EPIDEMIOLOGICAL STUDY OF CANCERS AMONG IRAQI PEOPLE IN ONCOLOGY TEACHING HOSPITAL IN MEDICAL CITY IN BAGHDAD FOR 2018

Abstract

Background: Cancer is a generic term for a large group of disease that can affect any part of the body. Other terms used are malignant tumors and neoplasms. Cancer in the second leading cause of death in the world after cardio-vascular disease. Aim: Investigation of cancer in Oncology Teaching Hospital in Medical City in Baghdad. Method: This study include (1152) cases, (542) case have excluded because lake of medical note or diagnosis. Medical notes and histopathological reports of patients with confirmed diagnosis of cancer types between January 2018 to January 2019, were reviewed for age, site and type of cancer. Results: A total of (1152) patients were included in this study. The ages which show high prevalence was (41-60Y) (42.7%) (p<0.01) and (61-80Y) (36.02%) (p<0.01) which show significant relationship between age and cancer types. Most cases were detected in Baghdad (72%) (p<0.05) then Dayala (7.6%) (p<0.05), then Anbar (4.6%) (Non-significant) and wasit (4.5%) (p<0.05) and other sites were non-significant. The most prevalent cancer type generally was gastro-intestinal tract cancer (26.8%) (p<0.01), then respiratory tract cancer (14.3%) (p<0.01), then uterine cancer (8.1%) (p<0.05) and then prostate cancer (6.1%) (Non-significant). Conclusion: The high prevalence and incidence rates of many cancers were concern especially for older ages mainly in Baghdad.

Full text

Al-Akeedi et al. European Journal of Biomedical and Pharmaceutical Sciences
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45
EPIDEMIOLOGICAL STUDY OF CANCERS AMONG IRAQI PEOPLE IN ONCOLOGY
TEACHING HOSPITAL IN MEDICAL CITY IN BAGHDAD FOR 2018
Janan M. Al-Akeedi*1, Nawar A. Abd Noor2 and Mustafa A. J. Alhiti3
1PhD Immunologist and Immunopathophysiology in Al-Farabi College/Baghdad/Iraq.
2FICMS (Immunologist) Oncology Teaching Hospital, Baghdad Medical City / Baghdad / Iraq.
3B.Sc. Agri. (Molecular Genetic) in Pathological Analysis Laboratory, In Biotechnology & Environmental Center, In
Fallujah University/Bagdad / Iraq.
Article Received on 30/03/2020 Article Revised on 20/04/2020 Article Accepted on 11/05/2020
INTRODUCTION
Cancer is among the top four causes of human
mortality.[1] In global epidemiological investigation de
mortal et al., found that 2 millions cases (16%) of 12.7
million newly diagnosis cancer were attributed exposure
to infectious agents with a higher rate recorded in
developing countries.[2] Globally in 2013, there were
(14.9) million incident cancer cases and (8.2) million
cancer related deaths.[3] While the incidence and
mortality rates for most cancers are decreasing in the
United States and among other western countries, the
incidence and mortality rates are both rising in developed
countries.[4]
The Eastern Mediterranean Region (EMR) countries are
experiencing marked variation in cancer incidence.[5] The
incident cancer cases have increased by (46.1%) between
2005 and 2015.[6] The countries registered in EMR are
(United Arab Emirate, Bahrain, Saudi Arabia, Oman,
Qatar and Kuwait) had reported (95, 183) newly
diagnosis cancer cases from January (1998) to December
(2007).[7]
MATERIAL AND METHODS
Study design
A survey of different cancer types in Iraqi males and
females during 2018were designed in order to determine
the age, governorate and types of cancers in Iraq.
Methods
Data of (1152) patients collected from register of
pathological laboratories and from the medical records of
patients from Oncology Teaching Hospital in Medical
city in Baghdad during the period of one year from
January 2018 to January 2019. (452) Cases were
excluded due to luck of medical records and diagnosis.
The information includes age ranged from (1-99y.),
governorate and types of cancer.
Data
All data were analyzed by the statistical analysis system-
SAS (2012) program was to detect the effect of
differences between study parameters. Chi-square test
was used to significant compare between percentage
(0.05 and 0.01 probability) in this study.[8]
SJIF Impact Factor 6.044
Research Article
ejbps, 2020, Volume 7, Issue 6, 45-51.
European Journal of Biomedical
AND Pharmaceutical sciences
http://www.ejbps.com
ISSN 2349-8870
Volume: 7
Issue: 6
45-51
Year: 2020
*Corresponding Author: Janan M. Al-Akeedi
PhD Immunologist and Immunopathophysiology in Al-Farabi College/Baghdad/Iraq.
Email id: Jananmajeed934@gmail.com, Mustafa.j.alhiti@uofallujah.edu.iq
ABSTRACT
Background: Cancer is a generic term for a large group of disease that can affect any part of the body. Other
terms used are malignant tumors and neoplasms. Cancer in the second leading cause of death in the world after
cardio-vascular disease. Aim: Investigation of cancer in Oncology Teaching Hospital in Medical City in Baghdad.
Method: This study include (1152) cases, (542) case have excluded because lake of medical note or diagnosis.
Medical notes and histopathological reports of patients with confirmed diagnosis of cancer types between January
2018 to January 2019, were reviewed for age, site and type of cancer. Results: A total of (1152) patients were
included in this study. The ages which show high prevalence was (41-60Y) (42.7%) (p<0.01) and (61-80Y)
(36.02%) (p<0.01) which show significant relationship between age and cancer types. Most cases were detected in
Baghdad (72%) (p<0.05) then Dayala (7.6%) (p<0.05), then Anbar (4.6%) (Non-significant) and wasit (4.5%)
(p<0.05) and other sites were non-significant. The most prevalent cancer type generally was gastro-intestinal tract
cancer (26.8%) (p<0.01), then respiratory tract cancer (14.3%) (p<0.01), then uterine cancer (8.1%) (p<0.05) and
then prostate cancer (6.1%) (Non-significant). Conclusion: The high prevalence and incidence rates of many
cancers were concern especially for older ages mainly in Baghdad.

Al-Akeedi et al. European Journal of Biomedical and Pharmaceutical Sciences
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46
RESULT
A total of (1152) subjects were diagnosed with deferent
types of cancer in the Oncology Teaching Hospital in
Medical city in Baghdad during 2018. The data showed
high percentage and prevalence age specific rate in the
range (41-60y.) (42.7%), then the age (61-80y.)
(36.02%), as shown in table (1) and (2).
Table (1): Frequency of ages of cancer types monthly during 2018.
Month
1-20
years
21-40
years
41-60
years
61-80
years
81-99
years
Total
Chi-Square
(X2)
1
1
0.7%
27
19.7%
52
37.4%
50
36.4%
7
5.1%
137
10.83 **
2
6
5.1%
12
10.3%
52
44.8%
40
34.4%
6
5.1%
116
10.06 **
3
2
2.9%
5
7.4%
35
52.2%
20
29.8%
5
7.4%
67
11.48 **
4
2
4.4%
8
17.7%
15
33.3%
20
44.4%
0
0%
45
9.85 **
5
0
0%
20
18.1%
50
45.4%
40
36.3%
0
0%
110
11.37 **
6
0
0%
10
15.3%
37
56.9%
18
27.6%
0
0%
65
11.61 **
7
1
2.3%
1
2.3%
13
30.9%
25
59.5%
2
4.7%
42
11.94 **
8
2
5%
10
25%
11
27.5%
16
40%
1
2.5%
40
9.33 **
9
3
2.8%
25
23.5%
39
36.7%
35
33.01%
4
3.7%
106
9.08 **
10
4
3.8%
17
16.3%
55
52.8%
27
25.9%
1
0.9%
104
10.73 **
11
5
3.3%
17
11.4%
57
38.5%
65
43.9%
4
2.7%
148
9.62 **
12
5
2.9%
25
14.5%
76
44.1%
59
34.3%
7
4.06
172
10.57 **
Chi-Square (X2)
1.08
NS
6.97
**
8.55
**
8.91
**
2.47
NS
--
_
** (P<0.01), NS: Non-Significant
Table (2): Demonstrate the Percentage of Age Range
During 2018.
Age Range
Percentage
1-20 Years
2.6 %
21-40 Years
15.3 %
41-60 Years
42.7 %
61-80 Years
36.02 %
81-99 Years
6.3 %
Baghdad showed higher frequency of different cancer
types (72%), then Dayala (7.6%), Anbar (4.6%) (Non-
significant) and Wasit (4.5%), than others. As show in
table (3) and (4).

Al-Akeedi et al. European Journal of Biomedical and Pharmaceutical Sciences
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47
Table (3): Showed the Frequency of cancer types in different area of Iraq monthly during 2018.
Month
Baghdad
Anbar
Salahalden
Wasit
Dayala
Babel
Karbala
Najaf
Maysan
Basra
Naseria
Samaia
Dewania
Kirkuk
Irbel
Mosul
Total
Chi-Square
(X2)
1
105
76.6%
9
6.5%
4
2.9%
6
4.3%
8
5.8%
3
2.1%
0
0%
1
0.7%
0
0%
0
0%
1
0.7%
0
0%
0
0%
0
0%
0
0%
0
0%
137
12.48 **
2
83
71.5%
5
4.3%
4
3.4%
4
3.4%
6
5.17%
5
4.3%
2
1.7%
0
0%
0
0%
0
0%
4
3.4%
0
0%
0
0%
1
0.8%
1
0.8%
1
0.8%
116
12.18 **
3
44
65.6%
4
5.9%
1
1.4%
0
0%
10
14.9%
3
4.4%
2
2.9%
0
0%
0
0%
0
0%
0
0%
0
0%
1
1.4%
0
0%
0
0%
2
2.9%
67
11.73 **
4
36
80%
3
6.6%
1
2.2%
0
0%
4
8.8%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
1
2.2%
45
13.47 **
5
89
72.7%
6
5.4%
4
3.6%
4
3.6%
10
9.09%
1
0.9%
2
1.8%
2
1.8%
1
0.9%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
110
12.36 **
6
46
70.7%
2
3.07%
3
4.6%
3
4.6%
9
13.8%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
1
1.5%
1
1.5%
0
0%
0
0%
65
10.47 **
7
33
78.5%
2
4.7%
0
%
4
9.5%
2
4.7%
0
0%
0
0%
1
2.3%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
42
12.84 **
8
28
70%
1
2.5%
0
0%
2
5%
6
15%
3
7.5%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
40
10.36 **
9
70
66.03%
8
7.5%
2
1.8%
8
7.5%
5
4.7%
4
3.7%
0
0%
1
0.9%
3
2.8%
0
0%
1
0.9%
0
0%
1
0.9%
3
2.8%
0
0%
0
0%
106
10.02 **
10
72
69.2%
3
2.8%
7
6.78%
4
3.8%
10
9.6%
3
2,8%
0
0%
1
0.9%
2
1.9%
1
0.9%
0
0%
1
0.9%
0
0%
0
0%
0
0%
0
0%
104
11.47 **
11
110
74.3%
2
1.3%
8
5.4%
5
3.3%
10
6.7%
2
1.3%
1
0.6%
2
1.3%
0
0%
0
0%
5
3.3%
0
0%
0
0%
0
0%
0
0%
3
2.02%
148
12.04 **
12
124
72.09%
8
4.6%
3
1.7%
12
6.9%
8
4.6%
6
3.4%
1
0.5%
3
1.7%
0
0%
0
0%
0
0%
2
1.2%
1
0.5%
1
0.5%
0
0%
3
1.7%
172
11.93 **
Chi-Square (X2)
5.03 *
2.07
NS
2.32
NS
4.63 *
5.11 *
2.74
NS
0.84
NS
0.72
NS
0.76
NS
0.24%
0.93
NS
0.33
NS
0.41
NS
0.52
NS
0.07
NS
0.73
NS
--
__
* (P<0.05), ** (P<0.01), NS: Non-Significant

Al-Akeedi et al. European Journal of Biomedical and Pharmaceutical Sciences
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48
Table (4): Show the frequencies of many cancer types
in Iraq during 2018.
Site
Percentage
Baghdad
72 %
Anbar
4.6 %
Salah Alden
3.2 %
Wasit
4.5 %
Dayala
7.6 %
Babel
2.6 %
Karbala
0.6 %
Najaf
0.9 %
Mesan
0.5 %
Basra
0.08 %
Naseria
0.9 %
Samaoa
0.2 %
Dewania
0.3 %
Kirkuk
0.5 %
Erbil
0.08 %
Mosul
0.8 %
The data also showed that the prevalence of gastro-
intestinal tract higher than other cancers (26.8%)
(P<0.01), then respiratory tract cancers (14.3%), then
uterus (8.1%), and then the prostate cancer (6.1%) (Non-
significant) than other types as illustrated in table (5) and
(6).
Table (5): Illustrate percentage of each type of cancer
during 2018.
No.
Cancer Types
Percentage
1
Gastro intestinal tract
26.8 %
2
Respiratory tract
14.3 %
3
Pancreas
2.6 %
4
Skin
4.6 %
5
Kidney
5.3 %
6
Urethra
1.9 %
7
Bladder
1.8 %
8
Testis
1.3 %
9
Prostate
6.1 %
10
Bone
3.03 %
11
Brain
0.5 %
12
Hodgkin’s
0.1 %
13
Non- Hodgkin’s
1.2 %
14
Uterus
8.1 %
15
Ovary
4.5 %
16
Soft Tissue
2.6 %
17
Liver
2.4 %
18
Thyroid
2.8 %
19
Lymphatic System
2.0 %

Al-Akeedi et al. European Journal of Biomedical and Pharmaceutical Sciences
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Table (6): Show the Frequency of different type of cancer in monthly during 2018.
Month
Gastro
intestinal
Respirato
ry
Pancreas
Skin
Kidney
Urethra
Bladder
Testis
Prostate
Bone
Brain
Hodgkin’s
Non -
Hodgkin’s
Uterus
Ovary
Soft
Tissue
Liver
Thyroid
Lymphati
c’s
Total
Chi-
Square
(X2)
1
23
16.7%
20
14.5%
3
2.1%
13
9.4%
11
8.02%
1
0.7%
3
2.1%
3
2.1%
13
9.4%
3
2.1%
8
12.1%
5
3.6%
1
0.7%
13
9.4%
6
4.3%
1
0.7%
3
2.1%
4
2.9%
2
1.04%
137
6.25
**
2
22
18.9%
20
17.2%
4
3.4%
9
7.7%
4
3.4%
4
3.4%
1
0.8%
0
0%
8
6.8%
4
3.4%
10
8.6%
3
2.5%
2
1.7%
10
8.6%
3
2.5%
3
2.5%
2
1.7%
3
2.5%
4
3.4%
116
6.87
**
3
26
38.8%
7
10.4%
3
4.4%
2
2.9%
3
4.4%
0
0%
1
1.4%
0
0%
3
4.4%
1
1.4%
7
10.4%
0
0%
0
0%
7
10.4%
2
2.9%
2
2.9%
2
2.9%
0
0%
1
1.4%
67
9.52
**
4
14
31.1%
12
26.6%
1
2.2%
0
0%
0
0%
1
1.2%
1
2.2%
1
2.2%
2
4.4%
2
4.4%
2
4.4%
1
2.2%
0
0%
4
8.8%
0
0%
2
4.4%
0
0%
2
4.4%
0
0%
45
8.77
**
5
26
23.6%
21
19.09%
0
0%
4
3.6%
5
4.5%
2
1.8%
1
0.9%
3
2.7%
10
9.09%
0
0%
6
5.4%
4
3.6%
3
2.7%
6
5.4%
5
4.5%
1
0.9%
3
2.7%
5
4.5%
5
4.5%
110
7.03
**
6
22
33.8%
8
12.3%
2
3.07%
3
4.6%
1
1.5%
2
3.7%
0
0%
1
1.5%
2
3.7%
1
1.5%
4
6.1%
2
3.07%
1
1.5%
4
6.1%
7
10.7%
1
1.5%
4
6.1%
0
0%
0
0%
65
8.63
**
7
13
30.9%
10
23.8%
3
7.1%
1
2.3%
2
4.7%
0
0%
1
2.3%
0
0%
3
7.1%
1
2.3%
2
4.7%
0
0%
1
2.3%
2
4.7%
1
2.3%
0
0%
2
4.7%
0
0%
0
0%
42
8.47
**
8
14
35%
2
5%
2
5%
2
5%
2
5%
0
0%
0
0%
1
2.5%
4
10%
3
7.5%
1
2.5%
0
0%
0
0%
5
12.5%
3
7.5%
1
2.5%
0
0%
0
0%
0
0%
40
7.92
**
9
32
30.1%
5
4.7%
3
2.8%
1
0.9%
9
8.4%
9
8.4%
3
2.8%
0
0%
4
3.7%
3
2.8%
5
4.7%
2
1.8%
0
0%
12
11.3%
6
5.6%
4
3.7%
1
0.9%
1
0.9%
1
0.9%
106
7.86
**
10
47
45.1%
15
14.4%
2
1.9%
5
4.8%
5
4.8%
1
0.9%
0
0%
1
0.9%
2
1.9%
4
3.8%
3
2.8%
0
0%
0
0%
5
4.8%
6
5.7%
3
2.8%
0
0%
3
2.8%
3
2.8%
104
10.26
**
11
37
25%
21
14.1%
2
1.3%
6
4.5%
12
8.1%
2
1.3%
4
2.7%
4
2.7%
6
4.05%
7
4.7%
6
4.05%
3
2.02%
5
3.3%
13
8.7%
5
3.3%
3
2.02%
3
2.02%
4
2.7%
4
2.7%
148
10.50
**
12
33
19.1%
24
13.9%
5
2.9%
7
4.6%
8
4.6%
1
0.5%
6
3.4%
2
1.16%
14
8.1%
6
3.4%
12
6.9%
2
1.16%
1
0.5%
13
7.5%
8
4.6%
9
5.2%
8
4.6%
4
2.3%
4
2.3%
172
6.87
**
1152
Total
Chi-
Square
(X2)
8.37
**
7.55
**
2.38
NS
4.58
*
2.41
NS
4.33
*
0.87
NS
0.90
NS
2.48
NS
0.97
NS
4.72
*
0.84
NS
0.77
NS
4.19
*
1.73
NS
1.66
NS
0.86
NS
0.71
NS
0.63
NS
--
--
* (P<0.05), ** (P<0.01), NS: Non-Significant

Al-Akeedi et al. European Journal of Biomedical and Pharmaceutical Sciences
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50
DISCUSSION
The Iraqi people are sometime colloquially,
Mesopotamians or other people.[9] The total population
of Iraq 38,872,655 according to the latest statistical data.
The number of patients with cancer disease is also
expected to increase in association with the increase of
population. Cancer surveillance, a key attribute of
epidemiology and public health practice, provides
intelligence data on the burden of different types of
cancer in a specified population and through evidence
based on health programs, assesses the success of actions
against cancer.[10] The study demonstrated that high
prevalence in age groups (41-60y.) & (61-80y.) (42.7%
& 36.02%) respectively than other age groups. Advanced
age is important risk factor of cancer and associated with
poor prognosis. Approximately half of all malignancies
are diagnosed in patients older than (65 years).[11] Aging
is a complex process that deeply affects the immune
system. The decline of immune system with age is
reflected in the increase susceptibility to disease, poorer
response to vaccination, increase prevalence of cancer,
auto-immune disease and other chronic diseases.[12]
Aging also characterized by a progressive loss of
physiological integrity leading to impaired function. This
deterioration is the primary risk factor for major
pathologies including cancer.[13]
The study revealed that Baghdad showed higher
incidence of different cancer types (72%), then Dayala
(7.6%), Anbar (4.6%), and Wasit (4.5%), as mentioned
in the results. The increasing incidence in Baghdad due
to high risk of exposure to different war contaminants
because it’s the political capital of Iraq. While Dayala,
Anbar and Wasit beside the war factor, is the exposure to
organo-chlorines which include pesticides which were
used in agricultural process, these chemical as
carcinogenic agents.[14] Also Baghdad has developed
cancer detection centers more than the rest of
governorates.
Gastrointestinal tract cancer showed high prevalence
(26.8%), and then respiratory tract cancers (14.3%), then
Uterine cancer (8.1%), then prostate cancer (6.1%) than
other types. This higher incidence of gastrointestinal
tract cancer is generally seen in high-income countries,
while gastric and esophageal cancers are generally seen
in low-income countries.[15] The gene expression pattern
of human colon comprises a very heterogeneous group of
disease driven by vast array mutations and mutagenes.[16]
There are many predisposing factors in gastrointestinal
cancers and Colon Rectal Cancer (CRC) which is age,
Inflammation Bowel Disease (IBD), abdominal
radiation, cystic fibrosis.[17]
Respiratory tract cancer usually uncommon in people
younger than (55 years) as it’s partly a disease of
aging.[18] Other factors are high pollution due to diesel-
fueled of electric generators that are present in Iraq and
high traffic load.[19] Inherited variant alleles of the genes
that encode glutathione-s-transferases (GSTM1 and
GSTT1) protein involved in metabolism of tobacco
carcinogenes (Cytochrome P450 – CYP 1Z1 genes) as
well as other genes responsible for DNA damage repair
are associated with increase susceptibility to respiratory
tract cancer especially the lungs.[20] Respiratory tract
cancer is the most commonly diagnosis cancer
worldwide and the leading cause of mortality.[21] Uterine
cancer is a top-ranking women cancer worldwide with
wide increase variation across countries and by rural and
urban area.[22] Abnormal uterine bleeding is most
common presenting symptom for women diagnosed with
endometrial cancer. Although genetic factors account for
a small percentage of women.[23]
Prostate cancer develops in the gland of the male
reproductive system.[24] Prostate cancer increase rapidly
during the last few years, the heterogeneity in the
genomic landscape of metastatic prostate cancer has
become apparent through several comprehensive
profiling efforts, but little is known about the impact of
this heterogeneity on clinical outcome.[25] The
gastrointestinal microbiome may help a role though
metabolism of estrogen, an increase of which has been
killed to the induction of prostatic neoplasia. Specific
microbiota such as bacteroides, streptococcus,
fecalibacterium, prausnitzii, Mycoplasma genitalium, has
been associated with differing risk of prostate cancer
development or extensiveness of prostate cancer disease.
The microbiome has the ability to regulate chemotherapy
of prostate cancer treatment.[26]
At the international level, the burden of cancer in
absolute numbers continues to increase mainly due to the
aging of population in many countries and the overall
growth of the world population.
In addition changing lifestyle with increasing cancer
causing behaviors, like cigarettes smoking, changing
dietary habits and sedentary life are among other, major
contibutory risk factors (27). Some other factor like
incomplete pregnancies and hysterectomy which affect
ovarian cancer.[28] Obesity factor which increased risk for
Hodgkin’s Lymphoma (HL).[29] Radio frequency, or
mobile phone possible carcinogenic to human and
expose to gliomas and acoustic neuromas.[30]
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