Source: http://www.crc.gov.my/documents/report/2nd%20National%20Cancer%20Registry.pdf
Cache : https://docs.google.com/file/d/0B86b-ALn-1MGM3Y2R1l1QzR5VTg/edit?usp=sharing
ABOUT THE NATIONAL CANCER REGISTRY
The National Cancer Registry (NCR) is a service supported by the Ministry of Health
(MOH) to collect information about cancers in Malaysia. The information allows us to
estimate the incidence of cancer, and to evaluate its risk factors, treatment and outcomes.
Such information is useful for assisting the MOH, Non-Governmental Organizations,
private providers and industry in program planning and evaluation, leading to cancer
prevention and control.
The NCR receives data on cancer from 3 main sources:
1. The Ministry of Health hospital information system
2. The National Registration Department (Jabatan Pendaftaran Negara)
3. And most important of all, the individual doctors who provide cancer diagnostic
services or who care for cancer patients, and voluntarily report data to the NCR.
The objectives of NCR are to:
1. Determine the disease burden attributable to cancer by quantifying the magnitude of
cancer morbidity and mortality, and its geographic and temporal trends in Malaysia.
2. Identify subgroups in the population at high risk of cancer to whom cancer prevention
effort should be targeted.
3. Identify potential risk factors involved in cancer.
4. Evaluate cancer treatment, control and prevention programme.
5. Stimulate and facilitate epidemiological research on cancer, e.g. generating hypotheses
on cancer aetiology.
REPORT SUMMARY
1. OVERALL CANCER INCIDENCE
A total of 21,464 cancer cases were diagnosed among Malaysians in Peninsular Malaysia
in the year 2003, comprising 9,400 males and 12,064 females. The corresponding figures
for Sabah and Sarawak are shown in Table 1.1.1. As the ASR were considerably lower
than that of Peninsular Malaysia, there is serious doubt about the completeness of cancer
registration from these two East Malaysian States. Hence, they were omitted from
further analysis in this report. On the other hand, case ascertainment for Peninsular
Malaysia was likely to be as good as for year 2002 if not better in terms of lower
inclusion of prevalent cases. Certainly, as can be seen from the ethnic specific ASR, case
ascertainment for the NCR is comparable with that of the Penang Cancer Registry.
The National Cancer Registry received 42,985 cancer notifications of Malaysian
residents in 2003 of which 23,746 were unique incident cancer cases. Thus there were 1.8
notifications per case. Of the 23746 cases, 22622 cases had histological verification thus
95.3 % of the cases had histological verification. There were 511 cases coded as Primary
Site Uncertain representing 2.2% of the total cases. There were no missing data for race
and age variable whereas there was only 1 case with missing sex.
The 2003 cancer incidence results presented in the rest of this report refer only to
Peninsular Malaysia.
2. CANCER BURDEN
The crude rate for males was 97.4 per 100,000 population and 127.6 per 100,000
population for females. The age standardized incidence rate for all cancers in the year
2003 was 134.3 per 100,000 males and 154.2 per 100,000 females.
Generally the cancer incidence rates were lower than in 2002 suggesting we have been
more successful in eliminating prevalent cases (rather than the alternative possibility of
deteriorating ascertainment, as explained above). This was to be expected of a maturing
registry. There appears to be a continuing problem with differential under-ascertainment
in the 2003 data especially affecting lung cancers.
On the other hand, the fact that unusual findings that were noted in the first report are
convincingly repeated in the second report deserve special attention and study, such as
the ranking of leukaemia among the top 5 cancers in males and top 10 cancers in females.
While the cancer rates for 2003 were generally lower, they are not that far off from 2002
results (which had included more prevalent cases), relative ranking of cancer incidence
was largely consistent, and most statements still held true. For example, incidence of
nasopharyngeal cancer among Chinese was still very high, and comparable to Singapore 35
To overcome the problem of under-ascertainment in some of the tumour sites mentioned
above, the reporting of cases to the National Cancer Registry had been extended to
include the chest physicians, gastroenterologist, hepatobiliary surgeons, neurosurgeons
and radiologists in addition to the pathologists, oncologists and palliative care personnel.
However, this would only show an effect on cancer trends from the middle of 2003
onwards.
3. VARIATION IN CANCER INCIDENCE BY AGE, SEX AND ETHNICITY
Cancer occurred at all ages. The median age at diagnosis for cancer in Malaysian males
was 59 years and 53 years for Malaysian females. The 5 most frequent cancers in
children (0-14 years old) were leukaemia, cancers of the brain, lymphoma, cancers of the
connective tissue and kidney. In the group of young adults (15-49 years old), the common
cancers were nasopharynx, leukaemia, lymphoma, lung, colon and rectum in men, and
cancers of the breast, cervix, ovary, uterus, thyroid gland and leukaemia in women. In
older subjects (50 years old and above), cancers of the lung, colon, rectum, nasopharynx,
prostate and stomach were predominant among men, while cancers of the breast, cervix,
colon, uterus, lung and rectum occurred commonly in women.
The crude incidence rate of age groups by sex, showed an increasing trend of incidence
with age. The crude incidence rate for males aged 0-19 years was 18.0 per 100,000
population; aged 20-39 years was 33.0 per 100,000; aged 40-59 years was 168.6 per
100,000 population and aged 60+ years was 731.8 per 100,000 population.
The crude incidence rate for females aged 0-19 years was 14.0 per 100,000 population;
aged 20-39 years was 54.8 per 100,000; aged 40-59 years was 318.2 per 100,000
population and aged 60+ years was 591.1 per 100,000 population.
The overall male crude incidence rate of 97.4 per 100,000 population was lower than the
female crude incidence rate of 127.6 per 100,000 population. The male to female ratio of
cancer incidence is 1:1.3. The most common cancer in males in the year 2003 was cancer
of the lung (13.8% of all male cancers). Whereas among females, the most frequent
cancer was cancer of the breast (31.0% of all female cancers).
There is variation of cancer incidence rate between the different ethnic groups. The crude
incidence rate for cancers in Malay male and females were 60.6 and 79 per 100,000
population respectively; for Chinese male and females 169.2 and 217.7 per 100,000
population respectively; and for the Indian male and females 85.7 and 147.2 per 100,000
population respectively. 36
4. INDIVIDUAL CANCERS
4.1 FEMALE BREAST CANCER
In 2003, there were 3738 female breast cancer cases that were reported, making it the
most commonly diagnosed cancer in women. It accounted for 31.0 % of newly diagnosed
female cases. Breast cancer was the commonest cancer in all ethnic groups and all age
groups in females from the age of 15 years. The overall ASR was 46.2 per 100,000
population.
The age pattern in 2003 showed a peak age specific incidence rate at the 50-59 age group
in Malays, Chinese, and Indians, and the rates then declined in the older age groups. Of
the cases diagnosed in 2003, 64.1 % were in women between 40 and 60 years of age.
Chinese had the highest incidence with an ASR of 59.7 per 100,000 population followed
by Indian women with an ASR of 55.8 per 100,000 population and Malay women with an
ASR of 33.9 per 100,000 population. Compared to 2002 data, the ASR is lower for all
races, but the age-specific incidence patterns are very similar.
4.2 LUNG CANCER
A total of 1758 incident cases of lung cancer were reported, comprising 13.8% of male
cancers and 3.8% of female cancers. The male: female ratio in terms of incidence for
Peninsular Malaysia was 2.8 : 1. Rates of lung cancer rose progressively with age for
both males and females. There was a steeper rise in incidence after the age of 40 years for
both sexes, with a progressive divergence of the curves for the two sexes.
The incidence of lung cancer among the Chinese was higher than the other ethnic groups.
The age-standardized incidence rate (ASR), for Chinese was more than twice that of
Malays and Indians for both sexes.
Even though lung cancer was in second place when colon and rectum were added
together, caution has to be exercised in its interpretation. This is because of : a) the
ascertainment rate calculated at 68% for 2002 data, and b) comparing the age incidence
rate with reports from Singapore and Penang.
We remind the reader that for this cancer, the registration was almost certainly
incomplete. The specific recruitment of radiologists and chest physicians to report
cancers to the NCR from the middle of 2003 onwards, it is hoped that more complete
results will be available in the future. 37
4.3 COLON AND RECTUM CANCER
Cancers of the colon and rectum were recorded separately in this report. On their own
each of them ranked among the top ten most common cancers in Malaysia. When taken
together, colorectal cancers would account for 14.2% of male cancers making it the
commonest cancer among men and the third most common cancer among women (10.1%
of female cancers).
The male to female ratio for colon cancer was nearly equal (0.98:1), with the frequency
in males rising more rapidly after the age of 60 years. In rectal cancer, the preponderance
of males was more noticeable (1.26:1), with a steeper rise in age specific incidence of
males occurring at age of 50 years onwards.
The age specific incidence for both colon and rectal cancers increased exponentially with
age. Chinese had a higher incidence of colon cancers than the other races. Comparing the
crude rates between Chinese and Malays, Chinese had more than 5.1 times the incidence
of male colon cancer, and 4.6 times the incidence of female colon cancer. With regard to
rectal cancers, Chinese had the highest incidence rate of rectal cancers which was 2.8
times the Malay male incidence and 3.4 times the Malay females.
4.4 CERVICAL CANCER
Cancer of the cervix was the second most common cancer among women. It constituted
12.9% of total female cancers. There were a total of 1,557 cases of cancer cervix, with an
ASR of 19.7 per 100,000 population.
Cervical cancer incidence rate increased with age after 30 years. It has a peak incidence
rate at ages 60 -69 years, and declined thereafter. These features were very similar to
data in 2002.
Chinese women had the highest ASR of 28.8 per 100,000 population, followed by
Indians with ASR of 22.4 per 100,000 population and Malays with ASR of 10.5 per
100,000 population.
4.5 LEUKAEMIA
A total of 539 cases of myeloid leukaemia and 433 cases of lymphatic leukaemia were
reported comprising 4.5% of the total number of cancers. Males predominated at a ratio
of 1.7:1 for lymphatic leukaemia and 1.1:1 for myeloid leukaemia. Leukaemia was the
fourth commonest cancer in males and seventh in females.
Age specific incidence curves of lymphatic leukaemia demonstrated a bimodal pattern.
Leukaemia was the commonest cancer in children less than 15 years old. It was the
second highest cancer among the 15-49 year old males, and the sixth commonest among
the 15-49 year old females. Leukaemia was no longer among the top 10 list after age 50
years for both sexes. 38
4.6 NASOPHARYNGEAL CANCER
Nasopharyngeal cancer was the second most common cancer among men. It constituted
8.8% of total male cancers. There were a total of 1,125 cases of nasopharyngeal cancer,
with an age standardized incidence of 10.2 and 3.6 per 100,000 population for males and
females respectively. The male to female ratio is 2.75:1.
The age specific incidence increased after 30 years with a peak incidence rate at ages 60 -
69 years, and declined thereafter. These features are very similar to data in 2002.
Chinese men had the highest age standardized incidence rate (18.1 per 100,000
population) followed by Chinese women (7.4 per 100,000 population), Malay males (4.8
per 100,000 population) and Indian males (2.6 per 100,000 population).
4.7 PROSTATE CANCER
There was a total of 602 cases reported (6.4% ) making it the 6th most common cancer
among males overall. The age specific incidence rate rises sharply after the age of 60.
The overall age standardised incidence was 10.3per 100,000 population.
No comments:
Post a Comment