Cancer in the Philippines

Transcription

1 Cancer in the Philippines Vol. V Part 1 Cancer Incidence C.A. Mapúa, A.V. Laudico, M.R.M. Lumague, M.T.M. Redaniel, T. Patama, E. Pukkala PHILIPPINE CANCER SOCIETY-MANILA CANCER REGISTRY DEPARTMENT OF HEALTH-RIZAL CANCER REGISTRY FINISH CANCER REGISTRY UNIVERSITY OF THE PHILIPPINES MANILA-SURGERY RESEARCH UNIT EDUARDO ABOITIZ FOUNDATION-METRO CEBU CANCER REGISTRY

2 Table of Contents FOREWORD... iv I. INTRODUCTION Population-Based Registries in Metropolitan Manila, Rizal Province, and Metro Cebu The Registration Areas Socio-demographic, Economic and Health Aspects... 6 II. METHODS Data Collection Overview Data sources Data Management Quality Control Data Analysis Incidence Maps III. RESULTS AND DISCUSSION Data Description Leading Cancer Sites Overall Cancer Incidence (All Sites) Oral Cavity Stomach Colon Rectum Liver Lung Breast... Error! Bookmark not defined Cervix Uteri Prostate Thyroid APPENDICES Population Census by Area, Age Group and Sex Annual Incidence per 100,000 by Age Group, Male, Manila Annual Incidence per 100,000 by Age Group, Female, Manila... Error! Bookmark not defined. Annual Incidence per 100,000 by Age Group, Male, Rizal... Error! Bookmark not defined. Annual Incidence per 100,000 by Age Group, Female, Rizal... Error! Bookmark not defined. Annual Incidence per 100,000 by Age Group, Male, Cebu... Error! Bookmark not defined. Annual Incidence per 100,000 by Age Group, Female, Cebu... Error! Bookmark not defined. Comparison of the Most Common Cancer Sites for Five Time Periods... Error! Bookmark not defined. Contributors... Error! Bookmark not defined. Philippine Cancer Society Board of Trustees... Error! Bookmark not defined. Philippine Cancer Society - Manila Cancer Registry... Error! Bookmark not defined. Department of Health - Rizal Cancer Registry... Error! Bookmark not defined. ii

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4 FOREWORD This monograph presents the fourth volume of the analysis of the incidence of cancer in the populations of Metropolitan Manila, Rizal Province, and Cebu Province in the Republic of the Philippines. The data used are from the three population-based cancer registries, namely the Department of Health-Rizal Cancer Registry, the Philippine Cancer Society-Manila Cancer Registry, and the Eduardo Aboitiz Foundation-Metro Cebu Cancer Registry. It covers the period from 2003 to Cancer in the Philippines Vol. 5 (CIP5) is now divided into two parts, CIP5 Part 1 Cancer Incidence , and, CIP5 Part 2 Cancer Incidence Trends In CIP5 Part 1, as in the third volume, the incidence rates for leading cancer sites are presented by age-group, sex and geographic subdivisions (cities/municipalities) of the registration area. These rates are then compared with those from other populations. Also, for the first time, incidence maps are included, provided by the Finnish Cancer Registry. In CIP5 Part 2, a trend analysis for leading cancer sites using joinpoint regression developed by the National Cancer Institute of the United States will be presented, and will also include incidence maps. The entire book was produced using personal computers and computer software, which are widely distributed. Hence, this volume proves that the results of a cancer registry may be summarized into a monograph illustrated by tables and figures with the aid of nothing more complicated than a personal computer. The production of the monograph was generously supported by the Degenerative Disease Office National Center for Disease Prevention and Control of the Department of Health. iv

5 I INTRODUCTION The Republic of the Philippines which is located in the Southeast Asia region, is an archipelago composed of more than 7,000 islands bounded by the Pacific Ocean and the South China Sea. The country is divided into three main island groups - Luzon, Visayas and Mindanao. Metropolitan Manila and Rizal Province are centrally located in Luzon, which is the second largest island, located in the northern portion of the archipelago. The exact location of these two areas is between latitudes and North and between longitudes and West. Metro Cebu is centrally located in the Visayas, located between latitudes 9 25'N and 11 15'N and between longitudes 'E and 124 5'E. Cancer in the Philippines Vol. 5 Part 1 presents an epidemiological profile of the major cancers in Metropolitan Manila and the province of Rizal for the period and the province of Cebu for the period. Data from the three population-based registries, the Department of Health-Rizal Cancer Registry (DOH-RCR), the Philippine Cancer Society-Manila Cancer Registry (PCS-MCR), and the Eduardo Aboitiz Foundation-Metro Cebu Cancer Registry (EAF-MCCR) were analyzed in detail with the age standardized rates (ASR) for each area being compared with the ASR for all the areas combined. Comparison with rates from other areas in the world are presented, as well as incidence maps Population-Based Registries in Metropolitan Manila, Rizal Province, and Metro Cebu Until 1987, the DOH-RCR and the PCS-MCR were the only population-based cancer registries in the country. The area covered by these two registries is the most populous and medically sophisticated in the country, enabling a fairly accurate view of cancer incidence to be obtained, and providing a basis for future epidemiological and clinical studies on cancer, as well as valuable inputs to cancer control activities The Department of Health - Rizal Cancer Registry (DOH-RCR) The first population-based cancer registry in the country was established in 1974 as one of the activities of the Community Cancer Control Program of the province of Rizal. At that time, Rizal was still composed of 26 municipalities, 12 of which were subsequently incorporated into Metropolitan Manila in From 1974 to 1979, data collection was entirely passive relying on notification from physicians and hospitals. This system was highly unsatisfactory so that active registration was started in Research assistants were trained in methods of cancer registration and were assigned to abstract data from hospitals and death certificates. In 1984, the registry started a cooperative effort with the Philippine Cancer Society-Manila Cancer Registry in covering 134 hospitals within the National Capital Region and Rizal Province. Both registries use the same forms and the same method of active data collection. Since 1978, data from the Rizal Cancer Registry have been included in Cancer Incidence in Five Continents ( Data for were part of Volume V, data in Volume VI, data in Volume VIII, and data in Volume X. The DOH-RCR is located in the Rizal Medical Center in Pasig City. It was initially funded by the Rizal provincial government but since 1975, funding has been a full responsibility of the Rizal Medical Center. Its present staff consists of a surgical oncologist who heads the registry, two surgeons, two full-time registry clerks, and five part-time cancer registry research assistants (collaborative work with IARC and the Andres Soriano Foundation) The Philippine Cancer Society - Manila Cancer Registry (PCS-MCR) The first formal cancer registration activity in the Philippines was started in 1959 by the Philippine Cancer Society (PCS) when it established the Central Tumor Registry of the Philippines (CTRP). The CTRP collected data from 26 hospitals, 25 in Metropolitan Manila and one located in Cebu, completely relying on notifications from these hospitals. 1

6 The CTRP was converted into a population-based registry in It covered the population of four cities included in the Metropolitan Manila area (Manila, Quezon City, Pasay City and Caloocan City) and was renamed the Philippine Cancer Society-Manila Cancer Registry. One of the first tasks of the PCS-MCR was a retrospective review of records covering the period of in all hospitals, since prior to 1983 data collection relied solely on passive notification of cases. A review of death certificates was also accomplished. All of the smaller hospitals which were not part of the CTRP network were now included in the PCS-MCR. The DOH-RCR was also able to provide data on cases it had identified among residents of the four cities. Incidence data from the PCS-MCR have been included in vols. VI, VII, VIII, IX and X of Cancer Incidence in Five Continents. The registry is located in the PCS building, and is fully funded by the PCS. The registry staff is composed of four parttime consultants (two surgical oncologists, one of whom heads the registry, and two epidemiologists), one full-time supervisor, and six cancer registry research assistants The Eduardo Aboitiz Foundation - Metro Cebu Cancer Registry (EAF-MCCR) The Metro Cebu Cancer Registry (MCCR) was founded in February Serving the needs of communities in the southern part of the country, it is the third internationally accredited population-based registry outside Metro Manila. The Eduardo J. Aboitiz Cancer Center, a program of Ramon Aboitiz Foundation Inc. is running the Metro Cebu Population-Based Cancer Registry that is located in Cebu, Philippines. The registry is manned by three (3) personnel (1 Project Officer and 2 research staff). The program is fully subsidized by the Ramon Aboitiz Foundation, Inc. being one of the component program of the Eduardo J. Aboitiz Cancer Center The Registration Areas The Republic of the Philippines is part of Southeast Asia, between the Pacific Ocean and the South China Sea (Figure 1.2.1, 1.2.2). The total land area involved in cancer registration in Luzon comprises of 1,944 km 2. The area is in the central part of Luzon Island, bounded by Manila Bay in the West, the province of Bulacan in the North, and the provinces of Cavite and Laguna in the southwest. To the East lies Quezon province. The southern border faces a large lake, the Laguna de Bay (Figures and 1.2.4). The total area of the Metropolitan Cebu is 1163 km 2, bounded by other Cebu municipalities and cities on the north, west and south, and by the Cebu Strait and Camotes Sea on the east (Figure 1.2.5). Metropolitan Manila, called the National Capital Region (NCR), consists of 16 cities and 1 municipality located in an area of 635 square kilometers. The NCR is the major urban center of the country. The present Rizal province consists of 1 city and 13 municipalities with an area of 1,039 square kilometers and a population that is 75 percent urban (Figure 1.2.6). The DOH-RCR covers the 26 municipalities of the original province of Rizal, encompassing a land area of 1343 km 2, situated between latitudes and North and between longitudes and West. Of the 12 municipalities that were incorporated into Metro Manila, 6 became cities during 1994 to Of the fourteen remaining municipalities of Rizal province, one (Antipolo) became a city in 1999, ten (10) are urbanizing and only three are rural. The PCS-MCR covers the four major cities (Manila, Quezon, Pasay, Caloocan) of the National Capital Region (NCR) which is the major urban center of the country. It encompasses a land area of km 2 located in the southwest portion of Luzon between latitudes and North and between longitudes and West. The city of Manila is the capital of the Philippines and is the country s main port, the hub of commerce and trade and the seat of cultural and intellectual activities. The EAF-MCCR covers the cities of Cebu, Mandaue, Lapu-Lapu, Talisay, Naga and the municipalities of Consolacion, Lilo-an, Compostela, Cordova, Minglanilla, Naga and San Fernando (Figure 1.2.7). Metro Cebu is a narrow stretch of land about 220 kilometers from the north to south and about 41 kilometers at its widest portion. It is located between the latitudes 9 25'N and 11 15'N and between longitudes 'E and 124 5'E. The total land area is 5,078 km 2. Hospital 2

7 coverage includes 26 hospitals (both public and private), 11 local Civil Registries (of each LGU covered) and all oncology clinics in Cebu. Figure Location of the Republic of the Philippines ( 3

8 Figure Location of the Republic of the Philippines in Southeast Asia. Figure Map of the Republic of the Philippines. 4

9 Figure Location of the registration area in Luzon Island. Figure Location of the registration area in the Visayas. 5

10 Figure Map of Metro Manila and Rizal Province. Figure Map of Metro Cebu. 6

11 1.3. Socio-demographic, Economic and Health Aspects The population covered by the DOH-RCR, based on the 2007 Census of Population and Housing was 7,116,987, with a male to female ratio of 0.96:1 (Figure 1.3.1). There had been a 21.3% increase compared to the 2000 census. The population was predominantly young (31.7% below 15 years of age and 3.1% 65 years and older). The largest ethnic group was Tagalog (82%) while the second and third largest groups were Bicol (4%) and Bisaya (3%), respectively. The following were the foreign groups noted: American/English (0.025%), Other Foreign (0.018%) and Chinese (0.012%). Eighty percent (80%) were Roman Catholic, 3.2% belonged to Iglesia ni Kristo and 0.17% were Muslims. The population covered by the PCS-MCR, based on the 2007 census, was 5,287,425, representing an increase of 15.2% as compared to that in As a whole, the population was young, with 30.5% under 15 years of age and only 3.2% 65 years and older (Figure 1.3.2). There were 140 different ethnic groups, the largest of which were Tagalog (69.85%), Bicol (4.27%), Ilocano (4.16%), Bisaya (3.87%) and Waray (2.81%). Among the foreign ethnic groups, the largest were Chinese (0.59%). People of American/English ethnicity and other foreign groups comprised 0.02% and 0.04%, respectively. Roman Catholics comprised 88.8% of the population while 3.2% belonged to Iglesia ni Kristo and 0.6 % were Muslims. Health services in the National Capital Region and the adjacent province of Rizal included four (4) cancer institutes, 168 secondary and tertiary care hospitals, 43 primary care hospitals and 32 clinics of the Department of Health for outpatient consultations. Ten hospitals had radiotherapy facilities. The population covered by the EAF-MCCR, based on the 2007 census was, 2,106,291. There has been a 10.5% increase compared to the 2000 census. One third (32.6%) of the population were under 15 years of age, and only 3.2% were over 65 years old (Figure 1.3.3). The people of Cebu are called Cebuanos and are of Austronesian, Chinese, and Spanish ancestries. The most commonly-used conversational dialect is Cebuano or Visayan, but the medium of instruction in educational institutions and business transactions is English. Other languages used are Filipino/Tagalog, Waray-Waray and Ilonggo. The majority of the Cebuanos are Christians, mostly Roman Catholics and Protestants. Other religions include Islam, Buddhism and Hinduism. Health services in Metro Cebu includes 3 cancer institutes, 29 tertiary and secondary hospitals. Three hospitals had radiotherapy facilities and one has a free standing laboratory. Figure Population distribution by age and sex, DOH-RCR, Figure Population distribution by age and sex, PCS-MCR,

12 Figure Population distribution by age and sex, EAF-MCCR, II METHODS 2.1. Data Collection Overview Although cancer is a notifiable disease, passive collection of cancer data from physicians and hospitals was unsuccessful. Previous experience in the DOH-RCR showed a high degree of under-reporting. Thus data collection shifted to an active search for cases. Registry research assistants, formerly known as cancer registry clerks, were trained to obtain pertinent cancer data from medical records and death certificates. Letters and visits to hospital directors and medical records officers preceded actual data gathering. Data collection from hospitals included the following activities: 1. Case finding or identification of cancer cases who were residents of the catchment area of the registry. A case-finding list was prepared for every hospital data source. These lists were later collated and matched 8

13 prior to abstracting. Pertinent information obtained by case finding was later integrated into the hospital abstract. 2. Actual abstracting of data from the medical records and completion of the hospital abstract form (Appendix III). Death certificates from the office of the Local Civil Registries were also reviewed. For death certificates, the death certificate abstract form (Appendix IV) was filled out for patients with cancer mentioned as the underlying, immediate or contributory cause of death and whose permanent address was within the catchment area of the registry. The registry staff also visited private oncologists and hematologists to ensure registration completeness Data sources These included the following: 1. Records of hospitals located in the Metropolitan Manila and Rizal areas. Cases were collected from the following data sources: a. Medical records, both inpatient and outpatient b. Pathology records including surgical pathology, cytology, hematology and autopsy reports and logbooks c. Radiotherapy records and logs d. Radiology, ultrasound, nuclear medicine and CT scan reports and logs e. Hospital Tumor registry, if available 2. Death certificates gathered from the offices of the Local Civil Registrar of the municipalities of Metropolitan Manila and the province of Rizal Data Management Data management was done as follows: 1. All documents received at registry were stamped with the proper date. 2. A summary of all cases abstracted in each hospital (the Intake of Cases) was prepared by giving the number of cases collected from a hospital per year and the distribution of cases per hospital by site. 3. A summary of all death certificate abstracts gathered per municipality per year (Intake of Deaths) was likewise prepared, giving the number of deaths from cancer per municipality per year and the distribution of cases by site as well as the cases for follow-back and the hospitals where the follow-back will be made. 4. Both hospital abstract and death certificate abstracts were checked for completeness as well as consistency. Abstracts with missing essential data or with inconsistencies were held in a Suspense File pending completion of data or correction of inconsistencies. 5. To avoid duplication, completed hospital and death certificate abstracts were compared with the following: a. The Master Patient Index File, which was an alphabetical file of all registered cancer cases, including both living and dead cases. b. Prior to Reference Date Cases, which was an alphabetically arranged file of cases diagnosed prior to the reference date of the registry. c. The Site Index File, which was an index file of cases, arranged by primary site. d. In matching the name of patients, allowance was made for errors in spelling (phonetic spelling of names or errors in spelling due to varying degrees of legibility of handwritten records). If there was a similarity of name, the age, sex, residence and diagnosis were compared. e. If the death certificate abstract was not previously registered, this was followed back in the hospital where the patient died, or if the patient died at home, the death certificate abstract was matched with 9

14 the different case-finding lists from the different hospitals to determine if the case was previously seen in a hospital or not. If the case could not be traced back to a hospital or to the physician who signed the death certificate, the case was then registered under the Death Certificate Only category (DCO). 6. Data were encoded using the IARC/IACR CanReg 4 software, which incorporated checks for consistency and validity of codes Quality Control Quality control was assessed through the following indices: 1. Histologically Verified (HV) Percentage: This was the percentage of cases whose diagnosis was based on histological examination of tissue from a primary site or from a metastatic site. For leukemia, this included examination of the bone marrow. Cases based on cytology or peripheral blood smear were not considered as histologically verified. Cases seen in Radiotherapy Units where the basis for diagnosis indicated were coded under the Clinical Only category. However, since most radiotherapy unit gave irradiation only to histologically verified cases, (with the exception of oncological emergencies), this would have led to the Histologically Verified percentage being an underestimate of the true value. 2. Death Certificate Only (DCO) Percentage: This is the percentage of cases where diagnosis was based solely on information obtained from a death certificate. If this percentage was high, it reflected the degree of underreporting in the registry. The percentages of cases of histologically verified and registered from death certificates only for each time period are shown in Tables and in the Results and Discussion part of this paper Data Analysis The calculation of incidence rates was based on the number of new cases registered by the DOH-RCR, PCS-MCR, and the EAF-MCCR for the time periods 1 January 2003 to 31 December In this fifth volume, analysis of the data included: 1. Average annual crude incidence rates per 100,000 by sex and site for the period covering Average annual age-specific incidence rates per 100,000 by sex, site and age groups for the period covering Age-standardized rates (ASR) per 100,000 carried out by the direct method using the world standard population. 4. A detailed analysis of the most frequent malignancies and other sites of interest, including the following: oral cavity, stomach, colon, rectum, liver, lung (bronchus), breast (female), cervix uteri, prostate, and thyroid for the period of Population The number of person-years was derived from the 2007 census reported by the National Census and Statistics Office (Appendix I) Geographic Subdivision As in the previous volume, volume IV calls the different geographical subdivisions (cities/municipalities) by their proper names in order to avoid confusion with the administrative regions used by the Department of Health. The numbering and geographic location of each city/municipality are: 10

15 PCS-Manila Cancer Registry 1. City of Manila N E 2. Caloocan City N E 3. Pasay City N E 4. Quezon City N E DOH-Rizal Cancer Registry 5. City of Pasig N E 6. City of Las Piñas N E 7. City of Makati N E 8. City of Antipolo N E 9. Taguig City N E 10. City of Parañaque N E 11. City of Marikina N E 12. City of Muntinlupa N E 13. City of Malabon N E 14. City of Mandaluyong N E 15. Cainta N E 16. City of Navotas N E 17. Taytay N E 18. Binangonan N E 19. San Mateo N E 20. City of San Juan N E 21. Montalban N E 22. Tanay N E 23. Angono N E 24. Pateros N E 25. Pililla N E 26. Morong N E 27. Cardona N E 28. Teresa N E 29. Baras N E 30. Jala-Jala N E EAF Metro Cebu Cancer Registry 1. Cebu City N E 2. Mandaue City N E 3. Lapu-Lapu City N E 4. Talisay City N E 5. Naga City N E 6. Minglanilla N E 7. San Fernando N E 8. Consolacion N E 9. Lilo-an N E 10. Compostela N E 11. Cordova N E The numbering and geographic locations were used in the production of the site-specific cancer incidence maps (Figures and 2.5.2) 11

16 Figure Map of Metro Manila and Rizal Province showing the number corresponding to each City/Municipality. Figure Map of Metro Cebu showing the number corresponding to each City/Municipality Statistical Methods For comparisons of age-adjusted incidence rates between the different areas, the significance of the difference between the incidence rate for each area, with that for the entire Rizal and Metro Manila (overall) was tested. The method used 12

17 was the Mantel-Haenszel (M-H) test. The difference in rates was significant at the = 0.05 when M-H is equal to or greater than This was indicated by an asterisk (*) in the tables. The M-H test takes into account the possible effect of the differences in the variance of age-groups to the ASR. It takes into consideration the differences in the variance by age-groups. This means that the M-H test underscores the variation between age-specific rates of the groups being compared. The formula for this is illustrated below. where : k K m m M Z 2x x 1x 2x x x 1 the number of cases in agegroup x in the second population the the g the person - years in agegroup the k g x 1 2x K K x total number 2x 1x person - years in x m M x x m 2x x m 2 M of cases in agegroup x total person - years in agegroup agegroup x in the first population x in the second population x 2.6. Incidence Maps The database was sent by the two registries to the Finnish Cancer Registry and consisted of annual number of cases by age-group in each city/municipality for each of the selected sites/sex, and the population of each city/municipality and their individual geographic locations. The ASRs were located using a metric coordinate system called Philippines Zone III. Every city/municipality was shown as a circle, the diameter of which described the order of the male or female populations. The size does not indicate absolute population size differences. There was a relative color scale used for showing the ASRs with 19 colors, ranging from blue and green tints depicting low rates, to red and violet depicting high rates. A step change from one color level to another corresponds to a 10% or 1.1-fold relative change in the ASR. The lower limit of the highest category is therefore always 5.07 times ( ) the upper limit of the lowest category. The color scale is fixed so that values of the ASRs can be seen. The map consists of layers, such as area boundaries, titles, scales and circles. The maps were created using a self-developed serverside software which can generate the map outlook. The software used the Mapserver module ( to handle the map layers and produce a single image. 13

18 III RESULTS AND DISCUSSION 3.1. Data Description The complete incidence data for All Sites, generated through the CANREG software of the International Agency for Research on Cancer are included in Appendix II, consisting of four separate Tables. The database used for the computations of this monograph differs slightly but not significantly, because of continuing updating of case files by the two registries. During the period between 2003 and 2007, a total of 77,174 new cases were included in the two registries. There were 32,398 cases among males and 44,776 cases among females, resulting in a male to female ratio of 1 male to every 1.38 females. From the PCS-MCR areas, a total of 39,141 cases were recorded, comprising of 16,437 males and 22,704 females. On the other hand, in the DOH-RCR areas, 38,033 new cases were recorded, 15,961 of which were males while 22,072 were females. Table shows that in DOH-RCR areas, 67.9 percent of cases among males were histologically verified (HV) while 9.7 percent were registered through death certificates (DCO). Among females, the proportions were 79.1 percent and 6.8 percent, respectively. For the PCS-MCR areas, 64.5 percent of cases among males were histologically verified while this proportion was 75.4 percent among females (Table 3.1.2). The proportion of cases that were identified through death certificates were 8.6 percent in males and 5.9 percent in females. A total of 10,195 new cases were included in EAF-MCCR between 2003 and There were 4,646 and 5,549 cases among males and females, respectively, with a male to female ratio of 1 male to every 1.19 females. Of the male cases, 35.7% were histologically verified and 26.4% were identified through death certificates (Table 3.1.3). Among females, the proportions of HV and DCO were 50.9% and 19.3%, respectively Leading Cancer Sites Metro Manila and Rizal Province The ten most common cancer sites in Metro Manila and Rizal Province for the period are shown in Figures , and The rankings based on the proportion of cases from the total in comparison with the previous years are shown in Appendix III. For both sexes, the four most common cancer sites were Breast, Lung, Colon and Liver. Compared to , Breast, and Lung remained in their ranks at 1 st and 2 nd respectively. The following cancers rose to up compared to the previous period: Colon cancer from 5 th to 3 rd, Thyroid from 7 th to 6 th, and Prostate from 10 th to 7 th. On the other hand, Liver moved down from 3 rd to 4 th, Cervix from 4 th to 5 th, Leukemias from 6 th to 8 th and Rectum from 8 th to 9 th. Corpus Uteri was now ranked ten. In men, the four most common cancers were the same as the previous period. However, Prostate rose up from 3 rd to 2 nd while Liver went down to 3 rd from 2 nd. Lung, Colon, Leukemias, and Rectum remained in their ranks at 1 st, 4 th, 5 th and 6 th, respectively. Non-Hodgkin Lymphoma climbed from 10 th to 7 th. Both Nasopharyngeal and Stomach went down one level lower, now ranked 8 th and 9 th respectively. Kidney was now ranked 10 th but Thyroid cancer did not make it to the top 10. For women, the four most common cancer sites were Breast, Cervix, Thyroid and Ovary. Compared to the period, cancers of the Breast, Cervix Uteri, and Corpus Uteri remained as 1 st, 2 nd, and 7 th, respectively. Thyroid cancer moved up from 6 th to 3 rd, Leukemias from 9 th to 8 th, and Liver from 10 th to 9 th. Cancer of the Ovary descended one level 14

19 down from 3 rd to 4th, Lung from 4 th to 5 th, and Colon from 5 th to 6 th. Rectum was now ranked 10. Cancer of the Brain and Nervous System did not make it to top 10. Table Percentage of cases registered with histological confirmation of diagnosis (% HV) or on the basis of information only from a death certificate (% DCO), DOH-RCR, ICD-10 Site Cases % HV % DCO Male Female Male Female Male Female C00-C06 Oral cavity C07-C08 Salivary glands C11 Nasopharynx C15 Oesophagus C16 Stomach C18 Colon C19-C21 Rectum C22 Liver C25 Pancreas C32 Larynx C33-C34 Lung C40-C41 Bone C44 Skin C47, C49 Connective and soft tissue C50 Breast C53 Cervix uteri C54 Corpus uteri C55 Uterus unspecified C56 Ovary C51-C52, C57 Other female genital organs C58 Placenta C60 Penis C61 Prostate C62 Testis C64 Kidney C67 Bladder C69 Eye C70-C72 Brain, nervous system C73 Thyroid C81 Hodgkin disease C82-C85, C96 Non-Hodgkin lymphoma C91 Lymphoid leukaemia C92-94 Myeloid leukaemia C95 Other and unspecified leukemias ALL All sites

20 Table Percentage of cases registered with histological confirmation of diagnosis (% HV) or on the basis of information only from a death certificate (% DCO), PCS-MCR, ICD-10 Site Cases % HV % DCO Male Female Male Female Male Female C00-C06 Oral cavity C07-C08 Lip C09 Tonsil C11 Nasopharynx C15 Oesophagus C16 Stomach C18 Colon C19-C21 Rectum C22 Liver C25 Pancreas C32 Larynx C33-34 Lung C40-41 Bone C44 Skin C47, C49 Connective and soft tissue C50 Breast C53 Cervix uteri C54 Corpus uteri C55 Uterus unspecified C56 Ovary C51-C52, C57 Other female genital organs C58 Placenta C60 Penis C61 Prostate C62 Testis C64 Kidney C67 Bladder C69 Eye C70-C72 Brain, nervous system C73 Thyroid C81 Hodgkin disease C82-C85, C96 Non-Hodgkin lymphoma C91 Lymphoid leukaemia C92-C94 Myeloid leukaemia C95 Other and unspecified leukemias ALL All sites

21 Table Percentage of cases registered with histological confirmation of diagnosis (% HV) or on the basis of information only from a death certificate (% DCO), EAF-MCCR, ICD-10 Site Cases % HV % DCO Male Female Male Female Male Female C00-C06 Oral cavity C07-C08 Lip C09 Tonsil C11 Nasopharynx C15 Oesophagus C16 Stomach C18 Colon C19-C21 Rectum C22 Liver C25 Pancreas C32 Larynx C33-34 Lung C40-41 Bone C44 Skin C47, C49 Connective and soft tissue C50 Breast C53 Cervix uteri C54 Corpus uteri C55 Uterus unspecified C56 Ovary C51-C52, C57 Other female genital organs C58 Placenta C60 Penis C61 Prostate C62 Testis C64 Kidney C67 Bladder C69 Eye C70-C72 Brain, nervous system C73 Thyroid C81 Hodgkin disease C82-C85, C96 Non-Hodgkin lymphoma C91 Lymphoid leukaemia C92-C94 Myeloid leukaemia C95 Other and unspecified leukemias ALL All sites

22 Breast Lung Colon Liver Cervix uteri Thyroid Prostate Leukemias Rectum Ovary Percentage Figure Most common cancer sites, both sexes, Metro Manila and Rizal, Lung Prostate Liver Colon Leukemias Rectum Non-Hodgkin lymphoma Nasopharynx Stomach Kidney Percentage Figure Most common cancer sites, males, Metro Manila and Rizal, Breast Cervix uteri Thyroid Ovary Lung Colon Corpus uteri Leukemias Liver Rectum Percentage Figure Most common cancer sites, females, Metro Manila and Rizal,

23 Metro Cebu The ten leading cancer sites in Metro Cebu for the period are shown in Figures , and The four leading cancer sites for both sexes were Liver, Breast, Lung and Colon. Cancers of the Thyroid, Prostate, Non-Hodgkin Lymphoma, Ovary, Cervix Uteri, and Corpus Uteri followed the list in descending order. Among males, the four most common cancers were Liver, Lung, Colon and Prostate. Other cancer sites that made it to the top ten were Non-Hodgkin Lymphoma, Thyroid, Rectum, Myeloid Leukemia, Stomach and Bone. Among females, the four leading sites were Breast, Thyroid, Lung, and Liver. The other common cancer sites were Ovary, Cervix Uteri, Colon, Corpus Uteri, Uterus unspecified and Non-Hodgkin lymphoma. Liver Breast Lung Colon Thyroid Prostate Non-Hodgkin lymphoma Ovary Cervix uteri Corpus uteri Percentage Figure Most common cancer sites, both sexes, Metro Cebu, Liver Lung Colon Prostate Non-Hodgkin lymphoma Thyroid Rectum Myeloid leukaemia Stomach Bone Percentage Figure Most common cancer sites, males, Metro Cebu,

24 Breast Thyroid Lung Liver Ovary Cervix uteri Colon Corpus uteri Uterus unspecified Non-Hodgkin lymphoma Percentage Figure Most common cancer sites, females, Metro Cebu, Overall Cancer Incidence (All Sites) Metro Manila and Rizal Province The overall (all sites) crude incidence rate for all the areas covered by PCS-MCR and DOH-RCR among males was per 100,000 population whereas the overall age-standardized incidence rate was per 100,000 population. For females, the overall crude and age-standardized rates were per 100,000 and per 100,000, respectively. The crude, age-standardized and 5-year age-specific incidence rates for the different areas covered by the registries are shown in tables and corresponding incidence maps. For males (Table and Figure ), the PCS-MCR had an ASR of per 100,000 population that was significantly higher than the overall ASR. Meanwhile, the DOH-RCR had an ASR of per 100,000 that was significantly lower. The DOH-RCR Rizal area had an ASR that was significantly lower than the overall (137.7 per 100,000) while there was not enough evidence to say that the ASR for the DOH-RCR Metro Manila area was significantly lower than the overall. The areas with ASRs that were significantly higher than that of the overall were Manila, Quezon City, Las Piñas, Mandaluyong, Parañaque, Pasig and San Juan. On the other hand, the areas with ASRs that were significantly lower than the overall ASR were Caloocan, Marikina, Navotas, Pateros, Taguig, Angono, Antipolo, Baras, Binangonan, Cainta, Cardona, Jala-Jala, Montalban, Morong, Pililla, San Mateo, Tanay, Taytay, and Teresa. For females (Table and Figure ), the PCS-MCR, likewise, had a significantly higher ASR (214.1 per 100,000) than the overall whereas the DOH-RCR had a significantly lower ASR (187.0 per 100,000). The Rizal areas covered by DOH-RCR similarly exhibited a significantly lower ASR (140.4 per 100,000). The ASR for the DOH-RCR Metro Manila areas was significantly higher than the overall (206.4 per 100,000). The cities/municipalities that showed significantly higher ASRs than the overall were Manila, Pasay, Quezon City, Las Piñas, Makati, Mandaluyong, Parañaque, Pasig and San Juan. Conversely, those that presented significantly lower ASRs were Caloocan, Malabon, Marikina, Navotas, Pateros, Taguig, Angono, Antipolo, Baras, Binangonan, Cainta, Cardona, Jala-Jala, Montalban, Morong, Pililla, San Mateo, Tanay, Taytay and Teresa. For both males and females, highly urbanized areas had higher ASRs while those less developed or with large less urbanized areas such as the case of Caloocan, had significantly lower ASRs. 20

25 Table Metro Manila and Rizal Province annual incidence rates per 100,000, all sites, male, by age group (years), Male All Sites (C00-C95) AREAS CASES CRUDE RATE ASR WORLD All Areas S.E. MANTEL- HAENSZEL TEST PCS-MCR * City of Manila * Caloocan City * Pasay City Quezon City * DOH-RCR * Metro Manila City of Las Piñas * City of Makati * City of Malabon City of Mandaluyong * City of Marikina * City of Muntinlupa City of Navotas * City of Parañaque * City of Pasig * City of San Juan * Pateros * Taguig City * Rizal Province * Angono * Baras * Binangonan * Cainta * Cardona * City of Antipolo * Jala-Jala * Montalban * Morong * Pililla * San Mateo * Tanay * Taytay * Teresa * 21

26 Table Metro Manila and Rizal Province annual incidence rate per 100,000, all sites, female, by age group (years), Female All Sites (C00-C95) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City * Pasay City * Quezon City * DOH-RCR * Metro Manila * City of Las Piñas * City of Makati * City of Malabon * City of Mandaluyong * City of Marikina * City of Muntinlupa City of Navotas * City of Parañaque * City of Pasig * City of San Juan * Pateros * Taguig City * Rizal Province * Angono * Baras * Binangonan * Cainta * Cardona * City of Antipolo * Jala-Jala * Montalban * Morong * Pililla * San Mateo * Tanay * Taytay * Teresa * 22

27 Figure Metro Manila and Rizal Province age-standardized incidence rates, all sites, males, Figure Metro Manila and Rizal Province age-standardized incidence rates, all sites, females,

28 Metro Cebu For all cities and municipalities covered by EAF-MCCR, the overall crude and age-standardized incidence rates per 100,000 population among males for all sites were per 100,000 and per 100,000, respectively. Among females, the overall crude incidence rate was per 100,000 while the overall age-standardized rate was per 100,000. Among males, Cebu City had significantly higher ASR of per 100,000 compared with that of overall Metro Cebu (Table and Figure ). All other areas, such as Mandaue, Lapu-Lapu, Talisay, Naga, Minglanilla, San Fernando, Consolacion, Lilo-an, Compostela, and Cordova had significantly lower ASRs than that of the overall Metro Cebu. Similar to those of males, females in Cebu City had significantly higher ASR of per 100,000 compared with that of overall Metro Cebu (Table and Figure ). Significantly lower ASRs than that of the overall were observed in other cities and municipalities of Metro Cebu. Figure Metro Cebu age-standardized incidence rates, all sites, males, Comparison with other Countries Figure shows that the all sites ASR among males was lowest among the Singaporean Indians. A step higher were Malays in Singapore and residents of the DOH-RCR area, followed by residents of EAF-MCCR and PCS-MCR, and the Chinese in Los Angeles (L.A.). Singaporean Chinese and Non-Hispanic Whites in L.A. had even higher ASRs. The highest ASR was observed among the Saarland residents in Germany and the Black population in L.A. This could indicate the influence of varying lifestyles not only between developed and developing countries but also between ethnic and/or economic groups within the same geographic area. Among females (Figure ) the all sites pattern was similar, with the Saarland population and Blacks and Filipino residents in L.A. having the highest ASRs. The lowest ASR was again observed among the Singaporean Indians. This similarity of the pattern observed in both males and females could indicate that the lifestyle differences that could lead to inter-country and intra-country variations in ASRs may affect both sexes. 24

29 Table Metro Cebu annual incidence rates per 100,000, all sites, male, by age group (years), Male All Sites (C00-C95) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City * Lapu-Lapu City * Talisay City * Naga City * Minglanilla * San Fernando * Consolacion * Lilo-an * Compostela * Cordova * Table Metro Cebu annual incidence rates per 100,000, all sites, female, by age group (years), Male All Sites (C00-C95) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City * Lapu-Lapu City * Talisay City * Naga City * Minglanilla * San Fernando * Consolacion * Lilo-an * Compostela * Cordova * 25

30 Figure Metro Cebu age-standardized incidence rates, all sites, females, Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, all sites, males,

31 Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, all sites, females, Oral Cavity This group included malignancies of the tongue, gum, floor of the mouth, buccal mucosa, hard and soft palate as well as malignancies of the mouth, not otherwise specified. ICD-10 codes are C01-C Metro Manila and Rizal Province There were a total of 865 new oral cavity cancers recorded between both sexes in the period covering 2003 to 2007 in both PCS-MCR and DOH-RCR. Among these, 460 were males while 405 were females, resulting in a male to female ratio of The CR for males was 1.5 while the ASR was 2.8 per 100,000. For females, the CR and ASR were 1.3 per 100,000 and 2.1 per 100,000, respectively. Among males (Table and Figure ), the PCS-MCR had an ASR of 2.9 per 100,000, while the ASR for DOH-RCR was 2.6 per 100,000. For both, there was not enough evidence to say that the ASRs differed from the overall. The ASR of Rizal Province (2.0 per 100,000) was significantly lower, while the ASR of the DOH-RCR Metro Manila areas was similar with the overall (2.9 per 100,000). The cities of Manila and Pasig had significantly higher ASRs (3.6 per 100,000 and 4.9 per 100,000, respectively) compared with the overall. No case of oral cancer was found in Baras and Teresa during this period. For females (Table and Figure ), there was not enough evidence to say that the ASRs of PCS-MCR (2.0 per 100,000) and DOH-RCR (2.2 per 100,000) were significantly different from that of the overall. Rizal Province exhibited a significantly lower ASR (2.1 per 100,000), but the same cannot be said of the ASR from the DOH-RCR Metro Manila area (2.1 per 100,000). Only Pasig City had a significantly different ASR (3.5 per 100,000) compared with the overall. Moring and Teresa did not have any case of oral cancer among females for this period. 27

32 Metro Cebu In the EAF-MCCR areas a total of 149 new cases of oral cavity cancer were recorded for both sexes from 2003 to Of these new cases, 89 were male and 60 were female, with a male to female ratio of The CR and ASR among males were 1.8 per 100,000 and 3.3 per 100,000, respectively (Table and Figure ). Compared with the overall ASR, Cebu City had a significantly higher ASR of 5.4 per 100,000. No case of oral cavity cancer was diagnosed in Talisay City. Among females, the overall CR was 1.2 per 100,000 while the ASR was 1.8 per 100,000 (Table and Figure ). Only Naga City had a significantly different ASR (0.4 per 100,000) compared to the overall Comparison with other countries Figure shows that the highest male oral cancer rates were observed among Saarland residents, and the Non- Hispanic White residents in L.A and the Singapore Indians. The lowest rates occurred in the Filipino and Chinese residents in L.A. and Singapore Malays. Slightly higher ASRs were seen among Singapore Chinese as well as Philippine residents. These rates could reflect the levels of cigarette smoking and, among the Asian populations, betelquid chewing a couple of decades ago. Among females, Figure shows that the differences were not large, and could indicate that the prevalence of cigarette smoking may have been lower compared to males. The highest ASR was seen among Singapore Indians and may be partly attributable to betel-quid chewing. Figure Metro Manila and Rizal Province age-standardized incidence rates, oral cavity, males,

33 Table Metro Manila and Rizal Province annual incidence rate per 100,000, oral cavity, male, by age group (years), Male Oral Cavity (C00-C06) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR City of Manila * Caloocan City Pasay City Quezon City DOH-RCR Metro Manila City of Las Piñas City of Makati City of Malabon City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas City of Parañaque City of Pasig * City of San Juan Pateros Taguig City Rizal Province * Angono Baras Binangonan * Cainta Cardona City of Antipolo Jala-Jala Montalban * Morong Pililla San Mateo Tanay Taytay Teresa

34 Table Metro Manila and Rizal Province annual incidence rate per 100,000, oral cavity, female, by age group (years), Female Oral Cavity (C00-C06) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR City of Manila Caloocan City Pasay City Quezon City DOH-RCR Metro Manila City of Las Piñas City of Makati City of Malabon City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas City of Parañaque City of Pasig * City of San Juan Pateros Taguig City Rizal Province Angono Baras Binangonan Cainta Cardona City of Antipolo Jala-Jala Montalban Morong Pililla San Mateo Tanay Taytay Teresa

35 Figure Metro Manila and Rizal Province age-standardized incidence rates, oral cavity, females, Figure Metro Cebu age-standardized incidence rates, oral cavity, males,

36 Table Metro Cebu annual incidence rate per 100,000, oral cavity, male, by age group (years), Male Oral Cavity (C00-C06) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City Talisay City * Naga City Minglanilla San Fernando Consolacion Lilo-an Compostela Cordova Table Metro Cebu annual incidence rate per 100,000, oral cavity, male, by age group (years), Female Oral Cavity (C00-C06) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City Mandaue City Lapu-Lapu City Talisay City Naga City * Minglanilla San Fernando Consolacion Lilo-an Compostela Cordova

37 Figure Metro Cebu age-standardized incidence rates, oral cavity, females, Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, oral cavity, males,

38 Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, oral cavity, females, Stomach Metro Manila and Rizal Province There were a total of 1,971 new cases of stomach cancer recorded in PCS-MCR and DOH-RCR from 2003 to Of these, 1084 were males while 887 were females giving a sex ratio of The CR for males was 3.5 per 100,000 whereas the ASR was 7.2 per 100,000. For females it was 2.8 per 100,000 (CR) and 4.5 per 100,000 (ASR). For males, there was not enough evidence to say that the ASR of 8.1 per 100,000 population for PCS-MCR and 6.5 per 100,000 for DOH-RCR were significantly higher than the overall (Table and Figure ). The ASR of Rizal Province (4.2 per 100,000) was significantly lower, while there was not enough evidence to say that the ASR of the DOH-RCR Metro Manila area was also significantly higher (7.5 per 100,000). Among males, Manila had an ASR that was significantly higher than the overall. On the other hand, the areas with ASRs that were significantly lower than the overall ASR were Caloocan City, City of Marikina, Binangonan, City of Antipolo, and Tanay. No cases were reported from the municipalities of Jala-Jala, Morong and Teresa. For females (Table and Figure ) there was not enough evidence to say that the ASR of PCS-MCR (5.0 per 100,000) and that of DOH-RCR (4.1 per 100,000) were significantly different than the overall. The same conclusions could be said of the ASRs from the DOH-RCR Metro Manila areas (4.5 per 100,000) and Rizal Province (3.0 per 100,000). City of Manila had a significantly higher ASR (6.3 per 100,100), while those with significantly lower ASRs were Caloocan and Taytay. No case was recorded in Teresa Metro Cebu A total of 276 new cases of stomach cancer were recorded for both sexes in the period 2003 to 2007 by the EAF- MCCR. Of these new cases, 142 were male and 134 were female, with a male to female ratio of The CR and ASR among males were 2.8 per 100,000 and 5.6 per 100,000, respectively. Among females, the CR was 2.6 per 100,000 while the ASR was 4.2 per 100,000. Among males, Cebu City had an ASR of 8.1 per 100,000 which was significantly higher than the overall Metro Cebu (Table and Figure ). On the other hand, the ASR of 2.5 per 100,000 observed in Lapu-Lapu City was significantly lower. 34

39 Among females, the ASRs observed in Cebu City and Talisay City were significantly higher than the overall Metro Cebu (Table and Figure ). No cases of stomach cancer were seen in San Fernando, Compostela, and Cordova Comparison with other countries The highest ASR of male stomach cancer was observed among Singapore Chinese, followed by residents of Saarland, Germany (Figure ). The rates observed among Philippine residents were not too different from the other Asian populations and Filipino residents of L.A. There seems to be a global trend of decreasing incidence of stomach cancer, and the rate observed among the Singaporean Chinese could be the residual effects of higher levels of lifestyle and environmental risk factors. Figure shows that the female Singaporean Chinese also had the highest ASR but was only half of that observed among their male counterparts. The lowest rates were seen among Non-Hispanic White residents in L.A. and Malays in Singapore. The rest had fairly comparable rates. Figure Metro Manila and Rizal Province age-standardized incidence rates, stomach cancer, males,

40 Table Metro Manila and Rizal Province annual incidence rate per 100,000, stomach, male, by age group (years), Male Stomach (C16) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR City of Manila * Caloocan City * Pasay City Quezon City DOH-RCR Metro Manila City of Las Piñas City of Makati City of Malabon City of Mandaluyong City of Marikina * City of Muntinlupa City of Navotas City of Parañaque City of Pasig City of San Juan Pateros Taguig City Rizal Province * Angono Baras Binangonan * Cainta Cardona City of Antipolo * Jala-Jala Montalban Morong Pililla San Mateo Tanay * Taytay Teresa

41 Table Metro Manila and Rizal Province annual incidence rate per 100,000, stomach, female, by age group (years), Female Stomach (C16) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR City of Manila * Caloocan City * Pasay City Quezon City DOH-RCR Metro Manila City of Las Piñas City of Makati City of Malabon City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas City of Parañaque City of Pasig City of San Juan Pateros Taguig City Rizal Province Angono Baras Binangonan Cainta Cardona City of Antipolo Jala-Jala Montalban Morong Pililla San Mateo Tanay Taytay * Teresa

42 Figure Metro Manila and Rizal Province age-standardized incidence rates, stomach cancer, females, Figure Metro Cebu age-standardized incidence rates, stomach cancer, males,

43 Table Metro Cebu annual incidence rate per 100,000, stomach, male, by age group (years), Male Stomach (C16) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City * Talisay City Naga City Minglanilla San Fernando Consolacion Lilo-an Compostela Cordova Table Metro Cebu annual incidence rate per 100,000, stomach, female, by age group (years), Female Stomach (C16) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City Talisay City * Naga City Minglanilla San Fernando * Consolacion Lilo-an Compostela Cordova

44 Figure Metro Cebu age-standardized incidence rates, stomach cancer, females, Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, stomach, males,

45 Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, stomach, females, Colon Metro Manila and Rizal Province Between 2003 and 2007, a total of 3,990 new cases of colon cancer were recorded by PCS-MCR and DOH-RCR. Among these, 2,031 cases were males and 1,959 were females, resulting in a sex ratio of The CR among males was 6.6 per 100,000 while the ASR was 13.2 per 100,000. For females, it was 6.1 per 100,000 (CR) and 10.0 per 100,000 (ASR). An ASR of 17.7 per 100,000 male population was recorded for PCS-MCR, which was significantly higher than the overall. The ASRs for the entire DOH-RCR areas (9.2 per 100,000), the DOH-RCR Metro Manila areas (9.6 per 100,000) and the Rizal Province (8.1 per 100,000) were significantly lower. Among males (Table and Figure ) the areas with ASRs that were significantly higher than the overall were Manila and Quezon City. On the other hand, the areas with ASRs that were significantly lower than the overall were Makati, Malabon, Marikina, Navotas, Pasig, Pateros, Taguig, Angono, Binangonan, Pililla, San Mateo, and Taytay. Similar to that in males, the ASR of the PCS-MCR (13.6 per 100,000) for females (Table and Figure ) was significantly higher than that of the overall. The ASR for DOH-RCR (6.7 per 100,000) was significantly lower the overall. The same can be said for the DOH-RCR Metro Manila areas (6.9 per 100,000) and Rizal Province (6.2 per 100,000). Among the areas, Manila and Quezon City showed significantly higher ASRs than the overall. Contrastingly, those that presented significantly lower ASRs were Malabon, Mandaluyong, Marikina, Muntinlupa, Navotas, Pasig, Taguig, Angono, Baras, Binangonan, Cainta, Antipolo, Montalban, and Taytay. 41

46 Metro Cebu The EAF-MCCR recorded a total of 790 new cases of colon cancer were recorded for both sexes in the period 2003 to 2007 by the EAF-MCCR. Of these new cases, 441 were male and 349 were female, with a male to female ratio of The CR and ASR among males were 8.8 per 100,000 and 16.1 per 100,000, respectively. Among females, the CR was 6.9 per 100,000 while the ASR was 11.3 per 100,000. Among males, the ASR of residents of Cebu City of 23.0 per 100,000 was significantly higher than Metro Cebu (Table and Figure ). Lapu-Lapu City, on the other hand, had a significantly lower ASR (12.5 per 100,000) compared with the overall. Among females in the EAF-MCCR areas, Cebu City had the highest ASR (15.3 per 100,000) and it was significantly different from the overall Metro Cebu (Table and Figure ). The ASRs in Lapu-Lapu City, Naga City and Minglanilla were significantly lower than the overall Comparison with other countries The colon cancer rates among male Singapore Indians and of those in the DOH-RCR area were the lowest (Figure ). These rates were less than half the ASR observed among Filipino and Chinese residents in L.A. The ASRs in the PCS-MCR and EAF-MCCR areas were almost twice the ASR seen in the DOH-RCR area. The highest rates were seen among the Black and Non-Hispanic White residents in L.A., Saarland, Germany residents and among the Singaporean Chinese. The lowest colon cancer rates among females were observed in the DOH-RCR registry and among the Singaporean Indians (Figure 3.6.4). The rate among Filipino residents in L.A. was only slightly higher than those in the PCS-MCR area. The ASR in EAF-MCCR was only slightly lower that of the PCS-MCR. The highest rates were observed among the Black and Non-Hispanic White residents in L.A., the Singaporean Chinese and among Saarland, Germany residents. The differences in rates may be largely attributable to lifestyle variability. Figure Metro Manila and Rizal Province age-standardized incidence rates, colon cancer, males,

47 Table Metro Manila and Rizal Province Annual incidence rate per 100,000, colon, male, by age group (years), Male Colon (C-18) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City Pasay City Quezon City * DOH-RCR * Metro Manila * City of Las Piñas City of Makati * City of Malabon * City of Mandaluyong City of Marikina * City of Muntinlupa City of Navotas * City of Parañaque City of Pasig * City of San Juan Pateros * Taguig City * Rizal Province * Angono * Baras Binangonan * Cainta Cardona City of Antipolo Jala-Jala Montalban Morong Pililla * San Mateo * Tanay Taytay * Teresa

48 Table Metro Manila and Rizal Province annual incidence rate per 100,000, colon, female, by age group (years), Female Colon (C18) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City Pasay City Quezon City * DOH-RCR * Metro Manila * City of Las Piñas City of Makati City of Malabon * City of Mandaluyong * City of Marikina * City of Muntinlupa * City of Navotas * City of Parañaque City of Pasig * City of San Juan Pateros Taguig City * Rizal Province * Angono * Baras * Binangonan * Cainta * Cardona City of Antipolo * Jala-Jala Montalban * Morong Pililla San Mateo Tanay Taytay * Teresa

49 Figure Metro Manila and Rizal Province age-standardized incidence rates, colon cancer, females, Figure Metro Cebu age-standardized incidence rates, colon cancer, males,

50 Table Metro Cebu annual incidence rate per 100,000, colon, male, by age group (years), Male Colon (C-18) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City * Talisay City Naga City Minglanilla San Fernando Consolacion Lilo-an Compostela Cordova Table Metro Cebu annual incidence rate per 100,000, colon, female, by age group (years), Female Colon (C-18) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City * Talisay City Naga City * Minglanilla * San Fernando Consolacion Lilo-an Compostela Cordova

51 Figure Metro Cebu age-standardized incidence rates, colon cancer, females, Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, colon, males,

52 Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, colon, females, Rectum Metro Manila and Rizal Province A total of 2,841 new rectal cancer cases were identified in the PCS-MCR and DOH-RCR areas for the period between 2003 and Among these, 1,536 were males and 1,305 were females resulting in a sex ratio of 1.2. The CR for males was 5.0 per 100,000 while the ASR was 9.3 per 100,000. For females, the CR was 4.1 per 100,000 while the ASR was 6.5 per 100,000. In males (Table and Figure ), the computed ASRs for PCS-MCR (10.2 per 100,000) and DOH-RCR (8.5 per 100,000) were not significantly different than the overall ASR. For the Metro Manila areas covered by the DOH-RCR (9.9 per 100,000), there was no sufficient evidence to say that the ASR was significantly lower. For Rizal Province, the ASR of 5.2 per 100,000 was significantly lower than the overall. The areas with an ASR that were significantly higher than the overall were Manila, Parañaque, Pasig, and San Juan. On the other hand, the areas with significantly lower ASRs were Caloocan, Taguig, Binangonan, Antipolo, and Montalban. The computed ASRs for females (Table and Figure ) for the PCS-MCR (6.9 per 100,000) and DOH- RCR (6.0 per 100,000) were not significantly different from the overall. The ASR for Rizal Province (4.1 per 100,000) was significantly lower than the overall but not for the Metro Manila areas covered by the DOH-RCR (6.8 per 100,000). The cities/municipalities that showed a significantly higher ASR than the overall were Manila, Las Piñas, and Parañaque. Conversely, those that presented significantly lower ASRs were Caloocan, Navotas, Angono, Binangonan and Montalban. There was no case reported for the municipality of Jala-Jala Metro Cebu The EAF-MCCR recorded a total of 282 new cases of rectal cancer for both sexes in the period 2003 to Of these new cases, 173 were male and 109 were female, with a male to female ratio of The CR and ASR among males were 3.4 per 100,000 and 6.5 per 100,000, respectively. The ASRs were significantly higher in Cebu City and Mandaue City compared to the overall Metro Cebu (Table and Figure ). The cities and municipalities of Lapu- 48

53 Lapu, Talisay, Naga, Minglanilla, San Fernando, Consolacion and Lilo-an had significantly lower ASRs compared to the overall. Among females, the CR was 2.1 per 100,000 while the ASR was 3.6 per 100,000. Only Cebu City had a significantly higher ASR (5.1 per 100,000) compared to Metro Cebu. The other areas of EAF-MCCR had lower ASRs than the overall, however, they were not statistically significant Comparison with other countries The highest male rectum cancer ASRs were among Saarland, Germany residents and the Chinese residents in Singapore (Figure ). The lowest rates were seen among the Philippine residents, specifically EAF-MCCR and Singaporean Indians. Slightly higher rates were observed among Filipino, Black, Chinese and Non-Hispanic White residents in L.A and Singaporean Malays. The ASRs among females were lower compared to males (Figure ). The pattern of the differences was however quite similar. The differences (or similarities) between and among sexes may also be attributable to lifestyle variations. Figure Metro Manila and Rizal Province age-standardized incidence rates, rectum cancer, males,

54 Table Metro Manila and Rizal Province annual incidence rate per 100,000, rectum, male, by age group (years), Male Rectum (C19-C21) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR City of Manila * Caloocan City * Pasay City Quezon City DOH-RCR Metro Manila City of Las Piñas City of Makati City of Malabon City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas City of Parañaque * City of Pasig * City of San Juan * Pateros Taguig City * Rizal Province * Angono Baras Binangonan * Cainta Cardona City of Antipolo * Jala-Jala Montalban * Morong Pililla San Mateo Tanay Taytay Teresa

55 Table Metro Manila and Rizal Province annual incidence rate per 100,000, rectum, female, by age group (years), Female Rectum (C19-C21) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR City of Manila * Caloocan City * Pasay City Quezon City DOH-RCR Metro Manila City of Las Piñas * City of Makati City of Malabon City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas * City of Parañaque * City of Pasig City of San Juan Pateros Taguig City Rizal Province * Angono * Baras Binangonan * Cainta Cardona City of Antipolo Jala-Jala Montalban * Morong Pililla San Mateo Tanay Taytay Teresa

56 Figure Metro Manila and Rizal Province age-standardized incidence rates, rectum cancer, females, Figure Metro Cebu age-standardized incidence rates, rectum cancer, males,

57 Table Metro Cebu annual incidence rate per 100,000, rectum, male, by age group (years), Male Rectum (C19-C21) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City * Lapu-Lapu City * Talisay City * Naga City * Minglanilla * San Fernando * Consolacion * Lilo-an * Compostela Cordova Table Metro Cebu annual incidence rate per 100,000, rectum, female, by age group (years), Female Rectum (C19-C21) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City Talisay City Naga City Minglanilla San Fernando Consolacion Lilo-an Compostela Cordova

58 Figure Metro Cebu age-standardized incidence rates, rectum cancer, females, Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, rectum, males,

59 Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, rectum, females, Liver Metro Manila and Rizal Province A total of 4,481 new cases of liver cancer were recorded by PCS-MCR and DOH-RCR from 2003 to Among these new cases, 3,191 were males and 1,290 were females resulting in a sex ratio of 2.5. The CR among males was 10.3 per 100,000 while the ASR was 18.6 per 100,000. On the other hand, the CR was 4.0 per 100,000 and the ASR was 6.5 per 100,000 for females. For males (Table and Figure ), an ASR of 20.5 per 100,000 population was recorded for PCS-MCR, which was significantly higher than the overall. Meanwhile, for DOH-RCR, the ASR of 16.9 per 100,000 was significantly lower than the overall. Likewise, the ASR of Rizal Province (13.6 per 100,000) was also significantly lower. There was no sufficient evidence to say that the ASR for the DOH-RCR Metro Manila areas (18.3 per 100,000) was different from the overall. Only Manila had an ASR that was significantly higher than the overall. On the other hand, the areas with ASRs that were significantly lower than the overall ASR were Navotas, Taguig, Binangonan, Cainta, San Mateo and Tanay. For females (Table and Figure ), there was not enough evidence to say that the ASRs of PCS-MCR (6.9 per 100,000) and DOH-RCR (6.2 per 100,000) were significantly different than the overall. Areas in Rizal Province exhibited a significantly lower ASR (5.2 per 100,000), but the same cannot be said of the ASR from the DOH-RCR Metro Manila areas (6.6 per 100,000). The cities that showed a significantly higher ASRs than the overall were Manila, Pasay, and Parañaque. Contrastingly, Mandaluyong presented a significantly lower ASR. 55

60 Metro Cebu The EAF-MCCR recorded a total of 2004 new cases of liver cancer for both sexes in the period 2003 to Of these new cases, 1526 were male and 478 were female, with a male to female ratio of The CR and ASR among males were 30.4 per 100,000 and 54.4 per 100,000, respectively. Among females, the CR was 9.4 per 100,000 while the ASR was 15.6 per 100,000. Among males, Cebu City had a significantly higher ASR (74.5 per 100,000) compared to the overall Metro Cebu (Table and Figure ). On the other hand, significantly lower ASRs than the overall were observed in Mandaue City, Talisay City, Naga City, Minglanilla, Consolacion, and Lilo-an. Similarly, the ASR of females from Cebu City was also significantly higher than the overall (Table and Figure ). Talisay City was significantly lower than Metro Cebu Comparison with other countries The highest ASR among males was observed in the EAF-MCCR areas, 2.5 times higher than the residents of PCS-MCR and DOH-RCR (Figure ). The rate among Filipino residents in L.A. was lower, but still higher than those observed among Saarland residents and Non-Hispanic Whites in L.A. The ASRs among females were lower compared to males (Figure ) but the pattern of differences between populations was basically similar. The differences (or similarities) between and among sexes may be largely attributable to the prevalence of hepatitis B infection, particularly chronic HBV infection. Figure Metro Manila and Rizal Province age-standardized incidence rates, liver cancer, males,

61 Table Metro Manila and Rizal Province annual incidence rate per 100,000, liver, male, by age group (years), Male Liver (C-22) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City Pasay City Quezon City DOH-RCR * Metro Manila City of Las Piñas City of Makati City of Malabon City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas * City of Parañaque City of Pasig City of San Juan Pateros Taguig City * Rizal Province * Angono Baras Binangonan * Cainta * Cardona City of Antipolo Jala-Jala Montalban Morong Pililla San Mateo * Tanay * Taytay Teresa

62 Table Metro Manila and Rizal Province annual incidence rate per 100,000, liver, female, by age group (years), Female Liver (C22) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR City of Manila * Caloocan City Pasay City * Quezon City DOH-RCR Metro Manila City of Las Piñas City of Makati City of Malabon City of Mandaluyong * City of Marikina City of Muntinlupa City of Navotas City of Parañaque * City of Pasig City of San Juan Pateros Taguig City Rizal Province * Angono Baras Binangonan Cainta Cardona City of Antipolo Jala-Jala Montalban Morong Pililla San Mateo Tanay Taytay Teresa

63 Figure Metro Manila and Rizal Province age-standardized incidence rates, liver cancer, females, Figure Metro Cebu age-standardized incidence rates, liver cancer, males,

64 Table Metro Cebu annual incidence rate per 100,000, liver, male, by age group (years), Male Liver (C-22) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City * Lapu-Lapu City Talisay City * Naga City * Minglanilla * San Fernando Consolacion * Lilo-an * Compostela Cordova Table Metro Cebu annual incidence rate per 100,000, liver, male, by age group (years), Female Liver (C-22) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City Talisay City * Naga City Minglanilla San Fernando Consolacion Lilo-an Compostela Cordova

65 Figure Metro Cebu age-standardized incidence rates, liver cancer, females, Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, liver, males,

66 Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, liver, females, Lung Metro Manila and Rizal Province There were a total number of 8,900 new lung cancer cases during the period between 2003 and 2007 in the PCS-MCR and DOH-RCR areas. There were 6,242 males and 2,658 females, resulting in a sex ratio of 2.8. The CR and ASR among males were 20.2 per 100,000 and 42.8 per 100,000, respectively. For females, the CR was 8.3 per 100,000 while the ASR was 13.7 per 100,000. For males (Table and Figure ), the ASR of 44.8 per 100,000 population for PCS-MCR was significantly higher than the overall. Meanwhile, for DOH-RCR, an ASR of 41.0 per 100,000 was significantly lower than the overall. Likewise, the ASR of Rizal Province (34.2 per 100,000) was also significantly lower than the overall, but the same could not be said for the DOH-RCR Metro Manila areas (43.9 per 100,000). The areas with ASRs that were significantly higher than the overall were Manila, Quezon City, Malabon, Pasig and San Juan. On the other hand, the areas with ASRs that were significantly lower than the overall ASR were Caloocan, Taguig, Baras, Binangonan, Antipolo, Jala-Jala, Pililla, and Teresa. For females (Table and Figure ), the ASR of PCS-MCR (14.7 per 100,000) was significantly higher while the ASR of DOH-RCR (12.9 per 100,000) was significantly lower from the overall. There was no sufficient evidence to conclude that the ASR from the DOH-RCR Metro Manila areas (14.0 per 100,000) was significantly different from the overall. However, the ASR for Rizal Province (10.1 per 100,000) was significantly lower than the overall. The cities/municipalities that showed a significantly higher ASR than the overall were Manila, Quezon City, Parañaque and San Juan. Contrastingly, those that presented a significantly lower ASR were Caloocan, Pateros, Binangonan, San Mateo, Tanay, and Taytay. 62

67 Table Metro Manila and Rizal Province Annual incidence rate per 100,000, lung, male, by age group (years), Male Lung (C33-34) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City * Pasay City Quezon City * DOH-RCR * Metro Manila City of Las Piñas City of Makati City of Malabon * City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas City of Parañaque City of Pasig * City of San Juan * Pateros Taguig City * Rizal Province * Angono Baras * Binangonan * Cainta Cardona City of Antipolo * Jala-Jala * Montalban Morong Pililla * San Mateo Tanay Taytay Teresa * 63

68 Table Metro Manila and Rizal Province Annual incidence rate per 100,000, lung, female, by age group (years), Female Lung (C33-C34) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City * Pasay City Quezon City * DOH-RCR * Metro Manila City of Las Piñas City of Makati City of Malabon City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas City of Parañaque * City of Pasig City of San Juan * Pateros * Taguig City Rizal Province * Angono Baras Binangonan * Cainta Cardona City of Antipolo Jala-Jala Montalban Morong Pililla San Mateo * Tanay * Taytay * Teresa

69 Figure Metro Manila and Rizal Province age-standardized incidence rates, lung cancer, males, Figure Metro Manila and Rizal Province age-standardized incidence rates, lung cancer, females,

70 Metro Cebu A total of 1596 new cases of lung cancer for both sexes in the period 2003 to 2007 were registered in the EAF-MCCR. Of these new cases, 1028 were male and 568 were female, with a male to female ratio of The CR and ASR among males were 20.5 per 100,000 and 42.3 per 100,000, respectively. Among females, the CR was 11.2 per 100,000 while the ASR was 19.0 per 100,000. Among males, the ASR of 58.9 per 100,000 in Cebu City was significantly higher than the overall (Table and Figure ). The other cities and municipalities, such as Talisay City, Naga City, San Fernando, Consolacion, and Lilo-an had ASRs that were significantly lower than the overall. From Table and Figure , the ASR of Cebu City among females was also significantly higher than the overall. The other cities and municipalities that had significantly lower ASRs than the overall were Lapu-Lapu City, Talisay City, Naga City, Minglanilla, San Fernando, and Cordova Comparison with other countries The highest male lung cancer ASRs were observed among Black residents in L.A. and among Saarland residents (Figure ). The lowest rate was seen among the Indians in Singapore. A range of intermediate rates could be observed among the other populations. The rate observed in the PCS-MCR area was higher than that of Filipino residents in L.A. The rates among females were lower but the pattern was essentially similar (Figure ). The three Philippine registries had similar ASRs. The rate observed among female Filipino residents in L.A. was slightly higher than that observed among Philippine residents. The differences (or similarities) between and among the sexes may be largely attributable to the prevalence of cigarette smoking and the level of exposure to secondhand smoke. Figure Metro Cebu age-standardized incidence rates, lung cancer, males,

71 Table Metro Cebu annual incidence rate per 100,000, liver, male, by age group (years), Male Lung (C33-C34) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City Talisay City * Naga City * Minglanilla San Fernando * Consolacion * Lilo-an * Compostela Cordova Table Metro Cebu annual incidence rate per 100,000, liver, male, by age group (years), Female Lung (C33-C34) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City * Talisay City * Naga City * Minglanilla * San Fernando * Consolacion Lilo-an Compostela Cordova * 67

72 Figure Metro Cebu age-standardized incidence rates, lung cancer, females, Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, lung, males,

73 Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, lung, females, Breast Metro Manila and Rizal Province Breast cancer was the most frequent type of cancer among females in the Philippines. There were a total of new cases registered among females from 2003 to 2007 in the PCS-MCR and DOH-RCR areas. The CR was 42.6 per 100,000 while the ASR was 59.6 per 100,000. The ASR of PCS-MCR (65.2 per 100,000) was significantly higher than that of the overall (Table and Figure ). DOH-RCR on the other hand, had a significantly lower ASR (54.6 per 100,000) than that of the overall. There is no sufficient evidence to conclude that the ASRs of DOH-RCR Metro Manila areas and that of the Rizal Province were different (60.9 per 100,000 and 39.5 per 100,000, respectively). The cities/municipalities that showed a significantly higher ASRs than the overall were Manila, Quezon City, Las Piñas, Makati, Mandaluyong, Parañaque, Pasig and San Juan. Contrastingly, those that presented significantly lower ASRs were Caloocan, Marikina, Navotas, Taguig, Baras, Binangonan, Cardona, Antipolo, Jala-Jala, Montalban, Morong, Pililla, San Mateo, Tanay, Taytay and Teresa Metro Cebu In the EAF-MCCR areas, 1729 new cases of breast cancer were recorded from 2003 to The CR and ASR among females were 34.0 per 100,000 and 50.2 per 100,000, respectively. The ASR of Cebu City (71.3 per 100,000) was significantly higher than the overall Metro Cebu (Table and Figure ). Except for Talisay City, other cities/municipalities of Metro Cebu had significantly lower ASRs compared with the overall. 69

74 Table Metro Manila and Rizal Province annual incidence rate per 100,000, breast, female, by age group (years), Female Breast (C50) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City * Pasay City Quezon City * DOH-RCR * Metro Manila City of Las Piñas * City of Makati * City of Malabon City of Mandaluyong * City of Marikina * City of Muntinlupa City of Navotas * City of Parañaque * City of Pasig * City of San Juan * Pateros Taguig City * Rizal Province * Angono Baras * Binangonan * Cainta Cardona * City of Antipolo * Jala-Jala * Montalban * Morong * Pililla * San Mateo * Tanay * Taytay * Teresa * 70

75 Table Metro Cebu annual incidence rate per 100,000, breast, female, by age group (years), Female Breast (C50) AREAS CASES CRUDE RATE ASR WORLD Metro Cebu S.E. MANTEL- HAENSZEL TEST Cebu City * Mandaue City * Lapu-Lapu City * Talisay City Naga City * Minglanilla * San Fernando * Consolacion * Lilo-an * Compostela * Cordova * 71

76 Figure Metro Manila and Rizal Province age-standardized incidence rates, breast cancer, females, Figure Metro Cebu age-standardized incidence rates, breast cancer, females,

77 Comparison with other countries The breast cancer ASRs observed among women in the PCS-MCR area, Singaporean Chinese and Chinese residents in L.A. were similar (Figure ). Interestingly, the rate among female Filipino residents in L.A. was almost double, and higher than those observed among Black residents in L.A. and in Saarland. The highest rate was seen among the Non-Hispanic White residents in L.A. The differences (or similarities) between populations could be largely attributable to variations in reproductive behavior and lifestyle. Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, breast, females, Cervix Uteri Metro Manila and Rizal Province For cancer of the cervix uteri, a total of 4,292 new cases were diagnosed between 2003 and 2007 in the PCS-MCR and DOH-RCR areas. The CR was 13.4 per 100,000 whereas the ASR was 17.5 per 100,000. The ASR of 19.0 per 100,000 in PCS-MCR was significantly higher than that of the overall (Table and Figure ). Conversely, DOH-RCR had a significantly lower ASR (16.2 per 100,000) than that of the overall. Likewise, the Province of Rizal exhibited a significantly lower ASR (12.1 per 100,000). For the DOH-RCR Metro Manila areas, there was not enough evidence to say that the ASR (17.9 per 100,000) was significantly different than the overall. The cities/municipalities that showed a significantly higher ASR than the overall were Manila, Pasay, and Las Piñas. Contrastingly, those that presented a significantly lower ASR were Caloocan, Quezon City, Baras, Binangonan, Cainta, Cardona, Antipolo, Montalban, San Mateo and Teresa. 73

78 Table Metro Manila and Rizal Province annual incidence rate per 100,000, cervix uteri cancer, by age group (years), Cervix uteri (C53) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City * Pasay City * Quezon City * DOH-RCR * Metro Manila City of Las Piñas * City of Makati City of Malabon City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas City of Parañaque City of Pasig City of San Juan Pateros Taguig City Rizal Province * Angono Baras * Binangonan * Cainta * Cardona * City of Antipolo * Jala-Jala Montalban * Morong Pililla San Mateo * Tanay Taytay Teresa * 74

79 Table Metro Cebu annual incidence rate per 100,000, cervix uteri cancer, by age group (years), Cervix uteri (C53) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City Talisay City Naga City * Minglanilla * San Fernando Consolacion Lilo-an * Compostela Cordova

80 Metro Cebu In the EAF-MCCR areas, 371 new cases of cervix uteri cancer were recorded from 2003 to The CR and ASR among females were 7.3 per 100,000 and 10.3 per 100,000, respectively. Table and Figure show that the ASR of Cebu City was significantly higher than overall Metro Cebu. On the other hand, Naga City, Minglanilla, and Lilo-an had ASRs that were significantly lower than the overall Comparison with other countries Compared to other countries, the ASRs of cervical cancer cases among female residents in the PCS-MCR and DOH- RCR residents were the highest (Figure ). The lowest rate was observed among Chinese residents in L.A. The ASRs of PCS-MCR and DOH-RCR residents were more than double of what was observed among Filipino residents in L.A. The ASR in the EAF-MCCR was almost half of that of PCS-MCR and DOH-RCR. The differences (or similarities) between populations can be largely attributed to the varying prevalence of chronic cervical HPV infection, and safe sex practices. To a certain extent, prevention resulting from screening may also have played a role. Figure Metro Manila and Rizal Province age-standardized incidence rates, cervix uteri cancer,

81 Figure Metro Cebu age-standardized incidence rates, cervix uteri cancer, Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, cervix uteri cancer,

82 3.12. Prostate Metro Manila and Rizal Province For cancer of the prostate among PCS-MCR and DOH-RCR residents, a total of 3,782 new cases were diagnosed between 2003 and The CR was 12.3 per 100,000 whereas the ASR was 31.8 per 100,000. Compared with the overall ASR, the ASR of 34.1 per 100,000 for PCS-MCR, was significantly higher while the ASR of DOH-RCR of 29.8 per 100,000 was significantly lower (Table and Figure ). Similarly, Rizal Province exhibited a significantly lower ASR (19.4 per 100,000). For the DOH-RCR Metro Manila areas, the ASR (34.1 per 100,000) was significantly higher from the overall. The cities/municipalities that showed a significantly higher ASR than the overall were Manila, Quezon City, Las Piñas, Mandaluyong, Parañaque, and San Juan. Contrastingly, those that presented significantly lower ASRs were Caloocan, Malabon, Navotas, Baras, Binangonan, Cardona, Antipolo, Jala-Jala, Montalban, Morong, Pililla, Tanay, Taytay and Teresa Metro Cebu In the EAF-MCCR areas, 423 new cases of prostate cancer were recorded from 2003 to The CR and ASR were 8.4 per 100,000 and 20.5 per 100,000, respectively. Consistently, Cebu City had a higher ASR (8.4 per 100,000) compared with the overall Metro Cebu (Table and Figure ). Cities/municipalities that had significantly lower ASRs than the overall were Lapu-Lapu City, Naga City, and San Fernando. Figure Metro Manila and Rizal Province age-standardized incidence rates, prostate cancer,

83 Table Metro Manila and Rizal Province annual incidence rate per 100,000, prostate cancer, by age group (years), Prostate (C61) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City * Pasay City Quezon City * DOH-RCR * Metro Manila * City of Las Piñas * City of Makati City of Malabon * City of Mandaluyong * City of Marikina City of Muntinlupa City of Navotas * City of Parañaque * City of Pasig City of San Juan * Pateros Taguig City Rizal Province * Angono Baras * Binangonan * Cainta Cardona * City of Antipolo * Jala-Jala * Montalban * Morong * Pililla * San Mateo Tanay * Taytay * Teresa * 79

84 Table Metro Cebu annual incidence rate per 100,000, prostate cancer, by age group (years), Prostate (C61) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City * Talisay City Naga City * Minglanilla San Fernando * Consolacion Lilo-an Compostela Cordova

85 Figure Metro Cebu age-standardized incidence rates, prostate cancer, Comparison with other countries The highest rate was observed in the Black population in L.A. (Figure ), while the lowest rates were seen among the Philippine and Singaporean populations. There was a wide range of intermediate rates observed in the other populations. Differences in the hormonal milieu that could have been brought about by lifestyle variations may be partly responsible for the differences in risk. Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, prostate cancer,

86 3.13. Thyroid Metro Manila and Rizal Province There were a total of 3,774 new cases of thyroid cancers recorded in the two registries from 2003 to Of these, 716 were males while 3,058 were females, resulting in a sex ratio of 1 male for every 4.3 females. The CR for males was 2.3 per 100,000 whereas the ASR was 3.4 per 100,000. For females it was 9.6 per 100,000 (CR) and 11.4 per 100,000 (ASR). For males (Table and Figure ), there was not enough evidence to say that an ASR of 3.8 per 100,000 for PCS-MCR and an ASR of 3.1 per 100,000 for DOH-RCR were significantly different from the overall. The ASR of Rizal Province (1.9 per 100,000) was significantly lower, while there was not enough evidence to say that the ASR of the DOH-RCR Metro Manila areas (3.9 per 100,000) was also significantly higher than the overall. Only Manila and Quezon City had ASRs that were significantly higher than the overall. On the other hand, only Taytay had an ASR that was significantly lower than the overall ASR. No case was reported for the municipality of Cardona. For females (Table and Figure ), the ASRs of PCS-MCR (12.5 per 100,000) and DOH-RCR (10.4 per 100,000) were significantly different from the overall. The ASR of Rizal Province (7.4 per 100,000) was significantly lower but there was not enough evidence to say the same for the ASR of the DOH-RCR Metro Manila areas (10.0 per 100,000). The cities/municipalities that showed significantly higher ASRs than the overall were Manila, Quezon City, Makati, Mandaluyong, Parañaque and San Juan. Contrastingly, those that presented a significantly lower ASR were Caloocan, Pasay, Malabon, Marikina, Muntinlupa, Antipolo, Binangonan, Montalban, Morong, Pililla, Tanay and Teresa Metro Cebu In the EAF-MCCR areas, 752 new cases of thyroid cancer were recorded from 2003 to Of these, 171 were male and 581 were female, with a male to female ratio of The CR and ASR among males were 3.4 per 100,000 and 4.8 per 100,000, respectively. Among females, the CR and ASR were 11.4 per 100,000 and 14.8 per 100,000, respectively. Among males, Cebu City and Lapu-Lapu City had significantly higher ASRs compared with the overall Metro Cebu (Table and Figure ). Other Metro Cebu areas had significantly lower ASRs compared with the overall except Compostela and Cordova. Among females, a significantly higher ASR (21.7 per 100,000) compared with the overall was observed in Cebu City (Table and Figure ). Lapu-Lapu City, Talisay City, Naga City, and Lilo-an had significantly lower ASRs compared with the overall Comparison with other countries Figure shows that the ASRs of male thyroid cancer were low, the highest being those among Filipino and Non-Hispanic White residents in L.A. The rates among Philippine residents were also higher than those seen in the other populations. Figure shows that the ASRs in females were practically triple those in males. The highest rate was observed among female Filipino residents in L.A., whose rates were among the highest in the world. While dietary and genetic factors had been implicated, the higher rates observed among women and in some populations still has to be adequately investigated. 82

87 Table Metro Manila and Rizal Province annual incidence rate per 100,000, thyroid, male, by age group (years), Male Thyroid (C73) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR City of Manila * Caloocan City Pasay City Quezon City * DOH-RCR Metro Manila City of Las Piñas City of Makati City of Malabon City of Mandaluyong City of Marikina City of Muntinlupa City of Navotas City of Parañaque City of Pasig City of San Juan Pateros Taguig City Rizal Province * Angono Baras Binangonan Cainta Cardona City of Antipolo Jala-Jala Montalban Morong Pililla San Mateo Tanay Taytay * Teresa

88 Table Metro Manila and Rizal Province annual incidence rate per 100,000, thyroid, female, by age group (years), Female Thyroid (C73) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST All Areas PCS-MCR * City of Manila * Caloocan City * Pasay City * Quezon City * DOH-RCR * Metro Manila City of Las Piñas City of Makati * City of Malabon * City of Mandaluyong * City of Marikina * City of Muntinlupa * City of Navotas City of Parañaque * City of Pasig City of San Juan * Pateros Taguig City Rizal Province * Angono Baras Binangonan * Cainta Cardona City of Antipolo * Jala-Jala Montalban * Morong * Pililla * San Mateo Tanay * Taytay Teresa * 84

89 Figure Metro Manila and Rizal Province age-standardized incidence rates, thyroid, males, Figure Metro Manila and Rizal Province age-standardized incidence rates, thyroid, females,

90 Figure Metro Cebu age-standardized incidence rates, thyroid, males, Figure Metro Cebu age-standardized incidence rates, thyroid, females,

91 Table Metro Cebu annual incidence rate per 100,000, thyroid cancer, male, by age group (years), Male Thyroid (C73) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City * Lapu-Lapu City * Talisay City * Naga City * Minglanilla * San Fernando * Consolacion * Lilo-an * Compostela Cordova Table Metro Cebu annual incidence rate per 100,000, thyroid cancer, female, by age group (years), Female Thyroid (C73) AREAS CASES CRUDE RATE ASR WORLD S.E. MANTEL- HAENSZEL TEST Metro Cebu Cebu City * Mandaue City Lapu-Lapu City * Talisay City * Naga City * Minglanilla San Fernando Consolacion Lilo-an * Compostela Cordova

92 Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, thyroid, males, Philippines PCS-MCR Philippines DOH-RCR Philippines EAF-MCCR Singapore Chinese Singapore Indian Singapore Malay Germany Saarland USA Los Angeles Black USA Los Angeles Chinese USA Los Angeles Filipino USA Los Angeles Non-Hispanic White ASR (W) Figure Comparison of age-standardized incidence rates with other countries, thyroid, females,

93 APPENDIX I 2007 Population Census by Area, Age Group and Sex POPULATIONS BY AREA, AGE GROUP AND SEX, PCS-MCR and DOH-RCR (2007 Census) Age Group PCS-MCR DOH-RCR PCS-MCR and DOH-RCR Male Female Male Female Male Female Total

94 POPULATIONS BY AREA, AGE GROUP AND SEX, PCS-MCR (2007 Census) Age Group City of Manila Caloocan City Male Female Male Female Total POPULATIONS BY AREA, AGE GROUP AND SEX, PCS-MCR (2007 Census) Age Group Pasig City Quezon City Male Female Male Female Total

95 POPULATIONS BY AREA, AGE GROUP AND SEX, DOH-RCR, METRO MANILA (2007 Census) Age Group City of Las Piñas City of Makati City of Malabon Male Female Male Female Male Female Total POPULATIONS BY AREA, AGE GROUP AND SEX, DOH-RCR, METRO MANILA (2007 Census) Age Group City of Mandaluyong City of Marikina City of Muntinlupa Male Female Male Female Male Female Total

96 POPULATIONS BY AREA, AGE GROUP AND SEX, DOH-RCR, METRO MANILA (2007 Census) Age Group City of Navotas City of Parañaque City of Pasig Male Female Male Female Male Female Total POPULATIONS BY AREA, AGE GROUP AND SEX, DOH-RCR, METRO MANILA (2007 Census) Age Group City of San Juan Taguig City Pateros Male Female Male Female Male Female Total

97 POPULATIONS BY AREA, AGE GROUP AND SEX, DOH-RCR, RIZAL PROVINCE (2007 Census) Age Group Angono Baras Binangonan Male Female Male Female Male Female Total POPULATIONS BY AREA, AGE GROUP AND SEX, DOH-RCR, RIZAL PROVINCE (2007 Census) Age Group Cainta Cardona City of Antipolo Male Female Male Female Male Female Total

98 POPULATIONS BY AREA, AGE GROUP AND SEX, DOH-RCR, RIZAL PROVINCE (2007 Census) Age Group Jala-Jala Montalban Morong Male Female Male Female Male Female Total POPULATIONS BY AREA, AGE GROUP AND SEX, DOH-RCR, RIZAL PROVINCE (2007 Census) Age Group Pililla San Mateo Tanay Male Female Male Female Male Female Total

99 POPULATIONS BY AREA, AGE GROUP AND SEX, DOH-RCR, RIZAL PROVINCE (2007 Census) Age Group Taytay Teresa Male Female Male Female Total

100 POPULATIONS BY AGE GROUP AND SEX, EAF-MCCR (2007 Census) Age Group EAF-MCCR Male Female Total

101 POPULATIONS BY AREA, AGE GROUP AND SEX, EAF-MCCR (2007 Census) Age Group Cebu City Lapu-Lapu City Mandaue City Male Female Male Female Male Female Total POPULATIONS BY AREA, AGE GROUP AND SEX, EAF-MCCR (2007 Census) Age Group City of Naga City of Talisay Compostela Male Female Male Female Male Female Total

102 POPULATIONS BY AREA, AGE GROUP AND SEX, EAF-MCCR (2007 Census) Age Group Consolacion Cordova Lilo-an Male Female Male Female Male Female Total POPULATIONS BY AREA, AGE GROUP AND SEX, EAF-MCCR (2007 Census) Age Group Minglanilla San Fernando Male Female Male Female Total

103 APPENDIX II A PHILIPPINES, MANILA ( ) Annual Incidence per 100,000 by Age Group Male Cancer Incidence in the Five Continents Vol. X, IARC

104 APPENDIX II B PHILIPPINES, MANILA ( ) Annual Incidence per 100,000 by Age Group Female Cancer Incidence in the Five Continents Vol. X, IARC

105 APPENDIX II C PHILIPPINES, RIZAL ( ) Annual Incidence per 100,000 by Age Group Male Cancer Incidence in the Five Continents Vol. X, IARC

106 APPENDIX II D PHILIPPINES, RIZAL ( ) Annual Incidence per 100,000 by Age Group Female Cancer Incidence in the Five Continents Vol. X, IARC

107 APPENDIX II E PHILIPPINES, METRO CEBU ( ) Annual Incidence per 100,000 by Age Group Male SITE ALL AGE CRUDE CUM CUM ASR (%) AGES UNK RATE (W) ICD (10th) Lip C00 Tongue C01-02 Mouth C03-06 Salivary glands C07-08 Tonsil C09 Other oropharynx C10 Nasopharynx C11 Hypopharynx C12-13 Pharynx unspecified C14 Oesophagus C15 Stomach C16 Small intestine C17 Colon C18 Rectum C19-20 Anus C21 Liver C22 Gallbladder etc C23-24 Pancreas C25 Nose, sinuses etc C30-31 Larynx C32 Trachea, bronchus and lung C33-34 Other thoracic organs C37-38 Bone C40-41 Melanoma of skin C43 Other skin C44 Mesothelioma C45 Kaposi sarcoma C46 Connective and soft tissue C47,C49 Breast C50 Penis C60 Prostate C61 Testis C62 Other male genital C63 Kidney C64 Renal pelvis C65 Ureter C66 Bladder C67 Other urinary organs C68 Eye C69 Brain, nervous system C70-72 Thyroid C73 Adrenal gland C74 Other endocrine C75 Hodgkin disease C81 Non-Hodgkin lymphoma C82-85,C96 Immunoproliferative diseases C88 Multiple myeloma C90 Lymphoid leukaemia C91 Myeloid leukaemia C92-94 Leukaemia unspecified C95 Other and unspecified Other All sites ALL All sites but C ALLbC44 103

108 APPENDIX II F PHILIPPINES, METRO CEBU ( ) Annual Incidence per 100,000 by Age Group Female SITE ALL AGE CRUDE CUM CUM ASR (%) AGES UNK RATE (W) ICD (10th) Lip C00 Tongue C01-02 Mouth C03-06 Salivary glands C07-08 Tonsil C09 Other oropharynx C10 Nasopharynx C11 Hypopharynx C12-13 Pharynx unspecified C14 Oesophagus C15 Stomach C16 Small intestine C17 Colon C18 Rectum C19-20 Anus C21 Liver C22 Gallbladder etc C23-24 Pancreas C25 Nose, sinuses etc C30-31 Larynx C32 Trachea, bronchus and lung C33-34 Other thoracic organs C37-38 Bone C40-41 Melanoma of skin C43 Other skin C44 Mesothelioma C45 Kaposi sarcoma C46 Connective and soft tissue C47,C49 Breast C50 Vulva C51 Vagina C52 Cervix uteri C53 Corpus uteri C54 Uterus unspecified C55 Ovary C56 Other female genital organs C57 Placenta C58 Kidney C64 Renal pelvis C65 Ureter C66 Bladder C67 Other urinary organs C68 Eye C69 Brain, nervous system C70-72 Thyroid C73 Adrenal gland C74 Other endocrine C75 Hodgkin disease C81 Non-Hodgkin lymphoma C82-85,C96 Immunoproliferative diseases C88 Multiple myeloma C90 Lymphoid leukaemia C91 Myeloid leukaemia C92-94 Leukaemia unspecified C95 Other and unspecified Other All sites ALL All sites but C ALLbC44 104

109 APPENDIX III Comparison of the Most Common Cancer Sites for , , , , Appendix IIIA. Comparison of the Most Common Cancer Sites for Both Sexes for Five Time Periods, PCS-MCR and DOH-RCR Site Number % Site Number % Site Number % Site Number % Site Number % Lung Lung Breast Breast Breast Breast Breast Lung Lung Lung Liver Liver Liver Liver Colon Cervix Cervix Cervix Cervix uteri Liver Leukemias Colon Leukemia Colon Cervix uteri Stomach Thyroid Colon Leukemias Thyroid Colon Stomach Thyroid Thyroid Prostate Thyroid Leukemias Ovary Rectum Leukemias Rectum Nasopharynx Stomach Ovary Rectum Prostate Ovary Rectum Prostate Ovary

110 Appendix IIIB. Comparison of the Most Common Cancer Sites for Males for Five Time Periods, PCS-MCR and DOH-RCR Site Number % Site Number % Site Number % Site Number % Site Number % Lung Lung Lung Lung Lung Liver Liver Liver Liver Prostate Prostate Prostate Prostate Prostate Liver Stomach Colon Leukemia Colon Colon Leukemia Stomach Colon Leukemias Leukemias Nasopharynx Nasopharynx Stomach Rectum Rectum Colon Leukemia Nasopharynx Nasopharynx Non-Hodgkin lymphoma Rectum Rectum Rectum Stomach Nasopharynx Oral Cavity Oral Cavity Non-Hodgkin Lymphoma Thyroid Stomach Non-Hodgkin Lymphoma Non-Hodgkin Lymphoma Oral Cavity Non-Hodgkin Lymphoma Kidney

111 Appendix IIIC. Comparison of the Most Common Cancer Sites for Females for Five Time Periods, PCS-MCR and DOH-RCR Site Number % Site Number % Site Number % Site Number % Site Number % Breast Breast Breast Breast Breast Cervix Cervix Cervix Cervix uteri Cervix uteri Lung Lung Ovary Ovary Thyroid Thyroid Thyroid Lung Lung Ovary Ovary Ovary Thyroid Colon Lung Leukemias Liver Colon Thyroid Colon Liver Colon Leukemia Corpus uteri Corpus uteri Colon Leukemias Liver Brain, Nervous System Leukemias Stomach Stomach Corpus uteri Leukemias Liver Corpus uteri Corpus uteri Rectum Liver Rectum

112 Appendix IIID. Most Common Cancer Sites for Both Sexes and by Age, EAF-MCCR, Both Sexes Male Female Site Number % Site Number % Site Number % Liver Liver Breast Breast Lung Thyroid Lung Colon Lung Colon Prostate Liver Thyroid Non-Hodgkin lymphoma Ovary Prostate Rectum Cervix uteri Non-Hodgkin lymphoma Thyroid Colon Ovary Myeloid leukaemia Corpus uteri Cervix uteri Bone Uterus unspecified Corpus uteri Stomach Non-Hodgkin lymphoma

113 Contributors Cynthia A. Mapua holds a Master of Science in Epidemiology from the College of Public Health, University of the Philippines Manila. Her association with the Philippine Cancer Society Manila Cancer Registry began with her Masteral thesis which was on population- based survival of breast cancer. Cyndi had undergone training on cancer registration methods and cancer epidemiology at the International Agency for Research on Cancer in Lyon, France. Cyndi is currently a Scientist/Epidemiologist at the Center for Biostatistics and Molecular Epidemiology and Center for Human Research Protection, Research and Biotechnology Group, St. Luke s Medical Center. Adriano V. Laudico is a surgical oncologist and Professor Emeritus of Surgery at the University of the Philippines Manila. He was the former head of the Department of Health- Rizal Cancer Registry, and currently heads the Philippine Cancer Society- Manila Cancer Registry. He was a Past President of the Philippine College of Surgeons, and the Founding President of the Surgical Oncology Society of the Philippines. Yago was also a Short Term Consultant on Cancer of the World Health Organization Western Pacific Region to several counties in Southeast Asia and the Pacific. Maria Rica Mirasol-Lumague is a general surgeon, and is the current head of the Department of Health Rizal Cancer Society. Rica is the Chief of Medical Professional Staff II of Rizal Medical Center, where she coordinates breast cancer treatment for the pilot study of DOH. She underwent training on Cancer Registration Methods and Cancer Epidemiology at the International Agency for Research on Cancer in Lyon, France Maria Theresa M. Redaniel holds a Doctor of Science in the Humanities at the Ruprecht-Karis-Universitat Heidelberg and a Master of Science in Epidemiology (Public Health) from the University of the Philippines Manila. Her association with the Philippine Cancer Society-Manila Cancer Registry started with her Masteral thesis which was on population-based survival of cervical cancer, and has subsequently coauthored several publications with the registry. Her doctoral dissertation was on the recent trends, up-to-date estimates and the determinants of cancer survival in a Philippine urban population, using the period analysis methodology. Toni Patama holds a degree of Master of Science (Environmental Sciences) from the University of Kuopio and specializes on geographical information systems and spatial epidemiology. Toni is currently an Assistant Researcher at the Finnish Cancer Registry. Eero Pukkala obtained his M.A. from the University of Helsinki, and his Ph.D. from the University of Tampere. He is currently Director of Statistics and an epidemiologist at the Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki. Eero is also Professor of Public Health and Epidemiology at Tampere School of Public Health, University of Tampere, chairman of the national Epidemiological Society and leader of several national and international research programs. 109

114 Philippine Cancer Society Board of Trustees Chairman Vice Chairman President Vice President Treasurer Assistant. Treasurer Executive Director and Corporate Secretary Philippine Cancer Society Manila Cancer Registry Ellen Nora S. Mesina Siony P. Alcos Erlinda G. Abris Marisol L. Mirasol Dency B. Orengo Lydia T. Navarro Josephine R. Isla Officers Roberto M. Paterno, PhD Antonio Ma. J. Guerrero Corazon A. Ngelangel, MD Atty. Enrique D. Perez Jose S. Sandejas, MD Virgilio L. Peña Rachel Marie B. Rosario, MD Trustees Emily Altomonte-Abrera Angela U. Crisostomo, MD Gloria Cristal-Luna, MD Francisco C. Eizmendi, Jr. Don M. Ferry, MD Jaime Z. Galvez-Tan, MD Cecilia Ladines-Llave, MD Conrado Ll. Lorenzo, MD Alberto B. Roxas, MD Department of Health Rizal Cancer Registry Wilma M. Grafilo Elena DC. Marquez The publication of this monograph was generously supported by the Degenerative Disease Office-National Center for Disease Prevention and Control of the Department of Health, under Dr. Yolanda E. Oliveros. The preparation of the manuscript was assisted by Francisco G. Valenzuela of Surgery Research Unit of the University of the Philippines Manila. 110