January 7th - Cencer Registry
Information about Iraq's cancer registry and treatment.
One of the problems with CanReg3, the international standard computerized cancer registration system, is that it cannot accept Arabic script. There is no standard form of transliteration for writing Arabic names in English. Some people would spell ‘Mohammed’ with one ‘m’ and some with two. The cancer registry team in Baghdad have made a dictionary of four hundred names. They require the hospitals to submit names in Arabic, so that they are transliterated only according to the dictionary and patients cannot be duplicated on the register or lost within it due to differences in the spelling of names.
Professor Dr A. Hadi Khalili is vice chair of the Iraqi Cancer Board and head of the Department of Neurosurgery at Baghdad University College of Medicine. The Board, he says, “is a unique organisation. It was established in 1985 but it has been latent, more or less, until 2002. The head is the Minister of Health and it consists of experts in the field, representatives of other ministries, like the Ministry of Higher Education, and other government offices, to coordinate and improve diagnosis, registration, early detection, rehab, palliative care, nursing, everything.”
It also runs the national cancer registry, which was started in 1974 and first operated in 1976. It’s been improved since then, computerised in 2000 and for the past three years it has used the international registration criteria of the WHO – the CanReg3 system, soon to be updated to expecting version 4. Prof Khalili believes the new version will be capable of accepting Arabic script. Previously they used a manual system of case reporting on standard WHO forms, covering all the cases in government hospitals and private diagnostic labs.
There is always an underestimation of the total cancer prevalence in the country because not all the cases are reported. Some patients can’t afford to get to the hospital, others are never diagnosed. Some are clinically too advanced for effective care, so are never admitted as in-patients. The team has careful procedures to prevent duplication, for example, if a patient is diagnosed in Basra and then comes to Baghdad for treatment.
Dr Ahmed, a cancer epidemiologist working with Prof Khalili, says they are currently reviewing all of the information registered since the computerisation in 2000. They moved into the Shahid Adnan hospital in the first days after the war when no one else was working, and managed to save all their data. Everything was on files which were kept safe from the fires and looting. They hope to complete the analysis within the first half of this year but they believe that both the number and behaviour of cancers has changed since the early to mid 1990s. Leukaemias have shown the biggest increase.
Breast cancer overtook bronchial and urinary cancers as the most common tumour. Brain, colloidal and colo-rectal cancers have also increased with a 5-7 fold increase in those types up to 1999. The biggest increases in patients presenting with cancers have been in the south of the country, up to 1999. The statistical predictions for increases by 2008 are massive based on that data.
Prof Khalili explained that the increasing aggression of cancers over the last 10 years means they see many ‘museum cases’ that would not be seen elsewhere, clinically advanced in a short time. He opened pictures on his computer, one of the few in the hospital, and showed me pictures of eye tumours and, with pride, the after picture, the eye saved.
Why? “Cancer is increasing throughout the world. Here the environment is full of carcinogens, in the air, the water, the soil. There have been three toxic wars using all kinds of weapons, including uranium weapons, and there have been explosions in weapons factories and dumps. There is also excessive use of canned food and the introduction of genetically modified food. Malnutrition increases susceptibility.
We do not know whether there is a statistically significant link between DU and cancer. We were planning to do a proper study with the WHO starting in march 2003 with six projects but it was delayed by the war and now it is on hold. So there is no solid evidence of a link, only presumptive evidence, because the biggest increases have been in the areas where the greatest amount of DU was used.”
Dr Ahmed points out a desperate need for training for epidemiology and diagnostic processes. Both agree that help from outside the country is urgently needed but needs to be coordinated through the Cancer Board, not on an ad-hoc basis.
Prof Khalili thinks the most urgent need is for experts in epidemiology and statistics. “We can do our own analysis but we know there is more to be done. We need to have experts analyse our data and help with planning strategies, to stay for two or three months and go into depth with our figures. One of the problems used to be that the government would not release any census information – it was forbidden for anyone to know how many people were living here. I don’t know why. So the two WHO experts who came could not do proper statistical analysis.”
Professor Dr A. Hadi Khalili is vice chair of the Iraqi Cancer Board and head of the Department of Neurosurgery at Baghdad University College of Medicine. The Board, he says, “is a unique organisation. It was established in 1985 but it has been latent, more or less, until 2002. The head is the Minister of Health and it consists of experts in the field, representatives of other ministries, like the Ministry of Higher Education, and other government offices, to coordinate and improve diagnosis, registration, early detection, rehab, palliative care, nursing, everything.”
It also runs the national cancer registry, which was started in 1974 and first operated in 1976. It’s been improved since then, computerised in 2000 and for the past three years it has used the international registration criteria of the WHO – the CanReg3 system, soon to be updated to expecting version 4. Prof Khalili believes the new version will be capable of accepting Arabic script. Previously they used a manual system of case reporting on standard WHO forms, covering all the cases in government hospitals and private diagnostic labs.
There is always an underestimation of the total cancer prevalence in the country because not all the cases are reported. Some patients can’t afford to get to the hospital, others are never diagnosed. Some are clinically too advanced for effective care, so are never admitted as in-patients. The team has careful procedures to prevent duplication, for example, if a patient is diagnosed in Basra and then comes to Baghdad for treatment.
Dr Ahmed, a cancer epidemiologist working with Prof Khalili, says they are currently reviewing all of the information registered since the computerisation in 2000. They moved into the Shahid Adnan hospital in the first days after the war when no one else was working, and managed to save all their data. Everything was on files which were kept safe from the fires and looting. They hope to complete the analysis within the first half of this year but they believe that both the number and behaviour of cancers has changed since the early to mid 1990s. Leukaemias have shown the biggest increase.
Breast cancer overtook bronchial and urinary cancers as the most common tumour. Brain, colloidal and colo-rectal cancers have also increased with a 5-7 fold increase in those types up to 1999. The biggest increases in patients presenting with cancers have been in the south of the country, up to 1999. The statistical predictions for increases by 2008 are massive based on that data.
Prof Khalili explained that the increasing aggression of cancers over the last 10 years means they see many ‘museum cases’ that would not be seen elsewhere, clinically advanced in a short time. He opened pictures on his computer, one of the few in the hospital, and showed me pictures of eye tumours and, with pride, the after picture, the eye saved.
Why? “Cancer is increasing throughout the world. Here the environment is full of carcinogens, in the air, the water, the soil. There have been three toxic wars using all kinds of weapons, including uranium weapons, and there have been explosions in weapons factories and dumps. There is also excessive use of canned food and the introduction of genetically modified food. Malnutrition increases susceptibility.
We do not know whether there is a statistically significant link between DU and cancer. We were planning to do a proper study with the WHO starting in march 2003 with six projects but it was delayed by the war and now it is on hold. So there is no solid evidence of a link, only presumptive evidence, because the biggest increases have been in the areas where the greatest amount of DU was used.”
Dr Ahmed points out a desperate need for training for epidemiology and diagnostic processes. Both agree that help from outside the country is urgently needed but needs to be coordinated through the Cancer Board, not on an ad-hoc basis.
Prof Khalili thinks the most urgent need is for experts in epidemiology and statistics. “We can do our own analysis but we know there is more to be done. We need to have experts analyse our data and help with planning strategies, to stay for two or three months and go into depth with our figures. One of the problems used to be that the government would not release any census information – it was forbidden for anyone to know how many people were living here. I don’t know why. So the two WHO experts who came could not do proper statistical analysis.”