Cancer Pattern among Adults in Najran, Saudi Arabia - 2014-2019

Abstract

Background: Najran is one of the thirteen regions in Saudi Arabia, located in the southwest of the country with a recently established oncology center and cancer registry. This paper describes for the first time the incidence of cancer in this region which has a unique geographic and demographic attribute. Methodology: This is a retrospective descriptive study that included all adult (diagnosis age >14 years) cancer patients captured by Najran regional cancer registry in the period of 2014 to 2019. Available data, including demographics, diagnosis, site of the tumor, and histopathology were analyzed. Pediatric malignancies were excluded. During the studied period, a regional registry was established and linked to the central Saudi Cancer Registry. All confirmed cancer cases in Najran were captured in this registry. Results: The Total number of records was 1600 diagnosed over a 6-year period (range, 200-330 per year). More females were reported (54.6%) than males (45.4%). The median age was 52 years (SD, ±19). The three most common cancers were breast (14.2 %), thyroid (11.8%), and Colorectal (8.4%). Among the females, breast (25.3%) was the most common cancer followed by thyroid (16.7%), and colorectal (7%); while in males, colorectal cancers (10.2%), hepatocellular carcinoma (6.7%), and leukemia (6.6) were the most common. Conclusions: Breast cancer in females and colorectal cancer in males were the most frequent types of solid malignancies in Najran, Saudi Arabia. Our study shows that the pattern of cancers bears some similarities with the national and Gulf data with some differences that warrant further exploration.

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International Journal of Innovative Research in Medical Science (IJIRMS)
Volume 05, Issue 10, October 2020,
https://doi.org/10.23958/ijirms/vol05-i10/979
www.ijirms.in
485
Original article
Cancer Pattern among Adults in Najran, Saudi
Arabia - 2014-2019
Ahmed M. Badheeb *, Nadeem M. Nagi, Mohamed A. Badheeb
Oncology Center, King Khalid Hospital- Najran Saudi Arabia
Corresponding Author: Prof. Ahmed M. Badheeb, MD; badheebdr@gmail.com
Received: 09 October 2020; Accepted: 23 October 2020; Published: 26 October 2020
Abstract
Background: Najran is one of the thirteen regions in Saudi Arabia, located in the southwest of the country with a recently established oncology
center and cancer registry. This paper describes for the first time the incidence of cancer in this region which has a unique geographic and
demographic attribute. Methodology: This is a retrospective descriptive study that included all adult (diagnosis age >14 years) cancer patients
captured by Najran regional cancer registry in the period of 2014 to 2019. Available data, including demographics, diagnosis, site of the tumor,
and histopathology were analyzed. Pediatric malignancies were excluded. During the studied period, a regional registry was established and
linked to the central Saudi Cancer Registry. All confirmed cancer cases in Najran were captured in this registry. Results: The Total number of
records was 1600 diagnosed over a 6-year period (range, 200-330 per year). More females were reported (54.6%) than males (45.4%). The
median age was 52 years (SD, ±19). The three most common cancers were breast (14.2 %), thyroid (11.8%), and Colorectal (8.4%). Among the
females, breast (25.3%) was the most common cancer followed by thyroid (16.7%), and colorectal (7%); while in males, colorectal cancers
(10.2%), hepatocellular carcinoma (6.7%), and leukemia (6.6) were the most common. Conclusions: Breast cancer in females and colorectal
cancer in males were the most frequent types of solid malignancies in Najran, Saudi Arabia. Our study shows that the pattern of cancers bears
some similarities with the national and Gulf data with some differences that warrant further exploration.
Keywords: Saudi Cancer Registry, Incidence, Najran, Saudi Arabia
Introduction
Cancer is a leading cause of death worldwide in countries of all
income levels. The incidence and mortality are expected to increase
rapidly as populations grow, age, and adopt lifestyle risk factors
that increase cancer risk such as tobacco use, physical inactivity,
obesity, and reproductive patterns are increasingly worldwide [1].
“In 2018, cancers accounted for over 9.6 million deaths and
there were more than 18.1 million new cases worldwide. The most
commonly diagnosed cancers worldwide are lung, breast, and
colorectal cancers. The most common causes of cancer death are
lung, stomach, and liver cancers “(The International Agency for
Research on Cancer 2018) [2].
In Saudi Arabia, breast, colorectal cancers are the
commonest type of cancers followed by the thyroid, Non-Hodgkin
lymphoma, and leukemia [3].
The aim of this paper is to describe the pattern of cancer in
Najran region and to explore the association with age, sex, and site
of cancer according to the international classification of disease
(oncology).
Materials and Methods
This is a retrospective descriptive study that included all adult
(diagnosis age >14 years) cancer patients captured by Najran
regional cancer registry in the period of 2014 - to 2019. Available
data, including demographics, diagnosis, site of tumor, and
histopathology was analyzed. Pediatric malignancies were
excluded. During the studied period, a regional registry was
established and linked to the central Saudi Cancer Registry. All
confirmed cancer cases in Najran, were captured in this registry.
The cancers were arranged according to the affected organ
to specify the most affected site in both males and females. The
data were analyzed to find percentages, means, and standard
deviations. All confirmed cancer cases that from Jan 2014 to
December 2019 were revised retrospectively. The cases identified
from the cancer registry. Demographic, clinical, and
histopathological data had been collected.
Results
The Total number of cases was 1600 for the period 2014-2019.
Cancer was more frequent in females (54.6%) than males (45.4%)
(figure1).

International Journal of Innovative Research in Medical Science (IJIRMS)
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486
Figure: Distribution of cases by sex
The median age was 52 years with a standard deviation (SD) of 19.
The three most common cancers were breast (14.2 %), thyroid
(11.8%), and Colorectal (8.4%). Among the females, breast
(25.3%) was the most common cancer followed by thyroid
(16.7%), and colorectal (7%). On the other hand, colorectal cancers
(10.2%), hepatocellular carcinoma (6.7%), and leukemia (6.6) were
the most prevalent among males. The five most common types
were breast (14.2 %), thyroid (11.8%), and Colorectal (8.4%),
gastric (4.8%), and leukemia (4.7%). (Table 1)
Table 1: The 10 Most Common Cancers
Site of Cancer
Number
% of all sites
1
Breast
228
14.2
2
Thyroid
189
11.8
3
Colorectal
135
8.4
4
Gastric
77
4.8
5
Leukemia
75
4.7
6
NHL
74
4.6
7
Liver
72
4.5
8
Head & Neck
56
3.5
9
Pancreas
55
3.4
10
Brain
53
3.3
All sites total
1600
100.0%
Regarding topographic distribution by sex, the five major cancers
in males were colorectal (10.2 %), liver (6.7), leukemia (6.6%),
NHL (6.2%), & gastric (6.1%), (Table 2), while in females, the
most common cancers were breast (25.3%), thyroid (16.7%),
colorectal (7 %), ovarian(5.8%), and gastric (3.8%) (Table:3).
Table 2: The 10 Most Common Male Cancers
Site of Cancer
% of all sites
1
Colorectal
10.2
2
Liver
6.7
3
LEUKEMIA
6.6
4
NHL
6.2
5
Gastric
6.1
6
THYROID
5.9
7
HEAD & NECK
5.8
8
BLADDER
5.6
9
Brain
4.7
10
Pancreatic
4.4
Table 3: The10 Most Common Female Cancers
Site of Cancer
% of all sites
1
Breast
25.3
2
THYROID
16.7
3
Colorectal
7.0
4
OVARIAN
5.8
5
Gastric
3.8
6
Uterine
3.4
7
NHL
3.3
8
LEUKEMIA
3.1
9
Hodgkin’s Lymphoma
2.7
10
Liver
2.6
Discussion
This study was performed to analyze the incidence of cancer
among adults at Najran region in Saudi Arabia constitutes of six
governorates (Najran, Sharourah, Yadama, Thar, Haboona, &
Badr-Aljanoob) with a population of 408,272 according to “2010
census” [4].
The results of our study showed that the malignancies were
more frequent in females (54.6%) than males (45.4%), and this is
similar to the National Saudi Cancer registry data were the females
(53.8%) while the males (46.2%).
The top ten cancers in this study were breast, thyroid,
colorectal, gastric, leukemia, Non-Hodgkin’s Lymphoma, liver,
head & neck, pancreas, and brain. There is a similarity in the
incidence of breast cancer (the first) & leukemia (the fifth position)
with the Saudi cancer registry 2015 and the Gulf Cooperation
Council (GCC) results [5,6].
Thyroid cancer as the fastest growing cancer in terms of its
incidence comes as the second common cancer (11.8%) which is
higher than the national (8.5%), GCC (6.3%), and the international
figures, this may be related to two factors, the first one is the
overdiagnosis by the fine needle aspiration biopsy, while the
second possible cause is the low iodine intake in Najran region as
showed in meta-analysis where a higher intake of dietary iodine
was as a protective factor against thyroid cancer [7-9].
Although our study showed a lower incidence of the
colorectal (8.4%) in comparison with the national figure of 12.2 %
we are in concordance with the GCC (9%) and the world (10%).
Gastric cancer ranked as the fourth (4.8%), while not seen
among the top 10 national cancers, but we are again in concordance
with the GCC, where the gastric cancer is the 8th one (3.4%) and
all over the world as the fifth (5.7%) [10].
The most commonly diagnosed cancer worldwide is the
lung cancer, while our study showed a low incidence of this cancer
(2.8%) mostly as a result of the lower prevalence of tobacco
smoking in Najran in contradictory to the higher prevalence of
tobacco chewing that may explain the higher incidence of head &
neck cancer (8th, 3.5%) as a unique finding differs from the local
& worldwide figures [11].
Our study showed pancreatic cancers among the top ten
with global similarity where about 338000 people had pancreatic
cancer in 2012 worldwide, making it the 11th most common
cancer. To date, the causes of pancreatic cancer are still
insufficiently known, although certain risk factors have been
identified, such as smoking, obesity, genetics, diabetes, diet,
inactivity. Our figures are higher than the national and GCC
figures, this warrants further exploration [9].
In males, the incidence of male genital system
malignancies (including prostate cancers), like other Arabian Gulf
and Asian countries, is very low compared to Western despite the

International Journal of Innovative Research in Medical Science (IJIRMS)
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487
high intake of calories and high consumption of animal fat [12-14].
This may be attributed to the lack of prostate screening programs
[15].
Conclusion
In conclusion, breast cancer in females and colorectal cancer in
males were the most frequent types of solid malignancies in
Najran, Saudi Arabia. Our results generally indicate that the pattern
of the most common registered cancer bears some similarities with
the national and Gulf data with some differences that warrant
further exploration.
Ethics approval and consent to participate
This study was conducted after approval of the Cancer Research
Committee in the oncology Department at King Khalid Hospital in
Najran. No informed consent needed for this type of study with no
extra burden for participants and anonymized data.
Data Availability
Data are available at Saudi Cancer Registry - Najran and it will be
included in the periodic report of the national registry.
Conflicts of Interest
The authors declare that there is no conflict of interest regarding
the publication of this paper.
Funding Statement
The research and publication of this article was self-funded.
Authors' contributions
AB analyzed and interpreted the patient data. NN and MB
performed were contributors in writing the manuscript. All authors
read and approved the final manuscript.
Acknowledgments
The authors would like to acknowledge Mrs. Rahma Mabkhoot at
the Saudi Cancer Registry Office, King Khalid Hospital - Najran
for her cooperation, to Dr. Iyad Sultan for reviewing the paper, and
to the colleagues in the oncology team for caring for cancer
patients and to their families.
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