According to a report from the Digestive Disease Research Center (DDRC) at Tehran Medical Sciences University (TUMS), Dr. Reza Malekzadeh, the Deputy Minister of Health for Research noted that the results of the report from the population-based gastric cancer registry is part of the first, yet most comprehensive and credible official report of cancer according to information from the population from 30 Iranian provinces (76 million and 639 thousand individuals) which was was carried out in 2014; recording an annual incidence of 112,000 cases of cancer nationwide and reporting the age-standardized rate of cancer as 158 per 100,000.
Annual incidence of more than 10,000 cased of stomach cancer in Iran
According to Dr. Malekzadeh, the frequency of cancer cases by sex was 60,432 thousand (53.9%) in men and 51, 628 cases (46.1%) for women.
Additionally, of the 10,498 cases of gastric cancer recorded annually in Iran, 7,150 cases were incidents which were recorded in men, while 3,348 cases occurred in women. In other words, the age-standardized rate of gastric cancer is 21.24 per 100,000 men and 9.44 per 100,000 Iranian women.
The principle-investigator of the largest cohort study in the Middle East and North Africa estimated that the combined incidents of cancer in the gastrointestinal system accounted for approximately 27% of morbidity and mortality from cancer in Iran, of which gastric cancer was the cause of death in 16%.
The most dangerous region in the country for the prevalence of gastric cancer
He further described the Northwest of Iran had the highest risk for the incidence of gastric cancer, while the prevalence of gastric cancer in the North, West, East, South and Central areas of the country respectively ranked from the highest to the lowest.
The Deputy Minister of Health for Research further noted that, "Overall, in terms of the global incidence of gastric cancer with regards to geographical areas around the World, the Northern regions are considered more risky and the incidence of gastric cancer decreases towards the south.”
The ranking of Iranian provinces with regards to the incidence of gastric cancer
• Provinces with extremely high prevalence
Dr. Malekzadeh, identified the provinces of Ardabil, Zanjan, Northern Khorasan, East Azarbaijan, West Azarbaijan, and Central Khorasan as the six provinces with “extremely high prevalence” of gastric cancer, with an incidence equal to, or more than, 30 cases per 100,000.
• Provinces with high prevalence
The provinces of Kurdistan, Ilam, Mazandaran, Golestan, Kohgiluyeh and Boyer Ahmad, Semnan and Lorestan were among the seven provinces with a "high prevalence" of gastric cancer, which are considered to have an incidence of 20 – 30 cases per 100,000.
• Provinces with moderate prevalence
The seven provinces of Qazvin, Tehran, Hamedan, Gilan, Markazi, South Khorasan, and Alborz have a "moderate prevalence" of gastric cancer, which is 15 – 20 cases per 100,000.
• Provinces with low prevalence
The ten provinces of Kerman, Kermanshah, Khuzestan, Fars, Isfahan, Sistan and Baluchestan, Bushehr, Yazd and Hormozgan ranked among provinces with a "low prevalence" of gastric cancer, which is less than 15 cases of gastric cancer per 100,000.
The age of onset and prevalence arte of gastric cancer in Iran
As a collaborating author in the global study for the burden of cancer, Dr. Malekzadeh pointed out another important statistical finding in this regard. Based on the first population-based cancer registry in Iran, the highest incidence of gastric cancer is respectively noted in the age groups of 80 – 84, 75 –79, 70 – 74, 65 – 69 and 60 – 64 among Iranian men and women.
The age of gastric cancer occurrence in Iran is 10 years younger than the world
Dr. Malekzadeh said that the (mean patient age at diagnosis) for gastric cancer in Iran is 10 years younger than the world average: the incidence of gastric cancer in Iran, mainly starts from 50 years of age and above, and rarely occurs under the age of 40, while the age at which the curve spikes and the rate of disease increases is over 60 years.
The Deputy Minister of Health for Research also added that while the global rate of gastric cancer is declining, its prevalence rate has either remained constant or increased in developing countries.
Improvement of the socioeconomic status considered as one of the most important factors for reducing gastric cancer
Dr. Malekzadeh noted improvement of socioeconomic conditions as one of the most important factors for reducing the prevalence rate of cancer, including gastric cancer, in all countries. He further pointed out the risk factors for gastric cancer, mentioning family history, smoking cigarettes, hookah pipes, and opium, the consumption of large quantities of salt, red meat, especially grilled meat, as well as high consumption of full-fat cream, drinking hot beverages, including hot tea, which are very common in the Northern areas of the country, to be among the risk factors for gastric cancer.
The role of Helicobacter pylori (H. pylori) in gastric cancer
As a gastroenterology and hepatology specialist, Dr. Malekzadeh mentioned that infection with H. pylori alone is not a sufficient factor for developing / causing gastric cancer, and other risk factors should also be present. However, he did mention that 90% of people afflicted with gastric cancer are infected with H. pylori.
Gastric cancer, the deadliest cancer in Iran
The head of the DDRI at TUMS noted that gastric cancer is the deadliest cancer in Iran and that the highest site of occurrence is the cardia of the stomach. This cancer is difficult to treat and 80% of patients die within two years after being affected by the disease, which is why prevention is a crucial factor in reducing disease mortality. He also mentioned that an effective vaccine against H. pylori is still not available anywhere in the world, and that the prevention of gastric cancer will become possible with the production of this vaccine.
The positive impact of aspirin consumption on preventing gastric cancer
Dr. Malekzadeh mentioned that taking an 80 mg tablet of aspirin daily (under the prescription of a physician) is extremely effective for the prevention of gastric cancer in men over 40 years and women over the age of 50. He then added that major global research has shown that the use of aspirin is not only effective in preventing gastric cancer, but also other types of cancers, and in countries such as the United States where the incidence of gastric cancer has shown to have decreased considerably, the regular use of this medication is recommended, especially for the prevention of colon cancer.
As a specialist for gastrointestinal and hepatic diseases, he also emphasized the positive impact of the daily consumption of aspirin 80 mg in the prevention of esophageal, gastric and colon cancer, and also recommended that people who are able to tolerate a daily dose of aspirin 80 mg to begin doing so on a regular basis from the age of 50 and for at least 10 years.
The first “population-based cancer registry report in Iran” was put together through the efforts of the three Deputies of Research, Curative Affairs and Health at the Ministry of Health and Medical Education in Iran, which was implemented and accomplished in collaboration with the universities of medical sciences throughout the country as the coordinators of the study. As a result of the high accuracy and quality of its data and information, it was accepted and approved for future publication by the world's most authoritative reference, "Cancer Incidence in Five Continents".
The preparation of this report and its approval by the most authoritative global reference for cancer registries is considered as a remarkable step for Iran, where cancer registry in the country previously faced limitations, difficulties and deficiencies similar to that of other developing countries. This is while the history of cancer registry systems in the world has shown that approximately 70% of all cancer cases occur in developing countries, while most population-based cancer registry systems were located in developed countries. On another hand, unfortunately, most cancer registry systems in developing countries had poor quality performance in collecting the information required for the assessment of cancer cases and incidence.