Epidemiologic features of upper gastrointestinal tract cancers in Northeastern Iran

Abstract

Previous studies have shown that oesophageal and gastric cancers are the most common causes of cancer death in the Golestan Province, Iran. In 2001, we established Atrak Clinic, a referral clinic for gastrointestinal (GI) diseases in Gonbad, the major city of eastern Golestan, which has permitted, for the first time in this region, endoscopic localisation and histologic examination of upper GI cancers. Among the initial 682 patients seen at Atrak Clinic, 370 were confirmed histologically to have cancer, including 223 (60%) oesophageal squamous cell cancers (ESCC), 22 (6%) oesophageal adenocarcinomas (EAC), 58 (16%) gastric cardia adenocarcinomas (GCA), and 58 (16%) gastric noncardia adenocarcinomas. The proportional occurrence of these four main site-cell type subdivisions of upper GI cancers in Golestan is similar to that seen in Linxian, China, another area of high ESCC incidence, and is markedly different from the current proportions in many Western countries. Questioning of patients about exposure to some known and suspected risk factors for squamous cell oesophageal cancer confirmed a negligible history of consumption of alcohol, little use of cigarettes or nass (tobacco, lime and ash), and a low intake of opium, suggesting that the high rates of ESCC seen in northeastern Iran must have other important risk factors that remain speculative or unknown. Further studies are needed to define more precisely the patterns of upper GI cancer incidence, to test other previously suspected risk factors, and to find new significant risk factors in this high-risk area.

Helicobacter pylori and oesophageal and gastric cancers in a prospective study in China

“…These two exposures are major risk factors for oesophageal squamous cell carcinoma in Western populations (Brown et al, 1994(Brown et al, , 2001), but play a much smaller role in such high-risk areas, such as Linxian (Tran et al, 2005) or northeastern Iran (Cook-Mozaffari et al, 1979;Islami et al, 2004).…”

Patho-epidemiological Features of Esophageal and Gastric Cancers in an Endemic Region: a 20-year Retrospective Study

“…With above statement, we can explain a predominance of cardiac cancer compared to all types of gastric cancers because it is more symptomatic (Islami et al, 2004;Kumar, 2007).…”

“…One important suggestion that need to be considered in morphological and topographic changes would be error due to investigation criteria. For example, study from Golestan province on 1969-71 (Islami et al, 2004) showed the ratio of esophageal /gastric cancer was estimated about 8/1 but in another study on 2001 (Islami et al, 2004) it was estimated about 2/1. This notable change might be result of changing in the technique of diagnosis because endoscopy had not been used in the older study and it's possible to diagnose many of cardiac tumors as esophageal cancer (due to dysphagia) (Islami et al, 2004).…”

Validity and reliability of a new food frequency questionnaire compared to 24 h recalls and biochemical measurements: pilot phase of Golestan cohort study of esophageal cancer

“…Etiologic factors responsible for these high rates are largely unknown (Islami et al, 2004), and only two studies have examined the role of diet in association with oesophageal cancer in this area (Hormozdiari et al, 1975;Cook-Mozaffari et al, 1979). Residents in the high incidence areas had lower intake of vitamins A and C, riboflavin, animal proteins and fresh vegetables and fruits and a higher consumption of sheep and goat milk than that of residents in other areas (Hormozdiari et al, 1975).…”