RESEARCH PAPER
Geographic trends of tobacco-related cancers in Cyprus
Paraskevi Farazi 1, 2  
,  
Lina Lander 3
,  
Pavlos Pavlou 4
,  
Lynne Le 3
,  
 
 
More details
Hide details
1
Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
2
Mediterranean Center for Cancer Research, Nicosia, Cyprus
3
Department of Epidemiology, 984395 University of Nebraska Medical Center, Omaha, USA
4
Cyprus Cancer Registry, Ministry of Health, Corner of Prodromou 1 and Chilonos 17, Nicosia, Cyprus
CORRESPONDING AUTHOR
Paraskevi Farazi   

Department of Life and Health Sciences, University of Nicosia, 46 Makedonitissas Ave, P.O. Box 24005, Nicosia 1700, Cyprus
Publish date: 2015-07-31
 
Tobacco Induced Diseases 2015;13(July):21
KEYWORDS
ABSTRACT
Background:
Causal relationships have been previously established between smoking and various cancers. In Cyprus, 39 % of men and 14 % of women reported daily smoking in 2008. The objective of this study was to compare the incidence of tobacco-related cancers to all other cancers by district and rural–urban classification to understand the impact of tobacco in Cyprus.

Methods:
Data on lung, urinary bladder, oral, pharyngeal, head/neck, and laryngeal cancers were obtained from the Cyprus Cancer Registry (1998–2008). There were 3,635 patients with tobacco-related cancers and 18,780 with non-tobacco cancers. Univariate analysis comparing tobacco-related cancers and all other cancers were conducted with regards to age at diagnosis, age groups, sex, smoking status, disease stage, and rural/urban status, with a p-value of 0.05 considered significant. Smoking prevalence, lung cancer, and bladder cancer rates of Cyprus were also compared to a number of other European countries.

Results:
Patients with tobacco-related cancers were older than those with non-tobacco cancers (mean age 67.2 ± 12.4 vs. 62.4 ± 17.1, p < 0.0001). Among those with tobacco-related cancers, 80.1 % were male compared to 45.4 % males with other cancer types. The proportion of ever smokers was higher among males compared to females in urban and rural districts. Sub-districts 41 (Age Adjusted Rate (AAR) 41.9, 95 % CI: 35.7-48.1), 60 (AAR 40.3, 95 % CI: 35.2-45.3), and 50 (AAR 36.3, 95 % CI: 33.8-38.7) had the highest rates of tobacco-related cancers. The overall tobacco-related cancer rate was the highest among males in urban districts (AAR 60.8, 95 % CI: 58.2-63.5). Among tobacco-related cancers, lung cancer had the highest overall AAR (17.9 per 100,000) while head and neck cancer had the lowest overall AAR (5.3 per 100,000). Additionally, even though Cypriot males aged 65–69 years old exhibited higher smoking prevalence than other European countries, the overall lung and bladder cancer rates were lower in Cyprus.

Conclusions:
Despite the high proportion of smokers in Cyprus, cancer rates are low compared to other countries. Future in-depth measurements of relevant risk factors and smoking exposure can help understand this phenomenon and provide insights for cancer prevention.

 
REFERENCES (44)
1. World Health Organization. WHO global report: mortality attributable to tobacco. Geneva: World Health Organization; 2012. Available at: http://www.who.int/tobacco/pub....
2. Adhikari B, Kahende J, Malarcher A, Pechacek T, Tong V. Smoking- attributable mortality, years of potential life lost, and productivity losses- United States. 2000–2004. Atlanta: Morbidity and Mortality Weekly Report; 2008.
3. World Health Organization. World Health Organization: Tobacco Fact Sheet. 2014. Available at: http://www.who.int/mediacentre....
4. U.S. Department of Health and Human Services. The health consequences of smoking: a report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
5. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Switzerland: World Health Organization; 2009.
6. Kumar V, Abbas AK, Aster JC. Chapter 7: environmental and nutritional disease. In: Robbins basic pathology. 9th ed. Canada: Anonymous Elsevier; 2012.
7. World Health Organization. IARC monographs on the evaluation of carcinogenic risk to humans. Volume 83- Tobacco smoke and involuntary smoking. Lyon, France: World Health Organization, International agency for Research on Cancer; 2004.
8. Han YY, Davis DL, Weissfeld JL, Dinse GE. Generational risks for cancers not related to tobacco, screening, or treatment in the United States. Cancer. 2010;116(4):940–8.
9. Burns DM. Nicotine addiction. In: Kasper D, Braunwald E, Hauser S, Longo D, Jameson JL, Fauci AS, editors. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill Professional; 2004.
10. Vogazianos P, Fiala J, Vogazianos M. The influence of active maternal smoking during pregnancy on birth weights in Cyprus. Cent Eur J Public Health. 2005;13(2):78–84.
11. Peto R, Lopez AD, Boreham J, Thun M, Heath Jr C. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet. 1992;339(8804):1268–78.
12. Observatory SPH. An atlas of tobacco smoking in Scotland: A report presenting estimated smoking prevalence and smoking attributable deaths within Scotland (Appendix 5). Scotland: NHS Health Scotland; 2007.
13. Yang MC, Fann CY, Wen CP, Cheng TY. Smoking attributable medical expenditures, years of potential life lost, and the cost of premature death in Taiwan. Tob Control. 2005;14 Suppl 1:i62–70.
14. Karekla M, Symeou A, Tsangari H, Kapsou M, Constantinou M. Smoking prevalence and tobacco exposure among adolescents in Cyprus. Eur J Public Health. 2009;19(6):655–61.
15. Republic of Cyprus. Smoking in Cyprus. Cyprus: Department of Statistics and Research; 1989.
16. Republic of Cyprus. Smoking prevalence among Cypriot population. Cyprus: Department of Statistics and Research; 1999.
17. Republic of Cyprus Statistical Service. Health Survey 2003. Nicosia: Printing Office of the Republic of Cyprus; 2005.
18. Republic of Cyprus Statistical Service. European Health Survey 2008. Nicosia: Printing Office of the Republic of Cyprus; 2010.
19. Christophi CA, Kolokotroni O, Alpert HR, Warren CW, Jones NR, Demokritou P, et al. Prevalence and social environment of cigarette smoking in Cyprus youth. BMC Public Health. 2008;8:190-2458-8-190.
20. Cooter M, Soliman AS, Pavlou P, Demetriou A, Orphanides C, Kritioti E, et al. Incidence and time trends of cancer in Cyprus over 11 years (1998–2008). Tumori. 2015;101(1):8–15.
21. Republic of Cyprus Ministry of Health. Cyprus Cancer Registry (CyCR) Report for the Triennial 1998–2000. Cyprus Cancer Registry, Cyprus.
22. Republic of Cyprus Ministry of Health. MECC Joint Registration Project Cyprus Cancer Registry (CyCR) Report for 2008–2009 (Data 2003–2005). Cyprus: Cyprus Cancer Registry; 2009.
23. Freedman LS, National Cancer Institute (U.S.), Middle East Cancer Consortium. Cancer incidence in four member countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East Cancer Consortium (MECC) compared with US SEER. 2006; 1 online resource (xvi, 150 p.)-1 online resource (xvi, 150 p.).
24. Forman D, Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Piñeros M, et al. Cancer Incidence in Five Continents, Vol. X (electronic version). Lyon: IARC; 2013.
25. Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA. 2014;311(2):183–92.
26. Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, Inoue M. Age standardization of rates: a new WHO Standard. GPE Discussion Paper Series: No. 31. 2001;.
27. Gandini S, Botteri E, Iodice S, Boniol M, Lowenfels AB, Maisonneuve P, et al. Tobacco smoking and cancer: a meta-analysis. Int J Cancer. 2008;122(1):155–64.
28. National Cancer Institute. 2009. Available at: http://www.cancer.gov/cancerto.... Surgeon General. 50 Years of Progress: A Report of the Surgeon General, 2014. Chapter 6:143-351. Available at: http://www.surgeongeneral.gov/....
29. Steliga MA, Dresler CM. Epidemiology of lung cancer: smoking, secondhand smoke, and genetics. Surg Oncol Clin N Am. 2011;20(4):605–18.
30. Li FX, Robson PJ, Chen Y, Qiu Z, Lo Siou G, Bryant HE. Prevalence, trend, and sociodemographic association of five modifiable lifestyle risk factors for cancer in Alberta and Canada. Cancer Causes Control. 2009;20(3):395–407.
31. Wlodarczyk A, Raciborski F, Opoczynska D, Samolinski B, GATS PWG. Daily tobacco smoking patterns in rural and urban areas of Poland--the results of the GATS study. Ann Agric Environ Med. 2013;20(3):588–94.
32. Gikas A, Merkouris P, Skliros E, Sotiropoulos A. Urban–rural differences in smoking prevalence in Greece. Eur J Public Health. 2007;17(4):402.
33. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2013: Cyprus. Switzerland: World Health Organization; 2013.
34. Hoshino Y, Mio T, Nagai S, Miki H, Ito I, Izumi T. Cytotoxic effects of cigarette smoke extract on an alveolar type II cell-derived cell line. Am J Physiol Lung Cell Mol Physiol. 2001;281(2):L509–16.
35. Aoshiba K, Tamaoki J, Nagai A. Acute cigarette smoke exposure induces apoptosis of alveolar macrophages. Am J Physiol Lung Cell Mol Physiol. 2001;281(6):L1392–401.
36. Mayo Clinic. 2012. Available at: http://www.mayoclinic.org/dise....
37. Alguacil J, Kogevinas M, Silverman DT, Malats N, Real FX, Garcia-Closas M, et al. Urinary pH, cigarette smoking and bladder cancer risk. Carcinogenesis. 2011;32(6):843–7.
38. Saikia BJ, Phukan RK, Sharma SK, Sekhon GS, Mahanta J. Interaction of XRCC1 and XPD gene polymorphisms with lifestyle and environmental factors regarding susceptibility to lung cancer in a high incidence population in North East India. Asian Pac J Cancer Prev. 2014;15(5):1993–9.
39. Steinau M, Saraiya M, Goodman MT, Peters ES, Watson M, Cleveland JL, et al. Human papillomavirus prevalence in oropharyngeal cancer before vaccine introduction, United States. Emerg Infect Dis. 2014;20(5):822–8.
40. Tornesello ML, Perri F, Buonaguro L, Ionna F, Buonaguro FM, Caponigro F. HPV-related oropharyngeal cancers: From pathogenesis to new therapeutic approaches. Cancer Lett. 2014;351(2):198–205.
41. Truta-Popa LA, Dinu A, Dicu T, Szacsvai K, Cosma C, Hofmann W. Preliminary lung cancer risk assessment of exposure to radon progeny for Transylvania. Romania Health Phys. 2010;99(3):301–7.
42. Wender R, Fontham ET, Barrera Jr E, Colditz GA, Church TR, Ettinger DS, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013;63(2):107–17.
43. Gulati S, Mulshine JL. Lung cancer screening guidelines: common ground and differences. Transl Lung Cancer Res. 2014;3(3):131–8.
44. Takahashi I, Matsuzaka M, Umeda T, Yamai K, Nishimura M, Danjo K, et al. Differences in the influence of tobacco smoking on lung cancer between Japan and the USA: possible explanations for the ‘smoking paradox’ in Japan. Public Health. 2008;122(9):891–6.
 
CITATIONS (2):
1. Lung cancer and tobacco smoking in Crete, Greece: reflections from a population-based cancer registry from 1992 to 2013
D. Sifaki-Pistolla, C. Lionis, V. Georgoulias, P. Kyriakidis, F. Koinis, S. Aggelaki, N. Tzanakis
Tobacco Induced Diseases
2. The contribution of Cyprus to non-communicable diseases and biomedical research from 2002 to 2013: implications for evidence-based health policy
Elena Pallari, Grant Lewison, Chryso Th. Pallari, George Samoutis, Mursheda Begum, Richard Sullivan
Health Research Policy and Systems
eISSN:1617-9625