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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 11-16

Cancer incidence in Southern Libya: Updated report from 2016 to 2018


1 Department of Genetic Engineering, Biotechnology Research Center, Benghazi, Libya
2 Department of Oncology, Sabha Oncology Center, Benghazi, Libya
3 Department of Medicine, Tripoli Central Hospital; Minisitry of Health, University of Benghazi, Benghazi, Libya
4 Department of Genetic Engineering, Biotechnology Research Center; Department of Pathology, University of Benghazi, Benghazi, Libya

Date of Submission25-Aug-2020
Date of Acceptance15-Mar-2021
Date of Web Publication10-Apr-2021

Correspondence Address:
Prof. Adam Elzagheid
Department of Genetic Engineering, Biotechnology Research Center, Tripoli
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_74_20

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  Abstract 


Background/Aim: Cancer is a major public health problem worldwide with significant association with deaths and disabilities. Monitoring the cancer incidence is important, but it has never been assessed prospectively in southern part of Libya. The aim of this study was to estimate the cancer incidence and incidence rates in southern part of Libya as part of the monitoring of the cancer incidence in Libya. Materials and Methods: This was a retrospective study based on data collected between January 2016 and December 2018, the total number of cases diagnosed with different types of cancer reported to the Sabha Cancer Center was 665. All Libyan males and females who were diagnosed with any type of cancer were included in this study. Results: Overall cancer was more among female than male; it affected 414 (62.3%) females and 251 (37.7%) males. With 374 (56.2%) of all recorded cases being found in Sabha, the city documented the highest percentage of all cases found in these regions. According to the study analysis, the most diagnosed type of cancer in southern Libya was breast cancer, with 318 (47.8%) cases, followed by colorectal cancer (118, 17.7%), prostate cancer (60, 9%), leukemia (31, 4.7), lung cancer (23, 3.5), ovarian cancer (18, 2.7%), and lymphoma (17, 2.6%). Among females, breast cancer remained the most reported cancer site, with a decrease in the incidence rate from 146 (45.9%) in 2016 – 73 (23%) cases in 2018. Colorectal cancer was the second most common cancer with a slight increase in the incidence rate from 34 (28.8%) in 2016 to 43 (36.4%) cases in 2018. Leukemia and ovarian cancer ranked third and fourth most-reported cancer sites, respectively. For males, colorectal cancer remained the most reported cancer site during the study period with a slight increase in the incidence rate from 23 (9.16%) in 2016 to 32 (12.7%) cases in 2018. Prostate cancer was the second most common cancer and decreased in the incidence rate from 34 (13.5%) in 2016 to 14 (5.57%) cases in 2018, followed by leukemia and lymphoma. The elderly age groups of ≥70 years account for 17% of the cancer cases. There was a steady rise in incidence rate of all cancers from age <14 years to 69 years and was greater in women. In elderly people (≥70 years), cancer rate was higher in male than female. Conclusion: The results of this study suggest the importance of further epidemiological and etiological studies to further reveal factors contributing to the cancer incidence trends in Libya.

Keywords: Cancer, cancer incidence, colorectal cancer, breast cancer, prostate cancer, Libya


How to cite this article:
Gusbi E, Eltaib FI, Abrahem AF, Benbubaker WM, Alhudiri IM, Al-dabea SA, Alemam HA, Elgriw N, Elshukri AM, Hamil AO, bettamer L, Enattah N, Elzagheid A. Cancer incidence in Southern Libya: Updated report from 2016 to 2018. Libyan J Med Sci 2021;5:11-6

How to cite this URL:
Gusbi E, Eltaib FI, Abrahem AF, Benbubaker WM, Alhudiri IM, Al-dabea SA, Alemam HA, Elgriw N, Elshukri AM, Hamil AO, bettamer L, Enattah N, Elzagheid A. Cancer incidence in Southern Libya: Updated report from 2016 to 2018. Libyan J Med Sci [serial online] 2021 [cited 2021 Jul 24];5:11-6. Available from: https://www.ljmsonline.com/text.asp?2021/5/1/11/313526




  Introduction Top


Cancer is a major cause of death worldwide including Libya. New cancer cases and cancer deaths have steadily increased. The worldwide cancer burden is estimated to have increased from 12.7 million new cases and 7.6 million deaths in 2008 to 18.1 million new cases and 9.6 million deaths in 2018. The most common cancer deaths are from lung (2.09 million cases), breast (2.09 million cases), colorectal (1.80 million cases), prostate (1.28 million cases), skin cancer (nonmelanoma) (1.04 million cases), and Stomach (1.03 million cases).[1] About 70% of deaths from cancer occur in poor- and middle-income countries, and one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol use, low fruit and vegetable intake, aging, infections, and lack of physical activity.[1] In many countries, cancer is clearly the second most common cause of death following cardiovascular diseases.[2] Cancer can occur at any age; however, an elderly people are still at risk for cancer.[2] In developed countries, cancer incidence patterns have been studied well[3],[4] but less is known in the developing countries, especially using population-based registration data.[5] In Libya, accurate and continuous incidence studies are scarce. Studies have covered only eastern and western parts of Libya.[6],[7],[8],[9],[10] In 2019, the Libyan population was estimated to be about 6.28 million people with a median age of 27.2 years and life expectancy of 77.7 years (75.3 – men, 80.1 – women). It comprised 32.8% of the age under 15 years, 62.7% between 15 and 64 years, and 4.6% above 64 years old. In addition, about 50.4% of the population were male and 49.5% were female. The sex ratio of the population was 1.01 males to 1.00 females (3,162,781 males to 3,116,838 females); however, the global sex ratio in the world was approximately 1.016 males to 1.000 females as of 2018.[11] Libya is the fourth largest country in Africa, which shares a border with the Mediterranean Sea to the North, Egypt and Sudan to the East, Niger, Chad, and Sudan to the South, and Algeria and Tunisia to the West. It is approximately 1,759,540 km2 in area and is divided into three geographical regions (East, West, and South). Sabha is the most populous city in southwestern Libya, about 640 km South of Tripoli. It is located in epidemiologic transition, and cancer is the third cause of death after heart diseases and road traffic accidents.[10],[12] Furthermore, the number of deaths generated by cancer is increasing dramatically in Sabha region over the past few years. Hence, it is essential for each region to elucidate the incidence and epidemiology of cancer disease in its own population. The source of the data in this article was Sabha Cancer Center program data. Diagnosis is based on cancer histological and/or cytological reports.

Cancer registries are being established in many cities in Libya and these may be used to help bring incidence figures and distribution figures together as one step toward developing national system and plan for cancer studies and management. Regional comparisons can also be made for example: In certain cancers such as colorectal cancer, similar incidence and gender distribution were found in Libya and Tunisia.[13] Changes in cancer types, distribution, and outcomes may also provide valuable insight into possible associations with changes that took place in a community when studies are carried out and compared at different time points. Thus, the current situation report on common cancer types includes cancers that are diagnosed with the greatest frequency in the southern part of Libya, which is lacking up to date information is of utmost importance. To our knowledge, there is no published study on cancer incidence in southern Libya, and hence, this study was carried out. The aim of the present study is to provide the incidence rate (age standardized) of different types of cancers in the southern region of Libya.


  Materials and Methods Top


This study shed light on the first data collected and analyzed from Sabha Cancer Registry, focusing on cases diagnosed from 2016 to 2018 in southern Libya. Data were included demographic characteristics, such as age, sex, residence, date of diagnosis, and histopathological diagnosis, which were coded using the World Health Organization's International Classification of Diseases-10th Revision. We have excluded the non-Libyan cases and the cases outside the southern regions of Libya.

Data analysis

Data were analyzed using the SPSS software version 23 (SPSS, Inc., Chicago, IL, USA). Descriptive statistics expressed as mean, standard deviation (SD), and the frequency with percentages were calculated for interval and categorical variables. Chi-square test between categorical variables and Student's t-test for interval variables were used as appropriate. The results were considered to be statistically significant if the two-tailed P < 0.05. Age-standardized rate (ASR) (per 100,000 persons) was calculated using the direct standardized method and world standard population.[14]

Ethical consideration

The study was conducted in accordance with the ethical principles of Helsinki Declaration. The protocol was approved by the Biotechnology Ethics Committee (BEC-BTRC-11-2019).


  Results Top


Between January 2016 and December 2018, the total number of cases diagnosed with different types of cancer reported to the Sabha Cancer Center was 665. The average age (± SD) of cases was 52.01 ± 20.36 years. Overall cancer was more among female than male; it affected 251 (37.7%) males and 414 (62.3%) females with a male-to-female ratio of 0.61–1.0. [Table 1] shows the principle cancer sites for both genders during 2016–2018. [Table 2] demonstrates the incidence rate for cancers in both genders that decreased from 244 cases in 2016 to 160 cases in 2017 and 152 cases in 2018. According to the study analysis, the most diagnosed type of cancer for both genders in southern Libya was breast cancer, with 318 (47.8%) cases, followed by colorectal (118, 17.7%), prostate (60, 9%), leukemia (31, 4.7), lung (23, 3.5), ovary (18, 2.7%), and lymphoma (17, 2.6%).
Table 1: Trend in the incidence of cancers at the major sites in southern Libya by 3-year period during 2016-2018

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Table 2: The foremost cancer sites for both genders during 2016-2018

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Among females, breast cancer remained the most reported cancer site, with a decrease in the incidence rate from 146 (45.9%) in 2016 to 73 (23%) cases in 2018 [Table 2]. Colorectal cancer was the second most common cancer with a slight increase in the incidence rate from 34 (28.8%) in 2016 to 43 (36.4%) cases in 2018. Leukemia and ovary incidence rates ranked third and fourth most-reported cancer sites, respectively. For males, colorectal cancer remained the most reported cancer site during the study period with a slight increase in the incidence rate from 23 (9.16%) in 2016 to 32 (12.7%) cases in 2018. Prostate cancer was the second most common cancer with decreased in the incidence rate from 34 (13.5%) in 2016 to 14 (5.57%) cases in 2018, followed by leukemia and ymphoma [Table 2].

With 374 (56.2%) of all recorded cases being found in Sabha, the city recorded the highest percentage of all cases found in these regions. Meanwhile, only three cases (0.5%) were reported in Jufra region during the period of study. This was the lowest incidence rate among all ten regions [Figure 1].
Figure 1: Distribution of Cancer Cases Reported to Sabha Cancer Center by Region 2016–2018

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The age distribution of all cancers and its differentiation according to the gender are presented in [Figure 2]. The elderly age groups of 70 years and above account for 17% of the cancer cases. There was a steady rise in incidence rate of all cancers from age 0–14 years to 69 years and greater in women in the registry. In elderly people, (over 70 years), the incidence rate of cancer was higher in male than female.

Among women and men, the age-specific incidence rate for all cancers peaked at 45–49 years and >75 years in the registry [Figure 2].
Figure 2: The incidence rates of all cancer types by age group in Southern Libya, 2016–2018

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The overall ASRs of all cancers incidence were determined for the southern region of Libya which represents 12.57 per 100,000 population comparing to the ASR in 2006 (15.85 per 100,000 population) [Table 3].
Table 3: Total frequency and age-standardized rates per 100,000 person-year (2018)

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  Discussion Top


Many studies on cancer incidence have been carried out in eastern and western regions of Libya to illustrate the extent of the problem.[6],[7],[8],[15],[16],[17],[18],[19],[20],[21] We have attempted in this study to provide the incidence rate (using ASR) of different types of cancers in the southern region of Libya. The present study comprises 3 years (2016–2018) of data and provides a reasonably accurate description of cancer incidence in southern Libya and can contribute to a better understanding of the epidemiology of various cancers in this region and consequently provide a useful guide for the decision-makers to make effectual decisions about cancer control program and policies in Libya.

In the current study, overall cancer was more among female than male; it affected 252 (37.8%) males and 414 (62.2%) females, the gender ratio (male to female) for the incidence of cancer was 0.61:1. Thus, our results differ from previous studies of El Mistiri et al., 2010, on the epidemiology of cancers in eastern Libya, of all cancer cases, 52.5% were male and 47.5% were female,[6] and Beyased et al.'s study, 2017, carried out in western Libya, of all cancer cases, 51.1% were male and 49.9% female.[9] In this respect, it should be noted that in the above-mentioned studies, population gender was not equal. The results from this study show that the most common cancers in 2016–2018 were breast cancer and colorectal cancer among women, this result is in agreement with previous study by Islam Elzouki et al. in the western region of Libya.[10] Furthermore, our results show that colorectal cancer was the most common in men followed by prostate cancer; however, this is contradictory to the results reported from previous studies in East and West Libya.[7],[10] In eastern and western Libya, the most frequently diagnosed cancer in men was lung cancer followed by colorectal cancer.

Our study shows that the incidence of cancer rises dramatically with age, most probably due to a buildup of risks for specific cancers that increase with age. In general, gender is known as a permanent and nonmodifiable risk factor in cancer epidemiology. Genders do not have equal susceptibility to disease and there are incidence rate differences in both sexes according to the type of cancer. The differences may be attributed to behavioral, physiological, hormonal, and reproductive differences of factors. The overall risk increase is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older. However, cancer will remain a major health problem around the world as elderly people are most susceptible to cancer and population aging continues in many countries.

Our study is limited by the fact that the Sabha Cancer Center is a relatively new and data reported here is for the last 3 years of the registry's existence. Due to the ongoing conflict since 2011 and incomplete data, we are sometimes unable to collect reliable data since then. Furthermore, it is possible that many patients for many reasons may be looked for care in Tripoli or Misurata Cancer Centers and so may be missed out in the registration process. The limitation of the present study also lacks information related to patients' occupation, socioeconomic status, education, lifestyle family history, and risk factors for cancer development.


  Conclusion Top


Our study highlights the need for urgent programs in Libya to improve research and training, screening, diagnosis, treatment, cancer registration, data handling, and the overall management of all cancer types. We anticipate our results may further assist and contribute to improving knowledge and research on cancer in southern part of Libya.

Acknowledgments

The authors would like to thank the support of the Authority for Research, Science, and Technology; also, they would like to thank Biotechnology Research Center.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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