Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul-Aug;42(4):252-261.
doi: 10.5144/0256-4947.2022.252. Epub 2022 Aug 4.

Trends in colorectal cancer in Iraq over two decades: incidence, mortality, topography and morphology

Salih Ibrahem  1 , Hussien Ahmed  2 , Suhair Zangana  3
Affiliations

Trends in colorectal cancer in Iraq over two decades: incidence, mortality, topography and morphology

Salih Ibrahem et al. Ann Saudi Med. 2022 Jul-Aug.

Abstract

Background: Colorectal cancer (CRC) is mainly a disease of the elderly in the Western world, but its characteristics are changing globally. Iraq does not have a well established CRC screening program. Understanding trends of CRC incidence, fatality and the clinical features of CRC patients is vital to the design of effective public health measures; public awareness, screening, diagnosis and treatment strategies to meet the future demands.

Objectives: Determine trends in demography, incidence proportion, mortality, topography (primary tumor site) and morphology (histology) over two decades.

Design: Registry-based study SETTING: Iraqi National Cancer Registry (INCR) database PATIENTS AND METHODS: We collected and analyzed data from CRC patients obtained from the INCR to calculate incidence and mortality proportion per 100 000 population for the period from 2000 to 2019. In addition to estimation, data were examined by anatomic location and morphological type.

Main outcome measures: Change in the incidence and mortality proportion, topography and morphology of CRC over 20 years.

Sample size: 20 880 CRC patients ranging in age from 14-80 years.

Results: The overall (males and females) CRC incidence proportion (CIP) increased from 2.28 to 6.18 per 100 000 population in 2000 and 2019, respectively, with an annual percentage change (APC) of 5.11%. The incidence proportion (IP) of CRC in patients from 20 to <50 years rose from 1.46 in 2000 to 4.36 per 100 000 population in 2019, which is an APC of 5.6%. The IP in patients older than 50 years rose from 12.7 to 40.59 per 100 000 population in 2000 and 2019, respectively, with an APC of 5.98%. The percentage of all CRC cases to all total malignancies in Iraq grew from 3.69% in 2000 to 6.5% in 2019. The CRC mortality proportion increased from 1.25 to 1.77 per 100 000 populations in 2010 and 2019, respectively, reflecting an APC of 3.54%. Anatomically, colon (C18) tumor represented 59.2% and 65.7% in 2000 and 2019, respectively. Rectal (C20) tumors were 37.2% in 2000 down to 31.4% in 2019, while rectosigmoid junction tumor (C19) were 3.6% in 2000 dropping to 2% in 2019.

Conclusions: CRC in Iraq is still a disease of the elderly and is rising in incidence and mortality in all age groups. This necessitates reconsidering health policy regarding CRC; public awareness, screening and management strategies to accommodate for these alarming changes.

Limitations: Data about stages, grades and molecular characterisations are not available in the INCR.

Conflict of interest: None.

PubMed Disclaimer

Figures

Figure 1A.
Figure 1A.
Incidence of colorectal cancer per 100 000 population (Both sexes=black, Male=blue, Female=pink).
Figure 1B.
Figure 1B.
Percentage of colorectal cancer compared to other malignancies (Both sexes=black, Male=blue, Female=pink).
Figure 2
Figure 2
The age-specific incidence proportion of colorectal cancer over the 20-year period. The graphs A and B show the incidence of CRC in two age groups <50 and 50 years and older respectively. The incidence rate is higher in the latter group with similar average annual percentage increases. Graphs C to H are for the remaining ten year age groups. The peak of the disease was at 60–69 years; the lowest was for the age group 20–29 years.
Figure 3A
Figure 3A
Sex-specific mortality proportion of CRC cancer cases per 100 000 population.
Figure 3B
Figure 3B
CRC mortality in males and females relative to all cancer deaths over time. (Both sexes=black, Male=blue, Female=pink).
Figure 3C
Figure 3C
The ratio of mortality proportion to incidence proportion per 100 000 population of CRC annually over ten years.
Figure 4
Figure 4
Percentages of specific anatomical CRC cases relative to other CRC cases.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33. - PubMed
    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2021;71(3):209–49. - PubMed
    1. 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: A Cancer Journal for Clinicians. 2018;68(6):394–424. - PubMed
    1. Zhou J, Zheng R, Zhang S, Zeng H, Wang S, Chen R, et al. . Colorectal cancer burden and trends: Comparison between China and major burden countries in the world. Chin J Cancer Res. 2021;33(1):1–10. - PMC - PubMed
    1. Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14(2):89–103. - PMC - PubMed