Cancer on the rise [Archives:2002/42/Health]

DR GAMAL A. H AL-ALAWI
FOR THE YEMEN TIMES
As in much of the world, cancer continues to be a major health problem in Yemen.
Various factors are causing more cancers, such as a growing and aging population, tobacco use, the AIDS epidemic and poor diet.
Certain cancers, notably gastrointestinal, nasopharangeal cancers, lymphoma, breast and skin cancers are largely malignancies in Yemen. In many cases, methods of prevention exist, but Yemen has limited resources for treatment.
Poverty characterizes much of Yemen. Development is being held back by rapid population growth, tribal wars, and lack of resources from the government.
The delay in the development of cancer treatment in Yemen is also related to the delay in all branches of medicine. There are many economic factors affecting the delivery of health care, such as a low income of health professionals, poor and not enough equipment, and poor communication , transportation and education.
Factors that contribute to cancer include a increase in Yemen’s median age; tobacco use; wrong use of plastic materials; wrong use of pesticides and insecticides; and increase of hepatitis infections (B & C); poor diet that is high in saturated fat; eating contaminated Khat; Chewing tobacco (shama); and recurrent infections with EBV and Malaria.
Common Cancers in Yemen
Cancer in Yemen has a characterized pattern. The gastric and oesophageal malignancies are the most common (14.3% Southeastern and 19.2 %Northern) . Oesophageal cancer is known to be associated with tobacco and alcohol consumption, but may be the main aetiologcal factors are probably micronutrient deficiency, thermal injury or mycotoxin .
Stomach cancer appears to be linked with residence in mountainous areas. Food preserving particles may also be a factor and Helicobacter pylori may be implicated .
Infection with helicobacter pylori is very common in Yemen .
Liver cancer is one of the commonest cancers in Yemen, corresponding with the increase incidence of hepatitis B and C and geographical pattern of food stuffs contaminated with aflatoxin.
The high incidence of Non-Hodgkin’s lymphoma was more common than Hodgkin’s disease (lymphoma 12.1% southeastern, 2.8% Northern) and clearly seen in children, middle age and elderly Exposure to pesticides and fertilizers was associated with increase of Non-Hodgkins lymphoma and brain tumors .
Viral infections particularly with Epstein Bar Virus may account for a proportion of lymphoma cases.
Tropical splenomegaly syndrome or big spleen disease is massive enlargement of spleen resulting from abnormal immune response to repeated attacks of malaria which observed in patients from Louder, Yafa and Socotra were found to develop splenic lymphoma with atypical hairy lymphocytes.
A possible association between Non-Hodgkin’s lymphoma and Occupational exposure to formaldehyde, plastic , rubber chemicals, organic solvents, lead arsenates, welding metal fumes and wood preservatives.

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