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EPIDEMIOLOGICAL PARALLELS OF RECTAL CANCER INCIDENCE IN KAZAKHSTAN AND KYRGYZSTAN
E. Makimbetov1, M. Kuzikeev2, Z. Kamarli1, B. Sultangazieva4, A. Jumanov5, M. Osombaev4, A. Toygonbekov4, O. Satybaldiev4, A. Estay3, V. Madjarov2
1 Kyrgyz-Russian Slavic university, Kyrgyzstan, Bishkek 2 Kazakh-Russian Medical University, Kazakhstan, Almaty 3 Kazakh Research Institute of Oncology and Radiology, Kazakhstan, Almaty 4 National Center of Oncology and Hematology, Kyrgyzstan, Bishkek 5 Asfendiarov Kazakh Medical university, Kazakhstan, Almaty
Summary
Background and Objectives: Of the colorectal malignant tumors, 30 percent will arise in the rectum. The incidence of rectal cancer is increasing with the change of diet habit and genetic factors. The etiology of colon and rectal cancer is a bit different. The risks of distal colon and rectal cancer are more likely to be related to environmental factors, such as polluted surface water sources, alcohol consumption, and habitual smoking. The lack of great change in the incidence of rectal cancer might be due to weaker associations with such lifestyle factors. The study was to analyze the incidence of rectal cancer in the Central Asian republics - Kazakhstan and Kyrgyzstan.
Methods: Dates of rectal cancer patients during 2000-2010 were collected from population-based cancer registry in Kazakhstan and hospital-based registry in Kyrgyzstan. Incidence and mortality of rectal cancer were calculated and analyzed.
Results: The crude incidence of rectal cancer in Kazakhstan and Kyrgyzstan from 2000 to 2009 were 6.8 per 100 000 (7.4 per 100 000 in males, 6.2 per 100 000 in females) and 3.3 per 100 000 (3.2 per 100 000 in males and 3.4 per 100 000 in females), respectively. The incidence of rectal cancer ranked seventh (Kazakhstan) and eight (Kyrgyzstan) respectively among all cancers. The incidence of rectal cancer was increased with age at the both countries. High incidence rate of rectal cancer was registered at the Russian ethnic group, compare with native Kazakhs and Kyrgyzs.
Conclusions: The incidence of rectal cancer is high in Kazakhstan compared to Kyrgyzstan. There are geographical and ethnic variabilities in rectal cancer incidence. High incidence rate of rectal cancer was registered in the North region of Kazakhstan, where predominance Russian population. Studies on the prevention and treatment of rectal cancer should be enhanced.
Key words: rectal cancer epidemiology, incidence, mortality, ethnic group, registration, variability, Kazakhstan, Kyrgyzstan.
Introduction. Colorectal cancer is the third most common noncutaneous malignancy in developed countries, such as the United States and the second most frequent cause of cancer-related deaths. In 2015, 132 700 cases of colorectal cancer were diagnosed in the United States and account for 49700 deaths. Of these cancers, 30 percent will arise in the rectum [1]. According to GLOBOCAN 2018 data, cancer of the colon is the fourth most incident cancer in the world, while cancer of the rectum is the eighth most incident. Together, colorectal cancers are the third most commonly diagnosed form of cancer globally, comprising 11% of all cancer diagnoses [2, 3].
The diagnosis, staging and treatment regimens for rectal cancer differ significantly from those for colon cancer and have undergone recent advances that are important for primary care providers, gastroenterologists and general surgeons to be aware of.
An overall decline or stabilisation in the incidence of colon and rectal cancer was noted in some developed and high income countries. In the most recent 10-year period for which data were available, however, significant increases were noted in the incidence of colon cancer in people younger than 50 years in Denmark (by 3.1%), New Zealand (2.9%), Australia (2.9%), and the UK (1.8%). Significant increases in the incidence of rectal cancer were also noted in this age group in Canada (by 3.4%), Australia (2.6%), and the UK (1.4%)
[4]. Additionally, in 2018, 10% of all colorectal cancers in the USA were diagnosed in people younger than 50 years (generally in people aged 40-49 years) [5].
In low income and undeveloped countries rectal cancer incidence is not high. In China registered a high incidence rate of colorectal cancer in Shanghai and Guangzhou with 14.3 and 14.0 per 100 000, respectively [6]. The crude incidence and mortality of rectal cancer in Guangzhou (China) from 2000 to 2002 were 9.6 per 100 000 (10.8 per 100 000 in males, 8.2 per 100 000 in females) [7].
Aim of study. The purpose of this study was comparing the rectal cancer incidence rate in two former Soviet Union countries - Kazakhstan and Kyrgyzstan.
Materials and methods.
Case sources. Date on registration of rectal cancer for the years 2000-2009 were obtained from Kazakh National Cancer Registry, which has the materials of incidence and mortality of malignant tumors. In Kyrgyzstan the incidence rate was collected due to hospital-based registry in Bishkek. Within 10 years, a total of 11098 new cases of rectal cancer were recorded and verified in Kazakhstan and 1075 in Kyrgyzstan. The information of population composition with an interval of ten years in Kazakhstan and Kyrgyzstan was obtained from National Statistics Committees of both republics. Method of analysis is descriptive epidemiology.
Statistical analysis. According to requirements for cancer registration in the Cancer Incidence in Five Continents IX publishing be the IARC (International Agency for Research on Cancer, the original registration data in 2000-2009 were reviewed and sorted regarding accuracy, completeness and reliability with the MS-FoxPro and IARCcrg Tools (http:// www.iarc.com.fr/iarctools,htm) from IARC@IACR. The propor-tion of case diagnosis with morphological verification, the proportion of cases with death certificate notification, and the ratio of mortality to incidence for rectal cancer in Kazakhstan and Kyrgyzstan was 88.2% and 80.2%, 4.2% and 2.8%, 0.54% and 0.76%, respectively.
The incidence and mortality date were coded and classified regarding to the International Classification of Disease version 10 (ICD-10). There were calculated crude and standardized incidence rates according the world standard population.
Results.
Incidence of rectal cancer. In two countries over 10 years a total 11 098 (5421 were males and 5677 females) and 2
796 (males and females) new cases of rectal cancer were identified in Kazakhstan and Kyrgyzstan, respectively. A sex (male/ female) ratio was 0.95:1.0 and 0.89:1.0 in Kazakhstan and Kyrgyzstan, respectively. Information of the incidence of rectal cancer was detailed in Table 1.
The median age of occurrence of rectal cancer was 66.6 ± 0.3 (95% CI 61.1; 67.1) years old in Kazakhstan and 68.2 ± 0.4 (95% CI 62.2; 71.3) years old in Kyrgyzstan. The incidence rates of rectal cancer reached the occurrence level in the age group from 65-69 years old in Kyrgyzstan and 5064 years old in Kazakhstan. They gradually got to the peak in the age group from 70-79 years old in both countries. The difference in incidence rates between males and females as the age rose regarding different age groups. However, there was some predominance of the incidence rate in females comparing males from 60 to 75+ years old in the Kyrgyzstan.
Information of the incidence of rectal cancer in age groups was demonstrated on Figure 1 (Kazakhstan) and Figure 2 (Kyrgyzstan).
Table 1. The incidence of rectal cancer in Kazakhstan and Kyrgyzstan from 2000
to 2009.
Countries Sex Ratio (%) Rectal/all cancer Crude rate (1/105) ASR (world) Cumulative rate (%) 0-74 years
Kazakhstan Male 4.1 7.4 7.2 0.9
Female 4.2 6.2 6.9 0.8
Kyrgyzstan Male 2.6 3.2 3.3 0.6
Female 3.0 3.4 3.5 0.7
Figure 1. The incidence of rectal cancer of different age groups in Kazakhstan from 2000
to 2009.
Age (years)
Figure 2. The incidence of rectal cancer of different age groups in Kyrgyzstan from 2000
to 2009.
Table 2. The mortality of rectal cancer in Kazakhstan and Kyrgyzstan from 2000 to
2009.
Countries Sex Ratio (%) Crude rate ASR Cumulative rate
Rectal/all cancer (1/105 (world) (%) 0-74 years
Kazakhstan Male 3.1 4.1 3.8 0.6
Female 4.2 3.5 3.2 0.5
Kyrgyzstan Male 2.8 2.3 2.6 0.3
Female 3.2 2.8 2.9 0.4
Mortality for rectal cancer. In Kazakhstan 5881 mortality cases of rectal cancer were found from 2000 to 2009, whereas 1537 in Kyrgyzstan (table 2).
The mortality rates of rectal cancer reached the average level, respectively, in the age group from 60 to 69 years in both countries. With a gradual increase, both arrived at the peak in the 80 years old age group.
The ratio of mortality to incidence (M/I) of rectal cancer was 0.54, with 0.55 for males and 0.56 for females in Kazakhstan, while the ratio of mortality to incidence (M/I) of rectal cancer was 0.76, with 0.71 for males and 0.82 for females in Kyrgyzstan.
Regional variability of rectal cancer incidence. In Kazakhstan a high incidence rate of rectal cancer (males
Crude
South Kazakhstan Atyrau Aktobe Karaganda North Kazakhstan Almaty
10
12
14
Figure 3. Rectal cancer incidence in the regions of Kazakhstan from 2000 to 2009.
Jalal-abad oblast Talas oblast Issyk-Kul oblast Bishkek
Crude
10
Figure 4. Rectal cancer incidence in the regions of Kyrgyzstan from 2000 to 2009.
and females) was registered in the Almaty city (former capital) with 12.4 per 100 000, Pavlodar (12.2), Kostanay (12.1), North and East Kazakhstan oblasts (11.6 and 10.8, respectively). Low incidence of rectal cancer was registered in the Atyrau, Jambyl, Kyzylorda, and South Kazakhstan oblasts - 3.4, 3.2, 2.8, and 2.7 per 100 000, respectively (Figure 3).
In Kyrgyzstan it was registered a low incidence of rectal cancer compared to Kazakhstan. Incidence of rectal cancer with 8.0 and 6.0 per 100 000 was registered in the Bishkek
city (capital of Kyrgyzstan) and Chuy oblast, respectively. Very low incidence of rectal cancer with 0.9, 1.5, and 1.8 was registered at the Batken, Jalal-Abad and Osh oblasts, respectively (Figure 4).
Ethnic variability of rectal cancer. The incidence of rectal cancer among Russians, both in Kazakhstan and Kyrgyzstan, was high and was at the level of 17.6 and 14.2, respectively. At the same time, in the northern regions of the Republic of Kazakhstan, the incidence rate of rectal cancer was 20 or more per 100 000. In these regions of Kazakhstan,
the Russian population is 65% or more of the total population. The Kazakh population (90% and more) mainly lives in the Southern and Western regions of Kazakhstan, where registered low incidence of rectal cancer.
Among native ethnic groups of Kazakhs, Kyrgyzs and Uzbeks, the incidence rate of rectal cancer was low - 3.3, 1.9, and 2.3, respectively.
Discussion. Many authors considered that it is difficult to write about the epidemiology of rectal cancer alone, with the exclusion of colon cancer, because the epidemiological data often refers to the large bowel entirely and is not separated in the two anatomical subsites [8, 9]. In Kyrgyzstan and Kazakhstan, the ratio rectal cancer to all cancer (total) was 2.8 and 4.15, respectively. It was similar to Guangzhou (China) - 3.4.
Overall, the lifetime risk of developing colorectal cancer is: about 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women. Colorectal cancer is already the third leading cause of cancer death in the world, and its incidence is steadily rising in developing nations. Moreover known as colorectal adenocarcinoma, this tumor usually emerges from the glandular, epithelial cells of the large intestine. The cancer arises when certain cells of the epithelium acquire a series of genetic or epigenetic mutations that confer on them a selective advantage [10].
Colorectal cancer is more incident among men than women and 3-4 times more common in developed than in developing nations. Age-standardized (world) incidence rates per 100,000 of colorectal cancer in both sexes were 19.7, in males is 23.6, and in females is 16.3 [11]. From the materials provided by the Kazakhstan and Kyrgyzstan cancer registries in 2000-2009, the current survey found the incidence rates (crude) of rectal cancer (total) were 6.8 and 3.3, respectively.
There are different gender patterns between colon cancer and rectum cancer. In the colon the incidences of cancer are similar for both male and female. However, there is a male predominance for rectum cancer (30-50% higher than in women) [12]. Although less frequent than colon cancer, rectal cancer seems to have many similar features to colon cancer in terms of geographic distribution [3]. Among the cities and regions with cancer registration in Kazakhstan, the standardized incidence rate of Almaty was apparently higher than that for Astana, Kostanay, Pavlodar, and especially Chimkent and Jambyl. In Kyrgyzstan, the highest incidence of rectal cancer was registered in Bishkek. Despite the fact that in Kyrgyzstan, in the mountainous regions, protein-rich foods with animal meat, fat and low fiber predominates, the incidence of rectal cancer was low. This requires additional research using analytical methods of epidemiology. However in recent time, as developing countries, in Kazakhstan and Kyrgyzstan, the incidence of rectal cancer has gradually increased from 2000 to 2009 by 10.4% and 8.6%, respectively.
In addition there were the ethnic variability of rectal cancer incidence in Kazakhstan and Kyrgyzstan. We demonstrated a high incidence of rectal cancer in Russians ethnic group. Most of Russians live in the Northern and
Eastern parts of Kazakhstan (about 70%). Totally, there was 3.8 million of Russian of 11 million of Kazakhs population (2009). In Kyrgyzstan, 3.8 Kyrgyzs, 0.8 Uzbeks, and 0.4 million Russians lived in 2009. Rectal cancer incidence rate was higher in Russians by 5.3 and 7.4 times compared to Kasakhs and Kyrgyzs, respectively.
In conclusion, the findings in our survey find the incidence of rectal cancer is high in Kazakhstan, and compare Kyrgyzstan, there were geographical and ethnic variabilities. Further studies on prevention and treatment for rectal and colon cancer are still requiring more improvements.
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ЦАЗАЦСТАН МЕН КЫРГЫЗСТАНДА Т1К 1ШЕК ОБЫРЫМЕН СЫРКАТТАНУШЫЛЬЩТЬЩ ЭПИДЕМИОЛОГИЯЛЬЩ ПАРАЛЛЕЛЬДЕР1
Е. Макимбетов1, М. Кузикеев2, З. Камарли1, Б. Султангазиева4, А. Жуманов5, М. Осомбаев4, А. Тойгонбеков4, О. Сатыбалдиев4, А. Естай3, В. Мадьяров2
1 Кыфгызстан-Ресей Славян университетi, Кыргызстан, Бiшкек ц.
2 Казацстан-Ресей Медициналыц Университетi, Кдзацстан, Алматы ц.
3 Казац онкология жэне радиология гылыми-зерттеу институты, Казацстан, Алматы ц.
4 Онкология жэне гематология ^лттыц орталыгы, Кыргызстан, Бшкек ц.
5 С.Д. Асфендияров атындагы Казац ¥лттыц медициналыц университетi, Казацстан, Алматы ц.
ТYЙiндi
Колоректальды цатерлi iсiктердiн жалпы популяциясыныц 30% - ы т1к iшек цатерлi кшне жатады. Тiк iшек цатерлi гагшщ жиiлiгi диеталыц эдеттер мен генетикалыц факторларга байланысты. Тоц iшек пен тк iшек цатерлi iсiгiнiн этиологиясы сэл езгеше. Тоц iшек пен тк шектщ дистальды цатерлi кш цаупi экологиялыц факторлармен байланысты, мысалы, су талапкерлерiнiн ласта-нуы, алкогольдi трыну жэне темекi шегу эдел. Аз дэрежеде аурудын жиiлiгi емiр салты сияцты фактормен байланысты. Б^л зерт-теу Орталыц Азиянын Казацстан мен Кыргызстан республикаларында тiк шек обырыныц жиiлiгiн талдау мацсатында журпзшд^
Эдiсi. 2000-2010 жылдар кезенiнде тк шек обырымен ауыратын науцастардын саны Казацстан халцынын саны мен Кыргызстандагы ауруханага жатцызу тiркелiмi негiзiнде аныцталды. Тiк iшек цатерлi iсiгiнiн жишп мен елiмi есептелiп талданды.
Нэтижелерь 2000 жылдан бастап 2009 жылга дейiнгi кезенде Казацстан мен Кыргызстанда тiк iшек обырыныц жиiлiгi тшсшше 100000 адамга шаццанда 6,8 (100000 ер адамга шаццанда 7,4 жэне 100000 эйел адамга шаццанда 6,2) жэне 100000 адамга шаццанда
3.3 (100000 ер адамга шаццанда 3,2 жэне 100000 эйелге шаццанда 3,4) цурады. Тк шек обырыньщ жишп цатерлi юктщ барлыц локализациясыныц шшде Кдзацстанда 7-шi жэне Кыргызстанда 8-ш орын алады. Екi республикада да тк шек цатерлi iсiгiнiн жишп артады. Кдзацтар мен цыргыздармен салыстырганда орыс этникалыц тобында жогары жишк тiркеледi.
Корытынды. Кдзацстанда тiк шек обырыныц жиiлiгi Кыргызстанмен салыстырганда жогары. Тк шек цатерлi iсiгiнiн жишпнде географиялыц жэне этникалыц езгерiстер бар. Тк шек обырыныц жогары жишп Ресейдщ популяциясы басым Казацстаннын солтустк облыстарында тiркеледi. Тiк iшек цатерлi iсiгiнiц алдын-алу жэне емдеу жолдарын зерттеудi кушешу керек.
Клт свздер: тгк Iшек цатерлг ШгШц эпидемиологиясы, ауру, вл1м, этникалыц топ, т1ркеу, взгерг1шт1к, Казацстан, Кыргызстан.
ЭПИДЕМИОЛОГИЧЕСКИЕ ПАРАЛЛЕЛИ ЗАБОЛЕВАЕМОСТИ РАКОМ ПРЯМОЙ КИШКИ
В КАЗАХСТАНЕ И КЫРГЫЗСТАНЕ
Е. Макимбетов1, М. Кузикеев2, З. Камарли1, Б. Султангазиева4, А. Жуманов5, М. Осомбаев4, А. Тойгонбеков4, О. Сатыбалдиев4, А. Естай3, В. Мадьяров2
1 Кыргызско-Российский Славянский университет, Кыргызстан, г. Бишкек 2 Казахстанско-Российский Медицинский Университет, Казахстан, г. Алматы 3 Казахский научно-исследовательский институт онкологии и радиологии, Казахстан, г. Алматы 4 Национальный центр онкологии и гематологии, Кыргызстан, г. Бишкек 5 Казахский медицинский университет имени С.Д. Асфендиярова, Казахстан, г. Алматы
Аннотация
Из общей популяции колоректальных злокачественных опухолей 30% прходится на рак прямой кишки. Частота рака прямой кишки зависит от диетических привычек и генетических факторов. Этиология рака толстого кишечника и прямой кишки немного отличается. Риск рака дистального отдела толстого кишечника и прямой кишки более вероятно связан с экологическими факторами, такими как загрязнение истчников воды, потребление алкоголя и привычка курить. В меньшей степени частота заболеваемости связана с таким фактором как образ жизни. Данное исследование проведено с целью анализа частоты рака прямой кишки в Центрально-Азиатских республиках - Казахстан и Кыргызстан.
Метод. Численность пациентов больных раком прямой кишки в период 2000-2010 годов была определена на основании численности населения Казахстана и регистра госпитализации в Кыргызстане. Частота и смертность от рака прямой кишки были вычислены и проанализированы.
Результаты. Частота рака прямой кишки в Казахстане и Кыргызстане в период с 2000 до 2009 года составила 6,8 на 100000 (7,4 на 100000 мужского населения и 6,2 на 100000 женского) и 3,3 на 100000 (3,2 на 100000 мужского населения и
3.4 на 100000 женского), соответственно. Частота рака прямой кишки среди всех локализаций рака занимает 7-ое место в Казахстане и 8-ое место в Кыргызстане. Частота рака прямой кишки увеличивается в возрастом в обеих республиках. Более высокая частота регистрируется в русской этнической группе в сравнении с Казахами и Киргизами.
Выводы. Частота рака прямой кишки выше в Казахстане в сравнении с Кыргызстаном. Существуют географические и этнические вариабельности в частоте заболеваемости раком прямой кишки. Более высокая частота рака прямой кишки регистрируется в северных областях Казахстана, где превалирует русская популяция. Следует усилить изучение путей профилактики и лечения рака прямой кишки.
Ключевые слова: эпидемиология рака прямой кишки, заболеваемость, смертность, этническая группа, регистрация, изменчивость, Казахстан, Кыргызстан.
