Saudi Arabia

CANCER REGISTRATION IN SAUDI ARABIA

Nasser Al Hamdan1, Shouki Bazarbashi2, Dahish Ajarim3, Hassan Al Idrissi4, As-

sem Al Radi5, Saleh Al Ghamdi6, Hassan Ghafouri7, Osama Koriech8, Peter Tallos9,
Abdul Rahman Al Dyab10

History of Cancer Registration in the Country

Saudi Arabia is a vast country and extends over four-fifths of the Arabian Peninsula, stretching from the Arabian Gulf in
the East to the Red Sea in the West. It is approximately 1,500,000 square miles in area. It is divided into 13 Administrative
Regions (Figure 1). The estimated Saudi population in 1996 is 14,089,156, of these 7,097,782 are males and 6,991,334
females. The estimated non-Saudi population in 1995 was 4,624,734.
Until recently, knowledge of the cancer pattern in Saudi Arabia had to be deduced from data on cancer cases treated in
the various major hospitals in the country, and especially in the main teaching hospital, King Faisal Specialist Hospital
and Research Center (KFS&RC). The National Cancer Registry (NCR) in Saudi Arabia is a population-based registry
developed in 1992 (1412H). It was established under the jurisdiction of the Ministry of Health (MOH) by the Order of His
Excellency the Minister of Health. The NCR commenced reporting cancer cases from 1 January 1994. The primary goal
of the NCR is to define the population-based incidence of cancer in Saudi Arabia. Future propositions include supporting
early detection and cancer screening programs and supporting cancer research projects.
Present Status
Asian Pacific J Cancer Prev, 2, IACR Supplement, 61-64

A Board of Directors was appointed to include represen-

tatives from MOH, King Faisal Specialist Hospital and
Research Center (KFS&RC), the Medical Services Depart-
ments of the Ministry of Defense and Aviation, Ministry of
Interior, the National Guard, King Saud University, King
Faisal University and King Abdulaziz University.
The Board is charged with the responsibility of overseeing
the NCR’s establishment, defining demographic and cancer-
related data to be collected, approving research requests,
and reporting findings, and dissemination of information
collected while ensuring the confidentiality of compiled data.
The Main Office with its administrative and technical staff
is located on the premises of KFSH&RC in Riyadh.
Apart from the Main Office, five regional branches and three
hospital offices were set up to ensure comprehensive data
collection from all over the Kingdom. These offices are:
Central Regions Branch: at King Khalid University
Hospital in Riyadh. It covers Riyadh, Qassim, and Hail
Health Regions.
Eastern Regions Branch: at King Fahad University
Hospital in Khobar. It covers Eastern, Hasa, and Hafr
Al-Batin Health Regions.
Western Regions Branch: at King Abdulaziz Hospital
and Cancer Center in Jeddah. It covers Jeddah, Makkah, Figure 1. Administrative Regions of Saudi Arabia

1 Chairman of the National Cancer Registry, Ministry of Health, 2 King Faisal Specialist Hospital & Research Center, 3 King Saud
University, Riyadh, 4 King Faisal University, Khobar, 5 King Abdulaziz Hospital and Cancer Center, Jeddah, 6 King Saud University,
Abha, 7 King Abdulaziz University, Jeddah, 8 Armed Forces Hospital, Riyadh, 9 National Guard Hospital, Riyadh, 10 Security Forces
Hospital, Riyadh

Asian Pacific Journal of Cancer Prevention, Vol 2, IACR Supplement, 2001 61

Nasser Al Hamdan et al
Taif and Gunfudah Health Regions. from the patients’ medical records based on clinical and
Southern Regions Branch: at the Medical College in histo-pathological diagnosis.
Abha. It covers Asir, Baha, Najran, Jazan and Bisha The computer software used for data entry is Epi Info ver-
Health Regions. sion 5.01b, and for analysis is CanReg 2 (cancer registration
Madinah Branch: (established June 1998) at King Fahad software developed by the International Agency for Research
Hospital in Madinah. It covers Madinah, Tabuk, Jouf on Cancer).
and Northern Health Regions.
Offices at the Medical Services Oncology Departments Incidence Data
of the following establishments:
Ministry of Defense and Aviation, with an office at Between January 1994 and December 1996, the total
the Armed Forces Hospital in Riyadh number of cancer cases reported among Saudis was 16,294
National Guard, with an office at King Fahad Hospital (8791 males and 7503 females). The crude incidence rate
in Riyadh. for all cancers in the Saudi population was 39/100,000 (
Ministry of Interior, with an office at the Security 42.3/100,000 for males and 36.8/100,000 for females). The
Forces Hospital in Riyadh. overall age-standardized incidence rate (world standard)
was 71.7/100,000 (72.2/100,000 for males and 70.1/100,000
Figure 2 presents the organization chart for the NCR. Each for females). Histological and/or cytological diagnosis of
of these branches and offices is under the supervision of malignancy was confirmed in 95% of cases. The remaining
a member of the Board of Directors, who is responsible diagnosis was made on clinical and radiological grounds in
for the daily management of the office and ensuring the 4.4% and the method of diagnosis was not known for 0.6%
accuracy of information reported. In addition to tumour of all cases reported.
registrars and secretarial staff, each office is provided In the Kingdom, taking into consideration the population
with the necessary computer facilities, printers, and a structure and the fact that cancer is primarily a disease of the
fax. old, the pattern of cancer had some significant differences.
During the period of reporting, between 1994 and 1996, just
The functions of the Central office include: over 10.2% of all cancers occurred before the age of 15,
- collation of data collected from all the and 29.8% occurred after the age of 64 years. For the total
regions and offices Saudi population the most common ten cancers are female
- assurance of no case duplication, breast cancer (8.8%), leukaemia (7.5%), liver cancer (7.4%),
verification of the diagnosis non-Hodgkin lymphoma (7.3%), colo-rectal cancer (5.5%),
- cleaning and validating the data and and thyroid cancer (5.2%). Fig 3 shows the most commonly
preparation of regular reports for registered cancers, by sex.
dissemination to the medical com- The number of patients registered declined during the period
munity, government establishment, between 1994-1996. This is probably related to registration
international organizations and the of some prevalent cases in the first year of reporting, and/or
media. some delay in reporting, rather than clinical or epidemio-
logical factors.
Data Management
For comprehensive data collection, a Ministerial Decree
has rendered cancer a mandatory notifiable disease. The
NCR has the full accessibility to all MOH, Governmental
and Private hospitals, clinics and laboratories throughout
the Kingdom. Data are extracted by NCR trained registrars

Figure 2. Organization Chart for the National Cancer Figure 3. The Ten Most Common Cancers for Saudis by
Registry Sex, 1994-1996
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 Saudi Arabia
Regional Variation

The four regions with the highest ASR were Riyadh at

106/100,000, Najran at 99.7/100,000, Eastern Province at
89.3/100,000 and Makkah at 80.2/100,000. Fig 4 shows
the ASR by sex for all the 13 administrative regions of
the Kingdom.The number of patients presenting with
malignant disease from the Riyadh region exceeds the an-
ticipated number per population. This can be explained by
the presence of many major referral hospitals for cancer
diagnosis and therapy in Riyadh. Many patients residing
in Riyadh for treatment purposes manage to produce a
permanent address. It is anticipated that this situation will
be resolved as soon as computerization of Identification
Documents is completed.

Epidemiology of the Principal Cancers Figure 4 . ASR Regional Distribution of all Sites of Cancer
in Saudi Arabia 1994-1996
Female breast cancer
Breast cancer was the most common cancer of females Table 1. Histology of Leukemia, 1994-1996
(19.1% of all newly diagnosed cases), with an ASR of
14/100,000. The incidence by age, is shown in Fig 5, and ICD-O code Histology %
the stage distribution in Fig 6.
982139 Acut lymphoblastic leukemia, NOS 47.4
986139 Acute meyloid leukemia 20.7
Leukemia
986339 Chronic myeloid leukemia 12.6
Between January 1994 and December 1996 there were 1216
982339 Chrinic lymphocytic leukemia 7.6
cases of leukemia among Saudis. These cases accounted
980139 Acute leukemia, NOS 2.1
for 7.5% of all newly diagnosed cases. The overall ASR
Other 9.7
was 3.5/100,000 population ( 3.9/100,000 for males and
3.0/100,000 for females). This cancer ranked third for both
Table 2. Histology of Liver Cancer, 1994-1996

ICD-O code Histology %

817039 Hepatocellular carcinoma, NOS 88.8
816039 Cholangiocarcinoma 3.2
814039 Adenocarcinoma, NOS 2.2
800039 Malignant tumour, NOS 1.7
801039 Carcimoma, NOS 1.5
Other 2.6

males and females.

Liver Cancer
Between January 1994 and December 1996 there were 1216
Figure 5. Average Age-specific Incidence Rate (AIR) for cases of liver cancer among Saudis. These cases accounted
Cancer in Saudi Arabia for 7.4% of all newly diagnosed cases. The overall ASR
was 6.3/100,000 population ( 8.5/100,000 for males and
3.5/100,000 for females). This cancer ranked first for males,
and fifth for females, with a sex ratio of 2.9:1.

Non-Hodgkin Lymphoma
Between January 1994 and December 1996 there were 1197
cases of non-Hodgkin’s lymphoma among Saudis. These
cases accounted for 7.4% of all newly diagnosed cases. The
overall ASR was 5.2/100,000 population ( 6.0/100,1000
Figure 6. Stage Distribution of Female Breast Cancer, for males and 4.3/100,000 for females). This cancer ranked
1994-1996 second for the male, and fourth for the female population.

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Nasser Al Hamdan et al

Colorectal cancer Table 3. Histology of Thyroid Cancer, 1994-1996

Between January 1994 and December 1996 there were 915
cases of colo-rectum cancer among Saudis. These cases ac- ICD-O code Histology %
counted for 5.6% of all newly diagnosed cases. The overall
ASR was 4.5/100,000 population ( 4.6/100,000 for males 805039 Papillary carcinoma, NOS 64.3
and 4.4/100,000 for females). This cancer ranked fifth for 834039 Papillary and follicular carcinoma 11.9
both males and females. 833039 Follicular adenocarcinoma, NOS 7.1
801039 Carcinoma, NO 5 3.3
Thyroid cancer 826039 Papillary adenocarcinoma, NOS 2.8
Between January 1994 and December 1996 there were Other 10.5
883 cases of thyroid cancer among Saudis. These cases ac-
counted for 5.4% of all newly diagnosed cases. The overall Table 4. Histology of Lung Cancer, 1994-1996
ASR was 3.5/100,000 population (1.9/100,000 for males
and 5.3/100,000 for females). This cancer ranked 14th for ICD-O code Histology %
males, and second for females. 80703 Squamous cell carcinoma, NOS 30.5
81403 Adenocarcinoma, NOS 23.5
Lung Cancer 80103 Carcinoma, NOS 12.1
Between January 1994 and December 1996 there were 779 80413 Small cell carcinoma, NOS 9.7
cases of lung cancer among Saudis. These cases accounted 80123 Large cell carcinoma, NOS 6.9
for 4.8% of all newly diagnosed cases. The overall ASR was Other 17.4
4.1/100,000 population. The ASR was 5.8/100,000 males
and 1.9/100,000 for females

Contact

National Cancer Registry

P.O. Box 3354, MBC 64
Riyadh 11211, Saudi Arabia
Website www.kfshrc.edu.sa/NCR/
E-mail [email protected]
PHONE 966-1-4423938 FAX 966-1-4423941

64 Asian Pacific Journal of Cancer Prevention, Vol 2, IACR Supplement, 2001