Catherine Herzog

Spatial Analysis of Hematopoietic Cancers in Gharbiah Province, Egypt

ABSTRACT: Hematopoietic cancers encompass a wide variety of cancer types that affect both the young and the old. Lymphomas, which are divided into a wide variety of subtypes including Hodgkin and Non-Hodgkin lymphoma, are neoplasms of lymphoid tissue. There are about 62,000 new cases of Hodgkin lymphoma annually, and about 280,000 new cases of Non-Hodgkin lymphoma annually (IARC, 2003). Rates of Non-Hodgkin lymphoma are on the rise today. In the Middle East Cancer Consortium, the highest rates of Non-Hodgkin lymphoma are seen in the Egyptian population (Freedman, 2006). Leukemias, the eleventh most common cancer in the world (IARC, 2003), are the neoplastic proliferation of immature cells of the hematopoietic system. There are about 250,000 new cases annually (IARC, 2003). Multiple myelomas account for 1% of all cancers (and 10% of hematopoietic cancers) (Sekeres, 2007) and are progressive cancers of the plasma cells (MMRF, 2009). Unfortunately, not much is known about the etiology of hematopoietic cancers. Risk factors that have been associated with most hematopoietic malignancies include ionizing radiation, viral infection (HCV, HIV, EBV, HHV8, HTLV-1), bacterial infection (H. pylori), occupational exposures (rubber, benzene, agricultural, pesticides), environmental exposures, family history, and various genetic mutations (IARC, 2003). However, study results vary widely on the importance of some of these factors. In Egypt, where hematopoietic cancers are considered common (Freedman, 2006), recent work by Elizabeth Lehman, Christiana Shoushtari, and Stacy Fedewa has demonstrated the feasibility of performing spatial analysis on cancers in Egypt. Given the uncertainty of the etiology of hematopoietic malignancy, spatial analysis would be a useful way to explore multiple risk factors for hematopoietic cancers and add to the current scientific knowledge on this topic.

SPECIFIC AIM #1: To perform secondary data analysis of hematopoietic malignancy cases from the Gharbiah Population-based Cancer Registry (GPCR) using data from 1999-2006. Cases will be plotted on a map using geographic information software (ArcGIS) and spatial analysis will be performed on these cases.

SPECIFIC AIM #2: To create overlay plots of cases (and clustering) on top of district-by-district maps of the prevalence of suspected risk factors. One prominent risk factor to be explored is HCV infection status. Other risk factors to be explored are potential occupational and environmental exposures (ex. pesticides) as well as other viral and bacterial infections. These risk factors, and others, will be assessed from information available in the literature and from local collaborators.

This study hopes to describe distribution and patterns of hematopoietic cancers and their relation to the distribution of suspected risk factors in Gharbiah Province. This study serves as a hypothesis generating study for future in-depth studies of key risk factors of hematopoietic cancers.

1. Freedman LS, Edwards BK, Ries LAG, Young JL (eds). Cancer Incidence in Four Member Countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East Cancer Consortium (MECC) Compared with US SEER. National Cancer Institute, 2006. NIH Pub. No. 06-5873. Bethesda, MD.
2. International Agency for Research on Cancer. WHO World Cancer Report. IARC Press: Lyon, 2003. 237-247.
3. Multiple Myeloma Research Foundation. Accessed 1/20/09.
4. Sekeres, MA; Kalaycio, ME; Bolwell, BJ. Clinical Malignant Hematology. McGraw Hill Medical: 2007, pgs. 833-840.