INTRODUCTION:

Cancer is defined as an unexplained tissue mass of which the growth is unorganized and that exists in an excessive fashion after the cessation of the stimuli that evoked the change¹. In 2007, Cancer has been the third most common prompt of death in developing nations as well as the second most common induce in economically advanced countries (heart diseases as well as diarrheal diseases)². An abnormal proliferation of cells that can invade or spread to various body parts characterizes a group of diseases known as cancer³. Globally, the approximated 9.6 million deaths, or one out of every six, were attributed to cancer in 2018, which makes it the second-most common induce of death. The most prevalent cancer lines in men are lung, prostate, stomach, colorectal, as well as liver cancers, and while the most prevalent cancers in women were also breast, lung, colorectal, cervical, and thyroid^4,5,6,7. Among the potential warning signs and symptoms are a lump, unusual bleeding, a persistent cough, unidentified loss of weight, as well as a change in bowel habits. These symptoms can nevertheless have other causes in addition to being a sign of cancer^8,9. Humans are affected by over 100 different types of cancer¹⁰.

Intriguingly, Saudi Arabia has recently published more cancer-related articles than its neighboring Arab nations have (from 5,000 in 2010 to 11,000 in 2017)¹¹. More than 11 million deaths from cancer are anticipated in 2030¹². Due to its high incidence, quick progression, as well as the poor prognosis, lung cancer had also risen to become one of the most common induce of cancer passing both globally as well as in the Saudi Arabia Kingdom^13,14. Colorectal cancer was really the cancer with the second-highest incidence by many Saudis including all ages (10.3%), as well as the most prevalent tumors in men (11.8%), in accordance with SCR (Saudi Cancer Registry) at KFSHRC (King Faisal Specialist Hospital and Research Centre) in Riyadh¹⁵. However, among Saudi females, breast cancer is the leading type of cancer, as well as it has risen significantly over the past decade, especially among more young females¹⁵. This review's goal is to provide an overall as well as precise view of the published data on the incidence of the most common subtypes of cancer in Saudi Arabia.

MATERIAL AND METHODS:

Initially, a dramatic search of the literature including all English-language literature reported in Saudi Arabia has been conducted using various databases such as Scopus, PubMed, Web of Science, as well as Google Scholar. The search strategy used the keywords “cancer incidence in Saudi Arabia,” “oral cancer,” “thyroid cancer,” “breast cancer,” “lung cancer,” “liver cancer,” “colorectal cancer,” “epidemiology,” and “mortality.” Subsequently, the search strategy was adjusted according to the requirements for each database.

RESULTS AND DISCUSSION:

Oral Cancer:

Of the 32,149 biopsies reviewed, 714 (2.2%) were oral and maxillofacial lesions. The participants’ ages ranged from 0 (neonatal) to 100 years. Additionally, the study also reported that the tongue has been found to be the most common site for oral, maxillofacial lesions as well as for carcinoma neoplasms. The most prevalent type has been malignant neoplasm (38.7%), accompanied by inflammatory lesions (16.5%). Furthermore, oral malignancies attributed for 15.8% of all cancers. The most common type has been oral squamous cell carcinoma (OSCC), which was accompanied by pyogenic granulomas as well as mucoceles (7% each)^[16. Recently, a systemic review concluded that the incidence of oral cancer in the Saudi Arabia varied from 21.6% to 68.6%. For example, in Jazan Province, the overall reported prevalence of oral cancer ranged from 32.1% to 62.4%. Furthermore, the primary cause of oral cancer was Shamma use. Shamma is an oral type of smokeless tobacco which traditionally used in some parts of Saudi Arabia. The most oral cancer patients were admitted to the hospital among an advanced stage (Stage III as well as Stage IV) of the disorder. Besides that, oral cancer has been most found on the tongue, accompanied by the mouth's innermost layer as well as the alveolar ridge. The five-year rate of survival ranged between 12.9% and 24%¹⁷. Regarding awareness of oral cancer between the general population, one study found that there was a lack of awareness concerning oral cancer and poor knowledge along with signs as well as health risks for oral cancer in general¹⁸. However, another study was shown that the effectiveness of teaching program increases the awareness of tobacco chewers on prevention of oral cancer^19,20.

Recently, World Health Organization (WHO) provides available data on the oral cancer mortality in Saudi Arabia achieved 465 or 0.35% of total number of deaths. With an age-adjusted death average of 1.85 per 100,000 people, Saudi Arabia ranks 142^nd in the globe²¹.

Thyroid cancer:

A review of medical records was done in Saudi Arabia's western region from January 2000 to December 2017 for patients with thyroid cancer. From a sample of 347 patient populations, 287(82.7%) cases of papillary thyroid cancer have been discovered. Follicular thyroid cancer came in second with 32(9.2%) cases, accompanied by Hurthle cell cancer along with 11 (3.2%) cases, while lymphoma was really only discovered in 7(2%) cases²².

Over the last decades, the incidence rate of thyroid cancer was increased²³. In an informative epidemiological examine of thyroid cancer that was the diagnosed among Saudi women from 2001 until 2008, the authors concluded that 2,930 cases were found in the Saudi cancer database. The Riyadh region in Saudi Arabia has been found to be the highest overall age-standardized incidence range (AISR) with 9.43 for each 100,000 women, accompanied by Tabuk at 7.11 as well as the eastern region with 6.5, while Jazan as well as Jouf has the lowest ASIRs with 1.97 as well as 2.72, respectively. Furthermore, the Qassim region revealed the greatest changes in ASIR, with 5.5 for each 100,000 women from 2001 until 2008²⁴. From 2000 to 2010, KFSHRC conducted a retrospective evaluation of thyroid cancer patients. The results demonstrated an increase in the thyroid cancer incidence rate, as well as it is now the second most prevalent cancer between many Saudi young women²⁵.

As mentioned, in the SCR for 2015, thyroid cancer has found to be the second as one of Saudi females as well as eighth as one of Saudi males. In 2015, there have been 1020 cases of thyroid cancer, accounting for 8.5% of all recently diagnosed cancers between many Saudi nationals. In addition, thyroid cancer impacted 793 (77.7%) females as well as 227 (22.3%) males, along with a female-to-male distribution of 349:100. Furthermore, the median age with diagnosis had 39 years for females (ranging between 4 to 95 years) as well as 44 years for males (ranging between 8 to 95 years)²⁶.

Lung cancer:

According to recent studies, smoking causes most of cases of lung cancer²⁷. From 2004 to 2008, 114 lung cancer patients were tracked in a four-year prospective study at a Saudi university hospital and concluded that squamous cell carcinoma became the most prevalent cancer and was strongly linked to smoking. At the time of presentation, the likelihood of metastasis was significant. The right lung as well as upper bronchus have been frequently involved. The broadest range of biological imbalances are hypercalcemia as well as hyponatremia²⁸. Data in SCR for 2015 revealed that lung cancer placed fifth with Saudi males as well as fifteenth between Saudi females. Moreover, there had been 416 patient cases of lung cancer reported, which accounted for 3.5% of all clinically diagnosed instances in Saudi Arabia in 2015. In addition, lung cancer influenced 324 males (77.9%) as well as 92 females (22.1%), along with a male: female range of 352:100. In men, the average age at diagnosis has been 64 years (with a range of 4 to 94 years), and within women, it was 63.5 years (with a range of 16 and 87 years). WHO statistics released in 2017 stated that lung cancer deaths in Saudi Arabia approached 906 along with 0.93% of total deaths. Moreover, the age-adjusted number of deaths is 5.53 per each 100,000 of the population, which ranks Saudi Arabia 133rd in the world²⁹. The latest WHO data show that 775 people in Saudi Arabia died from lung cancer in 2020, or 0.58% of all deaths. Saudi Arabia ranks #144 in the globe in terms of the age-adjusted number of deaths, with 4.27 deaths for every 100,000 people³⁰.

Breast cancer:

Breast cancer is the most common cause cancer death for females in the world⁴. According to Alghamdi, SCR documented 6,922 female breast cancer instances from 2001 to 2008³¹. In a data collected from SCR at KFSHRC, it was discovered that 708 (13.08%) of the 5,411 patients died due to breast cancer³². As mentioned in a retrospective epidemiological survey data obtained from information at SCR as well as from KFSHRC, the number of females with the breast tumor increased statically between 1990 until 2010. It was revealed that the distribution pattern of breast cancer appears to be gradually increasing based on the number of instances. Specifically, the years 2008, 2009, as well as 2010 witnessed 1152, 1083, and 1473 cases of breast cancer, respectively³³. According to recent research by Ahmed AE et al., there has been a rise in breast cancer cases in Saudi Arabia. The data revealed evidence of the individual influences of advanced age, Saudi national origin, female gender as well as the later years (2006 until 2014) on the rising risk of the breast cancer ³⁴. From October 2009 to February 2014, a maximum of 8061 women have been scanned for breast cancer in a nongovernmental screening program in the Saudi Arabia's Eastern Province. The exact number of cancers identified was 47, resulting in a cancer high detection of 5.83 for every 1000 women tested; 70.2% of the subtype cancers identified had either massless or perhaps lesions less than 2 cm in size ³⁵.

Early detection is one of the most important aspects in prevention breast cancer ³⁶. According to a report, mammography knowledge as well as utilization were indeed limited in Saudi Arabia, which highlights the need to raise awareness of early detection of breast cancer though the education programs ³⁷. The researchers have investigated the knowledge and understanding among 137 females aged 18 years and older. They discovered that 54% of the 137 affirmed that they were informed of breast cancer along with breast self-examination, but only 62% realized how to perform self-examination. Only few (38%) were aware of routine mammograms ³⁸. Face-to-face interviews were conducted in Jeddah with 200 female respondents to the research. It was found that 50.5% of the participants have been aware that breast lumps are a risk indication for breast cancer, a 57.5% understood exactly that family history had really a risk factor, 20.5% has been undergone breast screening, 79% have already heard of breast self-examination, as well as 47.5% were knowledgeable about how to do it ³⁹. Also, a similar study was suggested that there was a gap between the knowledge and performing of breast self-examination ⁴⁰. According to the SCR report from 2015, there were exactly 1,979 instances of female breast cancer, making it the most common form of cancer among women. 16.7% of all cancers observed among Saudi citizens were breast cancer, as well as 30.1% of all cancers identified among women of all ages were breast cancer. On average, the age of diagnosis ranged from 14 to 108 years, with a mean age of approximately 50 years.

Saudi Arabia experienced 900 breast preventable deaths in 2017, as well as 0.92% of all deaths, based on WHO data. Furthermore, 9.64 per 100,000 people is the age-adjusted death rate, which ranks Saudi Arabia 158 in the globe ⁴¹. According to the latest WHO data, Saudi Arabia encountered 908 breast cancer cases in 2020, accounting for 0.68% of all deaths. With a death of 8.30 for every 100,000 people when adjusted for age, Saudi Arabia has been ranked #174 worldwide ⁴².

Liver cancer:

According to information obtained from SCR at KFSHRC, among 2004 as well as 2014, Saudi Arabia's age-specific incidence rate as well as overall incidence rate of liver cancer both slightly increased. The areas with the highest rates of liver cancer between many Saudi males were Riyadh, Najran, as well as Tabuk, while for Saudi females it was Riyadh, the Eastern Region, as well as Tabuk. Male Saudis from Jazan as well as female Saudis from Baha and the Northern region had the lowest rates of liver cancer, respectively. Saudi men had significantly greater incidences of liver cancer than Saudi women did in terms of prevalence ⁴³. SCR 2015 report that liver cancer ranked it the sixth along with Saudi males as well as twelfth along with Saudi females. Moreover, there were 376 cases of liver cancer attributed to 3.1% of every cancer case diagnosed along with Saudi nationals in 2015. Liver cancer was affected 274 males (72.9%) as well as 102 females (27.1%) with a female to male distribution of 100:269. The median age at diagnosis has been found that 68 years in males varied between 0 to 99 years as well as 64 years in females varied between 1 and 102 years. WHO data published in 2017 reported liver cancer death cases in Saudi Arabia found to be 802 or 0.82% of total deaths. Furthermore, the age adjusted Death range is 5.37 per 100,000 of population ranks Saudi Arabia is 90 in the world ⁴⁴. In accordance with the most recent WHO statistics, 845 people in Saudi Arabia passed away from liver cancer throughout 2020, making up 0.63% of all deaths and injuries. Saudi Arabia has an age-adjusted death rate of 4.82 for every 100,000 people, placing it at position 104 in the universe ⁴⁴.

Colorectal cancer:

Colorectal cancer combines colon cancer and rectal cancer, which forms an abnormal tissue around the inner lining of colon and rectum called polyps ⁶. There were 192 patients who received a colonoscopy-based diagnosis of colorectal cancer at King Abdul Aziz University Hospital in Jeddah, Saudi Arabia, among both January 2005 as well as December 2009 ⁴⁵. According to findings from a retrospective review, colorectal cancer has become the 3rd most common cancer in women as well as the most prevalent cancer in men in Saudi Arabia since 2002, and it tends to manifest earlier in Saudis, particularly in women ⁴⁶. A case-control research study was conducted in Mecca, Saudi Arabia, to investigate how certain lifestyle choices may affect the risk of developing colorectal cancer. The results indicated that low economic status, a lack of education, as well as illiterate people all increased the probability of getting colorectal cancer. The findings revealed additional risk factors like such a sedentary lifestyle, job losses, diabetes, as well as a low body weight that are linked to a rise in the rate of colorectal cancer. Additionally, the outcomes demonstrated that family size as well as hypertension had no impact on incidence ⁴⁷.

In a survey of 1070 people from Riyadh, it was discovered that most respondents (42.9%) thought that screening for colon cancer should start as soon as symptoms appear. Less than 20% among all respondents, with significant variations depending on the education level, think that polyps are indeed a risk factor for colorectal cancer. An elevated factor for colorectal cancer is having a family history, but only 34.8% of survey participants were aware of this ⁴⁸. Furthermore, 1,465 instances of colorectal cancer had been reported in the SCR for 2015, which represents 12.2% including all newly patients diagnosed between many Saudi citizens that year. In terms of males, colorectal cancer came in first, and in terms of females, third. With a male to the female rate of return of 124:100, it influenced 810 (55.3%) men as well as 655 (44.7) women. In men, the average age at diagnosis was found to be 59 years (the variety was 8 to 94 years), and in women, it was 57 years (varied between 15 and 102 years). Colon-rectal cancer deaths throughout Saudi Arabia approached 1,311 that year, or 1.35% of all deaths, according to data published by WHO. Saudi Arabia has been placed 94 in the world by the age-adjusted death rate, which means that 7.67 for every 100,000 people ^[49]. According to the most current WHO statistics, Saudi Arabia has seen 1,630 deaths from colon-rectum cancer in 2020, as well as 1.22% among all deaths. With quite an age-adjusted incidence of 7.19 for every 100,000 people, Saudi Arabia has been currently ranks #116 in the worldwide ⁵⁰.

However, it is important to acknowledge the limitations of the present review. While the aim was to provide a comprehensive and precise overview of the incidence of the most common cancer subtypes in Saudi Arabia, the available number of studies specifically targeting these subtypes was limited. Therefore, future research should prioritize conducting more clinical case studies and expanding therapeutic-oriented investigations to enhance our understanding of these prevalent cancers in the Saudi population. By addressing these limitations, we can further improve our knowledge and inform better strategies for cancer prevention, early detection, and treatment in Saudi Arabia

CONCLUSION:

The prevalence rate of some cancer cases has increased twofold during recent years among the most prevalent cancers (oral, thyroid, lung, breast, liver, and colorectal), according to reports from Saudi Arabia. Men are more likely to develop colorectal, lung, stomach, prostate, and liver cancers, whilst also women are more likely to develop lung, breast, colorectal, cervical, as well as thyroid cancers. This increase may be caused by the evolving living of the Saudi population, a due to the absence of early detection as well as screening initiatives, a lack of cancer prevention, as well as social barriers to cancer research. Obesity, genetics, a sedentary lifestyle, infectious agents, tobacco utilize, a lack of iodine as well as vitamin D, along with other factors, appear to raise the likelihood of getting cancer in Saudi Arabia.

ACKNOWLEDGMENT:

The author greatly acknowledged University of Hafr Al Batin for its support.

CONFLICT OF INTERESTS:

None.

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Received on 26.04.2024 Modified on 29.06.2024

Research J. Pharm. and Tech 2024; 17(11):5457-5462.

DOI: 10.52711/0974-360X.2024.00835