A Survey Study of Cancer Types in Northern West Bank - Palestine

This study was carried out to investigate incidence rates and risk factors of non- hematology cancer types in the northern governorates of the West Bank (Nablus, Jenin, Tulkarm, Tubas, Qalqiliya, and Salfit). Risk factors may vary among different geographical locations. The main aim of this study was to investigate the differences in incidence rates among geographical locations and the relationship between geographical locations and cancer types with variation of risk factors. This is a retrospective study which covered cancer patients diagnosed between 2005 and 2008. The data were obtained from three governmental hospitals which had cancer therapy centers in the Northern West Bank (Al-Watani hospital in Nablus, Thabet- Thabet hospital in Tulkarm, and Jenin hospital in the city of Jenin). Medical and personal data were obtained from the registry files of patients, while lifestyle information and other data were obtained via interviews with patients or their close relatives in case of death. There were 1037 new cancer cases diagnosed between 2005 and 2008 in the six governorates of the north of the West Bank. The age-adjusted incidence rate over the period from 2005-2008 was 103.2 per 100,000 (95%CI: 96.9, 109.4) with a yearly rate of 25.7 cases per 100 000 people. The crude incidence rate was 112.3 per100 000 (95%CI: 105.4,119.1). Significant differences in incidence rates were found among governorates and types of location (rural, urban, and refugee camps). The lowest incidence rate was found in Jenin (age adjusted rate of 45.0 per 100 000 over the whole period) and the highest rate was found in Nablus (148.1 per 100 00). Refugee camps had higher incidence rate than urban and rural areas (age adjusted rate of 169.0 for refugee camps, 103.2 for urban areas, and 79.3 for rural areas). Breast, colorectal, uterus, and ovary cancers were the most frequent among women, while colorectal, bladder, lung, prostate, and stomach cancers were the most common among males. All governorates had high percentages of patients exposed to electromagnetic sources. Tulkarm and Qalqilia had high percentages of patients exposed to open sewage streams, Salfit and Qalqilia had high percentages of patients living close to garbage dumps, while Tubas and Jenin had high percentages of patients living close to stone factories. Tulkarm also had high percentage of patients living close to chemical factories compared to the other governorates. Risk of cancer increased with age (people in age groups of 40 years and older had much higher risk of cancer compared to the age group of less than 40 years). There was a strong relationship between family history (percentage of patients having relatives with cancer) and each of breast, cervical, uterus, ovary, colorectal, thyroid, testicular and neck cancers. A strong relationship was found between cancer type and smoking status. Cancers of the respiratory systems (lung, nasopharynx, and larynx), testicular cancer, and cancers of the bladder, prostate and stomach had high percentage of smoking patients (>75%). A strong relationship was also found between occupation and cancer types. Farmers made up the biggest working slice among cancer patients (13% of all patients) with males comprising the majority of this group (93 %) followed by teachers (7.8% of all cases), builders (6.1% of all cases) and factory workers (4.1% of all cases, all males). More than three fourths of cancer patients suffered from stress before being diagnosed with cancer: 54.3% suffered social stress, 28.8% suffered economic stress, 15.4% suffered political stress, and 6.6% suffered psychological stress. No differences were found among cancer types in the level of consumption for each of sweets, carbohydrates, salts, vegetables and fruits, but differences were found for fat consumption. Esophageal and testicular cancers were associated with high consumption of fat. Patients with colorectal, lung, bladder and head-brain cancers also consumed high levels of fat. Cancer patients had rare sport activity before being diagnosed (85% did not have any sport activity and only 2% of patients practiced sports daily). The results of this study stress the urgent need for measures to reduce the effects of environmental pollution and health educational programs should be implemented to target groups at higher risk of cancer like farmers and families with strong cancer history.