Cyprus has among the world’s highest rates of pediatric cancer

A pioneering study showed that Cyprus has among the world’s highest incidence rates as far as cancer in children is concerned with leukemias being the most frequent cancer, said Prof. Dr. Loizos Loizou Clinical Professor of Pediatrics, Pediatric Oncology - Hematology, Medical School, University of Nicosia.

He was addressing, on Friday, the 10th International Multi-thematic Scientific Bio-medical Congress, which takes place, at the European University Cyprus, in Nicosia.

The former Director of the Pediatric Oncology - Hematology Clinic of Archbishop Makarios III Hospital, Nicosia and President of the ELPIDA Foundation for children and adolescents affected by cancer or leukemia said in Cyprus, Cancer in children and adolescents (CAC) epidemiology was never before examined and the situation was unknown so they created the pediatric oncology registry of Cyprus (PORCY) to study the incidence rates in 0-19 age group because “we need information to understand etiology because only if we understand etiology, we can practice good prevention.”

The study examined incident rates and temporal trends between 0–19-year-olds from 1988-2017.

The PORCY study found 843 cases for this time period, 42 of cases as the mean number of cases per year and underlined attention on the ASRW (age-standardized rate according to the world standard population) where they found 203 which is the third highest in the world.

Out of all the cancers in Cyprus, he said, the percentage of childhood cancers is 1.5%, confirming that it is a rare disease.

Dr. Loizou underlined that the four most frequent cancers in Cyprus are leukemia, lymphomas, specified epithelial tumors and CNS tumors. These four groups are present in approximately 73% of all our cases, he added.

He said the distribution per five-year age group and the age group of 15–19-year-olds present the bigger number of cases, followed by the 0-4 years old, then the 10-13 finally followed by the 5-9 years old groups. He also said most acute leukaemia’s occur between the ages of 1-5 years old.

He said during the 20-year period, there has been no significant variation.

Regarding the incidence trends of the ASRW, there is a relatively stable distribution, except for thyroid cancer, for the 15–19-year-olds, involving both sexes. This is alarming, he said because for thyroid cancer in Cyprus, we see that we have again among the world’s highest, there is a very high annual change of 7.5% which represents almost 10% of all cancer types of this age group with females affected 3-5 times more than males, while papillary carcinoma is the dominant type and there is a four times increase in metastatic cases which is alarming. Fortunately, he added, there is 100% survival rate.

Dr. Loizou said one of the questions is why does Cyprus have among the highest incidence rates of childhood cancer in the world. Although it has remained stable throughout the last 20 years, this remains unanswered. The problem exists elsewhere too.

Professor Loizou said they decided to explore for Cyprus four causes, obesity, ionising radiation, arsenic and cancer predisposition syndromes.

Regarding obesity, he said it has significantly increased in the last 20 years, remarking that in 2015 obesity was affecting 20% but three years later, that percentage rose to 43%. Concerning ionising radiation, he said efforts and campaigns are underway to limit exposure. About arsenic, he said it can be carcinogenic in low concentrations and that there is a rising trend which is more prevalent in Nicosia district and higher than other countries.

For cancer predisposition syndromes, he said these are present in approximately 10% of the cases and this will be further examined.

Concluding, he said that this pioneering study showed that Cyprus has among the world’s highest incidence rates and only Italy and Belgium are higher that Cyprus, that there are differences of the most frequent types compared to worldwide patterns. Leukaemias are the most frequent cancers, however lymphomas and thyroid cancers are much more frequent in Cyprus than brain tumours.

For thyroid cancers, incidence rates in Cyprus are among the highest globally, significantly increasing temporal trends affecting mainly females and adolescents from 15–19-year-olds, Dr. Loizou noted. There are particular patterns in Cyprus that raise aetiology questions and therefore we should concentrate on exploring the genetic environmental and dietary factors in order to obtain novel insights for better prevention and better cancer control activities, he added.

The morning session was dedicated to abstract presentations and Medical Genetics as a tool for new therapies in Chronic and Rare Diseases.