Korean J Urol.  2012 May;53(5):304-309.

Incidence of Bladder Cancer in Sri Lanka: Analysis of the Cancer Registry Data and Review of the Incidence of Bladder Cancer in the South Asian Population

• Ranasinghe WKB
• De Silva D
• De Silva M
• Ranasinghe TIJ
• Lawrentschuk N
• Bolton D
• Persad R

Abstract

PURPOSE
To investigate the incidence of bladder cancer (BC) in Sri Lanka and to compare risk factors and outcomes with those of other South Asian nations and South Asian migrants to the United Kingdom (UK) and the United States (US).
MATERIALS AND METHODS
The incidence of BC in Sri Lanka was examined by using two separate cancer registry databases over a 5-year period. Smoking rates were compiled by using a population-based survey from 2001 to 2009 and the relative risk was calculated by using published data.
RESULTS
A total of 637 new cases of BC were diagnosed over the 5-year period. Sri Lankan BC incidence increased from 1985 but remained low (1.36 and 0.3 per 100,000 in males and females) and was similar to the incidence in other South Asian countries. The incidence was lower, however, than in migrant populations in the US and the UK. In densely populated districts of Sri Lanka, these rates almost doubled. Urothelial carcinoma accounted for 72%. The prevalence of male smokers in Sri Lanka was 39%, whereas Pakistan had higher smoking rates with a 6-fold increase in BC.
CONCLUSIONS
Sri Lankan BC incidence was low, similar to other South Asian countries (apart from Pakistan), but the actual incidence is likely higher than the cancer registry rates. Smoking is likely to be the main risk factor for BC. Possible under-reporting in rural areas could account for the low rates of BC in Sri Lanka. Any genetic or environmental protective effects of BC in South Asians seem to be lost on migration to the UK or the US and with higher levels of smoking, as seen in Pakistan.

Keyword

Cancer registry; Incidence; South Asia; Sri Lanka, Urinary bladder neoplasms

MeSH Terms

Asian Continental Ancestry Group
Great Britain
Humans
Incidence
Male
Pakistan
Prevalence
Risk Factors
Smoke
Smoking
Sri Lanka
Transients and Migrants
United States
Urinary Bladder
Urinary Bladder Neoplasms
Smoke

Figure

• 

  FIG. 1 Map of Sri Lanka denoting the districts and population estimates for 2005. Shaded districts were excluded from the study to ensure data reliability.

• 

  FIG. 2 Rates of bladder cancer in Sri Lanka by district and published rates of India [9] and Pakistan [10].

• 

  FIG. 3 Age-specific incidence of bladder cancer in males (A) and females (B). Rates adjusted to 10 year age bands to compare with the Indian [9] and Pakistani incidence data [10].

• 

  FIG. 4 Percentage of government workforce in each country employed in the occupations 'at risk'. (compiled using the government statistics of Labour in each country) [20-22].

Reference

1. GLOBOCAN 2008: the GLOBOCAN project. International Agency for Research on Cancer [Internet]. c2010. cited 2010 Jul 1. Lyon: IARC;Available from: http://globocan.iarc.fr/.

2. Parkin DM. The global burden of urinary bladder cancer. Scand J Urol Nephrol Suppl. 2008. (218):12–20.

3. Olfert SM, Felknor SA, Delclos GL. An updated review of the literature: risk factors for bladder cancer with focus on occupational exposures. South Med J. 2006. 99:1256–1263.

4. Curado MP, Edwards B, Shin HR, Storm H, Ferlay J. Cancer incidence in five continents: Volume IX. 2007. Lyon: IARC.

5. WHO Statistical Information System (WHOSIS) [Internet]. c2006. cited 2010 Jan 1. Geneva: World Health Organization;Available from: http://apps.who.int/whosis/database/core/core_select_process.cfm?country=lka&indicators=nha.

6. The World Bank [Internet]. c2012. cited 2010 Nov 1. Washington: The World Bank;Available from: http://data.worldbank.org/country/sri-lanka.

7. Segi M. Cancer mortality for selected sites in 24 countries (1950-57). 1960. Sendai: Department of Public Health, Tohoku University of Medicine.

8. Ministry of Health. Cancer incidence data: Sri Lanka Year 2000. National Cancer Control Programme, Sri Lanka. 2005. Maharagama: NCCP.

9. Rastogi T, Devesa S, Mangtani P, Mathew A, Cooper N, Kao R, et al. Cancer incidence rates among South Asians in four geographic regions: India, Singapore, UK and US. Int J Epidemiol. 2008. 37:147–160.

10. Bhurgri Y, Bhurgri A, Hassan SH, Zaidi SH, Rahim A, Sankaranarayanan R, et al. Cancer incidence in Karachi, Pakistan: first results from Karachi Cancer Registry. Int J Cancer. 2000. 85:325–329.

11. Goonewardena SA, De Silva WA, De Silva MV. Bladder cancer in Sri Lanka: experience from a tertiary referral center. Int J Urol. 2004. 11:969–972.

12. Wiwanitkit V. Overview of clinical reports on urinary schistosomiasis in the tropical Asia. Pak J Med Sci. 2005. 21:499–501.

13. Adeniran AJ, Tamboli P. Clear cell adenocarcinoma of the urinary bladder: a short review. Arch Pathol Lab Med. 2009. 133:987–991.

14. Zeegers MP, Kellen E, Buntinx F, van den Brandt PA. The association between smoking, beverage consumption, diet and bladder cancer: a systematic literature review. World J Urol. 2004. 21:392–401.

15. Rafique M. Clinico-pathological features of bladder carcinoma in women in Pakistan and smokeless tobacco as a possible risk factor. World J Surg Oncol. 2005. 3:53.

16. The Tobacco Atlas [Internet]. c2012. cited 2011.06.05. New York: World Lung Foundation;Available from: http://www.tobaccoatlas.org/.

17. Case RA, Hosker ME. Tumour of the urinary bladder as an occupational disease in the rubber industry in England and Wales. Br J Prev Soc Med. 1954. 8:39–50.

18. Ranasinghe WK, Sibanda T, de Silva MV, Ranasinghe TI, Persad R. Incidence of prostate cancer in Sri Lanka using cancer registry data and comparisons with the incidence in South Asian men in England. BJU Int. 2011. 108(8 Pt 2):E184–E189.

19. Kolonel LN, Altshuler D, Henderson BE. The multiethnic cohort study: exploring genes, lifestyle and cancer risk. Nat Rev Cancer. 2004. 4:519–527.

20. Sri Lanka Labour Force Survey. cited November 2010. Sri lanka: The Department of Census & Statistics - Sri Lanka;Available from: http://www.statistics.gov.lk/page.asp?page=Labour%20Force.

21. Labour Statistics. cited November 2010. India: Ministry of Labour - Government of India;Available from: http://labour.nic.in/.

22. Labour Force Statistics. cited November 2010. Pakistan: Federal Bureau of Statistics (FBS) Pakistan;Available from: http://www.statpak.gov.pk/depts/index.html.

23. Winter H, Cheng KK, Cummins C, Maric R, Silcocks P, Varghese C. Cancer incidence in the south Asian population of England (1990-92). Br J Cancer. 1999. 79:645–654.

24. Altekruse SF, Krapcho M, Neyman N, et al. SEER Cancer Statistics Review 1975-2007. cited 2010 November. Bethesda, MD: National Cancer Institute;based on November 2009 SEER data submission, posted to the SEER web site, 10. Available from: http://seer.cancer.gov/csr/1975_2007/.

25. Jain RV, Mills PK, Parikh-Patel A. Cancer incidence in the south Asian population of California, 1988-2000. J Carcinog. 2005. 4:21.