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2013 TRANSLATIONAL BIOMEDICINE
Vol. 4 No. 1:2 doi: 10.3823/439
Our Site: http://www.imedpub.com/
Occurrence of cancers of the gastrointestinal tract in the Republic of Suriname. Results from a descriptive study between the years 1980 and 2008
Dennis R.A. Mans1, Kitty Pelswijk1, Imona Boschveld1, Gracia Culbard1, Aruna Tewarie1, Shailes Adhin1, Bobby Ramautar1, Sachida Sewgobin1, Aviska Jagesar1, Renuka Mohan1, Rakesh Bansie1, Anushka Wangsawirana1, Martinus A. Vrede2
1D epartment of Pharmacology, Faculty of Medical Sciences, Anton de Kom University, Paramaribo, Suriname; 2 Pathologic Anatomy Laboratory, * Corresponding Author: Academic Hospital Paramaribo, email@example.com Paramaribo, Suriname.
Dennis R.A. Mans, PhD, Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University. Kernkampweg 6, Paramaribo, Suriname.
Background: Unhealthy dietary habits, physical inactivity, overweight and obesity, cigarette smoking, and excessive alcohol consumption have been associated with the development of non-communicable diseases including certain malignancies such as gastrointestinal tract cancers. This holds particularly true for economically developing countries such as the Republic of Suriname. In this study, we determined the incidence of gastrointestinal tract malignancies in Suriname for the period between 1980 and 2008. The data obtained have been stratiﬁed according to gender, age group, as well as ethnic background, and have been compared with international data.
Methods and ﬁndings: Numbers of diagnoses and patient information were
from the Pathologic Anatomy Laboratory. The General Bureau of Statistics provided relevant population data. Crude incidence rates were calculated for gastrointestinal tract malignancies cancers overall as well as for the various anatomical sub-sites (esophagus, stomach, small intestine, colon and rectum, anus and anal canal, liver, pancreas, and gallbladder), and were stratiﬁed according to gender, age strata 0-19, 20-49, and 50+ years, and the largest ethnic groups, viz. Hindustanis, Creoles, and Javanese. From these data, average incidence rates were calculated which were expressed as means ± SDs per year or per 100,000 populations per year. In the period covered by this study, 1,513 individuals (about 12 per 100,000 per year) were newly diagnosed with a neoplasm of the gastrointestinal tract. The maleto-female-ratio was close to 1:1. Colorectal, stomach, and liver cancer comprised in both genders 85% of overall gastrointestinal malignancies. Less than 4% of gastrointestinal cancers was seen in individuals aged between 0 and 19 years, 10 to 23% in those of 20 to 49 years of age, but more than 74% in those of 50 years and older. And most gastrointestinal tumors occurred twice more often in Creoles than in Hindustanis and Javanese. The exception was primary liver cancer, that was more common in men than in women (1.6 versus 0.6 per 100,000 per year), and more often diagnosed in Javanese than in Hindustanis and Creoles (41% versus 16 and 26% of cases, respectively).
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Key words: gastrointestinal tract cancers. 23]. more than one-quarter smokes. almost three-quarters of these patients eventually die from their disease . accounting worldwide for more than 30% of new cancer cases and almost 40% of cancer fatalities . Furthermore.25 million women . occurred more often at older than at younger age. small intestine. and manifested more frequently in Creoles than in Hindustanis and Javanese. 7]. colon and rectum. that nearly half has too little physical activity. 23]. Map of the Republic of Suriname. These differences have largely been related to regional variations in the distribution of associated risk factors. The most common histotypes were colorectal. roughly half is overweight. and obesity [6. gender. south to Brazil. ﬁshery. agriculture. east to French Guyana. Among the most common subtypes are colorectal. 9]. anus and anal canal. gastric. At the same time.000 . overweight.3823/439 Our Site: http://www. ethnic background. and/or gallbladder. which are each year newly diagnosed in more than two million men and about 1. about one-quarter is obese. incidence. However. and borders north to the Atlantic Ocean. which positions Suriname among the upper middle income countries on the World Bank’s list of economies . with or without aﬂatoxin B1 exposure . the Pan American Health Organization reported that almost one-third of Surinamese adolescents do not consume sufﬁcient fruits and vegetables. Circle in top left: Suriname’s location in South America 2 © Under License of Creative Commons Attribution 3. crude oil drilling. stomach. most gastrointestinal neoplasms were as common in men as in women. Regrettably. Introduction Cancers of the gastrointestinal tract are malignancies arising from the esophagus. 1:2 doi: 10. distribution. and approximately one-third consumes alcohol at higher than average amounts [22. and west to Guyana (Figure 1). In low-risk Western countries. most cases are attributable to alcohol-related cirrhosis and possibly non-alcohol fatty liver disease associated with obesitas . age. The main exception was primary liver cancer that was more common in males and in Javanese. excessive alcohol consumption . The gross national income per capita is around U$ 7. its prevalence is rising in economically developing countries with an aging population and an increasingly westernized lifestyle (such as Brazil) . about one out of ﬁve of this group is overweight. where it has been related to the consumption of excessively salted or otherwise preserved foods but insufﬁcient amounts of fresh fruits and vegetables [14. but also the most deadly conditions known to mankind. stomach. forestry. and cigarette smoking . Primary liver cancer incidence is particularly high in parts of Asia and Africa that are struck by chronic hepatitis B and C virus infection . and primary hepatic cancer. and that about 10% is an active cigarette smoker [22. colorectal cancer is most frequently seen in industrialized areas . and cigarette smoking [11.iMedPub Journals 2013 TRANSLATIONAL BIOMEDICINE Vol. ecotourism. and industry . The country’s main economic activities are gold and bauxite mining. 4 No. Incidence rates of gastrointestinal tract cancers vary widely throughout the world. Cancer of the stomach occurs at relatively high rates in Eastern Asia . These neoplasms are collectively among the most prevalent. commerce. Suriname. where it has been linked to physical inactivity. liver. and approximately one out of ﬁfteen is obese [22. The Republic of Suriname is situated on the north-east coast of South America. pancreas. services. and primary liver cancer. Recently. These devastating results are for an important part attributable to the fact that gastrointestinal tumors are often detected at an advanced stage. more and more Surinamese are adapting a Western life-style. Figure 1.0 License . when they are not curable by resection and respond poorly to chemotherapy [2-5]. 23]. For instance. Increased efforts should be dedicated to avoid the risk factors associated with gastrointestinal tract cancers. As far as Surinamese adults are concerned. 17]. chronic Helicobacter pylori infection [16.imedpub. 15]. 12]. Not surprisingly.com/ Conclusions: Suriname can be characterized as a low-risk country for gastrointestinal malignancies. the consumption of red and processed meat [8.
30]. in situ carcinomas. and above 50 years. as well as ethnic origin. because interracial marriages are even now rather uncommon. Average yearly crude incidence rates were estimated by dividing the number of cancer cases for each group by the estimated mid-year resident total population. a total of 1. These groups comprise approximately 27. diabetes mellitus. 1:2 doi: 10. numbers of overall gastrointestinal cancers. gender. Estimates of the male and female resident populations were derived from the total mid-year populations on the basis of reports indicating that both genders were more or less equally distributed over the Surinamese population [29. and an overall incidence rate of about 12 cases per 100. and were expressed per 100. Cancer cases are classiﬁed using the International Classiﬁcation of Diseases for Oncology . and certain types of cancer [24-26]. however. In the 29 years covered by this study. there were only 23 cases in individuals of 19 years and younger. Hindustanis (the descendents from contract workers attracted from Eastern India). Notably. the histopathologically conﬁrmed malignant gastrointestinal cancers registered in Suriname between January 1. viz.com/ These observations suggest that Suriname. age at the time of diagnosis.05 to indicate statistically signiﬁcant differences. Notably. age at the time of diagnosis. and ethnic background. of the total Surinamese population .0 License 3 . indicating that gastrointestinal tract malignancies occurred almost as often in men as in women (at average rates of roughly 25 men or women per year. and Javanese (the descendents from contract workers from the Indonesian island of Java). 30]. or 6 men or women per 100. For this reason. So far. Results Overall data Between the years 1980 and 2008. about 10 cases per year in age group 20 to 49 years. Statistics Data presented are means ± SDs and have been compared using Student’s t test or ANOVA. Thus. is facing increasing threats of lifestyle-related non-communicable diseases. these conditions represent the three most important causes of mortality in the country. © Under License of Creative Commons Attribution 3. gastrointestinal tract malignancies manifested predominantly in older individuals. accounting each year for over 40% of deaths . as well as numbers of cancers from the individual anatomical sites have been determined for males and females. and have been treated conﬁdentially.3823/439 Our Site: http://www. no comprehensive studies have been performed on the potential magnitude of this problem for public health in Suriname. The male-to-female-ratio was approximately 55 : 45 (Table 1). histopathological diagnosis. and almost four times more in patients of 50 years and older ( Table 1). and for the four largest ethnic groups. have been inventoried and stratiﬁed on the basis of histology. but more than 300 cases in the age group between 20 and 49 years. The age distribution of overall gastrointestinal cancers showed a marked increase with increasing age. and ethnic origin.000 populations. were provided by the Section Population Statistics of the General Bureau of Statistics from the Ministry of Planning and Developmental Cooperation [29. Table 1). 2008. similarly too many other economically developing countries. and about 40 cases per year in the group of 50 years and older ( Table 1). 1980 and December 31. This was consistent with approximately 52 new patients per year or one new patient per week. taking P values < 0.000 populations per year (Table 1).iMedPub Journals 2013 TRANSLATIONAL BIOMEDICINE Vol. among others. including estimates of the mid-year population of Suriname for each year covered by this study. Sources of data Relevant patient data were obtained from the Pathologic Anatomy Laboratory of the Academic Hospital of Paramaribo. their composition is still fairly homogeneous. for cases aged between 0 and 19 years. even though these sub-populations have settled for at least a century in Suriname. This corresponded to only 1 case per year in the youngest age group. between 20 and 49 years. 4 No. and gastrointestinal lymphomas have been excluded from the study. date of birth. Population data. respectively. This also holds true for a typically lifestyle-related group of cancers such as those of the gastrointestinal tract.imedpub. the referral center for histopathological cancer diagnosis and cancer registration in Suriname. Creoles (those from mixed black and white ancestry). and have been discussed within the framework of international incidence patterns.513 individuals were newly diagnosed with a malignancy of the gastrointestinal tract (Table 1). as well as gender. including cardiovascular ailments.000 population per year. The data obtained have been stratiﬁed according to gender. overall as well as for the various anatomical sites. Patients and methods Study population In this study. Benign lesions. we determined incidence rates of these malignancies in the country for the period between the years 1980 and 2008. Patients’ records include. and 15%. Data analysis For each year between 1980 and 2008. 18.
and Javanese ( Table 1).513) was diagnosed in representatives of the three largest ethnic groups. ANOVA). Almost 80% of overall gastrointestinal cancers (1. anus and anal canal. but 2 to 5 cases per year in the group of 20 to 49 years. Cancer of the stomach was seen in approximately one-quarter of both men and women ( Table 2) and at rates of about 2 per 100.3823/439 Our Site: http://www. about one-quarter was Javanese. and at frequencies up to 2 per year in those of 50 years and older (Table 3).2 ± 7.3 5. and 5.03 9.6 ± 2.51 40.6 ± 3.0009. and liver cancer ( Table 2). 2 Statistically signiﬁcantly different from ‘0-19 years’ (P = 0. most malignancies from the various sub-sites were also more frequently seen in Creoles than in Hindustanis and Javanese ( Table 4). as well as anus and anal canal comprised together 14 and 18% of gastrointestinal tract malignancies in males and females.0002.9 10.imedpub. 4 No. Notably.0 License 4 .0008.2 ± 1.7 22. respectively. Hindustanis.8 ± 0.513 824 672 17 23 308 1.5 ± 3.3 - Number of cases Males + females Males Females Unknown 0-19 years 20-49 years 50+ years Unknown Hindustanis Creoles Javanese Others 1. gallbladder.0 - Cancers of the colon and rectum comprised in males more than one-third and in females almost half of the total number of gastrointestinal cancers ( Table 2).1 ± 2. For all histiotypes. ANOVA).2 ± 0.. Cancers of the pancreas.72 2.82 10.1 ± 10.000 population per year ( Table 1).4 ± 4.iMedPub Journals 2013 TRANSLATIONAL BIOMEDICINE Vol. Creoles.8 ± 2. per 100. per 100.01 9. esophagus.205 out of 1.000 populations per year (Table 2). and liver cancer: there were only a few cases in the youngest age group.6 ± 1. This corresponded to incidence rates of roughly 2 and 3 cases. approximately 41% of colorectal cancers and more than 50% of stomach cancers were diagnosed in Creoles ( Table 4).000 populations per year in each gender ( Table 2). cancers of the gastrointestinal tract seemed to be twice more common in Creoles than in Hindustanis and Javanese. Average yearly number of cases 52. per 100. and 7 to 16 cases per year in that of 50 years and older ( Table 3). These malignancies accounted in each gender for approximately 85% of the total number of gastrointestinal tract malignancies diagnosed in this period. respectively.8 23. General characteristics of overall gastrointestinal cancers in Suriname in the period between 1980 and 2008. Cancers of the pancreas. stomach. and incidence rates were about 2.2 ± 13. Incidence of gastrointestinal tract malignancies by ethnic background Similarly to overall gastrointestinal malignancies ( Table 1). 3 Statistically signiﬁcantly different from ‘Hindustanis’ and ‘Javanese’ (P = 0.6 and 0. Incidence of gastrointestinal tract malignancies by gender The most common cancers of the digestive system between 1980 and 2004 in both males and females were colorectal.8 0.164 18 294 637 274 308 Crude rate 12. Accordingly. stomach.33 2. They occurred in both genders at rates of at the most 1 per 100. which was at least twice more when com© Under License of Creative Commons Attribution 3. Approximately one-quarter of this group was Hindustani. and at rates of about 1. ANOVA) and ‘20-49 years’ (P = 0. gallbladder. 1:2 doi: 10. Apparently. primary hepatic cancer was seen in 23% of males and 11% of female patients ( Table 2).6 ± 1.2 0.000 men or women per year ( Table 2). the incidence rates for the individual gastrointestinal tract cancers increased with increasing age ( Table 3).6 case(s).0018.com/ Table 1.2 2. respectively.9 28. 2.5 6. esophagus.0 ± 5. i. ANOVA). and that of 50 years and older more than 74 % ( Table 3). On the other hand. occurred at slightly higher numbers in those of 20 to 49 years. but almost half was Creole ( Table 1). This trend was particularly evident for colorectal. Incidence of gastrointestinal tract malignancies by age group As observed for gastrointestinal cancers overall ( Table 1).4 ± 0. but primary liver cancer seemed to occur about twice more often in men than in women.e. the number of patients between 0 and 19 years of age comprised less than 4 % of the total number of cases.4 ± 8. as well as small intestine were virtually non-existent in individuals aged 0 to 19 years. small intestine.2 ± 1. that between 20 and 49 years 10 to 23 %.7 5. respectively.000 per year in both genders ( Table 2). colorectal and gastric neoplasms were as common in men as in women. 1 Statistically signiﬁcantly different from ‘0-19 years’ (P = 0.
9 ± 0.1 1.1 ± 0.4 0.7 0.6 ± 0. ANOVA).3823/439 Our Site: http://www.4 ± 4.3 0.2 0.0 ± 0.4 ± 0.1 ± 0.1 ± 0.6 ± 0.2 Colon and rectum Stomach Liver Pancreas Esophagus Gallbladder Anus and anal canal Small intestine 2.5 ± 1.1 ± 0.12 Crude rate1 1. 2 Statistically signiﬁcantly different from ‘Females’ (P = 0.1 ± 0.8 1.8 ± 1.1 ± 0.2 ± 0.1 0. and average yearly incidence rates (± SDs) of gastrointestinal cancers in Suriname in age groups 0-19 years.3 ± 0.5 ± 1. 3 Although derived from the gastrointestinal tract.52 2.9 1.8 0.3 ± 0.0 1.1 ± 0.6 ± 0.0 ± 0.5 ± 0.4 ± 0.1 ± 0.0 7.62 50 years and older Total number of cases 453 330 195 59 45 42 20 17 Yearly number of cases 15.3 ± 0.1 0.2 ± 0.6 ± 0.000 population per year.0 ± 0.93 0.8 1.23 1.0 ± 0.1 ± 0. Table 3.4 ± 0.1 0.1 ± 0.62 0.1 ± 0.5 ± 0.2 0.1 ± 0.42 0.6 ± 6.1 0.0 ± 0.7 ± 1. and 50 years and older in the period between 1980 and 2008.6 0.1 ± 0.3 0.5 0.3 ± 0.0 ± 0.2 0.3 ± 0.1 ± 0. 4 No.63 2.6 ± 0.3 0. ANOVA).5 ± 0.1 0. and average yearly crude incidence rates (± SDs) of various gastrointestinal tract cancers in Surinamese males and females in the period between 1980 and 2008.5 0.0 0.2 ± 1.8 0.4 0.3 0.0 0.2 ± 0. average yearly numbers of cases (± SDs).0017.0 ± 0.4 ± 0.iMedPub Journals 2013 TRANSLATIONAL BIOMEDICINE Vol.6 ± 0. 3 Statistically signiﬁcantly different from ‘0-19 years’ and ‘20-49 years’ (P < 0.7 Crude rate1 2.0 ± 0. Total number of cases.imedpub.5 0.1 0.0 Total number of cases 136 76 58 13 5 8 6 3 20-49 years Yearly number of cases 4.8 Crude rate1 2.42 1.2 Crude rate1 0.5 0.43 11.2 0.1 ± 0.2 ± 1.7 ± 1.2 0.1 ± 0. 2 Statistically signiﬁcantly different from ‘0-19 years’ (P < 0.1 ± 0.4 0.3 ± 0.2 - 1 Expressed per 100.2 0.3 0.0 ± 0.4 ± 0.92 0.0 ± 1.4 0.83 6.0 1.1 ± 0.1 ± 0.82 0.7 6.6 ± 1.3 0.4 ± 3.7 ± 4. Total number of cases.0 License 5 .6 ± 0.0 ± 1.com/ Table 2.0 ± 0.4 ± 1.3 ± 0.0 2.4 ± 1. average yearly numbers of cases (± SDs). © Under License of Creative Commons Attribution 3.3 0. 20-49 years.1 0.7 Crude rate1 3.6 0.6 0.0 ± 4. 0-19 years Site Total number of cases 7 3 8 2 0 2 0 1 Yearly number of cases 0.9 1. Males Total number of cases Colon and rectum Stomach Liver Pancreas Esophagus Gallbladder Small intestine Anus and anal canal Uncertain histology3 287 225 185 42 34 16 13 11 11 Yearly number of cases 9.7 ± 0.3 0.0 0.43 2.5 6.000 population per year. Student’s t test).6 ± 1.2 Total number of cases 311 173 76 32 16 36 8 14 6 Females Yearly number of cases 10.6 1.1 0.7 ± 2.0 ± 0.3 ± 0. the histology of these malignancies was not certain.1 1 Expressed per 100.1 0.0 0.7 ± 3.001.001. 1:2 doi: 10.3 0.5 0.1 0.8 ± 3.9 ± 4.0 0.
respectively.4 0. Their frequencies in the country (2 to 5 case(s) per 100. 23]. The incidence rates of the most common gastrointestinal malignancies in Suriname .7 0. 2 Statistically signiﬁcantly different from ‘Hindustanis’ and ‘Javanese’ (P < 0.2 0.7 ± 2.4 ± 0.6 1.2 ± 1.1 0.1 ± 0.1 0.3 ± 0.22 2.0 ± 0.5 ± 3. and Javanese.4 0.6 0.05. and Javanese in the period between 1980 and 2008.1 ± 0.9 0. By © Under License of Creative Commons Attribution 3.3823/439 Our Site: http://www.4 ± 0. Total number of cases.4 0.3 ± 2.2 0.4 0.0 0.0 ± 0.2 0.0 ± 0.72 7. pared to Hindustanis and Javanese ( Table 4).9 ± 0. The study was: prompted by the imminent danger of lifestyle-related non-communicable diseases – including gastrointestinal tract cancers .5 ± 1.6 ± 0.2 ± 0. anus and anal canal. and 0.1 ± 0.0 ± 0.9 ± 0.82 0. 3 Statistically signiﬁcantly different from ‘Hindustanis’ and ‘Creoles’ (P < 0. and average yearly incidence rates (± SDs) of gastrointestinal cancers in Surinamese Hindustanis.3 3.1 ± 0. ANOVA). and compares the ﬁndings to international data. Discussion This paper reports on the incidence of gastrointestinal cancers in the Republic of Suriname between the years 1980 and 2008. Hindustanis Total number of cases Colon/rectum Stomach Liver Pancreas Esophagus Gallbladder Anus/anal canal Small intestine 122 78 43 14 12 13 6 6 Yearly number of cases 4. it can be inferred that almost 1 out of every 6 of such patients suffers from a gastrointestinal tract malignancy. Hindustanis.0. 1:2 doi: 10.0 ± 0.6 . it can be assumed that the frequency of these neoplasms in Suriname is well below that reported for low-incidence areas of the world (around 25 per 100.1 0. esophagus.7 2. but more than 40% was Javanese ( Table 4).1 0. Creoles.6 ± 0. gallbladder. respectively ( Table 4).0 ± 0. The exception to this trend was primary liver cancer: about 16 and 27% of cases was Hindustani or Creole. respectively ( Table 4).6 0.5 Crude rate1 Total number of cases 247 212 70 33 25 26 12 11 Creoles Yearly number of cases 8.4 ± 1.1 0. Each year.1 0.8 per 100. 4 No.000 populations per year) were well in line with those of 1.3 0. approximately 52 new Surinamese patients presented with a cancer of the gastrointestinal tract. Data analysis was based on the number of histo- pathologically diagnosed malignancies and estimations of the demographic situation of Suriname in the period covered by this study.6 per 100. and primary liver cancer – were consistent with this suggestion.2 ± 0.1 ± 1. The incidence rate in the latter group was approximately 2 per 100.2 0. A comparable pattern was observed for cancers of the pancreas.000 population per year.1 0.iMedPub Journals 2013 TRANSLATIONAL BIOMEDICINE Vol.5 ± 0.colorectal. Northern and Southern Africa for stomach cancer.1.1 ± 0.9 ± 0. When considering that per year roughly 300 Surinamese are newly diagnosed with cancer . and South-Central Asia and Northern Europe for primary liver cancer . placed against the background of international data.imedpub. and small intestine.2 ± 0.0 License 6 .2 ± 0.4 ± 0.to the health of the Surinamese community [22.4 ± 0. stomach.5 0.000 populations estimated for low-incidence regions in Middle Africa and South-Central Asia for colorectal cancer.1 ± 0.1 ± 0.1 1 Expressed per 100.5 0.0 ± 0.82 1.000 populations per year ( Table 4).6 0. During the period covered by this study.3 ± 3.1 1.2 0. 23].6 0.001.1 ± 0.6 to 5.4 ± 0.000 per year) .8 ± 0.7 ± 1.3 ± 0. but no more than 11 and 9 in Hindustanis and Javanese.1 0. 0.3 0.1 2.3 Crude rate1 1. average yearly numbers of cases (± SDs).000 per year) . there were up to 24 cases in Creoles. This suggests that Suriname (still) represents a lowrisk country for gastrointestinal tract malignancies.2 0.3 0.8 ± 0.6 ± 1.0.6 1. and even farther from that noted for high-incidence countries (more than 50 per 100.8 0.53 0.4 . despite the alarming frequency of non-communicable diseases in the country [22.4 0.000 population per year in Creoles.0 ± 0.1± 0.23 0.6 Crude rate1 Total number of cases 97 46 108 10 4 5 2 2 Javanese Yearly number of cases 3. The incidence rates of these malignancies were 2. ANOVA).com/ Table 4.4 ± 0.2 ± 0. Nevertheless.
unhealthy dietary habits [8. and Eastern and South-eastern Asia. but it must be veriﬁed in comprehensive future studies. per 100. respectively. Overall gastrointestinal tract cancers as well as most individual gastrointestinal tract cancers . Whether these considerations may hold true for Suriname needs to be determined in future studies. 9. respectively. 33]. In addition. up to 34. However. 15]. Middle. Examples of such areas are India. 42]. more often in men than in women . the lowest rates (less than 0. These values are also close to those reported for low-risk regions throughout the world. where this tumor is considerably more common in immigrants from areas where the hepatitis B virus is endemic (such as South-east Asian countries) when compared to other Americans [48. and around 20. 4 No. These values have been reported for African American males in the United States of America . respectively) are typically between 30 and 80 per 100.000 population per year) have been reported in the Israeli Sabra  and Asian/Paciﬁc Islanders in Hawaii .5 times and twice. This supposition may well hold true in light of the observations of the Pan American and the World Health Organization about the relative risk of Surinamese to develop non-communicable disorders [22. 23]. This has been described for colon cancer formation. Eastern Asia. The frequency of overall gastrointestinal tract cancers as well as that of the individual gastrointestinal tract malignancies – particularly colorectal. This ﬁnding is consistent with the typical 2.β signaling pathway. respectively. as well as large parts of Africa. including hyperproliferation of the epithelium as a result of loss of the APC tumor suppressor. 50 to 60%. and obesity [6. 44] also revealed that malignancy is more common in Surinamese Creoles than in Surinamese Hindustanis and Javanese. For small bowel and anal cancer.74) ). and Northern Africa as well as Central America. stomach. This suggests that Surinamese females are at least exposed to some of the same risk factors for these cancer types as their male counterpart. 14. respectively. 39. Relatively high rates of small intestinal and anal cancer are seen in the Maori of New Zealand (up to 4 ) and African American women (about 0. Such a sex distribution is not in agreement with reports mentioning that these malignancies occur approximately 1. On the other hand. 33. overweight.com/ comparison. respectively [32. and the progression to a carcinoma by the loss of the p53 tumor suppressor and release of the cells from DNA damage. It is clear that this suggestion also needs to be further pursued. and gallbladder cancer. a major risk factor for liver cancer [16.and stress-induced cell cycle arrest and apoptosis [41. incidence rates associated with a high risk for pancreatic. which involves at least ﬁve successive stages. the ‘esophageal cancer belt’ from northern Iran through the central Asian republics to North-Central China . respectively. with less than 3 cases of pancreatic. to consume alcohol and to smoke cigarettes. Cancers of the pancreas. There were nearly as many males as females with colorectal or gastric cancer in Suriname. 7 . Incidentally.3823/439 Our Site: http://www.000 per year [1. 1:2 doi: 10. 32. and more than twice more common in African Americans than in Caucasians. This trend is in accordance with the characterization of cancer as a group of diseases caused by multiple oncogenic mutations which act together or in sequence to initiate or promote carcinogenesis over many years. Furthermore. 12. exposure to aﬂatoxins may contribute to the high incidence of liver cancer in those tropical areas of the world where contamination of food grains with the fungus Aspergillus fumigatus is common . gallbladder. and most of Northern Europe and the United States of America. 37]. formation of an early adenoma due to increased genomic instability and the more rapid acquisition of mutations. esophageal. esophagus. There is no satisfactory explanation for these observations. 49]. 50].000 populations per year.imedpub.to 4-fold male-over-female excess seen in most areas of the world [1. 36. our previous studies [31.1 case. A comparable situation has been observed in the United States of America. and American Indians. 17]. excessive alcohol consumption . and women in Delhi (India) and Karachi (Pakistan) [33. and gallbladder cancer are approximately 13. including physical inactivity. Hispanics and Asian/Paciﬁc Islanders.particularly colorectal and stomach cancer – showed a clear predilection for Creoles rather than Hindustanis and Javanese. the majority of Europe. incidence rates of these neoplasms in high-risk regions (Northern America. 40].5 and less than 0.000 population . particularly China. and to have a higher body mass index . respectively [45-47]. The exception to the above-mentioned pattern was primary liver cancer that was two to three times more common in Javanese than in Creoles and Hindustanis. and has been tentatively attributed to gender-speciﬁc differences in exposure to risk factors: men are more likely than women to be infected with hepatitis B © Under License of Creative Commons Attribution 3. respectively. in the United States of America. formation of an intermediate adenoma due to activating mutations in the K-ras oncogene. formation of a late adenoma by loss of a SMAD gene and disruption of the growth inhibitory TGF. per 100. and/or cigarette smoking [11. primary liver cancer was approximately twice more common in Surinamese men than in Surinamese women. esophageal.7]. neoplastic disease has been found to be 10%. and liver cancer – increased markedly with older age. as well as anus and anal canal occurred in Suriname at rates of less than 1 per 100. 43.iMedPub Journals 2013 TRANSLATIONAL BIOMEDICINE Vol.0 License and C viruses. Individuals originating from these parts of the world have a relatively high rate of chronic infection with the hepatitis B virus. small intestine.37]. Western. and Australia/New Zealand.
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