the hashemite kingdom of jordan … · highly appreciating the efforts of our focal points listed...

The Hashemite Kingdom of Jordan

Ministry of HealthNon-Communicable Diseases Directorate

Jordan Cancer Registry

Cancer Incidence in Jordan 2010

15th Report

1Cancer Incidence in Jordan-2010

The Hashemite Kingdom of Jordan

Ministry of HealthNon-Communicable Diseases Directorate


Cancer Incidence in Jordan - 2010

Prepared by :Dr. Mohammad Tarawneh Dr. Omar Nimri

Dr. Kamal ArkoobDr . Marwan AL Zaghal

2 Cancer Incidence in Jordan-2010

This report is published annually. Comments and suggestions concerning its contents are encouraged and highly appreciated .Don’t hesitate to send your comments to the address below .To obtain extra copies of this report please send your request to the address below or download it from the Ministry of Health web site www.moh.gov.jo

Ministry of Health

Non communicable diseases Directorate

Cancer Prevention Department


Phone :00962-6-5662067

Telefax : 00962 –6-5656489

وزارة ال�صحـة

مديرية االمرا�ض غريال�صــاريـة

ق�صــم مـكــافــحـــة ال�صـــرطان

ال�صجل الـوطـني للـ�صــرطـان

هاتف: 0096265662067

تلفاك�ض: 0096265656489

Preparing JCR Team :

Dr . Ghazi SharkasDr . Rola Sahawenh

Miss . Aysha RantecyMr . Ayman QatashatMiss . Shanaz Rahalah

[email protected]


His Majesty King Abdullah II


Minister of Health

Dr. Abdallatif Woriekat

Foreword

It’s with great pleasure to launch the 15thannual report of Jordan Cancer Registry, which provided valuable data about the trends and characteristics of cancer in Jordan. Cancer is the second most common cause of death after cardiovascular diseases in Jordan. Both cancer incidence and prevalence have been increasing in the last few decades and cancer patterns are changing rapidly in Jordan. The emergence of cancer as an important cause of morbidity and mortality in the country in recent years has alerted the Ministry of Health to the urgent need for evolving suitable policies to curb this problem.In Jordan , cancer burden continues to grow, which is only normal for a low-middle income country as inter-national projections show such growth trends globally. Additionally, our population is growing and aging, still without having embraced healthy lifestyles that may help prevent many non-communicable diseases such as cancer.The unhealthy diet and potentially lethal habit of tobacco use in particular, unfortunately, remains highly common and acceptable among Jordanians, and will undoubtedly leave a large unwanted print with its strong contribution to the increasing incidence of cancer. At the national level, I am proud to say that we have been able to invest in providing state-of-the-art cancer treatment through different public and private health institu-tions, and develop a national body; the Jordan Breast Cancer Program, to address breast cancer and ensure early detection thus minimizing morbidity and mortality from the disease. We are now also heavily focusing on smoking cessation and palliative care. These initiatives and investments, I am proud to say, were taken largely in response to the data presented in this report.Representing a synthesis of cancer incidence in Jordan, this report is intended to provide readers with informa-tion on the epidemiology of cancer in Jordan and its distribution by site, gender, age groups and governorates. It also serves to assist researchers, cancer experts, and policy makers in identifying priorities for developing cancer control plans, national strategies and programs for cancer screening, early detection and prevention programs, and will also prove useful when planning for diagnostic and treatment services. I have personally witnessed the diligence and commitment of the JCR team, who have been working tirelessly to manage the col-lection, analysis and interpretation of data, and ensure its quality through the implementation of quality control procedures and cases ascertainment, while striving to maintain the highest ethical standards in preserving the confidentiality of patient information.While the Ministry of Health continues to support the National Cancer Registry, I would encourage and urge all other sectors to join in the control of cancer in the country by contribut-ing significantly towards the success of the National Cancer Registry.I extend grateful appreciation to everyone who helped in the development of this report, and assure the Ministry of Health’s continuous support of the Jordan Cancer Registry.


Acknowledgements

The National Cancer Registry offers its grateful appreciation to everyone who helped make this report

possible. We would like to specially thank the oncologists, pathologists, palliative care professionals,

other members of the medical professional from the various government, university, non-government

and private centers, upon whose commitment, hard work, and timely data submission this report ulti-

mately depends.

The efforts of National Cancer Registry staff and others who have worked tirelessly to provide, collect,

collate and analyze the data are commendable.

We would like to thank our Tumor registrar : Dr. Kamal Arkoob for his efforts in analysis the data using

different statistical softwares.

Special thanks to our focal points in all hospitals and laboratories for the timely collection and submis-

sion of cancer patients data .

Last and not the least, the continuous technical support and maintenance of the registey software from

Information Technology staff are highly appreciated.

We are very grateful to the National Cancer Institute (NCI) and the Middle East Cancer Consortium

(MECC) for their continuous valued support to publish this report.

Director of NCD Directorate

Dr. Mohammad Tarawneh

Director of Primary Health Care Administration

Dr. Bassam Al -Hijawi

Head Cancer Prevention Dept.Director Jordan Cancer Registry.

Dr. Omar Nimri

``


Special thanks for the directors of all public, private, military and university hospitals and private laboratories listed below.Highly appreciating the efforts of our focal points listed below for their contribution in this report of cancer incidence in Jordan. Our aim is the participation of all hospitals and laboratories and to continue doing our best to get good quality data from all partners. We hope that all will continue doing their best to achieve that purpose.

.No Name Hospital – Facilities

1 Hanan Musa Abu Romeah Al Basheer Hospital-MOH2 Hanan Mohamd Radwan Al Basheer Hospital-MOH3 Hiba Mohammad Abu AL Joud Al Basheer Hospital-MOH4 Nawal Alraqab Al Basheer Hospital-MOH5 Khalid Jamal Suleiman King Hussein Cancer Center6 Wael Ahmad Shehadeh King Hussein Cancer Center7 Dr Yassin Al Tawarah Royal Medical Services8 May Ali Yassin Islamic Hospital-Private9 Dalia Musa Naser Islamic Hospital-Private10 Saud Khaleel Allam Specialty Hospital-Private11 Amani Mohammad Alsayed Prince Hamza Hospital-MOH12 Mohammad Saleh Serais King Abdullah University Hospital13 Lubna Abu Ghosh Al khalidi Hospital-Private14 Mohammad Al zarro Al khalidi Hospital-Private15 SaudRashid Khlaeel Jordan University Hospital-Private16 Nedal Helmi Al Salymah Arab Center Hospital-Private17 Ahlam Ali Motlaq Arab Center Hospital-Private18 Rasha Al Twait Al Afia Center-Private19 Mohammad Ababneh Prince Basma Hospital- Irbid-MOH20 Amani Metani Prince Basma Hospital- Irbid-MOH21 Sakha’a Deif Al Allah Batayneh Prince Basma Hospital- Irbid-MOH22 Heilda Zeyad halsah Amman Surgery Hospital-Private23 Soud Meslem Al Shaweesh Ma’an Hospital-MOH24 Hana Ali Abu Hatab Jordan Hospital-Private25 Hidayeh Ahmad Douleh Istishari Hospital-Private26 Reem Moh. Mezher Istishari Hospital-Private27 Kefah Muneer Atwan Israa Hospital-Private28 Hanade Ahmad Al Jazzazy Al Hussein Hospital –Salt-MOH29 Tareq Al Zobaidi Ibn Al Haitham Hospital-Private


No Name Hospital – Facility30 Loey Bani Essa Prince Raya Hospital- Irbid-MOH31 Ruba Subhi Aletewi King Abdallah University Hospital32 Maher Sawalmah King Abdullah University Hospital33 Suleiman Khalil Al Asi Jarash Hospital-MOH34 Kholoud Karaymeh Jabal Al ZaitounHospital- Private35 Remah Al Ammory Jordan University Hospital – IT36 Hamda Ahnmad Esmaeel Jabal Al Hussein LAB. - Private37 Hamza Abd Al Hafeth Hasan Al Basheer Hospital LAB-MOH38 Baha’a Barham Jordan University Hospital– LAB39 Ali Aldomor Prince Hamza Hospital LAB-MOH40 Ibrahim Awad Swalha Al Basheer Hospital- IT41 Raed Jabali Ahmad Middle East LAB- Private42 Ola Hani Middle East LAB- Private43 Fatema Abd Al Mo’ate Aqel Zarqa Hospital LAB-MOH44 Kamal Saleh Directorate of statistics (DOS)

45 Fatima Hammad Information Technology Directorate –MOH

46 Raghda Awad Information Technology Directorate –MOH

47 Dr Majed Assad Information and Resarch Directorate-MOH


Executive Summary There is no doubt that cancer became an overwhelming problem worldwide. In Jordan as well the incidence and burden of cancer are increasing. Documentation of cancer cases helps to determine the magnitude of the problem and to provide suitable solutions.

This is the 15th annual report of cancer incidence and epidemiology in Jordan which describes cancer cases in the year 2010. The total number of new cancer cases was 6820, of them (4921) were Jordanians (72.2 %) and 1899 were non Jordanian (27.8%) . The total number of invasive cancers (behavior 3) for Jordanians was 4849 patients , of them (2330) were males and (2519) were females , while the number of in situ carcinoma was 72 cases. In 2010 , the number of new cases among Jordanians increased by 123 cases compared to 4798 cases in 2009.

The number of new cancer cases diagnosed among Jordanians has increased 46% in the past 10 years, from 3362 cases in 2000 to 4921 in 2010. The male to female ratio was 0.92:1 compared to 0.90:1 in 2009.The over-all median age at diagnosis was 56 (60 years for males and 52 years for females). The crude incidence rate of all cancers among Jordanians was 79.4 per 100,000 (74 for males and 85.1 for females). The Age Standardized Incidence Rate (ASR) adjusted to the world standard population was 135.1 per 100,000 population (132.8 for males and 138.4 for females.The age-Standardized Incidence Rate for all cancers combined increased by 8.5% (from 124.5 per 100,000 population in 2000 to 135.1 per 100,000 population in 2010).

Overall, 32.4% of new cancer cases in 2010 were diagnosed among people aged 65 and older , who account 3.3% of Jordanian population. Distribution of new cancer cases by age group showed that 4% of the caes were below 15 years and 25% in the age group 15- 44 years, and 38.4% in the age group 45-64 years.

The top five cancers among Jordanians (males and females) were: breast 951(19.6 %), colorectal 558(11.5%), lymphoma 382(7.9%), lung 380(7.8%) and prostate cancer 218(4.5%). Among Jordanian males, the top five cancer types were : colorectal 332(14.2%), lung 311(13.3%), prostate 218(9.4%), urinary bladder 186(8%) and leukemia 127(5.5%), while among Jordanian females , the top five cancer were: breast 941(37.4%), colorectal 226(9%), thyroid 136(5.4%), Non-Hodgkin lymphoma 130(5.2%) and uterus 113(3.6%). The distribution of cancer cases by regions showed that, 76.7% of the cases were in the central region (Amman accounted for 60.4%), 18% in the north region and 5.1% in the south region. In the pediatric age group (less than 15 years) the total number of cancer cases was194 accounted for (4% ) of all cancer cases in Jordan with a male to female ratio 1.3:1.The top five cancer types in the pediatric age group were : leukemia 38%, brain and CNS 27%, lymphoma 20%, kidney 8% and soft tissue cancers 7% . Mortality due to cancer shows that the most common cause of death due to neoplasms in males is lung( 30.2%), colorectal (10.3%), prostate (6.2%) and in females breast (22.4%) ,colorectal 8.9%,lung (7% ).


Table of ContentsAcknowledgement Executive SummaryList of Tables ……………………………………………………………………………………………………………. 12List of Figures & Annexes ………………………………………………………………………...…………………….. 14

Chapter One ……………………………………………....………………………………....…………………………… 17IntroductionJordanPopulation and Geography Jordan Cancer Registry ( JCR)Data Collection Methodology Trend of Cancer types of all sites 2000 – 2010Non Jordanians : Trend of cancer cases by year and sex

Chapter Two ……………………………………………………....………………………............……………………... 31Cancer Incidence among Jordanians -2010Distribution of cases by Age and SexFrequency of incident cases by Site , Age group and Sex Top ten cancers by sexTop ten cancers by age groupGeographical distribution of cancer types in Jordan

Chapter Three ………………………………………………………..…………………………...........……………….. 54Ten most common cancers among Jordanians , 20101-Breast 2-Colo-Rectal 3- Lymphoma 4- Lung 5- Prostate 6- Leukemia 7-Urinary Bladder 8- Thyroid 9- Brain and CNS 10- Stomach

Chapter Four Pediatric Malignancies in Jordan, 2010 ………………..…...........………......……….…..… 91Chapter Five Cancers among Non-Jordanians , 2010 ……………...……...........…………...…….……...…99Chapter Six Cancer Mortality , 2009 ……………………………...........…..…...………...…..………..... 105Summary in Arabic Cancer in Jordan 2010 ……………………….....…...........………………………....……… 123


List of TablesTable 1 Estimated population of the Kingdom by Age group and Sex, 2010………................………………..………21Table 2 Estimated population of the Kingdom by Governorates and Sex , 2010 ………................………….……..…22Table 3 World Standard Population used for age adjustment …………………………................………………....….28Table 4 Stability of Data Overtime ( Jordanians ) 2000-2010 …………………………...............………….……... .33Table 5 Basis of diagnosis of cancer cases among Jordanians ,2010 ……………….................……………..……...…34Table 6 SEER Summary staging, of incident cases among Jordanians, 2010 ……….................…………..…….....…34Table 7 Distribution of cancer cases by age group and sex - Jordan, 2010 …………................……………..…...…..35Table 8 Number of Cancer cases, ASIR and ASR by Sex ,2009 - 2010, Jordan ……................………………..…....36Table 9 Percentage & ASIR of cancer cases by Age group, Sex, 2010, Jordan ……….................………………….....37Table 10 Number of new Cancer cases by primary site and sex, Jordan , 2010 ……………................………….….…40Table 11 Frequency of Incidence cases among Jordanians by site and age group( Males), 2010 ……….................…...41Table 12 Frequency of Incidence cases among Jordanians by site and age group ( Females), 2010 …................……..42Table 13 Ten most common cancers among Jordanians both Sex, 2010 ……………………………….................….…44Table 14 Ten most common cancers among Jordanians ( Males), 2010 ………………….................………………… ..44Table 15 Ten most common cancers among Jordanians ( Females) , 2010 …………………….................………….….45Table 16 Top ten cancers for age group (0-19) years, both sex, 2010-Jordan……………….................…………..…….46Table 17 Top ten cancers for age group (20-49) years, both sex, 2010-Jordan…………….................……………….…47Table 18 Top ten cancers for age group (50+) years, both sex, 2010-Jordan …………………………...……...………....47Table 19 Distribution of cases by Governorates , Regions and Sex-2010…………………………..…………………....49Table 20 Median age of cancer cases by governorates, region-Jordan 2010……………………..……………………….49Table 21 Trend Frequencies of cancers among Jordanian Males 1996-2010 …………………..……………….…….....53Table 22 Trend Frequencies of cancers among Jordanian Females 1996-2010…………………….………………........54Table 23 Median age for top ten cancers among Jordanian both Sexes ,2010……………………….………….……….59Table 24 Breast cancer number and ASIR by Age-group and Sex …………………………………….……………..…61Table 25 Morphological Distribution among female breast cancer-Jordan .2010……………………………….…..........62Table 26 Incidence and percentage distribution of breast cancer by governorates,2010………………………………..64Table 27 Frequency distribution of female breast cancer cases by age group 1996-2010 ……………………………...….68Table 28 Distribution of Colo-Rectal cancers by topography and sex ………………………....……………………..…70Table 29 Colo-Rectal cancer numbers and ASIR by Age-group and sex…………………………………………...………...71Table 30 Incidence rate , percentage distribution of colorectal cancer by governorates, region 2010………………......73Table 31 Hodgkin’s Disease number and ASIR by Age-group and sex…………………………………...…………..…75

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Continue – list of tables

Table 32 Non-Hodgkin’s Lymphoma number and SIR by Age-group and sex ……………………………....………….76Table 33 Lung cancer number and SIR by Age-group and sex ……………………………………………………...……78Table 34 Distribution of Leukemia numbers and ASIR by Age-group and sex ……………………………………………80Table 35 Prostate cancer number and ASIR by Age-group and sex , 2010 ………………………………………………..81Table 36 U.Bladder cancer number and ASIR by Age-group and sex ……………………………………………………..84Table 37 Thyroid cancer number and ASIR by Age-group and sex , 2010 …………………………………………….…86Table 38 Distribution of brain & CNS cancer number and ASIR , 2010 …………………………………………….……88Table 39 Stomach cancer numbers and ASIR by Age-group and sex , 2010 …………………………………..…….….....90Table 40 Distribution of top ten childhood cancers by Age group, Jordan, 2010 ………………………………………….94Table 41 Distribution of childhood cancer by Governorates and Sex …………………………….………………………..95Table 42 Distribution of childhood cancer by Age group, Governorates and Sex ……………….…..…………………….95Table 43 Top ten cancers among Non Jordanian, both sexes -2010 ……………………………….……………………….100Table 44 Cancers among Non-Jordanians By age and gender- 2010 ………………………………………………….…...101Table 45 Cancers among Non-Jordanians by primary site and sex- 2010 …………………………………………...……....102Table 46 Most frequent types of cancer among Non-Jordanians, (Males), 2010 …………………………………….…….103Table 47 Most frequent types of cancer among Non-Jordanians, (Females), 2010 ………………………………………..103Table 48 Distribution of deaths due to cancer by age group and sex-2010 ……………………………………………….106Table 49 Distribution of deaths by governorate and regions , 2010 ……………………………………………………….....107Table 50 Percentage distribution of deaths due to cancers among Jordanian Males, 2010 ………….……………..….. 108Table 51 Percentage distribution of deaths due to cancers among Jordanian Females, 2010 …………..……………... .108Table 52 Number and percentage of deaths by cause of death according to ICD-10,Jordan -2009…………………….…..109Table 53 Distribution and percentages of deaths due to neoplasm by age group and sex- 2009 ………...…………………..110Table 54 Percentage distribution of deaths due to Neoplasm ,Governorates and sex , Jordan -2009….………………..….110Table 55 Distribution of deaths due to neoplasm-ICD-10 coding group causes of mortality 2009- Jordan ……………..……112Table 56 Distribution of top ten Male neoplasm deaths , Jordan -2009 …………………………….……………………..113Table 57 Distribution of top ten Female neoplasm deaths , Jordan -2009 ………………………..……………………….113

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List of Figures Page

Figure 1 Map of The Hashemite Kingdom of Jordan …………………………………….……………………........….. 20Figure 2 Population Pyramid , Jordan 2010 ……………………………………………………………….………….. 21Figure 3 Trend of cancer in Jordan, 1980-2010 ………………………………………………………………………... 29Figure 4 Trend of cancer in Jordan (Jordanian) by sex, 2000-2010 ………………………………………………. . …...29Figure 5 Trend of (ASIR) of cancer in (Jordanian) by sex 2000-2010 …………………………………………….…..30Figure 6 Trend of cancer in Jordan ,Non Jordanian by sex 2000-2010 ………………………………………………….29Figure 7 Percentage distribution of cancer among Jordanians by age-group and sex, 2010 ………………………….....36Figure 8 Age-Specific Incidence Rate (all sites) by sex - Jordan, 2010 …………………………………………..……...38Figure 9 Age Standardized Rate (all sites) by sex - Jordan, 2010 ……………………………………………….….. 38Figure 10 ASR for Male cancers ( all sites) , Jordan compared with other countries………..……………………….…39Figure 11 ASR for Female cancers (all sites), Jordan compared with other countries………………………………….39Figure 12 Percentage of number of cancer by Age group both sex, 2010-Jordan……………………..……………...…43Figure 13 Percentage of Top ten cancers by Site and Age group ,Males-2010 …………………………………………45Figure 14 Percentage of Top ten cancers by Site and Age group ,Females-2010 …………………………………..…. 46Figure 15 Crude Incidence Rate by Sex and Governorates, Jordan , 2010 ……………………………………………….49Figure 16 Crude Incidence Rate by Regions of Jordan, 2010 ……………………………………………...…………… 49Figure 17 Percentage distribution of the top ten cancers by sex, Central Region,2010…………………………………..50Figure 18 Percentage distribution of top ten cancer, sex, North Region, Jordan- 2010 ……………………………..…50Figure 19 Percentage distribution of top ten cancers by sex ( South Region) , Jordan – 2010 ………………………….51Figure 20 Percentage of Top Ten cancers among Jordanians both sex, 2010 …………………………………………56Figure 21 Number of Top Ten cancers among Jordanians by sex, 2010 ………………………………………...……57Figure 22 ASR of Top Ten cancers among Jordanians, both Sex, 2010 …………………………………………………57Figure 23 ASR for Top Ten cancers among Jordanian Males, 2010 ………………………………………….……….58Figure 24 ASR of top ten cancers among Jordanian Females, 2010 ……………………………..………….…………..58Figure 20 Breast Cancer Age-Specific Incidence rate by age group ........………………...…………..……………….. 61Figure 26 Distribution of female breast cancer by Summary Stage , 2009-2010 ………………………………………62Figure 27 Distribution of breast cancer cases by laterality , Jordan 2010 …………...……………………….………….63Figure 28 Distribution of female breast cancer by grade –Jordanians- 2010 ……………………...……..………………63Figure 29 Trend of number of female breast cancer 1996-2010, Jordan …………………………....…….……………..65

Figure 30 Trend of ASIR of female breast cancer, 2000-2010 , Jordan …….…………………………………..…….…..65


List of figures Page

Figure 31 Trend of ASR female breast cancer, 2000-2010-Jordan ……………………………………………………….…66Figure 32 ASR of Female Breast Cancer , Jordan , 2010 compared with some countries ……....……………………....…66Figure 33 Trend of In situ breast cancer cases, females(1996-2010)-Jordan, ……………………………………………....67Figure 34 Trend of In situ breast cancer cases,females by age group (1996-2010) ……………………………………….….67Figure 35 Distribution of Colorectal cases by Topography, 2010-Jordan ……………………………………………….…..70Figure 36 Colorectal cancer - Age Specific Incidence rate by sex, 2010 ………………………………………………….…...71Figure 37 Distribution of Colorectal cancer cases by Morphology 2010 …………………………………………………..….72Figure 38 Distribution of colorectal cancer cases by Summary Stage -2010-Jordan …………………………….…………..72Figure 39 Trend of ASIR, ASR for colorectal cancer 2000-2010-Jordan ………………………………………………….….73Figure 40 Age Specific Incidence Rate (ASIR) by sex ( Hodgkin's disease), 2010 ……………………………………………75Figure 41 Age-Specific Incidence Rate (ASIR) by sex ( NHL), 2010 …………………………………………………………..76Figure 42 Morphological Distribution of lung cancer -2010-Jordan ……………………………………………………….77 Figure 43 Age-Specific Incidence Rate(ASIR) by age group & sex ( Lung), 2010 …………………………………………….78Figure 44 Distribution of Leukemia by morphological subtypes-2010-Jordan ……………………………………………….79Figure 45 ASIR of Leukemia cases by Age group and Sex, 2010-Jordan ……………………………………………………...80Figure 46 Age Specific Incidence Rate Prostate cancer, 2011-Jordan ……………………………………………………...…82Figure 47 Distribution of Prostate cancer cases by SEER stage, 2010-Jordan …………………………………………….....82Figure 48 Morphological distribution of Urinary Bladder cancer, 2010-Jordan ………………………………………………83Figure 49 U.Bladder cancer Age Specific Incidence Rate by sex, 2010 ……………………………………………………….84Figure 50 Morphological distribution of thyroid cancer, 2010-Jordan …….……………………………………………….....85Figure 51 Thyroid cancer- Age Specific Incidence Rate by Age group and Sex ……………………………………………….86Figure 52 Morphological distribution of brain & CNS tumors , 2010-Jordan ………………………………………………..87 Figure 53 Brain and CNS - Age Specific Incidence by Age group and Sex ……………………………………………………88Figure 54 Morphological distribution of Stomach cancer , 2010-Jordan ………………………………………………………89Figure 55 Stomach cancer ,Age Specific Incidence Rate by Age group and Sex ………………………………………………90Figure 56 Distribution of pediatric cancer cases by Age group , 2010-Jordan ………………………………………………….92Figure 57 Percentage of top Five cancers in Pediatric age group( both Sex), 2010-Jordan ………………………………………93Figure 58 Top Five Cancers in Pediatric by Sex, Jordan,2010-Jordan ………………………………………...….....……..93Figure 59 Distribution of childhood cancer by Age group and Site, 2010-Jordan ………………………………………….94Figure 60 Distribution of childhood Leukemia by Age and Sex- 2010-Jordan ……………………………………………….96Figure 61 Distribution of childhood Brain & CNS by Age and Sex-2010-Jordan ………………………………………96


List of figures

Figure 62 Distribution of childhood Lymphoma by Age and Sex-2010 ……………………….....……………….. …..97Figure 63Distribution of Kidney tumors by Age and Sex-2010 ……………………………………………………………97Figure 64 Distribution of Childhood Soft tissue tumor by Age and Sex-2010 ………………………………………….98Figure 65 Distribution of Childhood bone tumor by Age and Sex-2010 …………………………………………….98Figure 66 Cancers among Non-Jordanians reported in (1996 – 2010) …………………………….……………….. 104Figure 67 Cancers among Non-Jordanians by nationality,2010 ………………………..……………………………..104Figure 68 Percentage Distribution of deaths by age group and sex 2010,JCR ……………………………………………….107Figure 69 Percentage of neoplasm deaths by age group and sex , Jordan 2009 ……………………………………………111Figure 70 Percentage distribution of neoplasm deaths by governorates, 2009 ………………………………………………111

Annexes :Annex (1) Jordan Cancer Registry ( JCR) Notification Form …………………………….…….…………………….114Annex (2) Jordan Cancer Registry Data Request Application Form ……………………….……………………………..115Arabic Summary………………….………………………………….………………………………….….......……..124

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Chapter One• Introduction • Population and Geography of Jordan• Jordan Cancer Registry ( JCR )

-Methodology and Data managment-Trend of Cancer in Jordan 2000-2010.

• Non Jordanians-Trend of cancer cases by Year and Sex


Introduction

This is the 15th annual report of the incidence of cancer in Jordan published by Jordan Cancer Registry. It com-prises the data for the year 2010 and a description of trends covering the period of 1996-2010. This report aims to explore the incidence of cancer in Jordan.

Cancer is one of the leading causes of morbidity and mortality in Jordan. It is the second cause of death (14.6%) after cardiovascular disease (35.9%).( MOH , Mortality Section - 2009 report) .Many factors play a role in cancer development, but it is important to mention that many types of cancers can be prevented by simple life style changes; such as smoking cessation which is responsible for not only lung cancer, but for many other types of cancer. Well-balanced diet is advantageous for many reasons: a diet rich in fruits and vegetables can reduce the risk of developing cancer and many other health related conditions. Fruits and vegetables contain antioxidants, which help in repairing damaged cells. Numerous studies showed that a diet high in animal fat increases the risk for several types of cancer, particularly colon cancer. Red meat contains much more fat than poultry and fish, so reducing the amount of red meat in diet may help to prevent cancer. A diet high in fat is a major cause of obesity, which is a risk factor for many types of cancer.

Physical activity is also important factor for cancer prevention. The American Cancer Society recommends exercising 30 minutes or more, at least 5 days a week for cancer prevention.

The main purpose of this report is to provide health professionals, researchers and policy-makers and others who are interested with detailed information about the most common types of cancer in Jordan and its distribu-tion by age, sex, address . Data provided by JCR may help in promoting new researches, to assist in planning and evaluation Cancer Control Strategies and identify priorities fo public health actions.

Jordan Breast Cancer Program (JBCP) is a good example for the utilization of Jordan cancer registry data of breast cancer epidemiology and clinical data about stage of tumor and median age. The availability of cancer data at JCR is a solid data base for initiating and establishing other cancer screening programmes.


Population and GeographyPopulationThe estimated population of Jordan in 2010 reached 611390, out of them 3146765 were males and 2959425 were females (male : female ratio 1.06 : 1). ( Department of Statistics Jordan,2010 ).About 12.7 % of the population were under 5 years, 37.2 % were under 15 years old. Only 3.3 % of the total population were above 65 years of age .

The percentage of males was a little higher than females in most of the age groups of the population, except in the age group 55-59 years and 70 years and above, where the percentage of females was higher than males ( table 1 ) .Table (1) and figure (2) show the age distribution of Jordan population, 2010 (Jordanian Population Pyramid).

Table ( 2 ) shows the population distribution of Jordanians by governorates and sex.The Central region (Am-man, Balqa , Zarqa, and Madaba governorates) constitute (62.8%) of Jordan population with a population density of (249.7) Km2, compared with Northern region (Irbid,Mafraq, Jarash and Ajlun) which Constitute (27.8%) of Jordan population with a population density of (55 Km2) and Southern region (Karak, Tafiela, Ma'an and Aqaba) constitute (9.4%) of jordan population with a population density of (11.7 Km2).

Geography

Jordan is located in the Middle East, between Latitudes 29-33 North and between Longitude35-39 East, ex-tending about 500 Kilometers from North to South, it is bounded in the North by Syria, in the East by Iraq and Saudi Arabia, in the South also by Saudi Arabia, and in the West by Palestine Authority.

The total area is 89.3 thousand Km2. Out of the total area, 75% is desert along the Eastern part of the country. Mountains height ranged between 1100 – 1854 meters above sea level. The Dead Sea area is the lowest area in the world and it is around 407 meter below sea level.

The climate of the country as a whole is moderate, there are four seasons summer, autumn, winter and spring. The temperature ranges from 4C in winter to 31C in summer.Jordan is divided from the administrative point of view into three regions (Central, North, and South) and twelve governorates (Figure 1 Map of Jordan).


Figure (1) Map of The Hashemite Kingdom of Jordan

Regions


Table (1) Estimated Population of Jordan by Age group and Sex, 2010

Age groupMales Females Total

No % No % No Sex RatioM:F

0-4 399635 12.7 379100 12.8 778735 105.45-9 394690 12.5 374955 12.7 769645 105.310-14 375435 11.9 355010 12.0 730445 105.815-19 344990 10.9 325355 11.0 670345 106.020-24 335475 10.6 311695 10.5 647170 107.625-29 287780 9.1 258850 8.7 546630 111.230-34 248765 7.9 229610 7.8 478375 108.335-39 201485 6.4 186270 6.3 387755 108.240-44 148975 4.7 140625 4.7 289600 105.945-49 104655 3.3 99820 3.4 204475 104.850-54 77625 2.5 76195 2.6 153820 101.955-59 67045 2.1 69440 2.3 136485 96.660-64 62600 2.0 55880 1.9 118480 112.065-69 42620 1.4 35600 1.2 78220 119.770-74 28210 0.9 31690 1.1 59900 89.075-79 14740 0.5 14980 0.5 29720 98.480-84 7360 0.2 8890 0.3 16250 82.885+ 8915 0.3 8035 0.3 16950 111.0Total 3151000 100.0 2962000 100.0 6113000 106.4

Figure (2) Population Pyramid, Jordan, 2010


Table (2) Estimated Population of Jordan by Governorates (Regions) and Sex , 2010

Governorate Males Females Total

Amman 1217000 1150000 2367000

Zarqa 471300 439500 910800

Balqa 212700 196800 409500

Madaba 78700 74200 152900

Central Region 1979700 1860500 3840200

Irbid 557200 530900 1088100

Jarash 94300 89100 183400

Ajloun 71600 69000 140600

Mafraq 148900 138400 287300

North Region 872000 827400 1699400

Karak 120700 117700 238400

Aqaba 74100 59100 133200

Maan 60900 55300 116200

Tafiela 43600 42000 85600

South region 299300 274100 573400

Total 3151000 2962000 6113000


Jordan Cancer Registry (JCR)

Jordan Cancer Registry (JCR) is a population-based registry which was established in 1996 under the jurisdic-tion of the Ministry of Health (MOH) by the order of His Excellency the Minister of Health. JCR is a unit of Cancer Prevention Department in the Non-communicable Disease Directorate. Cancer notification is compen-satory since 1996 through a ministerial decree.JCR monitor cancer incidence in Jordan and its trends over time. The aim of JCR is to provide national cancer incidence data to the public in a timely and accurate manner. JCR also provide a data for clinical and epide-miological research.The cancer registry plays a central role in all aspects of cancer control not only for the population covered but also for other populations with which results can be compared. The systematic collection, recording and analysis of data relating to cancer enables interpretation of clinical and pathological characteristics of cancer, cancer incidence and mortality, for various population and sub-groups. It also opens the way for epidemiological researches about the causes of cancer, and effects of interven-tions in prevention and early diagnosis, provided that patients can be identified and linked to data base systems as mortality data .and data base in other hospitals In many countries, the cancer registry has proved to be an important tool for public health surveillance, includ-ing the planning and evaluation of health services.

VisionTo meet the highest attainable international standards in cancer registeration, and surveillance.

MissionTo register all cancer cases reported in various health institutions in Jordan and to avail the data and / or information gathered for policy development and support in cancer research, treatment, control, preven-tion, and surveillance.

Objectives of JCR1. To define the size of cancer problem and patterns of cancer occurrence in Jordan.2. To provide data on cancer for epidemiological and clinical studies.3. To make data of cancer incidence and prevalence available for use by health planners and professionals in

order to plan for cancer prevention, control and management in a cost effective manner.

Methodology and Data managment

MethodologyFor Jordanians, all malignant and in-situ cases diagnosed from 1st Jan- 31 Dec. 2010 were notified and regis-tered to JCR, and for non Jordanians all cancer patients that treated in hospitals during this year were notified to our registry.For data collection we followed the two well known methods of data collection :

1. Active Method Data were collected and abstracted by a trained registry staff through regular visits to all hospitals distributed all over the country. The JCR strives for full access to cancer data from all governmental hospitals, private hospitals, Royal Medical Services and Universities hospitals as well as clinics and laboratories throughout the Kingdom. Can-cer data are abstracted by JCR trained staff (Cancer Tumor Registrars ) from patients’ medical records, based on clinical and/or histopathological diagnosis.


2. Passive MethodTrained focal points medical staff abstracted cancer data from patients files, completed a standardized form and forwarded it to the Jordan Cancer Registry. The data abstracted: includes personal identification (name, ID number, sex, age), demographic information (address, telephone number, nationality), and tumor details (diag-nosis date, primary site, histology, behavior, grade, stage, basis of diagnosis).

Sources of information Our Registry collects the most important data about cancer patients and ensures that it is complete and of high quality. Notifications of cancer may derived from many sources, such as:Hospital admissions and medical records departments from all public, private military and university hospitals all over Jordan (hospital dis-charge report) through international classification of disease and operation ICD-9 or 10 morbidity and mortal-ity coding system also from histopathogy reports in all these hospitals, inaddition to hospital patient registries such as King Hussien Cancer Center (KHCC). Another sources of information are histopathology laboratories: cytology, haematology in public and private histopathology laboratories.We also collected information from Forensic Medicine records through (death certificates).

ICD-O-3 Behavior Codes(0) Benign(1) Uncertain whether benign or malignant (bordere line)(2) Carcinoma in situ,(3) Malignant, primary siteBenign (behavior code 0) or borderline (behavior code 1) these cases were collected in JCR but not entered in the Can-Reg4 program and kept in special files specially those of brain and CNS.Localized basal cell and squamous cell carcinoma of non-genital skin sites (C44.0-C44.9) were included in our registry.Abstracting information is the essence of the cancer registry. The accuracy and completeness with which this function is performed determines the value of the registry. Users of cancer registry data must be confident that the abstracted information is a true representation of the patients' demographics, diagnosis, and treatment. An abstract is completed for each reportable case.

Reportable list in JCRCases with a behavior code of 2 or 3 according to the International Classification of Diseases for Oncology, third Edition (ICD-O-3)were included in the registry.

Data Variables The number of assessment varibles used by JCR was based on the international standard variables for all can-cer registries . There are various formats that may be used. JCR uses standards provided by the International Agency for Research on Cancer(IARC), these include :1- Patients details: first name , given/median name, last name, ID number, age/date of birth, sex and current residence (governorate).2- Tumor: incidence date,basis of diagnosis , primary site /topography (ICD-O) code, histology/morphology (ICD-O) code, behavior,grade and stage at diagnosis (SEER summary stage)3- Treatments: intial and subsequent treatments surgery ,radiotherapy, chemotherapy, hormonal therapy .4- Sources of data: hospital/ laboratory name, hospital / facility code number, name of abstractor and date of abstraction.5-Follow up : patient status (alive or dead) form the date of incidence, last date of contact with


physcian/ health care provider or if dead – date and cause of death. A complete JCR abstract form is appended to this report for more detailes Annex (1).

Classification and Coding The primary site (topography) and histology (morphology) of the malignancies are identified and coded accord-ing to the International Classification of Diseases for Oncology third Edition (ICDO- 3), published by the World Health Organization (WHO), 2000.

Data management Data is managed using server with network computers at the registry, a local area network is established to al-low staff to work on the registry data base simultaneously.Data is primarily managed through the use of Can Reg-4 Software, which also allows for statistical analysis. Abstract forms submitted from health care facilities are kept in box files and shelved in straight numerical order in cabinets.In order to ensure good flow of data/information between the registry and health care facilities, all cancer regis-trars are strictly bound by the professional code of observing confidentiality of patient information. Information users interested in JCR data and information services are required to obtain authority for acess to the data from Non communicable Disease Directorate (NCD) Director and are mutually bound to acknowledge the registry in their data usage. In order to maintain confidentiality of facility and patient information, inclusion of facility and patient identification details is restricted.


Quality assurance and completeness of dataAccuracy and consistency are essential in tumor registry reporting. Quality control means assessing for com-pleteness, accuracy, and uniformity of data at the case finding, abstracting, coding, and data processing levels.Quality control should be an ongoing process, and time should be allotted for registry personnel to carry out special quality control functions. The registry always perform quality control on data before presenting reports, Every effort is made to accurately code patient and tumor information, to ensure that all data can be reviewed, linked, and consolidated, as appropriate. Internal quality checks include random selection of some records which was done systematically for double checks of data abstraction to ensure completeness of data. Procedures for review include visual review, computerized data edits, and hospital queries. JCR staff per-formed quality assurance tasks upon receipt of abstracts from each reporting institution. Periodic review pro-cedures also include re-abstracting of cases and case finding studies.The reporting facility is required to resolve incomplete, incorrect, or inconsistent data upon JCR query.Before and during the phase of data entry, validation of data was done through the following :

Assurance of data completeness through continuous generation of patients’ lists who have rare or invalid categories or behaviour less than three to check fot it demographic data such as age , date of birth, sex , address. Patient lists were evaluated for duplicates.The computer software program used for data entry and incidence tables output is CanReg 4.31, which was developed by the International Agency for Research on Cancer, (IARC) Lyon, France, this software has a du-plicate entry checking facility.Validity checks are performed for consistency between items: site/histology, sex/site and age/site/histology combinations by CanReg4, Epi-info and other statistical programmers were used for further analysis by the JCR staff as SPSS.Frequencies for most of the variables collected were presented in this report, mainly primary site of cancer, age group, sex, governorate and regions , tables and graphs for cancer cases for Jordanians and non Jordanians and pediatric malignancy and top ten cancers for both genders were presented, tables and graphs from the literature were included for comparison of the rates with other countries .One chapter for mortality due to cancer was presented to identify the most common deaths due to cancer by gender and governorates. The new addition in this report is the analysis of mortality and follow up of cancer patients diagnosed in this year 2009 from our JCR data, this will enable us to do calculate the survival rate in the next reports. World standard population was used for calculate standard rates for national and international comparisons (Table 3).

Completeness of the cancer registry (degree of coverage)Completeness is the extent to which all incident cancers in the Jordanian population are included in the cancer registry. Incidence rates will be close to their true value if maximum completeness in case-finding procedures can be achieved.Expand the coverage for the registry by including all hospitals and private histopathology laboratories in ad-dition to field visits to these institutions. JCR received notifications from 50 sources hospitals, laboratories and facilities from all over Jordan.


Number of notifications/data sourcesThe number of notifications and data sources per tumor is a raw indicator of completeness, the higher the average, the more complete the registration process. The reasoning behind this is that very few cases will be missed when multiple sources are used. Linkage of data from different sources and source types leads to information that is more complete, precise and reliable.In 2010, the Jordan Cancer Registry has recorded 6820 notifications invasive and insitu tumors originat-ing from about 15000 notifications (on average 2.1 notifications per tumor).

ValidityValidity or accuracy is the proportion of cases in a dataset with a given characteristic (e.g. cancer site, TNM stage, age at diagnosis) which truely have the attribute. The validity of the data in the cancer reg-istry depends strongly on the quality offered by the sources. When discrepancies occurred, reapplication was made for the information at the original data source by means of direct questions. After linkage with data of other sources, more administrative and inconsistency checks were performed.

ConfidentialityTo ensure the protection and confidentiality of the identifying information collected by the JCR staff , the Procedure Manual contains, among other things:

1. Procedures to safeguard and secure the registry database and printed data generated from the data-base containing identifying information.

2. Procedures to destroy (e.g., by shredding) all printed materials containing identifying information when such materials are to be disposed of.

3. Procedures to make certain that all persons with access to JCR identifying information have signed a written statement acknowledging their responsibility to maintain confidentiality and subjecting them to penalties for violation of confidentiality requirements.


(Age (Years Count

0 - 4 120,000

5 - 9 100,000

10 - 14 90,000

15 - 19 90,000

20 - 24 80,000

25 - 29 80,000

30 - 34 60,000

35 - 39 60,000

40 - 44 60,000

45 - 49 60,000

50 - 54 50,000

55 - 59 40,000

60 - 64 40,000

65 - 69 30,000

70 - 74 20,000

75 - 79 10,000

80 - 84 5,000

85+ 5,000

Total 1,000,000

Table (3) World Standard Population

Trend of cancer types of all sites ( Jorda-nians, Non Jordanians )

The trend of cancer cases in Jordan during the period 1980 – 2010 is shown in figure (3) which clarified that prior to the establishment of Jordan Cancer Registry ( JCR) in 1996, the reported cancer cases presented as a Hos-pital – Based Registry which is mainly from Albasheer hospital after JCR establishment from1996 the reported cancer cases were col-lected from all over the country as Population- Based Cancer Registry.

Figure (3) shows the number of reported ma-lignancies according to the years of incidence in the years 1980 to 2010 .The number of registered cases markedly increase when the Registry transformed from Hospital –Based to Population –Based Registry.

Figures (4,5) show the trend number of reported cancer cases to JCR by sex and the Crude Inci-dence Rate for Jordanians from the year 2000 to 2010 by sex. Figure (6) shows the trend num-ber of cases of non Jordanians that reported to JCR by sex.These figures show that there is an increase in the number of incident cases among Jordanians and non Jordanians for both sexes and also there is increase in crude incidence rates for Jordanians and for both sexes.


Figure (3) Trend of cancer in Jordan, 1980-2010

Figure (4) Trend of cancer for Jordanians by sex, 2000-2010


Figure (5) Trend of Crude incidence rate of cancer by sex, 2000-2010 , Jordan

Figure (6) Trend number of cancer Non Jordanians by sex, 2000-2010*

* insitu cases were included (24 cases).

*


Chapter TwoCancer Incidence in Jordan -2010

Jordanians

• Distribution of cases by Basis of diagnosis & Summary stage

• Frequency of incident cases by Site , Age group and Sex , 2010

• Top ten cancers by Age group and Sex

• Geographical distribution of cancer cases in Jordan

• Top cancers by Regions


The 15th annual report for the year 2010, explored the number of new incident cases among Jordanians and Non-Jordanians (Residents and Non-residents ) those who were referred from neighboring and other countries for diagnosis and management in Jordan . Benign and Borderline malignancy are not reportable cases in our registry , only malignant behaviors and in situ are reported to the registry.For the purpose of analysis the behavior malignant category is only included as dataset for analysis.

In 2010 , the registry received around 15000 abstracted forms and pathology reports from all governmental , private , military and universities hospitals and histopathology laboratories. from private and public hospitals about (60 sources) , the registry recived average of (2.1) notification form per one case.

After filtering all recieved data we execluded duplicate and registered cases (prevalent cases after checking the case and ensure that it is not multiprimary case ) depending on multiprimary rules standards. Benign and borderline forms when received from hospitals and histopathology reports were checked by JCR staff and kept separately in special files in the registry.

During 2010 a total number of (6820) new cancer cases were registered, about ( 4921) cases, (72.2 %) were Jordanians (compared to (4798) cases in 2009), out of them (4849) were invasive cancers and 72 cases were in situ carcinoma , while the number of non Jordanians were (1899) cases (27.8%) (compared with (1752) in 2009), of them (1875) invasive cancer and 24 cases were in situ, (72) cases multi-primary tumors were regis-tered in 2010 , which constitutes 1.1% of the total cancer cases .Unless noted, only invasive cancers are included in the counts of cancer cases and in the calculation of all rates as requested by the Standards of International Agency of Research of Cancer (IARC) ,Can Reg 4 software.

Table (4) shows the trend and Stability of data overtime ( Jordanians ) 2000-2010, this method applied to observe published data with registered data on software, it is way to assure completness and stability of data.

This table shows the total number of registered cases of cancer by year and the updated number for cases for each year following publication of the report.


Table (4) Stability of Data Overtime ( Jordanians ) 2000-2010

Publish year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

2000 3362

2001 3366 3412

2002 3368 3413 3430

2003 3368 3413 3431 3468

2004 3369 3413 3432 3469 3591

2005 3369 3413 3433 3469 3592 3678

2006 3370 3414 3433 3469 3592 3682 4198

2007 3370 3414 3434 3470 3593 3684 4206 4332

2008 3370 3414 3434 3470 3593 3684 4210 4339 4606

2009 3370 3414 3434 3470 3593 3686 4210 4341 4616 4798

2010 3370 3414 3434 3470 3593 3686 4210 4341 4620 4824 4921

Maximum 3370 3412 3434 3470 3593 3686 4210 4341 4620 4824

Minimum 3362 3414 3430 3598 3591 3678 4198 4332 4606 4798

Max-Min 8 2 4 2 2 8 12 9 14 26

% Max Variation 0.24% 0.06% 0.12% 0.06% 0.06% 0.22% 0.29% 0.21% 0.30% 0.54%

Incidence Year

2.1 Distribution of cases by Basis of diagnosis, Summary stageTable (5)shows the distribution of incident cases by basis of diagnosis .It has been found that histology from the primary site constitute about (96.1%),and 2.8 % of the cases were diagnosed by clinical and clinical investi-gation, and only 0.6% were diagnosed by Death Certificate Only (DCO). JCR identifies previously unreported cancer cases through review of death certificate data to further improve case completeness. This process is referred to as death clearance and identifies cancers mentioned on death certificates that were not previously reported to the JCR. In some instances, the JCR obtains additional information on these cases through follow-up activities with hospitals and forensic medicine and data from mortality department in ministry of health. These “death certificate only” cancer diagnoses were, therefore, poorly documented, and have not been con-firmed by review of complete clinical information. Such cases are included in this report, but they comprise less than 0.6% of all cancer cases.

Typically, published incidence rates do not combine invasive and in situ cancers due to differences in the bio-


logic significance, survival prognosis, and types of treatment of the tumors. Because a substantial number of breast cancers are diagnosed at a pre-invasive (in situ) stage, we present an additional category for these data that is separate from the invasive breast cancer data. The in situ breast cancer cases are not added into the totals for all cancer sites combined.Table (6) shows the distribution of cancer cases diagnosed in 2010 among Jordanians by SEER summary stage where (33.5% ) of the diagnosed cases were localized while about 18.8% were advanced stage (distant me-tastasis), on the other hand ( 30.5%) of the cases , the stage was not recorded in the forms received.

Table ( 5) Basis of Diagnosis of cancer cases among Jordanians , 2010

Basis of diagnosis Frequency Percentage

Histology of primary site 4658 96.1

Clinical & Clinical Investigation / Ultrasound 134 2.8

Death Certificate Only (DCO) 28 0.6

Cytology/ Hematology 20 0.4

Histology of metastasis 9 0.2

Total 4849 100.0

Table (6) Stage distribution of incident cancer cases among Jordaniansaccording to SEER * Staging , 2010

Summary SEER Staging Frequency Percentage

Localized 1623 33.5

Regional 839 17.2

Distant Metastasis 910 18.8

Unknown 1477 30.5

Total 4849 100.0

* SEER : Surveillance , Epidemiology and End Results


2.2 Distribution of cancer cases by Age group and Sex:

A total of (4849) new cases of cancer were recorded among Jordanians for the year 2010, out of these, 2330 cases ( 48.1 %) were males and ( 2519 ) cases (51.9 %) were females , with slight increase in the male cases, and almost the same in females compared with 2009 report. The male to female ratio for cancer cases in Jordan was 0.92: 1; it's slightly higher than the ratio in 2009 (0.90:1).

The distribution of cancer cases by age group shows that about 44% of the cases occurred in the age group 60 years and above, male percentage was higher (56.5%) than female ( 43.5%) in this age group.Meanwhile female predominate (60.7%) in the age groups 30-59 years than males (39.3%) and this was mostly due to the high incidence of breast cancer in this age group. In childhood period 0-14 years، males was predominant (56.7%) than females (43.3%) . Table (7) and Figure (7) .

Table (7) Distribution of cancer cases by age group and sex - 2010, Jordan

Males Females Total

N % N % T %

0-14 110 4.7 84 3.3 194 4.0

15-29 140 6.0 196 7.8 336 6.9

30-44 306 13.1 571 22.7 877 18.1

45-59 566 24.3 730 29.0 1296 26.7

60-74 892 38.3 701 27.8 1593 32.9

75+ 310 13.3 231 9.2 541 11.2

Unknown 6 0.3 6 0.2 12 0.2

Total 2330 100.0 2519 100.0 4849 100.0

Age group

Gender


The overall median age at diagnosis was 56 years with considerable variation according to the cancer site and sex (60 years for males and 52 years for females).In 2010, the crude Incidence rate of all cancers among Jordanians was 79.4 per 100,000 population (74.0 for males and 85.1 for females).The Age-Standardized Rate (ASR) adjusted to the World Standard Population was (135.1) per 100,000 population (132.8 per 100,000 for males and (138.4) per 100,000 for females compared with 2009 ASR was 137.1 , for males 132.1, for females 143.1 / 100,000 population table (8).

Table (8) Cancer cases, ASIR and ASR by Sex, 2009 - 2010, Jordan

2009 2010

Males Females Total Males Females Total

Number of cancer cases 2280 2518 4798 2330 2519 4849

Crude Incidence Rate(100,000)

74.0 86.9 80.2 74 85.1 79.4

Age Standarized Rate ( 100,000)

132.1 143.1 137.1 132.8 138.4 135.1

Median age atDiagnosis

59 52 56 60 52 56

Rate 100.000

Figure (7) Percentage distribution of cancers for, Jordanians,2010, by age-group and sex

Incidence Rates

Gender


For all cancer sites the crude incidence rate increased with increasing age for both males and females and after the age of 60 .There were more increase in incidence rate for males as compared with females، as shown in Table (9) and Figures (8,9). Table (10) shows the number of new cancer cases in Jordan 2010, by primary site and sex.Tables (11) and (12) show the frequency distribution of incident cases of cancer by site and age group among Jordanian males and females.Figures (10,11) show the Age-Standardized Incidence Rate per 100.000 population (all cancer sites) for males and females, Jordan compared with other countries

Table (9) Percentage & ASIR of cancer cases by Age group, Sex, 2010, Jordan

Males Females Total

No % ASIR No % ASIR No % ASIR

0-4 50 2.1 12.5 35 1.4 9.2 85 1.8 10.9

5-9 31 1.3 7.9 21 0.8 5.6 52 1.1 6.8

10-14 29 1.2 7.7 28 1.1 7.9 57 1.2 7.8

15-19 37 1.6 10.7 47 1.9 14.4 84 1.7 12.5

20-24 58 2.5 17.3 58 2.3 18.6 116 2.4 17.9

25-29 45 1.9 15.6 91 3.6 35.2 136 2.8 24.9

30-34 63 2.7 25.3 135 5.4 58.8 198 4.1 41.4

35-39 99 4.2 49.1 177 7.0 95.0 276 5.7 71.2

40-44 144 6.2 96.7 259 10.3 184.2 403 8.3 139.2

45-49 168 7.2 160.5 277 11.0 277.5 445 9.2 217.6

50-54 191 8.2 246.1 223 8.9 292.7 414 8.5 269.1

55-59 207 8.9 308.7 230 9.1 331.2 437 9.0 320.2

60-64 283 12.1 452.1 281 11.2 502.9 564 11.6 476.0

65-69 328 14.1 769.6 220 8.7 618.0 548 11.3 700.6

70-74 281 12.1 996.1 200 7.9 631.1 481 9.9 803.0

75-79 173 7.4 1173.7 115 4.6 767.7 288 5.9 969.0

80-84 97 4.2 1317.9 88 3.5 989.9 185 3.8 1138.5

85+ 40 1.7 448.7 28 1.1 348.5 68 1.4 401.2

Unknown 6 0.3 - 6 0.2 - 12 0.2 -

Total 2330 100.0 74.0 2519 100.0 85.1 4849 100.0 79.4*ASIR: Age-Specific Incidence Rate per 100,000 population

Age group

Gender


Figure (8) Age-Specific Incidence Rate per 100,000 population( All sites)by Sex , 2010, Jordan

Figure (9) Age-Standardized Rate (ASR) per 100,000 population( All sites)by Sex, 2010, Jordan


Figure (10) Age-Standardized Incidence Rate for Male cancers ( all sites)compared with other countries.

Figure (11) Age-Standardized Incidence Rate for Female cancers ( all sites)


compared with other countries

Table (10) Number of new cancer cases by Primary site and Sex - Jordan, 2010

Males Females TotalN % N % N %

All Sites 2330 100.0 2519 100.0 4849 100.0Lip 5 0.2 1 0.0 6 0.1Tongue 6 0.3 10 0.4 16 0.3Mouth 11 0.5 6 0.2 17 0.4Salivary glands 4 0.2 10 0.4 14 0.3Pharynx 29 1.2 6 0.2 35 0.7Esophagus 18 0.8 11 0.4 29 0.6Stomach 90 3.9 62 2.5 152 3.1Small intestine 12 0.5 7 0.3 19 0.4Colon 223 9.6 149 5.9 372 7.7Rectum 109 4.7 77 3.1 186 3.8Liver, Biliary Passages 60 2.6 53 2.1 113 2.3Pancreas 57 2.4 37 1.5 94 1.9Other&UnspecifiedDigestive 17 0.7 10 0.4 27 0.6Larynx 74 3.2 6 0.2 80 1.6Lung, Bronchus 311 13.4 68 2.7 379 7.8Other Thoracic organs 27 1.2 10 0.4 37 0.8Bone 27 1.2 22 0.9 49 1.0Melanoma , Skin 7 0.3 10 0.4 17 0.4Other Skin 112 5.0 94 3.8 206 4.4Connective tissue 31 1.3 28 1.1 59 1.2Breast 10 0.4 941 37.4 951 19.6Cervix Uteri 0 0.0 41 1.6 41 0.8CorpusUteri,unspecified 0 0.0 113 4.5 113 2.3Ovary 0 0.0 84 3.3 84 1.7Other reproductive Female 0 0.0 13 0.5 13 0.3Prostate 218 9.4 0 0.0 218 4.5Testis 52 2.2 0 0.0 52 1.1Other reproductive Male 2 0.1 0 0.0 2 0.0Kidney 54 2.3 41 1.6 95 2.0Urinary Bladder 186 8.0 23 0.9 209 4.3Eye 8 0.3 6 0.2 14 0.3Brain, Nervous system 106 4.5 62 2.5 168 3.5Thyroid 39 1.7 136 5.4 175 3.6Other Endocrine 3 0.1 5 0.2 8 0.2Hodgkin disease 65 2.8 67 2.7 132 2.7Non-Hodgkin lymphoma 120 5.1 130 5.2 250 5.1Lymphoid Leukemia 53 2.3 40 1.6 93 1.9Myeloid Leukemia 60 2.6 40 1.6 100 2.1Leukemiaunspecified 14 0.6 11 0.4 25 0.5Multiple Myeloma 45 1.9 28 1.1 73 1.5

Primary SiteGender


Males Females TotalN % N % N %

Other&unspecified 21 0.7 23 0.9 44 0.8Primary site unknown 44 1.9 38 1.5 82 1.7

Site AllAges

Age.Unk 4 - 0 9 - 5 14 - 10 19 - 15 -24 20 29 - 25 34 - 30 39 - 35 44 - 40 49 - 45 54 – 50 59 - 55 64 - 60 69 - 65 74 - 70 79 - 75 84 - 80 85+ Total % ICD-10

lip 5 0 0 0 0 0 0 0 0 0 0 2 0 1 1 0 0 1 0 0 0.2 C00Tongue 6 0 0 0 0 0 0 0 0 2 0 0 1 1 0 0 0 0 1 1 0.3 C01-C02Mouth 11 0 0 0 0 0 0 0 0 1 0 0 0 2 4 1 3 0 0 0 0.5 C03-C06Salivary gland 4 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0.2 C07-C08Other Oropharynx 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0.0 C10Nasopharynx 26 0 0 1 1 1 2 1 2 2 4 0 1 4 4 1 0 1 1 0 1.1 C11Pharynx unspec 2 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0.1 C14Oesophagus 18 0 0 0 0 0 0 0 0 1 1 1 2 2 6 1 3 0 1 0 0.8 C15Stomach 90 0 0 0 0 0 2 1 2 4 9 6 5 8 9 13 14 10 6 1 3.9 C16Small intestine 12 0 0 0 0 0 0 0 0 0 2 1 2 2 0 1 3 1 0 0 0.5 C17Colon 223 0 0 0 0 1 0 0 6 12 15 21 18 17 25 47 27 18 10 6 9.6 C18Rectum 109 0 0 0 0 0 0 0 1 5 11 10 13 11 15 17 16 6 2 2 4.7 C19-C21

Liver 32 0 2 0 0 1 0 0 0 2 2 1 3 4 2 6 3 4 0 2 1.4 C22Gallbladder etc 28 0 0 0 0 0 0 1 0 1 0 0 5 4 5 4 5 1 2 0 1.2 C23-C24Pancreas 57 0 0 0 0 0 0 0 0 1 3 4 7 4 9 12 8 6 0 3 2.4 C25Nose. sinuses etc 6 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 0 1 1 0 0.3 C30-C31Larynx 74 0 0 0 0 0 0 1 1 4 3 6 12 11 7 13 8 5 3 0 3.2 C32Bronchus. lung 311 1 0 0 0 0 1 2 0 4 18 31 32 36 47 56 47 16 16 4 13.4 C33-C34Other thoracic organs 16 1 2 0 0 1 1 0 2 1 3 1 1 1 0 0 2 0 0 0 0.7 C37-C38Bone 27 0 0 1 4 5 5 1 2 0 3 0 0 0 3 0 1 0 1 1 1.2 C40-C41Melanoma of Skin 7 0 0 0 0 0 0 2 0 0 0 0 2 0 1 0 1 0 1 0 0.3 C43Other Skin 112 1 0 0 0 0 0 2 1 3 6 11 7 7 14 15 17 13 10 5 4.8 C44Mesothelioma 5 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0.2 C45Kaposi sarcoma 4 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 1 0.2 C46Connective,Soft tissue 31 0 3 0 2 0 4 1 1 1 1 2 2 2 3 1 3 3 2 0 1.3 C47;C49Breast 10 0 0 0 0 0 0 0 1 0 1 0 0 1 2 2 1 0 2 0 0.4 C50Penis 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0.0 C60Prostate 218 0 0 0 0 0 0 0 0 0 0 3 6 21 36 44 53 34 16 5 9.4 C61Testis 52 1 3 0 0 3 10 8 5 13 4 3 2 0 0 0 0 0 0 0 2.2 C62Other male genital 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0.0 C63Kidney 54 0 4 1 1 0 2 0 0 2 6 3 5 4 9 10 4 2 1 0 2.5 C64-65Bladder 186 1 0 0 0 0 0 1 0 2 11 14 22 21 28 33 25 18 7 3 8.0 C67Eye 8 0 4 0 0 0 0 0 0 0 1 0 0 0 3 0 0 0 0 0 0.3 C69Brain, Nervous system 106 0 11 7 5 3 5 2 9 5 9 11 6 9 10 7 5 1 1 0 4.5 C70-C72Thyroid 39 0 0 0 0 1 0 8 7 5 4 1 3 5 0 3 1 1 0 0 1.7 C73Other Endocrine 3 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0.1 C74-C75Hodgkin disease 65 1 1 4 3 5 13 4 10 9 4 5 1 3 0 1 0 1 0 0 2.8 C81Non-Hodgkin lymphoma 120 0 3 3 4 6 5 6 4 7 8 9 10 8 9 11 13 7 4 3 5.1 C82-C85;C96Multiple Myeloma 45 0 0 0 0 0 0 0 0 1 4 6 6 3 5 9 5 5 1 0 1.9 C90Lymphoid Leukaemia 53 0 6 6 3 4 1 1 3 1 3 2 1 6 8 1 2 4 1 0 2.3 C91Myeloid Leukaemia 60 0 4 6 3 2 4 1 4 3 4 7 1 2 6 3 5 3 1 1 2.6 C92-C94Leukaemia unspec 14 0 2 1 2 2 0 0 0 1 1 0 1 0 0 2 0 1 1 0 0.6 C95Myeloproliferative Disease 6 0 0 0 0 2 0 0 0 0 0 0 0 0 1 0 1 2 0 0 0.3 D46-D47Myelodysplastic diease 4 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0.2 D4 69Other & unspecified 24 0 3 1 0 0 0 0 1 1 1 1 7 2 2 4 0 1 0 0 1.0 C26.C76,C48 Primary site unknown 44 0 0 0 0 0 1 0 0 4 2 6 5 4 4 6 2 5 4 1 1.9 C80

All sites 2330 6 50 31 29 37 58 45 63 99 144 168 191 207 283 328 281 173 97 40 100.0 ----All sites except C44 2218 5 50 31 29 37 58 43 62 96 138 157 184 200 269 314 264 160 87 35 95.2 Not C44

Table (11) Frequency of incident cases among Jordanians by Site and Age-group (Males), 2010, Jordan


Site AllAges Age Unk. 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+ Total % ICD-10

Lip 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0.0 C00

Tongue 10 0 0 0 0 0 0 0 0 1 1 1 1 0 2 1 1 0 1 1 0.4 C01-C02

Mouth 6 0 0 0 0 0 0 0 0 0 0 0 1 3 0 1 0 1 0 0 0.2 C03-C06

Salivary glands 10 0 0 0 0 1 0 0 0 0 1 1 2 2 1 1 0 0 0 1 0.4 C07-C08

Oropharynx 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 C10

Nasopharynx 6 0 0 0 0 1 1 0 1 0 0 2 0 1 0 0 0 0 0 0 0.2 C11

Pharynx unspec 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 C14

Oesophagus 11 0 0 0 0 0 0 0 0 0 0 1 2 1 1 3 0 3 0 0 0.4 C15

Stomach 62 0 0 0 0 0 0 2 2 4 9 7 6 3 10 5 4 6 2 2 2.5 C16

Small intestine 7 0 0 0 0 0 0 0 0 1 2 0 0 0 1 0 1 0 2 0 0.3 C17

Colon 149 0 0 0 0 0 2 3 5 6 11 14 18 19 27 15 11 6 9 3 5.9 C18

Rectum 77 0 0 0 0 0 0 0 2 5 9 8 8 12 12 7 6 3 3 2 3.1 C19-C21

Liver 19 0 2 0 0 1 0 1 1 1 0 1 0 0 3 2 3 0 4 0 0.8 C22

Gallbladder etc 34 0 0 0 0 0 0 2 0 0 2 2 5 2 6 5 3 6 0 1 1.3 C23-C24

Pancreas 37 0 0 0 0 0 1 0 2 1 2 2 3 5 4 6 7 3 1 0 1.5 C25

Nose, sinuses etc 3 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0.1 C30-C31

Larynx 6 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 2 1 1 0 0.2 C32

Trachea,Bronchus,Lung 68 0 0 0 0 0 0 0 3 4 2 5 12 5 12 8 9 2 4 2 2.7 C33-C34

Other Thoracic organs 6 0 0 0 0 0 0 0 2 1 0 1 1 0 0 1 0 0 0 0 0.2 C37-C38

Bone 22 0 1 1 1 4 3 2 2 2 1 1 0 0 1 2 1 0 0 0 0.9 C40-C41

Melanoma of Skin 10 0 0 0 0 0 1 1 0 0 0 0 1 1 4 0 2 0 0 0 0.4 C43

Other Skin 94 1 0 0 1 0 1 1 0 5 6 6 4 4 7 14 25 12 5 2 3.7 C44

Mesothelioma 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0.0 C45

Kaposi sarcoma 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0.0 C46

Connective,Soft tissue 28 0 4 0 2 1 3 1 2 2 3 2 1 2 1 1 0 3 0 0 1.1 C47;C49

Breast 941 2 0 0 0 0 2 19 51 90 151 144 106 91 109 74 50 26 21 5 37.4 C50

Cervix Uteri 41 0 0 0 0 0 0 1 3 4 8 6 2 3 4 3 6 1 0 0 1.6 C53

Corpus Uteri 70 1 0 0 0 0 0 2 2 0 5 11 3 10 9 8 8 9 1 1 2.8 C54

Uterus unspec 43 0 0 0 0 0 0 0 0 0 2 3 6 7 5 6 5 6 3 0 1.7 C55

Ovary 84 0 0 2 0 2 3 5 5 5 7 10 6 13 6 8 8 2 2 0 3.3 C56

Other Female Genital 11 0 1 0 0 0 0 0 1 0 0 3 1 0 1 1 1 1 1 0 0.4 C57

Placenta 2 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0.1 C58

Kidney 41 0 6 1 0 0 0 1 1 3 3 4 2 6 2 2 4 3 2 1 1.6 C64

Bladder 23 0 0 1 0 0 0 0 0 0 0 2 1 2 2 7 1 1 5 1 0.9 C67

Eye 6 0 3 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0.2 C69

Brain, Nervous system 62 0 6 6 6 4 3 2 2 5 3 4 2 4 6 4 3 1 1 0 2.5 C70-C72

Thyroid 136 1 0 0 0 5 11 17 24 23 13 11 7 9 5 4 3 0 2 1 5.4 C73

Other Endocrine 5 0 3 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0.2 C74-C75

Hodgkin disease 67 0 0 2 3 17 13 16 4 1 2 2 0 2 1 3 1 0 0 0 2.7 C81

Non-Hodgkin lymphoma 130 1 2 2 3 5 5 9 11 9 5 11 8 12 13 11 11 6 3 3 5.2 C82-C85;C96

Multiple Myeloma 28 0 0 0 0 0 0 0 0 0 1 1 5 3 8 3 5 1 0 1 1.1 C90

Lymphoid Leukaemia 40 0 6 4 5 1 1 1 2 0 0 2 1 3 1 2 4 4 3 0 1.6 C91

Myeloid Leukaemia 40 0 1 2 3 1 5 2 2 1 3 2 5 1 3 1 4 2 2 0 1.6 C92-C94

Leukaemia unspec 11 0 0 0 4 0 1 0 2 1 0 0 0 0 1 0 1 0 1 0 0.4 C95 MyeloproliferativeDisease 7 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 2 2 0 0.3 D46-D47

Myelodysplastic disease 6 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0.2 C46.9

Other&unspecified 19 0 0 0 0 1 0 0 1 0 2 1 1 0 5 2 4 1 1 0 0.8 C26. C76-C48

Primary site unknown 38 0 0 0 0 0 0 0 2 1 5 4 2 3 5 6 4 2 3 1 1.5 C80

All Sites 2519 6 35 21 28 47 58 91 135 177 259 277 223 230 281 220 200 115 88 28 100.0 ----

All sites except C44 2425 5 35 21 27 47 57 90 135 172 253 271 219 226 274 206 175 103 83 26 96.3 Not C44

Table (12) Frequency of incident cases among Jordanians by Site and Age-group (Femals), 2010-Jordan


2.3 Top ten cancers in males and females by Age group, 2010 - Jordanians

Figure (12) shows the percentage distribution of cancer cases,. by age groups from 0-19 years, 20-49 years and 50 years and above for males and females. Most of the cases occur in the age group 50 years and more and in male more common than females, while cancer in females was more common in the age group 20-49 years . In males the percent of cancer was 6.3%, 24.8% and 68.8% in the age groups 0-19, 20-49 years and 50 years and more respectively, it was slightly higher in males in the age group 0-19 years and 50 years.Tables from ( 13-15) show the top ten cancers for males and females and for both sexes, and figures (13,14) show the distribution of top ten cancers in both males and females but in different age group and sex.While tables (16-18 ) show top ten cancers in three main age group (0-19 years, 20-49 years and 50 years and more) by sex: it shows that leukemia , lymphoma , brain and CNS were predominant cancer in the age group 0-19 years in both sexes accounted for more than two third of the cases in this age group , while breast cancer is markedly the commonest (45.8%) in females in the age group 20-49 years followed by thyroid cancer 9.9% in this age group, while in males colorectal , lung and Hodgkin lymphoma are the commonest.In the age group 50 years and more, breast cancer again ranked first in females while in males lung ,colorectal and prostate cancer are the commonest cancers.

Figure (12)Percentage of cancer by Age group both sex, 2010-Jordan


Table (13) Ten most common cancers among Jordanians both Sex, 2010

Rank Cancer No %

1 Breast 951 19.6

2 Colorectal 558 11.5

3 Lymphoma ( Hodgkin, Non Hodgkin ) 382 7.9

4 Lung 380 7.8

5 Prostate 218 4.5

6 Leukemia 218 4.5

7 U. Bladder 209 4.3

8 Thyroid 175 3.6

9 Brain, Nervous system 168 3.5

10 Stomach 152 3.1

N.B: The total of the top Ten both sex cancers accounted 3410 ( 70.3%)

Table (14) Ten most common cancers among Jordanian Males, 2010-Jordan

Rank Cancer No %1 Colorectal 332 14.2

2 Lung 311 13.3

3 Prostate 218 9.4

4 U. Bladder 186 8.0

5 Leukemia 127 5.5

6 Non-Hodgkin lymphoma 120 5.2

7 Brain, Nervous system 106 4.5

8 Stomach 90 3.9

9 Larynx 74 3.2

10 Hodgkin disease 65 2.8

N.B: The total of the top Ten male cancers accounted 1629 ( 70%)


Table (15) Ten most common cancers among Jordanian Females , 2010

Rank Cancer No %

1 Breast 941 37.42 Colo-rectal 226 9.03 Thyroid 136 5.44 Non-Hodgkin lymphoma 130 5.25 Uterus 113 4.56 Leukemia 91 3.67 Ovary 84 3.38 Lung 68 2.79 Hodgkin disease 67 2.7

10 Stomach 62 2.5

N.B: The total of the top ten female cancers accounted 1918( 76.1%)

Figure (13) Percentage of Top ten cancers by Site and Age group, Males-2010


Figure (14) Percentage of Top ten cancers by site and age group ,Females-2010

Table (16) Top ten cancers for age group (0-19)years, both sex, 2010-Jordan

Males Females

Cancer Site No % Cancer Site No %

Leukemia 41 27.9 Leukemia 27 20.6

Brain, CNS 26 17.7 Brain, CNS 22 16.8

NHL 16 10.9 Hodgkin disease 22 16.8

Hodgkin disease 13 8.8 NHL 12 9.2

Kidney 6 4.1 Kidney 7 5.3Bone 10 6.8 Connective tissue 7 5.3Connective tissue 5 3.4 Bone 7 5.3

Eye 4 2.7 Thyroid 5 3.8

Testis 6 4.1 Eye 3 2.3

Others 20 13.6 Others 19 14.5

Total 147 100.0 Total 131 100.0


Table (17) Top ten cancers for age group (20-49) years, both sex, 2010-Jordan

Males Females

Cancer Site No % Cancer Site No %

Colorectal 81 14.0 Breast 457 45.8Lung 56 9.7 Thyroid 99 9.9Hodgkin disease 45 7.8 Colorectal 65 6.5Testis 43 7.5 NHL 50 5.0Brain, CNS 41 7.1 Hodgkin disease 38 3.8NHL 39 6.8 Ovary 35 3.5Leukemia 36 6.2 Leukemia 25 2.5U. Bladder 28 4.9 Uterus 25 2.5Thyroid 25 4.3 Stomach 24 2.4Others 183 31.7 Others 179 18.0Total 577 100.0 Total 997 100.0

Table (18) Top ten cancers for age group (50+) years, both sex, 2010-Jordan

Males Females

Site No % Site No %

Lung 255 15.9 Breast 482 34.8

Colorectal 250 15.6 Colorectal 161 11.6

Prostate 215 13.4 Uterus 87 6.3

U.Bladder 157 9.8 NHL 67 4.8

Stomach 66 4.1 Lung 54 3.9

NHL 65 4.0 Ovary 45 3.2

Larynx 59 3.7 Liver , Biliary 40 2.9

Liver , Biliary 50 3.1 Leukemia 39 2.8

Leukemia 50 3.1 Stomach 38 2.7

Others 434 27.1 Others 372 26.9

Total 1600 100.0 Total 1385 100.0


2-4 Geographical distribution of cancer cases Distribution of the number and rate of cancer cases by Governorates and regions and top ten cancers for regions, table (19) shows the distribution of new cancer cases in 2010 by governorates. Amman, the capital reported (60 %) of all cases followed by Irbid (14 %), Zarqa (10 %) and Balqa(4%).Meanwhile only 0.9 % was reported from Tafila , and 1.1% was reported from Aqaba and Maan was .Regarding the crude cancer incidence rate per 100,000 population by governorates, Amman showed the highest rate (123.7) per 100,000 population and the lowest was in Mafraq (27.5) /100,000 population followed by Aqaba and Ajloun , showed (39.8) per 100,000 population. Table (20) shows the median age at diagnosis in governorates and regions where the high-est median age at diagnosis in cancer was in Amman 58 years and the lowest was in Mafraq 48 years and. For males also Amman showed the highest median age at diagnosis of cancer 62 years with Maan governorate followed by Irbid 60 years , while in females the highest median age was seen in Jarash 61 years while the lowest median age was seen in Mafraq governorate 43 years followd by Maan 46 years and Madaba 46.5 years. Figures from (15,16) show the crude incidence rate in governorate and regions by sex The incidence rate of cancer in the Central region was 97 per 100,000 population while it was 51.4 per 100,000 population in the North region and 42.9 per 100,000 population in the South region. Figures (17-19) show the most frequent types of cancer by sex and the regions of Jordan (Central , Northern, and Southern regions ).Table (21-22) show the Trend number of Cancers among Jordanian by primary site and sex (Males, female) from 1996-2010.Table (19) Distribution of cases by Governorates ,Regions and Sex-2010

Males Females TotalNo ASIR No ASIR No ASIR %

Central Region 1802 91.0 1918 103.1 3720 96.9 76.7Amman 1434 117.8 1494 129.9 2928 123.7 60.4Zarqa 226 48.0 271 61.7 497 54.6 10.2

Balqa 98 46.1 109 55.4 207 50.5 4.3Madaba 44 55.9 44 59.3 88 57.6 1.8North Region 411 47.1 462 55.8 873 51.4 18.0Irbid 306 54.9 350 65.9 656 60.3 13.5Jarash 38 40.3 44 49.4 82 44.7 1.7Ajloun 30 41.9 26 37.7 56 39.8 1.2Mafraq 37 24.8 42 30.3 79 27.5 1.6South Region 111 37.1 135 49.3 246 42.9 5.1Karak 41 34.0 56 47.6 97 40.7 2.0Aqaba 27 36.4 26 44.0 53 39.8 1.1

Maan 29 47.6 25 45.2 54 46.5 1.1Tafiela 14 32.1 28 66.7 42 49.1 0.9Out side 3 - 1 - 4 - 0.1Unknown 3 - 3 - 6 - 0.1Total 2330 73.9 2519 85.0 4849 79.3 100.0ASIR: Age Specific Incidence Rate

Gender

Governorate


Table (20) Median age at diagnosis for Governorates and Regions by Sex-2010

Males Females Overall

Central Region 61 53 57Amman 62 54 58Zarqa 57.5 51 53Balqa 55.5 52 54Madaba 59.5 46.5 50.5North Region 58 49 54Irbid 60 49 54Jarash 56.5 61 57Ajloun 56.5 50.5 53.5Mafraq 54 43 48South Region 55 49 51Karak 55 51 54Aqaba 50 51.5 50Maan 62 46 49Tafiela 52.5 47.5 50.5Total 60 52 56

Figure (15) Crude Incidence Rate by Sex and Governorates, 2010, Jordan

GenderGovernorate


Figure (16) Crude Incidence Rate by Regions of Jordan, 2010

Figure (17)Percentage distribution of the most frequent types of cancer by sex, Central Region, Jordan , 2010


Figure (18 )Percentage distribution of the most frequent of cancer by sex, North Region, Jordan , 2010

Figure (19) percentage distribution of the most frequent cancers by sex South Region, Jordan–2010


Table (21) Trend of Cancers among Jordanian Males, 1996-2010

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Lip 13 10 8 4 5 6 9 8 2 13 11 18 13 10 5Tongue 11 5 4 8 7 8 7 6 2 8 7 9 6 7 6Mouth 20 12 19 8 23 11 20 17 9 26 19 14 16 20 15pharynx 22 14 29 25 25 21 27 22 15 20 26 34 37 24 29Esophagus 19 17 16 17 20 16 16 7 14 15 17 14 10 18 18Stomach 79 83 81 78 82 84 106 76 78 67 79 96 95 68 90Small intestine 8 6 16 12 10 11 7 8 14 11 12 8 9 9 12Colon 68 75 121 85 94 110 122 140 149 130 167 189 210 178 223Rectum 55 55 63 52 81 53 81 64 70 73 80 91 119 112 109Liver 54 35 48 34 31 35 37 56 45 39 59 37 52 52 60Pancreas 20 14 24 17 23 30 22 17 19 26 31 35 50 34 57 Other &UnspecifiedDigestive 9 1 2 1 0 1 0 1 1 10 0 1 0 7 17

Larynx 61 64 51 45 58 76 60 52 62 68 87 72 86 88 74Bronchus, lung 185 176 196 174 198 208 168 171 166 194 256 243 297 256 311Other thoracic organs 10 9 21 15 17 11 20 24 14 34 19 4 22 14 27Bone 33 39 34 26 31 28 31 25 37 32 32 27 33 30 27Connective tissue 21 20 23 20 28 23 13 27 24 27 22 14 27 35 31Melanoma of Skin 6 8 9 4 7 7 7 3 10 6 6 11 7 2 7Non-Melanoma 109 104 127 89 114 116 109 124 112 104 123 139 156 169 116Breast 10 8 13 10 4 5 12 25 6 10 16 9 9 16 10Prostate 89 124 108 101 123 151 143 149 147 139 133 158 163 179 218Testis 39 34 26 36 34 37 33 32 21 41 31 47 44 50 52Other male genital 1 1 1 3 2 1 0 2 1 0 1 0 0 3 2U.Bladder 168 178 151 146 129 158 169 149 146 147 177 157 171 184 186Kidney etc 44 44 61 55 32 42 53 44 48 48 53 55 63 60 54Eye 15 4 4 7 5 13 7 11 6 11 14 9 12 7 8Brain, nervous system 88 99 98 83 95 83 87 78 97 90 85 82 89 100 106Thyroid 36 24 23 33 29 28 38 33 26 23 31 31 37 39 39Other endocrine 13 8 6 4 5 3 5 4 6 0 4 3 16 11 3Lymphoid leukemia 70 66 63 67 24 18 24 26 25 120 76 51 78 78 53Myeloid leukemia 37 62 49 39 55 125 50 31 44 60 70 50 53 73 60Leukemia unspecified 51 25 27 14 62 3 76 77 103 28 14 21 21 38 14Hodgkin's disease 59 58 65 72 60 62 57 46 49 54 71 80 65 68 65Non-Hodgkin lymphoma 102 112 97 93 80 88 59 68 75 50 109 113 115 128 120

Multiple Myeloma 17 22 30 20 20 19 24 21 24 28 30 33 43 56 45Other and unspecified 20 13 26 27 20 22 35 35 32 21 22 34 15 11 31 Primary site unknown 42 70 37 36 44 27 26 64 60 45 57 59 35 46 44All Sites 1704 1699 1777 1560 1677 1740 1760 1743 1763 1818 2047 2048 2274 2280 2330

Year

Primary site


Table (22) Trend of Cancers among Jordanian Females, 1996-2010

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Lip 3 0 2 3 4 3 3 5 3 3 6 5 1 7 1Tongue 9 8 2 5 1 4 4 4 1 6 5 3 2 4 10Mouth 13 9 16 9 14 16 16 10 5 15 14 15 14 14 16Pharynx 11 13 9 13 9 11 11 13 9 11 18 9 22 13 6Esophagus 11 4 9 10 5 7 10 5 11 4 12 9 9 5 11Stomach 49 51 53 47 50 35 47 46 38 45 64 55 73 77 62Small intestine 8 6 9 5 5 7 9 8 6 7 4 8 7 8 7Colon 75 83 80 111 99 100 111 103 113 107 125 169 145 173 149

Rectum 36 45 62 42 72 50 67 50 50 61 68 73 74 91 77Liver 34 51 55 40 31 37 44 41 36 35 27 38 57 45 53Pancreas 11 9 8 10 16 14 6 12 14 14 12 31 26 30 37Other &Unspecified Digestive 3 0 0 0 0 0 0 0 1 8 0 0 0 9 10Larynx 5 9 4 5 6 7 5 4 9 11 10 9 13 6 6Bronchus, lung 38 45 30 37 25 45 46 36 31 44 54 54 59 43 68Other thoracic organs 2 6 11 15 5 9 19 12 7 28 15 5 11 12 10Bone 23 20 25 22 16 15 32 19 20 20 23 21 14 14 22Connective tissue 16 19 17 14 12 11 19 20 19 9 10 22 27 19 28Melanoma of Skin 1 2 4 6 9 6 4 5 18 5 15 8 11 7 10Non-Melanoma 81 98 81 76 82 64 63 72 75 56 81 74 78 113 95

Breast 455 468 478 513 551 566 501 551 646 674 749 817 855 926 941

Cervix uteri 33 48 40 22 25 45 31 41 23 37 52 57 42 44 41

Corpus Uteri 70 75 55 60 64 89 96 91 121 88 114 125 127 104 113Ovary 53 45 76 80 63 70 54 60 54 50 69 80 83 75 84

Other female genital 12 13 13 8 9 9 7 11 3 6 8 10 14 23 13

U.Bladder 32 23 18 16 25 17 30 21 21 30 18 26 27 22 23

Kidney 31 25 29 19 28 28 27 32 19 26 27 26 25 35 41

Eye 15 11 6 7 9 9 2 3 6 6 4 9 8 9 6Brain, nervous system 81 66 55 53 77 57 44 48 65 60 53 60 65 72 62

Thyroid 77 74 67 78 77 71 98 91 93 103 125 107 109 140 136Other endocrine 5 11 2 7 5 8 8 6 3 1 10 9 7 8 5Lymphoid leukemia 47 36 49 40 17 10 8 19 21 71 51 45 35 33 40Myeloid leukemia 37 40 41 47 51 85 47 46 38 56 53 56 45 50 40

Leukemia unspecified 25 14 15 6 43 0 44 69 70 18 11 15 14 31 11

Hodgkin's disease 54 44 36 29 48 51 57 31 32 37 59 55 46 79 67

Non-Hodgkin lymphoma 74 85 68 50 54 40 48 42 50 34 84 90 107 110 130

Multiple Myeloma 17 21 12 23 20 22 15 21 23 21 31 34 24 26 28

Other and unspecified 14 10 29 20 19 28 29 35 24 17 19 13 16 12 38

Primary site unknown 37 68 37 34 39 26 8 51 46 36 51 42 39 29 38

All Sites 1598 1655 1603 1582 1685 1672 1670 1735 1828 1860 2151 2284 2332 2518 2519

Year

Primary site


Chapter ThreeTen most common cancers among Jordanians


3.Ten most common cancers among Jordanains , 2010

This chapter explores the epidemiology of top ten cancers in both sexes in Jordanian for the year 2010 The rank order of cancers by number of cases figure (20) and number of ten cancers by sex (figure(21). Age Standardized Rate per 100,000 population for top ten cancers in both sexes is shown in the figure (22). Distribu-tion of top ten ASR in Jordan 2010 in both males and females figure (23,24) : there are types of cancers that more common in females than males : Breast , Thyroid and Lymphomas (both Hodgkin and Non hodgkin lym-phoma), on the other hand the following cancers are more common in males than females as :Lung, colorectal, Urinary bladder, Leukemia Brain and stomach) as shown in the figures below. Table (23) presented the median age for the top ten cancers for males and females. Figure (20) Percenrtage of Top Ten cancers a mong Jordanians both sex, 2010


Figure (21) Number of Top Ten cancers among Jordanians by sex, 2010

Figure (22) ASR of Top Ten cancers among Jordanians, both Sex, 2010


Figure (23) ASR for Top Ten cancers among Jordanian Males, 2010

Figure (24) ASR of (top ten cancers) mong Jordanian Females, 2010


Table (23) Median age at diagnosis for Top Ten cancers, both sex. 2010

Males Females Total

Breast 65.5 50.0 58.0

Colorectal ColonRectum

63.06462

58.05957

61.06159

Non-Hodgkin LymphomaHodgkin Lymphoma

52.031.5

51.023.0

51.526.0

Lung 63.0 60.0 62.0

Prostate 69.0 - 69.0

Leukemia 41.0 42.0 41.5

U.Bladder 64.0 66.0 64.5

Thyroid 37.0 37.0 37.0

Brain, CNS 43.0 36.5 40.5

Stomach 63.0 56.5 61.5

3.2 Most Common Cancers by Site ( Top ten cancers)

1. Breast Cancer ( C50 ) In the year 2010 there were 978 cases of breast cancer in both sexes accounting for 19.8% of all newly diag-nosed cancer cases, out of these there were 27 cases in situ (26 females, 1 male) . 941 invasive breast cancer cases were registered in females (37.4% of cancers in females ) and 10 cases in males . Female to male ratio 94:1 .Median age at diagnosis for breast cancer in females was 50 years , ranging from 21 years to 91 years, while the median age for males was 65.5 years . About 31.3 % of the women diagnosed with breast cancer were aged between 40 and 49 years, 21% of the cases in the age group 50-59 years, 17% were under 40 years , and only 28.5 % of the cases were aged 60 years and above .The crude incidence rate for female breast cancer was (31.8) per 100,000 female population, compared to 32.0 per 100,000 in 2009). The highest age-specific incidence rate in females was (236.2) per 100,000 at the age-group 80-84 years, followed by the age-group 65-69 years (207.9 per 100,000) .The Age Standardized Rate (ASR ) for female breast cancer was 52.6 / 100,000 compared with 53.8 per 100,000 in 2009. Table (24) and figure (25)

Gender

Site


Ductal carcinoma was the most frequent morphological type (79%) and 6.1% were lobular carcinoma, other pathalogical types accounted ... 15% (table 25).Regarding stage of breast cancer figure (26) shows that about 34% were localized and 45% were regional stage and 9% were distant metastasis compared with 2009. Approximately half of the breast cancer cases (44%) affected the right breast , while the left breast was affected in 42% of the cases ,only 2 % of the cases were bilateral , meanwhile laterality was not mentioned in 4% of registry records figure (27).Regarding the grade of tumor, it was found that 37.6% of the cases were moderate differentiation, 34.6% were poor differentiated and 24.4% of the cases the differentiation is not registered, figure (28)

Table (24) Frequency and ASIR of breast cancer by Age-group and sex-2010

Males Females Total.No ASIR .No ASIR No. *ASIR

0-4 0 0.0 0 0.0 0 0.0

5-9 0 0.0 0 0.0 0 0.0

10-14 0 0.0 0 0.0 0 0.0

15-19 0 0.0 0 0.0 0 0.0

20-24 0 0.0 2 0.6 2 0.3

25-29 0 0.0 19 7.3 19 3.5

30-34 1 0.4 51 22.2 52 10.9

35-39 0 0.0 90 48.3 90 23.2

40-44 1 0.7 151 107.4 152 52.5

45-49 0 0.0 144 144.3 144 70.4

50-54 0 0.0 106 139.1 106 68.9

55-59 1 1.5 91 131.0 92 67.4

60-64 2 3.2 109 195.1 111 93.7

65-69 2 4.7 74 207.9 76 97.2

70-74 1 3.5 50 157.8 51 85.1

75-79 0 0.0 26 173.6 26 87.5

80-84 2 27.2 21 236.2 23 141.5

85+ 0 0.0 5 62.2 5 29.5

Unknown 0 - 2 - 2 -

Total 10 0.3 941 31.8 951 15.6

Age group

Gender


Figure (25) ASIR of breast cancer by Age-group and sex-2010

Table (25) Morphological distribution of female breast cancer, 2010 - Jordan

Morphology No %

Ductal Carcinoma 744 79.1

Lobular carcinoma 57 6.1

Carcinoma, NOS 45 4.8

Mixed types 25 2.7

Malignant tumor, NOS 17 1.8

Mucinous Carcinoma 11 1.2

Other types 42 4.5

Total 941 100.0


Figure (26) Distribution of female breast cancer by Summary Stage , 2009 and 2010

2009 2010

Figure (27) Distribution of breast cancer cases by laterality, 2010 - Jordan


Figure (28) Grade distribution among female breast cancer cases, 2010 - Jordan

Distribution of female breast cancer cases by governorate showed that the highest rate was 47.0/100,000 in Amman while the lowest rate was in Mafraq (10.1/100,000) Table (26)The distribution of cases by the regions of the Kingdom showed that the highest rate was found in the Central region (37.8 /100,000) , the lowest rate was found in the North region (20.9 /100,000 ) meanwhile the rate in the South region was 22.6 /100,000 .Table (26 ) .


Table (26) Percentage distribution and ASIR* of Female Breast cancers by Governorates and Regions, Jordan 2010

Governorate Frequency Crude incidenceRate Percent

Central Region 703 37.8 74.7

Amman 541 47.0 57.5

Balqa 41 20.8 4.4

Zarqa 111 25.3 11.8

Madaba 10 13.5 1.1

North Region 173 20.9 18.4

Irbid 133 25.1 14.1

Mafraq 14 10.1 1.5

Jarash 17 19.1 1.8

Ajloun 9 13.0 1.0

South Region 62 22.6 6.6

Karak 28 23.8 3.0

Tafiela 14 33.3 1.5

Maan 8 14.5 0.9

Aqaba 12 20.3 1.3

Unknown 3 - 0.3

Total 941 31.8 100.0

The following figures (29-31) show the trend of incident number of cases, ASIR , ASR of female breast can-cer cases from 1996-2010, Figure (32) shows the ASR of female breast cancer in Jordan compared with other countries . Figures (33-34) represent number of in situ cases in Jordan from 1996-2010 and distribuion of in situ breast cancer cases by age group and years 1996-2010.Table (27) shows the trend of frequency distribu-tion of female breast cancer by age group from 1996-2010.


Figure (29) Trend of number of female breast cancer 1996-2010, Jordan*

* 26 in situ cases were not included Figure (30) Trend of ASIR* of female breast cancer, Jordan 2000-2010 , Jordan

*ASIR : Age specific incidence rate /100,000 population


Figure (31) Trend of ASR* female breast cancer , Jordan 2000-2010 , Jordan

*ASR : Age Standardized Rate per 100,000 population

Figure (32) Age Standardized Rate (ASR) of Female Breast Cancer , Jordan , 2010 com-pared with some countries


Trend of breast cancer (in situ ) cases 1996-2010Figure (33) Trend of In situ female breast cancer cases, (1996-2010) , Jordan

Figure (34) Trend of In situ females breast cancer cases, by age group (1996-2010)


Table (27) Frequency distribution of Female breast cancer cases by age group 1996-2010

96 97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 *2010

0-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10-14 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15-19 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0

20-24 0 0 2 2 4 1 0 7 3 4 1 3 1 0 2

25-29 6 6 12 13 11 14 12 8 14 16 8 15 18 13 19

30-34 10 5 29 31 36 26 43 30 43 38 40 44 38 46 53

35-39 45 50 52 55 51 69 51 59 80 62 84 69 79 89 91

40-44 47 46 72 54 64 75 62 86 91 110 101 129 125 129 156

45-49 67 75 55 60 80 70 73 87 96 102 111 126 133 134 148

50-54 50 50 91 92 76 88 78 64 80 87 79 92 112 117 110

55-59 70 102 54 64 68 85 61 80 86 86 93 96 93 100 95

60-64 56 35 44 56 66 57 35 61 71 73 86 80 104 120 112

65-69 70 50 34 49 43 37 49 38 39 47 75 60 56 72 75

70-74 6 13 18 13 25 25 19 19 19 28 37 51 53 46 50

75-79 20 20 15 24 27 8 12 6 17 12 20 27 23 33 28

80-84 5 8 0 0 0 6 3 2 6 4 9 10 10 16 21

85+ 2 5 0 0 0 5 5 4 1 3 1 6 7 9 5

Unknown 0 0 0 0 0 0 0 0 0 2 0 1 3 1 2

Total 455 466 478 513 551 566 503 551 646 674 749 817 855 926 *967

insitu cases of breast cancer were included (26)

Age group

Gender


2. Colo- Rectal cancer ( C18-C21 )

In 2010, there were 558 colo-rectal cancer cases , accounted (11.9%) of all newly diagnosed cases among Jor-danians. It ranked the second among all new cancers, and ranked the first among males where it affected 332 males (14.2%) and the second among females, where it affected 226 females (9.0% ). Male to female ratio was (1.5 : 1 ) compared with 1.1:1 in 2009.

The median age at diagnosis was 61 years (for both sexes), 64 years for the colon in males and 59 years for females and 62 years for the rectum in the males and 57 years for females. Crude incidence rate in both sexes was ( 9.1 /100,000) population , it is higher in males (10.6/100,00) than females (7.6 /100,000).

The highest (ASIR ) for both sexes was found in the age group 80-84 years (147.7/100,000 ) for males ( 170.9 /100.000) for females (135/100,000).

The overall Age-Standardized Incidence Rate (ASR) was 17.0/100,000. (ASR for males was 20.2 / 100,000 and for females 13.7/ 100,000 ).Distribution of cases by topography of the cancer shows that cancer in the sigmoid colon accounted 19.4 %, rectun (21%),while colon NOS was 16.3% table (28) and figure (35) .Table (29) & figure (36 ) shows the distribution of number of colo-rectal cancer and ASIR by age-group and sex.Regarding morphology it was found that (85.7%) of all colorectal cancers were adenocarcinomas and (6.5%) % were muscinous carcinoma, about 4.9 % were muscinous carcinoma.and (2.7 %) of the cases were of carci-noma NOS type figure (37).

Figure (38) shows the distribution of colorectal casaes by stage of tumour according to Summary Stage System, it was found that about 34% of cases were diagnosed as localised tumor and about 11.8% were diagnosed as distant metastasis. Figure (39) shows the trend of ASIR & ASR for colorectal cancer during 1996-2010.


Table (28) Distribution of Colorectal cancer by sub site & sex, 2010 - Jordan

Topography Males Females Total %

Cecum 30 17 47 8.4

Appendix 1 3 4 0.7

Ascending colon 21 14 35 6.3

Hepaticflexureofcolon 9 6 15 2.7

Transverse colon 11 6 17 3.0

Splenicflexureofcolon 11 5 16 2.9

Descending colon 21 12 33 5.9

Sigmoid colon 69 39 108 19.4

Overlapping Colon 3 3 6 1.1

Colon. NOS 47 44 91 16.3

Recto sigmoid Junction 34 26 60 10.8

Rectum. NOS 69 48 117 21.0

Anus and anal canal 6 3 9 1.6

Total 332 226 558 100.0

Figure (35) Distribution of Colorectal cases by Topography, 2010 - Jordan


Table (29) Colorectal Cancer cases by Age-group and sex-Jordan, 2010

Males Females Total

.No ASIR .No ASIR .No ASIR

0-4 0 0.0 0 0.0 0 0.0

5-9 0 0.0 0 0.0 0 0.0

10-14 0 0.0 0 0.0 0 0.0

15-19 1 0.3 0 0.0 1 0.1

20-24 0 0.0 2 0.6 2 0.3

25-29 0 0.0 3 1.2 3 0.5

30-34 7 2.8 7 3.0 14 2.9

35-39 17 8.4 11 5.9 28 7.2

40-44 26 17.5 20 14.2 46 15.9

45-49 31 29.6 22 22.0 53 25.9

50-54 31 39.9 26 34.1 57 37.1

55-59 28 41.8 31 44.6 59 43.2

60-64 40 63.9 39 69.8 79 66.7

65-69 64 150.2 22 61.8 86 109.9

70-74 43 152.4 17 53.6 60 100.2

75-79 24 162.8 9 60.1 33 111.0

80-84 12 163.0 12 135.0 24 147.7

85+ 8 89.7 5 62.2 13 76.7

Total 332 10.6 226 7.6 558 9.1

Age Group

Gender


Figure (36) Colorectal cancer - Age Specific Incidence rate by sex, 2010

Figure (37) Distribution of Colorectal cancer cases by Morphology 2010


Figure (38) Distribution of colorectal cancer cases by Summary Stage -2010, Jordan

Figure (39) Trend of ASIR, ASR for colorectal cancer 2000-2010, Jordan


Table (30) shows the percentage distribution & Incidence rate of colorectal cancer cases by governorates and regions shows that the highest incidence rate was in Amman 31.3/100,000 followed by Madaba 14.8/100,000. The highest percent in Amman 64.5% followed Irbid governorate 10.8%.

Table (30) Percentage distribution and ASIR* of colorectal cancers by Governorates and Regions, 2010, Jordan

Governorate No ASIR %

Central Region 445 23.9 79.7

Amman 360 31.3 64.5

Balqa 20 10.2 3.6

Zarqa 54 12.3 9.7

Madaba 11 14.8 2.0

North region 84 10.2 15.1

Irbid 60 11.3 10.8

Mafraq 10 7.2 1.8

Jarash 8 9.0 1.4

Ajloun 6 8.7 1.1

South region 28 10.2 5.0

Karak 8 6.8 1.4

Tafiela 6 14.3 1.1

Maan 8 14.5 1.4

Aqaba 6 10.2 1.1

Unknown 1 - 0.2

Total 558 18.8 100.0


3- Lymphomas (C81-85,C96)

In 2010 there were a total of 382 cases of lymphoma accounting for (7.9%) of all cancer cases.Lymphoma ranked the third among all newly diagnosed cancer cases in both sexes, and ranked the fifth in males and third in females for the year 2010 .

Lymphoma is of two types according to originating site : nodal (originated from lymph node) or extranodal. Distri-bution of cases by sex shows that there is no much difference between males and females ; 185 (48.4% ) in males, and 197(51.6%) in females with a male to female ratio 0.93:1.

Other hsitological classification of lymphoma is :

Hodgkin lymphoma : the number of cases was (132 /382) accounting 34.5% of all cases of lymphoma , It was relatively common among adolescents and young adults with slight higher in females (50.8%) than males (49.2%). Male : Female Ratio was 0.97:1. The median age for both sexes was 26 years (for males it was (31.5) years and 23 years for females) .

Non hodgkin lymphoma (NHL) : about 250 cases were NHL which accounted (65.5%) of all Lymphomas (250/382).It was relatively more frequent in females (52.2%) than in males ( 47.8%), with a male to female ratio of 0.93 : 1 , and it was more commonly occur in older age groups than Hodgkins disease but still in yougest age group .The median age for both sexes was (51.5) years , for males it was 52 years and 51 years for females .

Age Specific Incidence rate (ASIR) for Hodgkin lymphoma was 2.2/100,000 (2.1 for males, 2.3 for females),while ASIR for NHL was 4.1/100,000 (3.8 /100,000 for males, 4.4 /100,000 for females).

Overall Age Standardised Rate (ASR) for Hodgkin lymphoma was 2.2 /100,000 population (for males 2.1/100,000, for females 2.3/100,000), while overall ASR for NHL was 6.4/100,000 (for males 6.2/100,000 for females 6.7/100,000 .

Table (31) and figure (40) show the distribution and Age-Specific Incidence Rates for Hodgkin’s Lymphoma.

Table (32) and figure (41) show the distribution and Age-Specific Incidence Rates for Non- Hodgkin’s Lymphoma.


Table (31) Hodgkin lymphoma by Age-group and sex, 2010 - Jordan

Males Females Total.No *ASIR .No *ASIR .No *ASIR

0-4 1 0.3 0 0.0 1 0.1 5-9 4 1.0 2 0.5 6 0.8 10-14 3 0.8 3 0.8 6 0.8 15-19 5 1.4 17 5.2 22 3.320-24 13 3.9 13 4.2 26 4.0 25-29 4 1.4 16 6.2 20 3.7 30-34 10 4.0 4 1.7 14 2.9 35-39 9 4.5 1 0.5 10 2.6 40-44 4 2.7 2 1.4 6 2.1 45-49 5 4.8 2 2.0 7 3.4 50-54 1 1.3 0 0.0 1 0.7 55-59 3 4.5 2 2.9 5 3.7 60-64 0 0.0 1 1.8 1 0.8 65-69 1 2.3 3 8.4 4 5.1 70-74 0 0.0 1 3.2 1 1.7 75-79 1 6.8 0 0.0 1 3.4 80-84 0 0.0 0 0.0 0 0.0 85+ 0 0.0 0 0.0 0 0.0Unknown 1 - 0 - 1 -Total 65 2.1 67 2.3 132 2.2 Figure ( 40 ) Age Specific Incidence Rate (ASIR) by sex (Hodgkin's disease), 2010

Age group

Gender


Table (32) Non Hodgkin lymphoma by Age-group and sex, 2010 - Jordan

Males Females TotalNo ASIR No ASIR No ASIR

0-4 3 0.8 2 0.5 5 0.6 5-9 3 0.8 2 0.5 5 0.6 10-14 4 1.1 3 0.8 7 1.0 15-19 6 1.7 5 1.5 11 1.620-24 5 1.5 5 1.6 10 1.5 25-29 6 2.1 9 3.5 15 2.7 30-34 4 1.6 11 4.8 15 3.1 35-39 7 3.5 9 4.8 16 4.1 40-44 8 5.4 5 3.6 13 4.5 45-49 9 8.6 11 11.0 20 9.8 50-54 10 12.9 8 10.5 18 11.7 55-59 8 11.9 12 17.3 20 14.7 60-64 9 14.4 13 23.3 22 18.6 65-69 11 25.8 11 30.9 21 26.8 70-74 13 46.1 11 34.7 24 40.1 75-79 7 47.5 6 40.1 13 43.7 80-84 4 54.3 3 33.7 7 43.1 85+ 3 33.7 3 37.3 6 35.4Unknown 0 - 1 - 1 -Total 120 3.8 130 4.4 250 4.1

Figure (41) Age-Specific Incidence Rate (ASIR) by sex (NHL), 2010 - Jordan

Gender

Age group


4. Lung Cancer (C34 )

There were 379 cases of lung cancers accounting (7.8 %) of all newly diagnosed cancer cases in 2010. Lung cancer affected 311 (13.3%) males and 68 (2.7%) females with a male to female ratio of 4.6:1.Lung cancer ranked 2nd among males and 8th among females. The overall crude Age-Specific Incidence Rate for lung cancer was 6.2 /100.000 ( for males 9.9, and for females 2.3 per 100,000).The highest Age-Specific Incidence Rate (123.1 per 100,000 population) was seen in the age group 80-84 years for both sex , it is ( 217.4 for males , 45.0 for females) / 100,000 population .The median age at diagnosis was 62 years , with a minimum of 23 years and maximum of 88 years . The me-dian age at diagnosis was 63 years for males and 60 years for females. The overall ASR was 12.1 /100,000, for males the ASR was 19.8/100,000 and for females 4.3/100,000 .Regarding the major histological types, it was found that small cell carcinoma accounted 12.1% , Non small cell carcinoma accounted (68.1%): (adenocarcinoma 25.5%, squamous cell carcinomas 16.3%, Non-small cell carcinoma NOS 26.5 %) as shown in figure (42 ).Table (33) and figure (43) show the distribution and Age- Specific Incidence rates for lung cancer.

Figure (42) Morphological Distribution of lung cancer -2010, Jordan


Table (33) Lung Cancer ASIR by Age-group and sex-2010, Jordan

Males Females Total.No *ASIR .No *ASIR .No *ASIR

0-4 0 0.0 0 0.0 0 0.0 5-9 0 0.0 0 0.0 0 0.0 10-14 0 0.0 0 0.0 0 0.0 15-19 0 0.0 0 0.0 0 0.020-24 1 0.3 0 0.0 1 0.2 25-29 2 0.7 0 0.0 2 0.4 30-34 0 0.0 3 1.3 3 0.6 35-39 4 2.0 4 2.1 8 2.1 40-44 18 12.1 2 1.4 20 6.9 45-49 31 29.6 5 5.0 36 17.6 50-54 32 41.2 12 15.7 44 28.6 55-59 36 53.7 5 7.2 41 30.0 60-64 47 75.1 12 21.5 59 49.8 65-69 56 131.4 8 22.5 64 81.8 70-74 47 166.6 9 28.4 56 93.5 75-79 16 108.5 2 13.4 18 60.6 80-84 16 217.4 4 45.0 20 123.1 85+ 4 85.5 2 36.6 6 59.2Unknown 1 - 0 - 1 0.0Total 311 9.9 68 2.3 379 6.2

Figure (43) Age-Specific Incidence Rate(ASIR) by age group and sex (Lung), 2010 - Jordan

Gender

Age group


5. Leukemia (C91- C95)

In 2010, there were (218) cases of leukemia accounting (4.5%) of all newly diagnosed cancer, it ranked 5th among Jordanians. Leukemia is more common in males than females, it affected 127 males(58.2%) and 91 females (41.8%) with a male to female ratio of 1.4:1, compared to 1:6 in 2009. Leukemia is a cancer that com-monly affected younger age groups in both males and females with a median age at diagnosis of 41.5 years (41years for males ,42 years for femals).There was differrences between median age by morphological type of leukemia as in lymphoid leukemia it was 40 years , in myeloid leukemia 42.5 years while in Leukemia NOS the median age at diagnosis was 30 years.

Age Spescific Incidence rate ASIR for leukemia was 3.6/100,000 population (3.1 /100,000 for males, and 3.6)/100,000 for females ).The overall ASR was 5.0 /100,000 . ASR for males was 5.6/100,000 and 4.1/100,000 for females. The most common types of leukemia in all age groups and both sexes was myeloid Leukemia (45.8 %) (100/218). Lymphatic Leukemia accounted for (93/218) (42.6%) of all types of leukemias. Other types includes Leukemia NOS (11.5%). Figure (44) shows the distribution of cases of leukemia by morphological sub types .Leukemia was common in children (below the age 15 years ) about 58 cases out of 218 (26.6%) of all cases of leukemia in all age groups , the most prevalent type of leukemia in this age group was lymphatic leukemia 30/58 (52%) while myeloid leukemia (33)%.

Table (34) and figure (45) show the distribution and Age-Specific Incidence Rates for leukemia of all types.

Figure (44) Distribution of Leukemia by morphological subtypes-2010, Jordan


Table (34) Leukemia by Age-group and Sex, 2010 - Jordan

Males Females Total

.No ASIR .No ASIR .No ASIR 0-4 12 3.0 7 1.8 19 2.4 5-9 13 3.3 6 1.6 19 2.5 10-14 8 2.1 12 3.4 20 2.7 15-19 8 2.3 2 0.6 10 1.520-24 5 1.5 7 2.2 12 1.9

25-29 2 0.7 3 1.2 5 0.9 30-34 7 2.8 6 2.6 13 2.7 35-39 5 2.5 2 1.1 7 1.8 40-44 8 5.4 3 2.1 11 3.8 45-49 9 8.6 4 4.0 13 6.4 50-54 3 3.9 6 7.9 9 5.9 55-59 8 11.9 4 5.8 12 8.8 60-64 14 22.4 5 8.9 19 16.0 65-69 6 14.1 3 8.4 9 11.5 70-74 7 24.8 9 28.4 16 26.7 75-79 8 54.3 6 40.1 14 47.1 80-84 3 40.8 6 67.5 9 55.4 85+ 1 11.2 0 0.0 1 5.9Total 127 4.0 91 3.1 218 3.6 Figure (45) ASIR of Leukemia cases by Age group and Sex, 2010 - Jordan

Gender

Age group


6. Prostate Cancer (C61 ) There were 218 cases of prostate cancer accounting 4.5% of all cancer cases. It ranked 6th among cancers in males. Prostate cancer is more common in the age group 60 years and above where (86.2%) of cases found at this age-group. The highest age specific incidence rate (230.7/100,000 ) was in the age group 75-79 years. The incidence of prostate cancer increased steadily with increasing age.The median age at diagnosis was 69 years .The ASR was 14.6/100,000, which is relatively higher than 2009 (11.5/100,000). The majority of the morphology of prostate cancer was adenocarcinomas (89%). Table (35) and figure (46) show the distribution and Age- Specific Incidence rate for prostate cancer. Regarding tumor stage, about 48.6% of the cases were localized and about 28% are advanced stage (distant metastasis) as shown in figure (47 ).

Table (35) ASIR and number of Prostate cancer by Age group, 2010 - Jordan

Age GroupMales

.No *ASIR

0- 4 0 0.0

5- 9 0 0.0

10- 14 0 0.0

15- 19 0 0.0

20- 24 0 0.0

25- 29 0 0.0

30- 34 0 0.0

35- 39 0 0.0

40- 44 0 0.0

45- 49 3 2.9

50- 54 6 7.7

55- 59 21 31.3

60- 64 36 57.5

65- 69 44 103.2

70- 74 53 187.9

75- 79 34 230.7

84 80- 16 217.4

85+ 5 56.1

Total 218 6.9ASIR : Age Specific Incidence Rate


Figure (46) Age Specific Incidence Rate of Prostate cancer, 2010 Jordan

Figure (47) Distribution of Prosate cancer cases by SEER summary stage, 2010 - Jordan


7. Urinary Bladder (C67)

There were (209) cancer cases of urinary bladder accounting (4.3 %) of all newly diagnosed cancers. Bladder cancer ranked 4th in males where it affected 186 males (89%) and 23 females (11%) with a male to female ratio of 8:1 compared to 6.3: 1 in 2009. It is far more frequent in males than in females. The highest age specific incidence rate of U.bladder cancer in males was seen in the age group 75-79 years (122.1/100,000), while the highest ASIR in females was seen in the age group 80-84 years (56.2/100.000).The median age at diagnosis was 65 years (for males 64 years, for females 66 years). Crude incidence rate for urinary bladder cancer is 3.4 (for males 5.9, and 0.8 for females per 100,000). Overall ASR for urinary bladder cancer was 6.7/100,000 (for males 11.8/100,000, for females 1.5/100,000).According to morphology of bladder cancer, papillary transitional cell was the commonest type (55%), transi-tional cell carcinoma (33%) as shown figure (48).

Table (36) and figure (49) show the distribution and Age-Specific incidence Rates for urinary bladder cancer.

Figure (48) Morphological distribution of Urinary Bladder cancer, 2010 - Jordan


Table (36) Urinary Bladder Cancer by Age group and Sex, 2010 - Jordan

Males Females Total


25-29 1 0.3 0 0.0 1 0.2 30-34 0 0.0 0 0.0 0 0.0 35-39 2 1.0 0 0.0 2 0.5 40-44 11 7.4 0 0.0 11 3.8 45-49 14 13.4 2 2.0 16 7.8 50-54 22 28.3 1 1.3 23 15.0 55-59 21 31.3 2 2.9 23 16.9 60-64 28 44.7 2 3.6 30 25.3 65-69 33 77.4 7 19.7 40 51.1 70-74 25 88.6 1 3.2 26 43.4 75-79 18 122.1 1 6.7 19 63.9 80-84 7 95.1 5 56.2 12 73.8 85+ 3 33.7 1 12.4 4 23.6Unknown 1 - 0 - 1 -Total 186 5.9 23 0.8 209 3.4

Figure (49) Bladder cancer Age Specific Incidence Rate by sex, 2010 - Jordan

gender

Age group


8-Thyroid Cancer (C73)

there were 175 thyroid cancer cases accounting 3.6 % of all newly diagnosed cancers cases. it ranked 3rd among female cancers .Thyroid cancer was one of the few tumors which by far more frequent in females than in males. It affected 136 femals ( 5.4%) of all female cancers and 39 (1.7%) of all male cancers . Female to male ratio 3.5:1. About 59% of thyroid cancer in females affected the women below 40 years.The Median age at diagnosis for both sexes was 37 years, ( for males and females 37 years ). The distribution of thyroid cancer by histopatho-logical type was as follow : Papillary 71% , follicular carcinoma 10% , papillary carcinoma follicular variant 7% figure (50). Crude incidence rate for thyroid cancer was 2.9 /100,000 population (1.2 /100,000 for males , 4.6 /100,000 for females). The over all ASR for thyroid cancer was 3.5 /100,000 (1.6 /100,000 for males , and 5.6 /100,000 for females). Table (37) and figure (51) show the distribution of numbers and Age- Specific Incidence rates for thyroid cancer by sex.

Figure (50) Morphological distribution of thyroid cancer, 2010 - Jordan


Table (37) Thyroid cancer by Age-group and Sex-2010, Jordan

Males Females Total

.No ASIR .No ASIR .No ASIR 0-4 0 0.0 0 0.0 0 0.0 5-9 0 0.0 0 0.0 0 0.0 10-14 0 0.0 0 0.0 0 0.0 15-19 1 0.3 5 1.5 6 0.920-24 0 0.0 11 3.5 11 1.7 25-29 8 2.8 17 6.6 25 4.6 30-34 7 2.8 24 10.5 31 6.5 35-39 5 2.5 23 12.3 28 7.2 40-44 4 2.7 13 9.2 17 5.9 45-49 1 1.0 11 11.0 12 5.9 50-54 3 3.9 7 9.2 10 6.5 55-59 5 7.5 9 13.0 14 10.3 60-64 0 0.0 5 8.9 5 4.2 65-69 3 7.0 4 11.2 7 8.9 70-74 1 3.5 3 9.5 4 6.7 75-79 1 6.8 0 0.0 1 3.4 80-84 0 0.0 2 22.5 2 12.3 85+ 0 0.0 1 12.4 1 5.9Unknown 0 - 1 - 1 -Total 39 1.2 136 4.6 175 2.9

Figure (51) Thyroid cancer- Age Specific Incidence Rate by Age group and Sex, 2010 - Jordan

Gender

Age group


9. Cancers of the Brain & CNS (C71-C72)

Cancers of the central nervous system sites include the brain, cerebellum, brain stem, meninges, spinal cord and other sites. There were 168 cases accounting 3.5% of all newly diagnosed malignant cancers 2010. These cancers ranked the 7th in males and affected 106 males ( 4.5%) and 62 females (2.5%) with a male to female ratio of 1.7: 1.These tumors were relatively rare among adults above 65 years old, but more common among children and adolcence, about 64.3% of the cases occur in the age group below 50 years .Median age at diagnosis was 40.5 years (43 years for males and 36.5 years for females) .Morphology of brain tumors showed that about 38.7% of brain tumors were of glioblastoma type followed by astrocytoma (19.6%) figure (52 ) .Regarding the basis of diagnosis : about 9.5% of brain tumors were diagnosed by clinical and clinical inves-tigation and about 88.7% were diagnosed by biopsy of primary site and 3 cases diagnosed by Death certifi-cate only. Crude incidence rate was 2.8 /100,000 population .The over all ASR for brain & CNS tumors was 3.8/100,000 (4.8 /100,000 for males,2.8 /100,000 for females).Table (38) and figure (53) show the distribution and Age-Specific Incidence Rates for brain & nervous system tumors.

Figure (52) Morphological distribution of brain & CNS tumors , 2010-Jordan


Table (38) Brain & CNS by Age-group and Sex-2010, Jordan

Males Females Total


25-29 2 0.7 2 0.8 4 0.7 30-34 9 3.6 2 0.9 11 2.3 35-39 5 2.5 5 2.7 10 2.6 40-44 9 6.0 3 2.1 12 4.1 45-49 11 10.5 4 4.0 15 7.3 50-54 6 7.7 2 2.6 8 5.2 55-59 9 13.4 4 5.8 13 9.5 60-64 10 16.0 6 10.7 16 13.5 65-69 7 16.4 4 11.2 11 14.1 70-74 5 17.7 3 9.5 8 13.4 75-79 1 6.8 1 6.7 2 6.7 80-84 1 13.6 1 11.2 2 12.3 85+ 0 0.0 0 0.0 0 0.0Total 106 3.4 62 2.1 168 2.8 Figure (53) ( Brain and CNS)Age Specific Incidence by Age group and Sex 2010 jordan

Gender

Age group


10. Stomach Cancer (C16) There were 152 cases of stomach cancer among Jordanians, accounting 3.1% of all newly diagnosed cancer cases. It affected 90 males (3.9 %) and 62 females (2.5 %). Stomach cancer occurred more frequently in males than in females, with a male to female ratio of 1.5: 1. Crude incidence rate was 2.5 /100,000 (2.9 100,000 for males, and 2.1/100,000 for females). In males, the peak Age –Specific Incidence rate (81.5) per 100,000 popu-lation was observed in the age 80-84 years , but in females its 40.1 per 100,000 population observed in the age-group 75-79 years. The overall ASR for stomach cancer was 4.5/100,000 (5.4 for males and 3.6 /100,000 for females).The median age at diagnosis was 61.5 years (63 years for males and 56 years for females ).The most predominant histological type of stomach cancer was adenocarcinoma 53.3%. followed by signet ring 28.3% as shown in figure (54) Table (39) and figure (55) show distribution and age- specific incidence rates for stomach cancer.

Figure (54) Morphological distribution of Stomach cancer , 2010-Jordan


Table (39) ASIR and number of Stomach cancer by Age group and Sex- 2010, Jordan. Males Females Total

.No *ASIR .No *ASIR .No *ASIR

0-4 0 0.0 0 0.0 0 0.0 5-9 0 0.0 0 0.0 0 0.0 10-14 0 0.0 0 0.0 0 0.0 15-19 0 0.0 0 0.0 0 0.020-24 2 0.6 0 0.0 2 0.3

25-29 1 0.3 2 0.8 3 0.5 30-34 2 0.8 2 0.9 4 0.8 35-39 4 2.0 4 2.1 8 2.1 40-44 9 6.0 9 6.4 18 6.2 45-49 6 5.7 7 7.0 13 6.4 50-54 5 6.4 6 7.9 11 7.2 55-59 8 11.9 3 4.3 11 8.1 60-64 9 14.4 10 17.9 19 16.0 65-69 13 30.5 5 14.0 18 23.0 70-74 14 49.6 4 12.6 18 30.1 75-79 10 67.8 6 40.1 16 53.8 80-84 6 81.5 2 22.5 8 49.2 85+ 1 11.2 2 24.9 3 17.7Total 90 2.9 62 2.1 152 2.5

Figure (55) Stomach cancer Age Specific Incidence Rate by Age group and Sex - 2010, Jordan.

Gender

Age group


Chapter FourPediatric Malignancies in Jordan, 2010


Cancers among Jordanians under 15 years, 2010

There were (194) child in the age-group 0-14 years diagnosed with new cancer in Jordan which constitutes (4%) of all registered malignant tumors in the year 2010. The distribution of cases by sex shows that there were 110 male cancers (56.7%) and 84 cases in females (43.3%) .The Male to female ratio was 1.3: 1. The crude incidence rate for all cancers in this age group was 85 per million (94 per million for boys and 76 per million for girls). Mean age at diagnosis was 6.5 years. About 44% of registered cases were under the age 5 years figure (56 ) .

It is clearly noticed that cancer in pediatric group was higher in males than females for the following cancers (Leukemia , lymphomas, Brain & CNS) only kidney , soft tissue cancers are relatively higher in females than males figure ,table (40) and figures (57-59 ) show the distribution of numbers and percentage of top ten can-cers among Jordanian in both sexes and different age group and top five cancers in males and females.

Figure (56) Percentage Distribution of pediatric cancer cases by Age group, 2010 - Jordan


Figure (57) Percentage of top Five cancers in Pediatric age group (both Sex), 2010 - Jordan

Figure (58) Top Five Cancers in Pediatric by Sex, 2010 - Jordan


Table (40) Distribution of childhood cancers by Age group, 2010 - Jordan

0-4 5-9 10-14 Total %

Leukemia 19 19 20 58 29.9

Brain &CNS 17 13 11 41 21.1

Lymphoma 6 11 13 30 15.5

Kidney 10 2 1 13 6.7

Soft tissue 7 0 4 11 5.7

Neuroblastoma 7 1 0 8 4.1

Bone 1 2 5 8 4.1

Eye 7 0 0 7 3.6

Others 11 4 3 18 8.8

Total 85 52 57 194 100.0Brain and CNS: include 3 cases neuroblastoma Neuroblastoma include all sites out side Brain and CNS.

Figure (59) Distribution of childhood cancer by Age group and Site of tumor, 2010 - Jordan

SiteAge group


The following tables (41-42) shows the distribution of number and percentages of chilhood cancers by gov-ernorates and regions. Most of the cases occur in Central region (73.7%) while 18% in north region and only 8.3 % in south region.

Table (41) Distribution of childhood cancer by Governorates and Sex, 2010 - Jordan

Males Females TotalNo %

Central region 85 58 143 73.7Amman 56 44 100 51.5Zarqa 18 7 25 12.9Balqa 9 3 12 6.2Madaba 2 4 6 3.1North region 18 17 35 18.0Irbid 10 13 23 11.9Mafraq 4 3 7 3.6Jarash 1 1 2 1.0Ajloun 3 0 3 1.5South region 7 9 16 8.2Karak 2 2 4 2.1Maan 2 3 5 2.6Tafiela 2 1 3 1.5Aqaba 1 3 4 2.1Total 110 84 194 100.0

Table (42) Distribution of childhood cancer by Age group, Governorates and Sex

years 0-4 years 5-9 years 10-14 Total

Males Females Males Females Males Females Males Females TotalAmman 25 23 18 10 13 11 56 44 100Zarqa 9 3 6 1 3 3 18 7 25Balqa 5 1 2 1 2 1 9 3 12Madaba 1 0 1 1 0 3 2 4 6Central Region 40 27 27 13 18 18 85 58 143Irbid 6 3 1 5 3 5 10 13 23Mafraq 1 1 1 1 2 1 4 3 7Jarash 0 0 0 1 1 0 1 1 2Ajloun 0 0 1 0 2 0 3 0 3North Region 7 4 3 7 8 6 18 17 35Karak 0 0 1 0 1 2 2 2 4Aqaba 1 2 0 0 0 1 1 3 4Maan 1 2 0 1 1 0 2 3 5Tafiela 1 0 0 0 1 1 2 1 3South Region 3 4 1 1 3 4 7 9 16Total 50 35 31 21 29 28 110 84 194

GenderGovernorate

Governorate

Age group / gender


The following graphs from (60) to figure (65) represent the distribution of most common childhood cancer by the age of the patients from age 1 to age 14 years .

Figure (60) Distribution of childhood Leukemia by Age and Sex, 2010 - Jordan

Figure (61) Distribution of childhood Brain &CNS by Age and Sex, 2010 - Jordan


Figure (62) Distribution of childhood Lymphoma by Age and Sex, 2010 - Jordan

Figure (63) Distribution of Kidney tumors by Age and Sex, 2010 - Jordan


Figure(64) Distribution of Childhood Soft tissue tumor by Age& Sex, 2010 - Jordan

Figure(65) Distribution of Childhood bone tumor by Age and Sex, 2010 - Jordan


Chapter FiveCancer among Non- Jordanians, 2010

Distribution of cancer cases by age group and sex

Distribution of cases by primary site

Top ten cancers by sex

Distribution of cancer cases by nationality


Cancer among Non-Jordanians, 2010

The total number of cancer cases among Non-Jordanians was (1899) accounting (27.8%) of all cancers re-ported to Jordan Cancer Registry that were registered in 2010, of these, (1875) cases were invasive cancer and (24) cases were in situ and 6 cases were multi primary cancers, The distribution of cases by sex shows that: males were 987 (52.6%) while females were 888 (47.4%). Males to female ratio of (1.1: 1).

The median age at diagnosis for Non-Jordanians was 52 years , (54 years for males and 50 years for females). The highest percent in males was in the age group 60-64 years (12.5%) of all cases while the highest percent in females was in the age group 50-54 years (11.5%). There were (108) cases below the age 15 years which counted (5.8 %) of all Non –Jordanians registered in the year 2010,of them 65 males (6.6%) of male cancers ,and 43 females (4.8%) of female cancers.The commonest types of cancer among Non-Jordanians are breast, colorectal and lung cancer, table (43).

Table (43) Top ten cancers among Non Jordanian, both sexes, 2010 - Jordan

Primary site N %

Breast 313 16.7

Colorectal 161 8.6

Lung 128 6.8

Brain &CNS 120 6.4

Non- Hodgkin's Lymphoma 101 5.4

Leukemia 97 5.2

Thyroid 88 4.7

Stomach 76 4.1

Prostate 72 3.8

Urinary Bladder 68 3.6

Others 651 34.7

Total 1875 100


Table (44) Shows the distribution of cancers among Non-Jordanians by age group and sex and table ( 45) shows the distribution of cases by primary site and sex.Table (46-47) show the most frequent types of cancer in 2010 among Non Jordanian males and females as docu-mented by the Jordan cancer Registry Figure (66) shows the trend number of cases of cancers among Non Jordanians reported to Jordan Cancer Reg-istry during the years 1996 – 2010 by gender.Figure (67) shows the number of cancers among Non-Jordanians reported to Jordan Cancer Registry during 2010 by nationality( country of origin).

Table (44) Cancers among Non-Jordanians By age group and gender 2010*

Age group Males % Females % Total %

0-4 27 2.7 21 2.4 48 2.6

5-9 21 2.1 13 1.5 34 1.8

10-14 17 1.7 9 1.0 26 1.4

15-19 33 3.3 21 2.4 54 2.9

20-24 30 3.0 23 2.6 53 2.8

25-29 37 3.7 46 5.2 83 4.4

30-34 44 4.5 51 5.7 95 5.1

35-39 51 5.2 75 8.5 126 6.7

40-44 58 5.9 89 10.0 147 7.8

45-49 74 7.5 92 10.4 166 8.9

50-54 100 10.1 102 11.5 202 10.8

55-59 97 9.8 87 9.8 184 9.8

60-64 123 12.5 87 9.8 210 11.2

65-69 97 9.8 74 8.3 171 9.1

70-74 76 7.7 43 4.8 119 6.3

75-79 63 6.4 33 3.7 96 5.1

80-84 25 2.5 13 1.5 38 2.0

85+ 9 0.9 7 0.8 16 0.9

Unknown 5 0.5 2 0.2 7 0.4

Total 987 100 888 100 1875* 100

* 24 insitu not included


Table (45) Cancers among Non-Jordanians by primary site & sex- 2010

Males Females Total.No % .No % .No %

All Site 987 100 888 100 1875 100Lips 0 0.0 0 0.0 0 0.0Tongue 7 0.7 7 0.8 14 0.7Mouth 16 1.6 7 0.8 23 1.2Pharynx 27 2.7 11 1.2 38 2.0Esophagus 6 0.6 1 0.1 7 0.4Stomach 48 4.9 28 3.2 76 4.1Small Intestine 7 0.7 2 0.2 9 0.5Colon 51 5.2 43 4.8 94 5.0Rectum 36 3.6 31 3.5 67 3.6Liver &Biliary Passage 29 2.9 18 2.0 47 2.5Pancreas 15 1.5 16 1.8 31 1.7Other&UnspecifiedDigestive 8 0.8 1 0.1 9 0.5Larynx 36 3.6 4 0.5 40 2.1Lung 107 10.8 21 2.4 128 6.8Other&UnspecifiedRespiratory 18 1.8 8 0.9 26 1.4Bone 21 2.1 20 2.3 41 2.2Connective Tissue 19 1.9 13 1.5 32 1.7Skin 22 2.2 10 1.1 32 1.7Breast 8 0.8 305 34.3 313 16.7Cervix Uteri 0 0.0 26 2.9 26 1.4CorpusUteriUnspecified 0 0.0 26 2.9 26 1.4Ovary 0 0.0 33 3.7 33 1.8Other Reproductive Female 0 0.0 7 0.8 7 0.4Prostate 72 7.3 0 0.0 72 3.8Testis 12 1.2 0 0.0 12 0.6Other Reproductive Male 0 0.0 0 0.0 0 0.0Kidney & Other Urinary 31 3.1 24 2.7 55 2.9 U.Bladder 57 5.8 11 1.2 68 3.6Eye 8 0.8 3 0.3 11 0.6Brain &CNS 83 8.4 37 4.2 120 6.4Thyroid 26 2.6 62 7.0 88 4.7Other Endocrine 3 0.3 4 0.5 7 0.4Leukemia 69 7.0 28 3.2 97 5.2Hodgkin's Disease 31 3.1 22 2.5 53 2.8Non- Hodgkin's 67 6.8 34 3.8 101 5.4Multiple Myeloma 25 2.5 11 1.2 36 1.9AllOthers&Unspecified 8 0.8 8 0.9 16 0.9Primary Site Unknown 14 1.4 6 0.7 20 1.1

Primary Site

Gender


Table (46) The most frequent types of cancer among Non-Jordanians (Males), 2010

Rank Primary Site No. %1 Lung 107 10.82 Colo-rectal 87 8.83 Brain &CNS 83 8.44 Prostate 72 7.35 Leukemia 69 7.06 Non Hodgkin Lymphoma 67 6.87 U. Bladder 57 5.88 Stomach 48 4.99 Larynx 36 3.610 Hodgkin Lymphoma 31 3.111 Others 330 33.4

Total 987 100

Table (47) The most frequent types of cancer among Non-Jordanians (Females), 2010

Rank Primary Site No. %

1 Breast 305 34.3

2 Colo-rectal 74 8.3

3 Thyroid 62 7.0

4 Brain & CNS 37 4.2

5 Non Hodgkin Lymphoma 34 3.8

6 Ovary 33 3.7

7 Stomach 28 3.2

8 Leukemia 28 3.2

9 Cervix 26 2.9

10 Uterus 26 2.9

11 Others 235 26.5

Total 888 100


Figure (66) Cancers trend among Non-Jordanians reported in (1996 – 2010)

Figure (67)Number of Cancers among Non-Jordanians by nationality, 2010


Chapter Six

Cancer mortality

- Mortality data from Jordan cancer registry

- Mortality data from Mortality Section

(Information and Research Directorate)


Cancer Mortality

Following up cancer patients is crucial issue in order to identify the vital status of the patient , to explore the survival of the patient thie in turn will reflect the quality of care received to patient and evluate the mehods of treatment ,establishing programs to discover cancer in early stages which will improve survival and decrease mortality from cancer, breast cancer screening program is good example.

In this year we have two types of mortality data, first is data from our registry as follow up of patients diag-nosed in the year 2010 from date of diagnosis to the date of last visit to health facility or date of death that registered in hospitals or vital statistics and the following tables represent this type of follow up (active and passive follow up).

JCR Mortality Data (2010):

Number of deaths from total cancer cases in the year 2010 till the date 31-12-2011 is 1226 patients out of 4849 (25.3%). Number of death is higher in male 712 / 2330 (30.5%) than in female 514 /2519 (20.4%). Deaths by age group , table (48) and figure (68) and distribution of deaths by governorates and regions table (49) , tables (50-51) shows the most common causes of death due to cancer in both males and females.

Table (48) Distribution of deaths by age group and sex-2010

Males % Females % Total %

0-9 12 1.7 10 1.9 22 1.8

10-19 12 1.7 12 2.3 24 2.0

20-29 17 2.4 24 4.7 41 3.3

30-39 28 3.9 43 8.4 71 5.8

40-49 88 12.4 79 15.4 167 13.6

50-59 154 21.6 85 16.5 239 19.5

60-69 191 26.8 118 23.0 309 25.2

70-79 164 23.0 99 19.3 263 21.5

80-89 44 6.2 39 7.6 83 6.8

90+ 2 0.3 5 1.0 7 0.6

Total 712 100 514 100.0 1226 100

Data deaths from JCR , 2010

Age group

Gender


Figure (68) Percentage Distribution of deaths by age group and sex, 2010, JCR

Table (49) Distribution of deaths by governorate & regions , 2010Governorate Death %

Amman 700 57.1

Zarqa 129 10.5

Balqa 79 6.4

Madaba 31 2.5

Central Region 939 76.6

Irbid 163 13.3

Mafraq 21 1.7

Ajloun 15 1.2

Jarash 21 1.7

North Region 220 17.9

Karak 25 2.0

Aqaba 15 1.2

Maan 17 1.4

Tafiela 9 0.7

South Region 66 5.4

Total 1226 100.0


Table (50) Percentage distribution of deaths due to cancers among Jordanian Males, 2010

Rank Cancer No %

1 Lung 215 30.2

2 Colorectal 73 10.3

3 Prostate 44 6.2

4 Brain & CNS 43 6.0

5 Leukemia 39 5.5

6 U.Bladder 36 5.1

7 Pancreas 32 4.5

8 Stomach 31 4.4

9 Liver,Biliary 31 4.4

10 NHL 28 3.9

11 Others 140 19.7

Total 712 100

Table (51) Percentage distribution of deaths due to cancers among Jordanian Females, 2010

Rank Cancer No %1 Breast 115 22.4

2 Colorectal 46 8.9

3 Lung 36 7.0

4 Leukemia 29 5.6

5 Stomach 29 5.6

6 Brain CNS 27 5.3

7 NHL 26 5.1

8 Liver, Biliary 25 4.9

9 Ovary 23 4.5

10 Pancreas 21 4.1

11 Others 137 26.7

Total 514 100


Cancer mortality data (mortality section, 2009).

Based on the data from the annual mortality report for the year 2009 ( Department of Mortality –MOH ) it is reported that the first cause of death in Jordan is Cardiovascular diseases representing (35.9%) followed by Neoplasms which constitue (14.6%).

In the year 2009 a total of 14807 death notifications were received, reviewed and classified according to the International Classification of Diseases (ICD-10) , based on the selection criteria for the underlying cause of death in the Department of mortality-MOH.

Distribution of deaths by sex shows that 8589 were males (58%) and 6218 females (42%) .The number of deaths due to neoplasm is 2164 (14.6%), in males 1237 (14.4%) and in females 927 (14.9%). Male to female ratio is 1.3:1.Table (52) shows the main causes of deaths in Jordan for the year 2009 according to International classification of Disease – tenth revision (ICD-10), other tables (53-57) and figures (67-70) show the distribution of neo-plasm causes of death by age group and sex , governorates, main categories of ICD-10 mortality codes of death due to neoplasms and top ten causes of deaths due to neoplasm in both sexes for the year 2009 .

Table (52) Number and percentage of deaths by cause of death according to ICD-10, Jordan -2009

Cause of death ICD-10 Code Frequency %

Diseases of the circulatory system (I00-I99) 5318 35.92

Neoplasm's (C00-D48) 2164 14.61

External causes of mortality (V01-Y89) 1471 9.93

Endocrine, nutritional and metabolic diseases (E00-E89) 1123 7.58

Certain conditions originating in the perinatal period (P00-P96) 1039 7.02

Diseases of the respiratory system (J00-J98) 931 6.29

Congenital malformations (Q00-Q99) 745 5.03

Diseases of the digestive system (K00-K92) 423 2.86

Symptomsandsignsnotelsewhereclassified (R00-R99) 406 2.74

Diseases of the genitourinary system (N00-N99) 368 2.49

Diseases of the nervous system (G00-G98) 314 2.12

Certain infectious and parasitic diseases (A00-B99) 297 2.01

Diseases of blood and blood forming organs (D50-D89) 86 0.58

Diseases of skin and subcutaneous tissue (L00-L98) 42 0.28

Diseases of the musculoskeletal system& connective tissue (M00-M99) 40 0.27

Pregnancy, childbirth and the puerperium (O00-O99) 26 0.18

Mental and behavioral disorders (F01-F99) 14 0.09

Total 14,807 100


Table (53) Distribution and percentages of deaths due to neoplasm by age group & sex- 2009

(Age group) year Males Females Total %0-9 33 26 59 2.710-19 30 15 45 2.120-29 36 22 58 2.730-39 49 73 122 5.640-49 115 135 250 11.650-59 208 178 386 17.860-69 339 216 555 25.670-79 293 181 474 21.980-89 117 68 185 8.590+ 17 13 30 1.4Total 1237 927 2164 100

Table (54) Percentage distribution of deaths due to Neoplasm by Governorates and sex , Jordan -2009

Governorate Males % Females % Total %Amman 501 40.5 419 45.2 920 42.5Irbid 209 16.9 135 14.6 344 15.9Zarqa 176 14.2 144 15.5 320 14.8Balqa 99 8.0 70 7.6 169 7.8Karak 60 4.9 33 3.6 93 4.3Mafraq 29 2.3 21 2.3 50 2.3Ajloon 24 1.9 21 2.3 45 2.1Jerash 26 2.1 16 1.7 42 1.9Aqaba 23 1.9 17 1.8 40 1.8Maan 22 1.8 12 1.3 34 1.6Madaba 21 1.7 13 1.4 34 1.6Tafilah 10 0.8 11 1.2 21 1.0Unknown 37 3.0 15 1.6 52 2.4Total 1237 100 927 100 2164 100


Figure (69) Percentage of neoplasm deaths by age group and sex, 2009 - Jordan

Figure (70 )Percentage distribution of neoplasm deaths by governorate, 2009


Table (55 ) Distribution of deaths due to neoplasm by main ICD-10 coding groups causes of mortality, 2009- Jordan

Primary Site Male Female Total

Malignant neoplasms of lip, oral cavity and pharynx (C00-C14) 39 9 48

Malignant neoplasm of oesophagus (C15) 10 1 11

Malignant neoplasm of stomach (C16) 55 33 88

Malignant neoplasms of small intestine, colon, rectum (C17-C21) 131 104 235

Malignant neoplasms of liver and intrahepatic bile ducts (C22) 49 25 74

Malignant neoplasm of pancreas (C25) 43 30 73

Malignant neoplasm of larynx (C32) 11 2 13

Malignant neoplams of trachea, bronchus and lung (C33-C34) 273 69 342

Malignant neoplasm of breast (C50) 6 211 217

Malignant neoplasm of cervix uteri (C53) 0 14 14

Malignant neoplasms of corpus uteri and uterus(C54-55) 0 29 29

Malignant neoplasm of ovary (C56) 0 35 35

Malignant neoplasm of prostate (C61) 92 0 92

Malignant neoplasms of kidney (C64-C65) 20 6 26

Malignant neoplasm of bladder (C67) 43 13 56

Malignant neoplasms of meninges, brain and CNS (C70-C72) 58 57 115

Hodgkin's disease (C81) 2 1 3

Non-Hodgkin's lymphoma (C82-C85) 45 34 79

Leukaemia (C91-C95) 138 76 214

Allotherandunspecifiedmalignantneoplasms 164 148 312

In situ neoplasms, benign ,unknown neoplasms (D00-D48) 58 30 88

Total 1237 927 2164


Table (56) Distribution of top ten Male neoplasm deaths, 2009 - Jordan

Primary Site N %

Malignant neoplasm of trachea, bronchus and lung (C33-C34) 273 22.1

Leukaemia (C91-C95) 138 11.2

Malignant neoplasms of small intestine, colon, rectum and anus (C17-C21) 131 10.6

Malignant neoplasm of prostate (C61) 92 7.4

Malignant neoplasms of meninges, brain and CNS (C70-C72) 58 4.7

Malignant neoplasm of stomach (C16) 55 4.4

Malignant neoplasms of liver and intrahepatic bile ducts (C22) 49 4.0

Non-Hodgkin's lymphoma (C82-C85) 45 3.6

Malignant neoplasm of pancreas (C25) 43 3.5

Malignant neoplasm of bladder (C67) 43 3.5

Allotherandunspecifiedmalignantneoplasms 164 13.3

In situ neoplasms, benign neoplasms and (D00-D48) 58 4.7

Other neoplasms 88 7.1

Total 1237 100.0

Table ( 57) Distribution of top ten Female neoplasm deaths, 2009 - Jordan

Primary site N %

Malignant neoplasm of breast (C50) 211 22.8

Malignant neoplasms of small intestine, colorectal, anus (C17-C21) 104 11.2

Leukaemia (C91-C95) 76 8.2

Malignant neoplams of trachea, bronchus and lung (C33-C34) 69 7.4

Malignant neoplasms of meninges, brain and CNS (C70-C72) 57 6.1

Malignant neoplasm of ovary (C56) 35 3.8

Non-Hodgkin's lymphoma (C82-C85) 34 3.7

Malignant neoplasm of stomach (C16) 33 3.6

Malignant neoplasm of pancreas (C25) 30 3.2

Malignantneoplasmsofcorpusuterianduterus,unspecified(C54-55) 29 3.1

Allotherandunspecifiedmalignantneoplasms 148 16.0

In situ neoplasms, benign neoplasms and neoplasms (D00-D48) 30 3.2

Other neoplasms 71 7.7

Total 927 100.0


Annex (1)Jordan Cancer Registry ( JCR) notification form

fax : 00962 –6-5656489


Annex (2) Jordan Cancer Registry Data Request Application Form


Definitions of TermsIncidenceA cancer incidence rate is the number of new cancers of a specific site/type occurring in a specified population during a year, usually expressed as the number of cancers per 100,000 populations at risk. That is, Incidence rate = (New cancers / Population) × 100,000The numerator of the incidence rate is the number of new cancers; the denominator is the size of the population. The number of new cancers may include multiple primary cancers occurring in one patient. The primary site reported is the site of origin and not the metastatic site.

PrevalencePrevalence is defined as the number or percent of people alive on a certain date in a population who previously had a diagnosis of the disease. It includes new (incidence) and pre-existing cases and is a function of both past incidence and survival. Information on prevalence can be used for health planning, resource allocation, and an estimate of cancer survivorship.

Crude incidence rate (CR)The number of new cancer cases (incidence cases) observed in the population during a defined period , divided by the number of population at risk in the same period .It is usually expressed per 100,000 .

Age-Specific Incidence Rate (ASIR)The number of cancer cases occurring during a specific period in a population of a specific age group and sex, divided by the number of mid-year population of that age group and sex multiplying by 100,000.AR= Ni / Pi x 100,000Ni- Number of new cancer cases occurring in the ith age groupPi – person –years at risk in the ith age group

Age-Standardized Rate (ASR)An age-adjusted rate is a weighted average of the age-specific rates, where the weights are the proportions of persons in the corresponding age groups of a standard population. The potential confounding effect of age is reduced when comparing age-adjusted rates computed using the same standard population.The most frequently used standard population is the world standard populations. The calculated incidence is known as the world standardized incidence rate. The rate is expressed per 100.000 populations.

RankThis measure reflects the importance of a specific cancer site relative to other sites, in terms of the number of registrations. Ranking illustrates the most and least frequent cancer sites in a population according to their frequency.


SurvivalCancer survival statistics are typically expressed as the proportion of patients alive at some point subsequent to the diagnosis of their cancer. Relative survival is an estimate of the percentage of patients who would be expected to survive the effects of their cancer. Observed survival is the actual percentage of patients still alive at some specified time after diagnosis of cancer

MortalityA cancer mortality rate is the number of deaths, with cancer as the underlying cause of death, occurring in a specified population during a year. Cancer mortality is usually expressed as the number of deaths due to cancer per 100,000 population. That is, Mortality Rate = (Cancer Deaths / Population) × 100,000The numerator of the mortality rate is the number of deaths; the denominator is the size of the population. The population used depends on the rate to be calculated. For cancer sites that occur in only one sex, the sex-specific population (e.g., females for cervical cancer) is used. The mortality rate can be computed for a given cancer site or for all cancers combined.

ICD-O-3The World Health Organization’s International Classification of Diseases for Oncology, 3rd Edition has been the standard coding system for neoplasm for over 25 years. The coding system includes a four character code for primary site, a four-digit numeric code for cell type, one-digit code for behavior and a one-digit code for tumor aggressiveness (grade).


ال�شرطانات اخلم�س االكرث �شيوعا بني الذكور

القولون وامل�ستقيم 290 %12.7

الرئة 256 %1.2

الليمفاوي 196 8.6 %

اللوكيميا 189 8.3 %

املثانة 184 8.1 %

القولون وامل�ستقيم 332 %14.2

الرئة 311 %13.3

الربو�ستات 218 9.4 %

املثانة 186 8.0 %

�سرطان الدم 127 5.5 %

ال�شرطانات اخلم�س االكرث �شيوعا بني االناث االردنيات

الثدي 926 36.8 %

القولون وامل�شتقيم 264 %10.5

الليمفاوي 189 %7.5

الغدة الدرقية 140 5.6 %

لوكيميا 114 %4.5

الثدي 941 37.4 %

القولون وامل�ستق 226 9.0 %

الغدة الدرقية 136 5.4 %

ال هوجكنز ملفوما 130 5.2 %

الرحم 127 %5.4

231194اجمايل احلاالت بني االطفال االردنيني للذكور واالناث

136110اجمايل احلاالت بني االطفال الذكور

9584اجمايل احلاالت بني االطفال االناث

توزيع حاالت ال�شرطان االكرث �شيوعا بني االطفال

�شرطانات الدم 36 %

الدماغ واالع�شاب 24 %

الليمفاوية 27 %

الكلى 7 %

الغدة الكظرية والغدد 6 %

�سرطانات الدم %29.9

الدماغ واالع�ساب 21.1 %

الليمفاوية )بنوعيه( %15.5

الكلي %6.7

االن�سجه ال�سامه %5.7


التوزيع الن�شبي حلاالت ال�شرطان بني االردنيني ح�شب املحافظات

1- حمافظات اقليم الو�شط :

عمان %59.8

الزرقاء %10.5

البلقاء %5

مادبا %1.7

2- حمافظات اقليم ال�شمال :

اربد %13.2

املفرق %1.9

جر�س %1.2

عجلون %1.3

3- حمافظات اقليم اجلنوب :

الكرك 2.3 %

الطفيلة 0.8 %

معان 1.1 %

العقبة 0.9 %

حمافظات اقليم الو�سط :

عمان %60.4

الزرقاء %10.2

البلقاء %4.3

مادبا 1.8 %

2- حمافظات اقليم ال�سمال :

اربد %13.5

املفرق %1.6

جر�ش %1.7

عجلون %1.2


الكرك 2.0 %

الطفيلة 0.9 %

معان 1.1 %

العقبة 1.1 %

معدل اال�شابة للجن�شني لكل 100.000 من ال�شكان ح�شب املحافظات

حمافظات اقليم الو�شط :

عمان 123.8

الزرقاء 56.7

البلقاء 59.4

مادبا 54.2

2- حمافظات اقليم ال�شمال :

اربد 59.7

املفرق 31.7

جر�س 31.8

عجلون 43.6


الكرك 46.3

الطفيلة 45.4

معان 45.7

العقبة 34.5

حمافظات اقليم الو�سط :

عمان 123.7

الزرقاء 54.6

البلقاء 50.5

مادبا 57.6

2- حمافظات اقليم ال�سمال :

اربد 60.3

املفرق 27.5

جر�ش 44.7

عجلون 39.8


الكرك 40.7

الطفيلة 49.1

معان 46.5

العقبة 39.8


معدالت احلدوث حلاالت ال�سرطان ح�سب املحافظات لكل 100.000 :

حمافظات الو�سط : عمان 123.7 , الزرقاء 54.6 مادبا 57.6 , البلقاء 50.5

حمافظات ال�سمال : اربد 60.3 , جر�ش 44.7 , عجلون 39.8 و املفرق : 27.5

حمافظات اجلنوب : الكرك 40.7 , الطفيله : 49.1 , العقبة 39.8 ثم معان 46.5

جدول يبني مقارنة اح�سائيات وبع�ض م�ؤ�سرات ال�سرطان للعام 2009 والعام 2010

العام 2010العام 2009املوؤ�شر

65506820اجمايل احلاالت امل�شجلة

47984921اجمايل احلاالت بني االردنيني

17521899اجمايل احلاالت بني غري االردنيني

22802330اجمايل احلاالت بني الذكور االردنيني

25182519اجمايل احلاالت بني االناث االردنيات

5656متو�شط العمر عند الت�شخي�س للجن�شني

5960متو�شط العمر عند الت�شخي�س للذكور

5252متو�شط العمر عند الت�شخي�س لالناث

80.279.4معدل اال�شابة اخلام للجن�شني ) لكل 100.000( من ال�شكان

74.074معدل اال�شابة اخلام للذكور لكل ) 100.000 ( من الذكور

86.985.1معدل اال�شابة اخلام لالناث لكل ) 100.000 ( من االناث

137.1135.1معدل اال�شابة املعاير عمريا للجن�شني لكل )100.000 ( من ال�شكان

132.1132.8معدل اال�شابة املعاير عمريا للذكور لكل ) 100.000 ( من الذكور

معدل اال�شابة املعاير عمريا لالناث

لكل ) 100.000 ( من االناث

143.1138.4

92.885معدل االإ�شابة اخلام لالأطفال للجن�شني لكل مليون

93.194معدل االإ�شابة اخلام لالأطفال للذكور لكل مليون

92.476معدل االإ�شابة اخلام لالأطفال لالناث لكل مليون


Community Based( اإن ال�سجل الوطني لل�سرطان من االأوائل والرواد يف ال�سجالت املجتمعية البيانات من �سجالت ال�سرطان .وحيث

فانه يقوم بتدريب كوادر من الدول العربية . االإقليم يف )Registryعام 2008 مت الغاء مديرية مكافحة ال�سرطان وا�ستحدث ق�سم مكافحة ال�سرطان ومت االبقاء على ال�سجل الوطني لل�سرطان ليتبع كل منهما

اىل مديرية االإمرا�ش غري ال�سارية حيث يتابع ق�سم مكافحة ال�سرطان وال�سجل الوطني لل�سرطان اأعماله من ت�سجيل احلاالت ال�سرطانية

املكت�سفة وتطبيق ن�ساطات اال�سرتاتيجية الوطنية يف جمال مكافحة ال�سرطان يف االأردن. قدم ال�سجل العديد من االأوراق العلمية يف املومترات

املحلية والدولية وقد اأ�سبحت قاعدة البيانات املرتاكمة لدى ال�سجل مق�سد العديد من الباحثني الإجراء الدرا�سات والبحوث العلمية.

اأهم اإح�سائيات التقرير ال�سن�ي اخلام�ض ع�سر لعام 2010يتم جمع احلاالت اعتمادًا على تاريخ الت�سخي�ش من تاريخ 2010/1/1 حتى تاريخ 2010/12/31 , بلغ جمموع احلاالت امل�سجلة )6820 (

حالة منها )4921 ) اردنيني ما ن�سبته 72.2% من اإجمايل عدد احلاالت منها 4849 حاله ذات ال�سلوك اخلبيث لالورام والتي تعتمد يف التحليل

ح�سب املعايري الدولية لتحليل احلاالت ال�سرطانية و72 حالة ذات �سلوك ) In situ( مقارنة مع )4798( حالة يف العام 2009 . وبلغ عدد

احلاالت بني الذكور االأردنيني ) 2330( )48.1( واالإناث 2519 )51.9 %( يف حني بلغ اإجمايل احلاالت بني غري االأردنيني ) 1899( حالة ما

ن�سبته ) 27.8 % ( من جمموع احلاالت.

• ال�سرطانات اخلم�ض الأكرث �سي�عًا بني الأردنيني للجن�سني : احتل �سرطان الثدي املرتبة االأوىل حيث بلغ اإجمايل احلاالت امل�سجلة ب )951( حالة ما ن�سبته 19.6 % تالها �سرطانات القولون وامل�ستقيم

حيث بلغ اإجمايل احلاالت )558( ما ن�سبته 11.5% ثم �سرطان الغدد الليمفاوي )382( حاله )7.9%( ثم �سرطان الرئة )380( حالة ما

ن�سبته 7.8 % . ثم �سرطان الربو�ستات و�سرطانات الدم والدم ) 218( بن�سبة )%4.5( .

• ال�سرطانات اخلم�ض الأكرث �سي�عًا بني الذك�ر كانت على النح� التايل: القولون وامل�ستقيم )332( حاله بن�سبة )14.2%( ثم �سـرطان الرئة )311( حاله ) 13.3%( , �سرطان الربو�ستات ) 218( بن�سبة )%9.4( ,

�سرطان املثانة )186( بن�سبة )8 %( ثم �سرطانات الدم 127 )5.5 %(.

• ال�سرطانات اخلم�ض الأكرث �سي�عًا بني الإناث كانت على النح� التايل : �سرطان الثدي )941( حالة بن�سبة )37.4 %( , القولون وامل�ستقيم ) 226( بن�سبة )9.0 %( , �سرطانات الغدة الدرقية )136( بن�سبة )%4.5(

ثم �سرطانات الليمفوما ال هودجكنز 130 بن�سبة )5.2% ( ثم �سرطان الرحم 113 )4.5%( من جمموع �سرطانات االإناث.

* يف حني بلغ جمموع �سرطانات االأطفال لالأعمار ا�سغر من 15 �سنة )194 حالة( بن�سبة 4 % من جمموع ال�سرطانات الكلي , منها )110( بني

الذكور و ) 84( بني االإناث , حيث كانت موزعة على النحو التايل :

�سرطان واخريا .% 6.7 بن�سبة الكلى �سرطان ثم ,% 15.5 الليمفاوية ال�سرطانات % 21 واالأع�ساب الدماغ �سرطان ,% 30 : الدم �سرطان

االن�سجة ال�سامة 5.7 % .

معدلت الإ�سابة بال�سرطان لعام 2010• املعدل اخلام لالإ�سابة بال�سرطان للبالغني بلغ ) 79.4 ( لكل) مائة اإلف ( من ال�سكان ) للذكور 74.0 ولالإناث 85.1 ( .

• معدل االإ�سابة املعايري عمريا لكل مائة األف من ال�سكان للجن�سني 135.1 ) للذكور 132.8 واالناث 138.4(

• معدل االإ�سابة اخلام لالأطفال فقد بلغ 85 ) لكل مليون طفل ( 94 للذكور و 76 لالناث .

الت�زيع الن�سبي حلالت ال�سرطان ح�سب املحافظات:حمافظات الو�سط: عمان 60 % , , الزرقاء 10.2% البلقاء 4.3% ثم مادبا 1.8 %

حمافظات ال�سمال : اربد 13.5 % , املفرق 1.6 % , عجلون 1.2% ثم جر�ش 1.7 %

حمافظات اجلنوب : الكرك 2.0 % العقبة 1.1 % معان 1.1 % الطفيلة %0.9.


وبائية ال�سرطان لعام 2010التقرير ال�سن�ي اخلام�ض ع�سر لل�سجل ال�طني لل�سرطان

مديرية االأمرا�ش غري ال�سارية - ق�سم مكافحة ال�سرطان - ال�سجل الوطني لل�سرطان

الر�ســالة : تخفيف عبء مر�ش ال�سرطان من خالل خف�ش معدالت االإ�سابة وذلك بتبني �سيا�سات وبرامج وطنية

ملكافحة ال�سرطان تت�سمن زيادة تدابري الوقاية والك�سف والت�سخي�ش املبكر.

الــروؤيا : نحو جمتمع واعي للتدابري الوقائية من ال�سرطان وطرق الك�سف املبكر ومب�ساركة كافة اجلهات الوطنية و�سواًل اإىل معدالت متدنية

من االإ�سابة وبالتايل الوفيات من هذا املر�ش.

الأهـــداف :• اإعداد اإ�سرتاتيجية وخطة وطنية �ساملة ملكافحة مر�ش ال�سرطان يف اململكة.

• الر�سد امل�ستمر ) الذاتي والن�سط( لت�سجيل حاالت ال�سرطان يف اململكة اعتمادًا على املعايري العاملية.

• اإعداد الربامج الوطنية ملكافحة ال�سرطان بناًء على معدالت احلدوث يف اململكة.

• ن�سر الوعي ال�سحي حول اأهمية الك�سف والت�سخي�ش املبكر ملر�ش ال�سرطان.

• اإعداد دالئل اإر�سادية وطنية للك�سف املبكر عن ال�سرطانات االأكرث �سيوعًا ) الثدي, القولون(

ال�سجل ال�طني لل�سرطاناأن�سئ ال�سجل الوطني لل�سرطان كوحدة يف وزارة ال�سحة مبوجب قرار وزاري وترتبط اإداريا مبعايل الوزير يف عام 1996 حيث كانت حاالت

اأ�سبحت جميع حاالت ال�سرطان املكت�سفة وامل�سخ�سة ال�سرطان اخلبيث قبل ذلك ت�سجل من م�ست�سفى واحد يتبع لوزارة ال�سحة . بعد ذلك

اأ�سلوبني يف عملية الر�سد لتلك يف االأردن ومن كافة القطاعات ال�سحية واملختربات تر�سد من خالل ال�سجل الوطني لل�سرطان وذلك باإتباع

اأولها اأ�سلوب الر�سد الذاتي حيث يتم التبليغ الذاتي عن وجود حاالت �سرطانية عن طريق تعبئة ا�ستمارة اأعدت خ�سي�سا تت�سمن احلاالت

جمموعة من البيانات حول املر�ش وتر�سل مبا�سرة اإىل ال�سجل وذلك من خالل حوايل 68 �سابط ارتباط اأكفاء مدربني وموزعني على كافة

امل�ست�سفيات يف القطاعني العام واخلا�ش وم�ست�سفيات اخلدمات الطبية امللكية وم�ست�سفيات اجلامعات باالإ�سافة اإىل املختربات العامة واخلا�سة

اأما الطريقة الثانية املتبعة يف ر�سد حاالت ال�سرطان يف االأردن فهي من خالل الر�سد الن�سط حيث يقوم فريق من كادر ال�سجل الوطني بزيارة

امل�ست�سفيات واملختربات واجلهات ذات العالقة وا�ستنباط احلاالت ال�سرطانية امل�سخ�سة يف تلك االأماكن.

فيما بعد تتم عملية مراجعة وتنقيح للمعلومات والبيانات و عملية الرتميز با�ستخدام )ICD-O3( ومن ثم اإدخال احلاالت اإىل نظام ر�سد يف

احلا�سوب با�ستعمال برنامج معد خ�سي�سًا من قبل معهد البحوث ال�سرطانية IARC ) اإحدى فروع منظمة ال�سحة العاملية WHO ( ويراعي

الذاتية والداخلية الرقابة اآليات وم�ستويات من املدخلة وذلك من خالل عدة ازدواجية يف احلاالت الدقة واحلر�ش لتجنب اأعلى درجات

واأي�سًا الرقابة اخلارجية على جمريات عمل واإجنازات ال�سجل.

بعد االنتهاء من اإدخال كافة احلاالت امل�سخ�سة للفرتة الزمنية املحددة )�سنة( يتم حتليل تلك املعلومات با�ستخدام برامج التحليل االإح�سائية

لي�سار بعد ذلك اإىل اإعداد التقرير ومن ثم ن�سر التقرير ال�سنوي الذي يبني منطية وانت�سار مر�ش ال�سرطان يف االأردن حيث يبني التقرير وجود

خا�ش واآخر االأطفال ب�سرطانات خا�ش جزء اإعداد يتم اجلغرايف.كما والتوزيع واجلن�ش والعمر االإ�سابة مكان حيث من ال�سرطان حاالت

بال�سرطان بني غري االأردنيني يف االأردن.ويتم اأي�سا اإعداد جزء خا�ش بالوفيات ب�سب ال�سرطان موزعة ح�سب اأنواع ال�سرطانات والفئات العمرية

واجلن�ش وكذلك التوزيع اجلغرايف .

وقد عمل ال�سجل على اإيجاد قاعدة بيانات للمر�سى ح�سب املعايري العاملية املتبعة يف ا�ستنباط وترميز وا�ستعمال هذه البيانات يف رفد متخذي

اإ�سدار امل�ستويات واالأ�سعدة )اإدارية وتخطيط وعلمية...( وقد عمل ال�سجل على ال�سرطان على جميع القرار وجميع املهن يف جمال مر�ش

جمع يف الدقة درجات اأعلى على وحفاظا Cancer Incidence واحد عام فرتة يف املكت�سفة ال�سرطانية احلاالت لوجود �سنوي تقرير

وا�ستنباط بجمع العاملني االرتباط ل�سباط التدريبية الدورات من العديد بعقد دوري وب�سكل ال�سجل يقوم ال�سرطانية احلاالت وترميز


وزارة الصحة

مديرية األمراض غير السارية

السجل الوطني للسرطانوبائية السرطان في األردن لعام

2010

المملكة االردنية الهاشمية

اعداد

الدكتور كمال عرقوبالدكتور عمر النمريالدكتور محمد الطراونة

وزارة الصحة

مديرية األمراض غير السارية

السجل الوطني للسرطان

وبائية السرطان في األردن لعام

2010

المملكة االردنية الهاشمية

التقرير السنوي الخامس عشر

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