Marked increase in breast cancer incidence in young women: A 10-year study from Northern Iran, 2004-2013.

INTRODUCTION: Breast cancer is the most frequent cancer among women worldwide. Breast cancer incidence in young women is a health issue of concern, especially in middle-income countries such as Iran. The aim of this study is to report the breast cancer incidence variations in Golestan province, Iran, over a 10-year period (2004-2013). METHODS: We analyzed data from the Golestan Population-based Cancer Registry (GPCR), which is a high-quality cancer registry collecting data on primary cancers based on standard protocols throughout the Golestan province. Age-standardized incidence rates (ASRs) and age-specific incidence rates per 100,000 person-years were calculated. Time trends in ASRs and age-specific rates were evaluated using Joinpoint regressions. The average annual percentage change (AAPC) with correspondence 95% confidence intervals (95%CIs) were calculated. RESULTS: A total of 2106 new breast cancer cases were diagnosed during the study period. Most cases occurred in women living in urban areas: 1449 cases (68%) versus 657 cases (31%) in rural areas. Statistically significant increasing trends were observed over the 10-year study period amongst women of all ages (AAPC = 4.4; 95%CI: 1.2-7.8) as well as amongst women in the age groups 20-29 years (AAPC = 10.0; 95%CI: 1.7-19.0) and 30-39 years (AAPC = 5.1; 95%CI: 1.4-9.0). CONCLUSION: The incidence of breast cancer increased between 2004 and 2013 in Golestan province amongst all age groups, and in particular amongst women aged 20-39 years. Breast cancer should be considered a high priority for health policy making in our community.

Building cancer registries in a lower resource setting: The 10-year experience of Golestan, Northern Iran.

INTRODUCTION: The Golestan population-based cancer registry (GPCR) was established in Golestan province, Northern Iran, within the Asian belt with predominance of upper-gastrointestinal cancers. We aimed to present the experiences of the registry in a resource-limited setting over the 10 years since its inception (2004-2013). METHODS: The GPCR was established as a research project to enable sustainable funding. A clear plan was developed for use of the GPCR data. New primary cancers were registered based on international standards, indices of data quality were routinely assessed and age-standardized incidence rates (ASR) per 100,000 person-years calculated using IARC's CanReg-5 software. RESULTS: Overall, 19807 new cancer cases were registered during the study period, an average of 1981 cases per annum, with overall ASR of 175.0 and 142.4 in males and females, respectively. The GPCR data suggested gastrointestinal and breast cancers as the most common malignancies in Golestan province. We observed increasing incidence rates of breast and colorectal cancers but declining trends of esophageal cancer. Overall, indices of data quality were within acceptable ranges. CONCLUSIONS: The GPCR data have been included in IARC's Cancer Incidence in Five Continents series, were used in 21 research projects, and published as 30 research papers. The key ingredients for the successful establishment and maintenance of the GPCR included sustainable sources of funding, a clear action plan for the use of data as well as stakeholder cooperation across all areas of the registration. The GPCR may be considered as a model for planning population-based cancer registries in lesser-resourced settings.

Epidemiology of leukemia and multiple myeloma in Golestan, Iran.

BACKGROUND: The aim of this paper was to present the incidence rates of leukemia and multiple myeloma (MM) in Golestan province located in northeastern Iran during 2004-2009. MATERIALS AND METHODS: This was a descriptive cross-sectional study. Data on newly diagnosed (incident) leukemia and MM cases were obtained from collected from Golestan population-based cancer registry. Data was entered into CanReg-4 software. Age standardized incidence rates (ASR) (per 100000 person-years) for leukemia and MM were calculated. Data on Golestan population was obtained from the data of Iranian national census in 2006. RESULTS: Totally, 11036 new cancer cases were registered in GPRC from 2004-2009. Leukemia and MM accounted for 693 and 124 of cases, respectively. The mean age in patients with leukemia and MM was 43.8 and 62.4 years, respectively. The ASRs for leukemia among men and women were 10.4 and 7.8, respectively (p<0.001). The ASRs for MM were 2.1 and 2 in men and women, respectively (p=0.93). The rate of leukemia was significantly higher in rural areas (p=0.02) whereas the incidence of MM was higher in urban areas (p<0.001). CONCLUSIONS: Our results showed a high incidence rate of leukemia in Golestan province of Iran. The incidence of leukemia was significantly higher in males and residents of rural areas. High exposure to pesticides and other agricultural related products may be a possible explanation for epidemiological pattern of leukemia in this area. Determining and controlling important risk factors, especially environmental factors, of leukemia may lead to decrease in its burden in Golestan province of Iran.

Goiter frequency is more strongly associated with gastric adenocarcinoma than urine iodine level.

PURPOSE: We designed our study to evaluate the hypothesis that gastric cancer is correlated with iodine deficiency or thyroid dysfunction. MATERIALS AND METHODS: We investigated the total body iodine reserve, thyroid function status and autoimmune disorder in 40 recently diagnosed gastric adenocarcinoma cases versus 80 healthy controls. The participants came from a region with high gastric cancer rate but sufficient iodine supply due to salt iodination. The investigation included urine iodine level, thyroid gland clinical and ultrasonographic examination, and thyroid function tests. RESULTS: Goiter was detected more frequently in the case group (P=0.001); such a finding, however, was not true for lower than normal urine iodine levels. The free T3 mean level was significantly lower in the case group compared to the control group (P=0.005). CONCLUSIONS: The higher prevalence of goiter rather than low levels of urinary iodine in gastric adenocarcinoma cases suggests that goiter, perhaps due to protracted but currently adjusted iodine deficiency, is more likely to be associated with gastric adenocarcinoma compared to the existing iodine deficiency itself.