith, MPH
Doctoral Student
Department of Epidemiology
University of Nebraska Medical Center
Conflict of Interest Disclosure
University of Nebraska Medical Center
I, or an immediate family member, including spouse or partner, have NO financial relationship(s) relevant to the content of this educational activity.
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Learning Objectives
University of Nebraska Medical Center
• Understand the unique challenges present during research in developing countries
• Grasp the training necessary to prepare students for international research
• Discern the paths students may take after conducting research in an international setting.esea c a te at o a sett g
My Background
University of Nebraska Medical Center
B.S. BiotechnologyMPH, concentration in Health PromotionWork Experience:
– Laboratory research 2007‐2014Mi bi l A i l Ph i l S C• Microbiology, Animal Physiology, Surgery, Cancer
School-Related Experience
– CEESP
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University of Nebraska Medical Center
Cancer Epidemiology Education in Special Populations
Morocco
Cancer in Morocco
University of Nebraska Medical Center
2 Cancer Registries
– Rabat (hospital‐based, 2005)
– Casablanca (population‐based, 2005‐2007)
In both cities the most common cancers are:In both cities the most common cancers are:–Men: Lung & Prostate
–Women: Breast & Cervix
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Healthcare in Morocco
University of Nebraska Medical Center
Universal Coverage for Cancer & Chronic DiseasesFlexibility in seeking medical care
– Low & middle SES to public hospitals
– High SES to private clinics
Flexibility in choosing place of histopathological diagnosis
Stomach Cancer in Morocco
Clinical impressions from M k h t dMarrakech suggested a higher frequency of stomach cancer compared to Casablanca
Clinicians suggested differences in diet between the 2 cities as a possible risk factor
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Summer Research Objectives• Year 1: Evaluate the incidence of stomach cancer in
Marrakech & compare to Casablanca Registry• Year 1: Investigate demographic and clinical
characteristics of stomach cancer patients in Marrakech
• Year 2: Evaluate presence of gastrointestinal diseases treated or diagnosed at CHU Mohammaddiseases treated or diagnosed at CHU-Mohammad VI in Marrakech
MethodsMedical Records
– Center Hospital University‐Mohammad VICenter Hospital University Mohammad VI in Marrakech, Morocco
– Used logbooks and medical records to record collect cases
Pathology Reports– 4 large private pathology laboratories in
Marrakech
– Collected pathology reports for patients with confirmed stomach cancerconfirmed stomach cancer
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MethodsUniversity of Nebraska Medical Center
Manual Search of Hospital Records n=169
Manual Search of Hospital Records n=169
Cases Identified from Hospital Logbook
n=141
Cases Identified from Hospital Logbook
n=141
Cases Abstracted from Medical Records
n=327
Cases Abstracted from Medical Records
n=327
Cases Abstracted from Pathology Labs’ Records
n=447
Cases Abstracted from Pathology Labs’ Records
n=447
Total Casesn=725
Total Casesn=725
*Cases excluded due to Residence or metastasis
from Lymphoman=49
*Cases excluded due to Residence or metastasis
from Lymphoman=49
Data Management & Analysis
1 Marrakech 3. Casablanca1. Marrakecha. Removal of duplicate cases from
labs and medical records
2. Censusa. Population data obtained from
the 2004 census• Population totals by age &
gender • Percent growth and natural
a. Data was abstracted from registries for 2004‐2007
• Percent growth and natural population increase rates used to estimate 2008-2012 population
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International Collaborators
Casablanca• Pathology
R i t C di t• Registry Coordinator
Marrakech• Physicians• Residents
Stomach Cancer Incidence
University of Nebraska Medical Center
Marrakech Casablanca Rate Ratio (95% CI)
Male 7.19 3.91 1.8 (1.6‐2.1)
Female 3.87 2.58 1.5 (1.2‐1.8)
Total Incidence comparison in Marrakech (20082012) and Casablanca (20042007)
All 5.50 3.23 1.7 (1.5‐1.9)
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StrengthsC ti d i t t i th j t– Cooperation and interest in the project by local collaborators
– Receiving records from the largest pathology labs in the city and the largest public hospital in the city
– Cancer registry from Casablanca & cooperation from those who made the registryregistry
– Open Access to all records
Challenges in Morocco
– Spelling of names were not always
University of Nebraska Medical Center
p g yaccurate, making removal of duplicates a challenge
– Some cases identified in the logbook were not found in medical records, and vice versa
– Organization of Records
– Better residence data from medical recordsBetter residence data from medical records than labs
– Identifying the population denominator (See next slide)
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Learning Opportunities
University of Nebraska Medical Center
Be assertive & confident, but also patient Learn about the culture Record observations everywhere How to manage incomplete data Cancer care in other areas of the world W ki i h i li i d h Working with varying mentalities around research
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Future Directions
University of Nebraska Medical Center
Investigate variable rates of stomach cancer in other regions of MoroccoExplore the presence of possible risk factors including
– H. pylori ratespy
– Variation in diet
Evaluate further the rates of gastric disease that may increase risk of stomach cancer
My Future PlansCurrently pursuing PhD in
University of Nebraska Medical Center
Currently pursuing PhD in EpidemiologyInterests include:
– Combining current knowledge in biotechnology and public health
– Cancer & Infectious Disease
– Working with global and domestic populations
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University of Nebraska Medical Center
R fReferences1.Jemal, Ahmedin, et al. “Global cancer statistics.” CA: a cancer journal for clinicians 61.2 (2011): 69-90. 2.2. Bertuccio, Paola, et al. “Recent patterns in gastric cancer: a global overview.” International journal of cancer 125.3 (2009): 666-673.
