Northern Africa, West & Central Asia
In this diverse region with countries at differing stages of the cancer transition, cancers associated with infection, smoking, and excess body weight are all common.
Northern Africa and Central and Western Asia is a large and diverse region characterized by low but increasing cancer incidence rates. The overall number of cases estimated for 2018 in the region was around 745,000, with this number predicted to increase to 1.4 million cases annually by 2040. However, each of the three sub-regions have distinct cancer profiles. (Map 1)
NORTHERN AFRICA
In Northern Africa, cancer incidence rates are typically about one-third to half of the corresponding rates in Western countries, with incidence rates for all cancer sites combined ranging from less than 90 cases per 100,000 population in Sudan to more than 160 in Egypt in men, and less than 100 in Libya and Sudan to more than 140 in Algeria and Morocco in women. (Figure 1) Liver cancer is the second most common cancer in both sexes combined, with incidence rates in Egypt estimated to be the second-highest worldwide in both men and women. (Figure 2a & b)
Figure 1. All-sites cancer incidence and mortality rates (excludes non-melanoma skin cancer) in Northern Africa and West and Central Asia, both sexes combined, 2018. Age-standardized rate (world) per 100,000. In Yemen, incidence 76.1 and mortality 57.3. In Tajikistan, incidence 87.3 and mortality 65.4. In Saudi Arabia, incidence 88.7 and mortality 43.3. In Uzbekistan, incidence 91.4 and mortality 60.9. In Sudan, incidence 95.9 and mortality 67.7. In Qatar, incidence 97.3 and mortality 65.1. In Oman, incidence 103.3 and mortality 60.8. In Bahrain, incidence 105.2 and mortality 70. In Iraq, incidence 105.5 and mortality 64.7. In Azerbaijan, incidence 106.2 and mortality 75.3. In United Arab Emirates, incidence 112.5 and mortality 61.7. In Tunisia, incidence 115.4 and mortality 71.3. In Turkmenistan, incidence 117.8 and mortality 84.1. In Libya, incidence 120.3 and mortality 69.1. In Kuwait, incidence 121.8 and mortality 68.3. In Kyrgyzstan, incidence 128.8 and mortality 90.8. In Algeria, incidence 130.8 and mortality 73.3. In Morocco, incidence 139.6 and mortality 86.9. In Georgia, incidence 143.2 and mortality 87.9. In Egypt, incidence 156.9 and mortality 107.1. In Jordan, incidence 157.8 and mortality 89.7. In Gaza Strip and West Bank, incidence 158.6 and mortality 101.1. In Kazakhstan, incidence 170.1 and mortality 109.5. In Armenia, incidence 194.8 and mortality 134.3. In Turkey, incidence 225.1 and mortality 121.5. In Israel, incidence 233.5 and mortality 90.9. In Lebanon, incidence 242.8 and mortality 119.8.
We need to ask ourselves: What legacy do we want our generation to be known for? The one that watched the NCD epidemic destroy the lives of our children and our children’s children, or the generation that said ‘enough is enough’ and took action?
Figure 2a. Estimated number of new cancer cases and distribution (%) by type (excludes non-melanoma skin cancer) in Northern Africa and West and Central Asia, both sexes, 2018. In Northern Africa, there were an estimated 279,000 cancer cases. The leading cancer cases are breast (19%), liver (10%), lung (7%), colorectum (7%), bladder (6%), non-Hodgkin lymphoma (6%), prostate (4%), and other cancers (41%). In Western Asia, there were an estimated 391,000 cancer cases. The leading cancer cases are breast (14%), lung (13%), colorectum (10%), prostate (7%), thyroid (5%), bladder (5%), stomach (5%), and other cancers (40%). In Central Asia, there were an estimated 75,000 cancer cases. The leading cancer cases are breast (13%), stomach (11%), lung (11%), colorectum (8%), cervix (6%), esophagus (5%), liver (5%), and other cancers (42%).
Figure 2b. Estimated number of cancer deaths and distribution (%) by type (excludes non-melanoma skin cancer) in Northern Africa and West and Central Asia, both sexes, 2018. In Northern Africa, there were an estimated 177,000 cancer deaths. The leading cancer deaths are liver (16%), breast (11%), lung (11%), colorectum (6%), non-Hodgkin lymphoma (6%), bladder (5%), leukemia (5%), and other cancers (41%). In Western Asia, there were an estimated 220,000 cancer deaths. The leading cancer deaths are lung (22%), colorectum (9%), stomach (8%), breast (8%), pancreas (5%), leukemia (5%), brain and central nervous system (5%), and other cancers (39%). In Central Asia, there were an estimated 51,000 cancer deaths. The leading cancer deaths are lung (14%), stomach (14%), breast (9%), colorectum (7%), liver (6%), esophagus (6%), cervix (5%), and other cancers (39%).
WESTERN ASIA
Western Asia is a large region, with close to 400,000 estimated cancer cases annually, but high-quality cancer registry data are available for only few countries, partly due to large numbers of displaced persons and ongoing conflicts. Some of the countries in the region have very high bladder cancer incidence rates; Lebanon notably has the highest estimated incidence rate in the world (40 cases per 100,000 in men), while rates in Israel, Syria, and Turkey also exceed 20 per 100,000 in men. Western Asia also includes the Gulf countries, with specific cancer profiles corresponding to their high national levels of HDI, high prevalence of obesity, and varying levels of smoking uptake, but low alcohol consumption. (Map 2)
CENTRAL ASIA
Cancer incidence rates in Central Asia are relatively low but increasing. Cancer profiles are consistent with low- to medium-HDI countries, with a high incidence of infection-related cancers such as stomach (11% of all cancer cases) and cervical cancer (6% of all cancer cases). The region forms part of the so-called esophageal cancer belt, which includes Turkmenistan, Tajikistan, Uzbekistan, Kazakhstan, Afghanistan and the eastern part of Turkey, with some of the highest incidence rates worldwide, particularly in men.
Cancer cases expected to double in this region:
Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, France: IARC. Available from: https://gco.iarc.fr/today.
Text:
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, France: IARC. Available from: https://gco.iarc.fr/today.
Map 1 and Figures 1 and 2:
Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon, France: IARC. Available from: https://gco.iarc.fr/today.
Map 2:
Arnold M, Lam F, Ervik M, Soerjomataram I (2015). Cancer and Obesity: Global burden of cancer attributable to excess weight. Lyon, France: International Agency for Research on Cancer. Available from: http://gco.iarc.fr/obesity, accessed May 23, 2019.