Cancer incidence in Golestan province: Report of an ongoing population-based cancer registry in Iran between 2004 and 2008

Background: Golestan Province, at the western end of the Asian esophageal cancer (EC) belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry (GPCR). Methods: The GPCR collected data from newly diagnosed (incident) cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer (IARC). Age-standardized incidence rates (ASR) of cancers were calculated using the 2000 world standard population. Results: From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean (SD) age was 55.5 (18.6) years, and 54 were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach (ASR:30.7), esophagus (24.3), and lung (15.4) were the most common cancers in males. In females, breast cancer (ASR:26.9) was followed by malignancies of the esophagus (19.1) and stomach (12.4). The diagnosis of cancer was based on histopatho- logical reports in 71 and on death certificate only in 9 ofcases. Conclusions: The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase

Healthcare utilization in patients with esophageal cancer in a high risk area in northeast of Iran

Introduction: Golestan, a province located north of Persian Gulf in northeastern part of Iran is a well known area for high risk of esophageal cancer (EC) in the world. There is no information about healthcare utilization in populations residing in the area. This study was conducted to assess utilization of healthcare and its associated factors among esophageal cancer patients in this region as well as to address ethical implication of this utilization. Methods: All new cases of EC in Golestan province during year of 2007 were recruited. Seven diagnostic and five therapeutic services were used to assess diagnostic utilization index (DUI), and therapeutic utilization index (TUI), respectively. Multivariate regression analysis was used to assess the relationship between variables and DUI or TUI. P-value of less than 0.05 was considered as statistically significant. Results: Tow hundred twenty three, patients were enrolled with mean (Standard Deviation) age of 64.3 (12.5) years with 57.8% male. We observed that occupation (P<0.01), ethnicity (P<0.01) and sex (P=0.03) were strongly associated with DUI. Insurance coverage (P<0.01), place of residency (P<0.01), and occupation (P=0.01) were associated with TUI. Conclusion: We concluded that several factors contribute to disparity in healthcare utilization in the studied population

Esophagus cancer incidence among females in Golestan Province, Iran (2004)

The main aim of this study was to find and describe province-specific estimates of incidence in females by age groups for esophagus cancer. The data used in this study were collected in a cancer registry that was conducted by Health Deputy of Golestan province for a period of 1 year (2004). The age distribution was collected according to the following age strata: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84 and 85 above. Esophagus cancer data was identified and collected through the 18 Pathology Laboratory centers (where female populations referred to these centers) in Golestan province. A total of 348 primary cancer cases were captured. From these 32 cases was esophagus cancer. There were 26 squomous cell carcinoma (81.25%), 1 adenocarcinoma (3.12%). Esophagus cancer incidence among females in Golestan province was 7.62/100000. But esophagus cancer with the highest ASR: 127.91/100,000 was in age 75-79. The incidence of esophagus cancer in age over 75-79 has risen sharply and it was the lowest in age 30-34 (ASR: 1.68/100,000). For the present time it can be said that esophagus cancer in females appear to be one of the most prevalent and serious type of cancer (especially squomous cell carcinoma) in Golestan province and esophagus cancer is rising with ageing

Epidemiology of female reproductive cancers in Iran: Results of the gholestan population-based cancer registry

Background: Malignancies of the female reproductive tract are estimated to be the third most common group of cancers in women. Objectives: We here aimed to present their epidemiological features in Golestan provincelocated in Northeast of Iran. Materials and Methods: Data on primary female reproductive cancers diagnosed between 2004-2010 were obtained from Golestan Population-based Cancer Registry (GPCR). CanReg-4 and SPSS software were used for data entry and analysis. Age standardized incidence rates (ASR) (per 100,000 person-years) were calculated using the world standard population. Poisson regression analysis was used to compare incidence rates. P-values of less than 0.05 were considered as significant. Results: A total of 6,064 cancer cases were registered in Golestan females in the GPCR during 2004-2010, of which 652 cases (11%) were female reproductive cancers. Cancers of the ovary (ASR=6.03) and cervix (ASR=4.97) were the most common. We found significant higher rates in females living in cities than in villages. Our results showed a rapid increase in age specific incidence rates of female reproductive cancers at the age of 30 years. Conclusions: We found significant higher rates of female reproductive cancers among residents of cities than villages. Differences in the prevalence of risk factors including reproductive behavior between the two populations may partly explain such diversity. Our results also showed a rapid increase in incidence rates of these cancers in young age females. Further studies are warranted to determine risk factors of female reproductive cancers in our population

Impact of immunosuppressive treatment on liver fibrosis in autoimmune hepatitis

The impact of treatment on progression of fibrosis in autoimmune hepatitis (AIH) is unknown. We assessed the changes in liver fibrosis before and after treatment among these patients. Nineteen AIH patients who had paired liver biopsies were studied. Of these, seven had been treated with 6 months of cyclosporine A and the rest with 6 months of prednisolone for induction of remission. Thereafter all had been maintained on azathioprine. Biopsy specimens before and after treatment were reviewed by one pathologist and scored by the Ishak method. Mean fibrosis stages before and after treatment were compared. Also, factors predicting significant fibrosis (stage �3) and cirrhosis (stage �5) at presentation were assessed. Mean interval between biopsies was 3.38 years. Mean fibrosis stage decreased from 4.53 to 2.16 following treatment (P < 0.001). Mean decrement in inflammatory grade was 8 scores (range, 4-10) in patients in whom fibrosis improved, and 2 scores (range, 0-4) in patients in whom fibrosis did not decrease after treatment (P < 0.001). ALT-to-platelet ratio was the best predictor of significant fibrosis and also cirrhosis. Fibrosis commonly improves after immunosuppressive treatment in AIH. ALT-to-platelet ratio can predict accurately the presence of significant fibrosis and cirrhosis in AIH. © 2005 Springer Science+Business Media, Inc

Analysis of Competing Risks of Causes of Death in Cancer Patients from Golestan, Iran over Twelve Years (2004-2016)

Background: Cancer-related causes of death (cancer CoD) are the main etiologies of death in cancer patients. Recent increase in survival rates of cancer patients resulted in higher risk of dying from causes other than cancer, called competing causes of death (competing CoD). We aim to characterize competing CoD among cancer patients in Golestan province, Northern Iran. Methods: Data on cancer incidence was obtained from the Golestan population-based cancer registry (GPCR) dataset. Data on causes of death was obtained from the Golestan death registry (GDR) dataset. Using a linkage method between the GPCR and GDR dataset, we prepared the study dataset including data on vital status and causes of death in our cancer patients. The proportions of cancer CoD and competing CoD were calculated. Multivariate logistic regression analysis was considered to assess the relationship between competing CoD and other variables. Results: Overall, 4,184 cancer patients died in the study population, including 2,488 men (59.9). Cause of death in 3,455 cases was cancer and 729 cases (17.4) died due to competing CoD. Ischemic heart disease (40.7) was the most common competing CoD in our population. Higher survival rate was the strongest variable related to the competing CoD (adjusted OR=1.91; 95CI: 1.61-2.26). Residence area, age group and year of death were other indicators of competing CoD in our population. Conclusion: Our results suggest high rates of competing CoD in our cancer patients. Competing CoD should be mentioned in cancer control planning both in clinical practice as well as in public health policy making. © 2021. All Rights Reserved

Predictors of survival in oesophageal cancer patients in a high-risk area in Northern Iran: the role of health services utilisation

We aimed to determine predictors of survival in oesophageal cancer (EC) patients in a high-risk area. This study was conducted on EC patients diagnosed in 2007–2008 in Golestan province, Iran. Diagnostic (DU) and Therapeutic (TU) services utilisation indices were determined. DU and TU indices of 1 were considered as good utilisation. EC-specific survival rates were calculated. Multivariate Cox-regression model was used to calculate adjusted hazard ratios (AHRs). Two hundred and twenty-three EC subjects were enrolled. The median survival time was 10.47 months and the 5-year survival rate was 11. Cox-regression analysis suggested that stage of tumour (AHRregional = 3.75, 95 confidence interval CI: 2.34–6.00; AHRmetastasis = 12.21, 95% CI: 7.42–20.08) and TU (AHR = 1.78, 95% CI: 1.25–2.52) were the strongest variables related to EC survival. The median survival time in patients with good and poor TU were 14.37 and 8.53 months respectively (p &lt;.01). There was no significant relationship between DU and EC survival. We found relatively low survival rates in our EC patients when compared with developed countries. Our results also suggested an increasing trend for EC survival rate during recent years. Good TU could predict higher survival rates. Patients' access to therapeutic services may be considered as an important indicator in decision-making for controlling EC. © 2016 John Wiley & Sons Lt

Histopathological damage and stress- and immune-related genes' expression in the intestine of common carp, Cyprinus carpio exposed to copper and polyvinyl chloride microparticle

The present study aimed at assessing the singular and combined effects of water copper and polyvinyl chloride microplastic (MPVC) on intestinal copper accumulation, histopathological damage, and stress-/immune-related genes' expression in common carp, Cyprinus carpio. Four groups of fish were maintained in triplicate: control (kept in clean water), Cu (exposed to 0.25 mg/L of copper), MPVC (exposed to 0.5 mg/L of MPVC), and Cu-MPVC (exposed to 0.25 mg/L of copper + 0.5 mg/L of MPVC). After 14-day exposure, the fish of Cu and Cu-MPVC treatments exhibited significantly higher intestinal copper contents, compared to the fish of control and MPVC treatments. In this regard, the Cu-MPVC fish had significantly higher copper content than the Cu fish. Exposure to copper and/or MPVC significantly upregulated the intestinal heat shock protein 70 (hsp70), cytochrome P450 family 1 subfamily A member 1 (cyp1a1), lysozyme (lys), defensin (def), mucin 2 (muc2), and mucin 5 (muc5) expression. The highest expression of hsp70, cyp1a1, lys, and def was related to Cu-MPVC treatment; whereas, the highest expression of muc2 and muc5 was observed in Cu and MPVC treatments. Exposure to copper and/or MPVC induced intestinal damage, which Cu-MPVC fish exhibited the highest severity. The present study revealed that exposure to copper and/or MPVC causes intestinal histopathological damage and upregulation in stress- and immune-related genes' expression. The most serious effects were observed in Cu-MPVC treatment that might be due to additive effects of copper and MPVC and/or higher copper accumulation in this treatment. © 2021 Wiley Periodicals LL