Graduation Date

Spring 5-6-2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Epidemiology

First Advisor

Dr. Amr Soliman

Abstract

Background: Uterine cancer is one of the top-ranking cancers of women with wide international variations in incidence rates. Egypt has a lower incidence of uterine cancer than other countries in the Middle East. In addition to the international incidence variation, there are also wide variations in incidence by rural and urban areas within countries. Therefore, this research project focused on the Gharbiah province, north of Cairo in the Nile Delta, with the aims of investigating demographic and clinical characteristics of uterine cancer, assessing rural/urban variation in incidence rates, and evaluating the possible role of hysterectomy in under-estimating the disease incidence in this population.

Methods: Uterine cancer data of 660 cases were obtained from the Gharbiah Population-based Cancer Registry in Gharbiah, Egypt during the period 1999-2010. The hysterectomy data of 1040 cases were abstracted from the main pathologic labs over the entire region. The Egypt 2006 data census was used to determine the total population of Gharbiah and the rural and urban subgroups. Crude, age-standardized (ASR), and age-specific rates were calculated and associated with demographic and clinical characteristics of patients. The uterine cancer incidence pre- and post- adjustment for hysterectomy prevalence were compared and 95% confidence intervals (CIs) were calculated.

Results: The results confirmed the low ASR of uterine cancer in Gharbiah, [4.1 per 100,000 (95% CI: 3.8-4.4)]. The incidence rate significantly increased over the 12-year period. The ASR was 2.5 times higher in urban areas compared to rural areas (6.9 and 2.8 per 100,000), in urban and rural areas, respectively. The prevalence of hysterectomy did not have a significant impact on the uterine cancer incidence rate.

Conclusions: The study confirmed the low incidence rate of uterine cancer in the Gharbiah province of Egypt and a statistical significant increase in incidence in recent years. Although the rate of uterine cancer in this population increased over the past decade, it is still lower than the corresponding global rates. The lack of evidence about the possible role of hysterectomy in lowering of uterine cancer rates adds to the need for research to identify the apparent protective factors for uterine cancer in this population.

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