Main statistics presented at the ICA press conference:
Israel ranks first in Non-Hodgkin's Lymphoma (NHL) morbidity in the top 20 countries with the highest morbidity rates in the world, and second in mortality rates.
The NHL incidence rates are on an upward trend, mainly among Jewish men, with a trend towards stability over the past decade.
Incidence rates (new cases) for cancers in general have been declining among the Jewish population, as of 2008, and among the Arab population, as of 2010.
There has been a downward trend in mortality rates for overall cancers, has been observed since 1995 among the Jewish population - men and women alike. Among the Arab population, the downward trend began in 2007-8.
In international comparisons, Israel ranks low in overall cancer incidence and mortality, and ranks below the OECD average.
Dr. Lital Keinan-Boker - Deputy Director of the Israel Center for Disease Control of the Ministry of Health, presents new National Cancer Registry statistics on cancer incidence (new cases for this year) and mortality in Israel as per 2012.
Main Findings: General Statistics on Cancer in Israel:
In 2012, 28,709 individuals were diagnosed with malignant tumors in Israel and 10,640 succumbed to the disease.
The main cancers that account for 50% of overall cancer morbidity among men: prostate, lung, and colorectal cancers, and cancer of the urethral diverticulum, as well as non-Hodgkin's lymphoma (NHL). Among women: breast, colorectal, and uterine cancers, as well as NHL.
The main cancers that account for over 50% of overall mortality are similar among the Jewish and Arab populations, in men: lung, colorectal and pancreatic cancers, in women: breast, colorectal and lung cancers.
An international comparison uploaded on the Globocan website, among the top 20 countries with the highest incidence and mortality rates in the world, indicate that Israel ranks relatively low. Israeli men rank 19th highest and Israeli women 15th highest, both in incidence and mortality.
Upon comparing cancer mortality in Israel with that of OECD countries, as per 2011, Israel ranks below average, with a relatively low mortality rate (8th lowest).
Detailed information (in Hebrew) may be found in the attached data file.
Non-Hodgkin's Lymphoma (NHL)
Lymphoma is a cancer disease that affects the lymphatic system. There are two main types of lymphoma: one is called Hodgkin's Lymphoma and the other Non-Hodgkin's Lymphoma (NHL). as the lymph nodes and tubes are located throughout the entire body, NHL may appear in any part of the body. The most common areas in which NHL appear are in the lymph nodes in the neck, armpit, chest, groin (inguinal lymph nodes) or stomach.
NHL is classified in several ways, the most common type - Diffuse Large B-Cell Lymphoma (80-90% of all NHL), T-Cell Lymphoma, and other lymphomas. The relative portion of B-Cell Lymphoma has risen over the years, from 53% in 1990 to 83% in 2012.
In 2012, 1,304 new patients were diagnosed with NHL in Israel, 690 men and 614 women.
There is insufficient knowledge regarding the risk factors for NHL, however it is known that the disease is more prevalent in men, and the risk for the disease increases with age.
The morbidity rate for Non-Hodgkin's Lymphoma (NHL) has risen by 27% from 1990-2012 among Jewish men (from 12.4 to 15.7 per 100,000), and by 49% among Arab women (from 6.7 to 10.0 per 100,000). It should be noted that over the past decade, stability has been observed among Jewish men and Arab women, as has a moderate downward trend among Jewish women and Arab men.
The reasons for the increase in morbidity rates are unknown. It is possible that they derive from enhanced diagnosis, genetic factors, a defect of the immune system, increased alcohol consumption, etc.
NHL is the 5th most common cause of death in Jewish men, and the 6th most common cause of death in Jewish women.
The mortality rates for NHL in Israel are on the rise among Jewish men (a 24% increase), and among Arab women (12% increase). A decrease has been recorded among Jewish women (16%) and among Arab men (49%). Among the Jewish population, it appears that there has been an increase in mortality rates up to the late 1990s and the early 2000s. Subsequently, there has been a slight decline in men and stability among women.
Among Arab men as well, there has been an increase in mortality rates up to the late 1990s, and a moderate decline thereafter. Among Arab women, it is difficult to indicate a clear trend, due to the fluctuations deriving from the small numbers.
The five-year survival rates are on the increase, and stand at an estimated 70%. This apparently involved enhanced treatment modalities.
Research on the Reasons for the Increase in Non-Hodgkin's Lymphoma Prevalence, Prof. Ora Paltiel - Senior Hematologist and Prof. of Epidemiology*
Since the 1970s, throughout the globe and in countries that have organized cancer registries in particular, an impressive increase has been observed, tending towards a doubling or even a tripling of NHL incidence (the number of new cases per year). In order to explain this phenomenon, we must focus and discuss the risks factors for the disease, and observe whether there are changes which may potentially explain the drastic increase in disease prevalence.
All the known risk factors, such as dysregulation or dysfunction of the immune system, family history, multiple infectious diseases, enhanced diagnostics, environmental and employment conditions, partially explain NHL morbidity, however they do not explain the sharp increase in incidence over the past two decades.
What is the researchers' hypothesis regarding the reasons for the increase in disease prevalence?
The hypothesis that is under review in research asserts that the increase in NHL prevalence partly stems from medical advances which enable survival for newborns with a congenital defect. In the past, these newborns died as a result of common infections such as pneumonia. The years during which the increase in NHL incidence was observed correspond to the period of the drastic decrease in newborn mortality rates from infectious diseases.
In the research study headed by Prof. Paltiel, among an estimated 17,000 Jerusalemite infants , from 1964-1976, it emerged that among infants who were admitted to the hospital during the first year of their lives due to infection, there was a three-fold increase in the risk of developing NHL. In an additional research study conducted in Sweden a similar link emerged, with a two-fold increase in the risk of B-cell NHL, and in particular in the risk of aggressive lymphoma, among those who were admitted to the hospital in infancy.
An in-depth research study is currently underway among the Jewish and Arab population in Israel, and in the West Bank, to study the mechanism that will explain the above findings. The multi-center research study is the product of scientific cooperation between Israeli and Palestinian investigators and is funded by the National Foundation of Science in Israel and the Middle East Regional Cooperation (MERC) Program, funded by the U.S. government. Among a group of B-Cell NHL patients and a healthy control group, this research is examining whether there is a correlation between morbidity and exposure to infections, family history of diseases, such as lymphoma and autoimmune diseases, and genetic variation in genes related to the immune system. In one viral disease, it emerged that there is a correlation between chronic carriership of the virus, family history of lymphoma and risk of NHL, which indicates shared susceptibility between infection on the one hand and lymphoma on the other.
The researchers' hypothesis and the initial findings indicate that it is possible that B-Cell Lymphoma is related to the development and advancement of humankind, which has led to the survival of infants who in the past wouldn't have survived due to infections; these infants survive to adolescence, however they are at a higher risk of developing NHL; nevertheless, lymphoma patients may current be treated and cured. There have been significant advances in the capacity to cure patients of non-Hodgkin's lymphoma as well, and that is the reason why the increase in morbidity has not been coupled with a rise in mortality in most countries.
* The Hematology Dept. at Hadassah Medical Center, Ein Karem, and the School of Public Health & Community Medicine, Hebrew University of Jerusalem.
The full article is attached hereto.
A new research study currently being conducted by Prof. Paltiel is funded by an enlarged grant for outstanding research of the Israel Cancer Association.
The research study deals with the dry eye syndrome which is common in the general population and in Israel in particular. In some patients this is a manifestation of Sjogren's syndrome, an autoimmune disease characterized by extreme dryness of the eyes and mouth. Patients who suffer from tis syndrome may develop B-Cell NHL.
This research study, overseen by Prof. Paltiel, is examining biological and genetic markers in the blood, as well as environmental risk factors among patients who suffer from dry eye syndrome, patients who suffer from Sjogren's syndrome, and patients who have different kinds of B-cell lymphatic disorders, with the objective of acquiring tools which will help identify patients at risk of developing lymphoma.
Israel Cancer Association Activities with the approach of/marking World Cancer Day
Prevention GENEration - new free app available
The Prevention GENEration app allows users to create a "genetic portrait" showcasing the facial features of the person downloading the application and those of a first degree relative. This exposure fusion, merging two photos into one, demonstrates the similarity between family members, under the theme: 'You never know what genes may be passed down.'
The app refers users to the online Prevention GENEration questionnaire on the ICA website, which informs women if they are at risk of developing breast and/or ovarian cancer, and encourages them to seek genetic counselling.
The app was produced courtesy of Gitam BBDO, and was developed by Monolith Software and funded by the NCF (Northern Charitable Foundation, Inc.).
The Israel Cancer Association (ICA) produced a new booklet called 'Stay Healthy: Reducing the Risk of Cancer and Recommendations for Early Detection'. The booklet indicates risk factors for cancers, as opposed to protective factors which assist in reducing the risk of developing cancer, or even prevent it. The booklet includes new updates of the European Code against Cancer - IARC and the European Commission. This booklet is available free of charge (in Hebrew) and may be requested by contacting the ICA Telemeida teleinformation hotline at: 1-800-599995
A unique and moving clip has been recently posted on Youtube, as part of the ICA's national 'Look Good....Feel Better' project.About twenty breast cancer patients and survivors, most of whom are ICA 'Yad Lehachlama' (Reach to Recovery) volunteers, were involved in the production of this clip featuring three moving makeover sessions. These women had their hair done, received cosmetic treatment, and had wardrobe fittings. They could look in the mirror only at the end of the entire process. The moments of excitement and surprise are all documented on camera. The hair stylist (Mr. Avi Malka), the makeup artists (Mr. Dudi Malka and his team) and the stylist (Ms. Mazal Hasson), photographer (Mr. Alon Shafransky), clip director and editor (Mr. Nimrod Peled), vocals and music (Mr. Ohad Hitman), lyrics (Mr. Yoav Ginai), were enlisted for this project and they all provided their services on a completely volunteer basis. Highly recommended for viewing.
Please click here to view the clip
Marking World Cancer Day, the ICA has embarked on a unique public information campaign, based on place and time, called 'Don't be tempted to engage in a lethal relationship', which will appear on cellphone screens of bar hoppers, during the night hours, at entertainment spots. The message warns against the lethal combination of smoking and alcohol consumption. This campaign has been made possible through the generous support of Walla.
The SMS-Stop pilot - a text message-based smoking cessation intervention - has recently been launched. The Israel Cancer Association has partnered with the Ministry of Health, and the Hebrew University-Hadassah, headed by Dr. Haggai Levin, as well as the Israel Medical Association's Society for Smoking Prevention and Cessation.
For more information and to register for the 'SMS-Stop' program
The European Code against Cancer launched on 14 October 2014
The European Code is an initiative of the European Commission and has been developed by the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO).
The Code contains a set of 12 research-based recommendations to reduce the risk of developing cancer.
12 Ways of reducing your risk of developing cancer:
Do not smoke. Do not use any form of tobacco.
Make your home smoke-free. Support smoke-free policies in your workplace.
Maintain a healthy body weight.
Be physically active in day to day life. Limit the time you spend sitting.
Maintain a healthy diet.
Eat a lot of whole grains, lentils, fruits and vegetables.
Limit your intake of high-calorie foods (foods that are high in fat and sugar) and avoid sweetened beverages.
Avoid consuming processed meat, limit your consumption of red meat, and foods rich in salt.
If you drink alcohol of any kind, limit your intake. Avoiding alcohol is better for cancer prevention.
Avoid too much sun, especially for children. Use sun protection. Do not use sunbeds.
In the workplace, proect yourself against cancer-causing substances by following health and safety instructions.
Find out if you are exposed to radiation from naturally high radon levels in your home. Take action to reduce high radon levels.
For women:
Breast feeding reduces the mother's cancer risk. if you can, breastfeed your baby.
Hormone replacement therapy (HRT) increases the risk of certain cancers. Limit use of HRT.
Ensure your children take part in vaccination programs for:
Hepatitis B (for newborns).
Human papillomavirus (HPV) for girls, before age of intercourse.
Take part in national cancer screening programs for:
Colorectal cancer (women and men).
Breast cancer (women).
Cervical cancer (women).
Four Messages of the Union for International Cancer Control (UICC) for World Cancer Day 2015
Choose a healthy lifestyleReducing environmental and social risk factors for cancer, and empowering individuals to make healthy choices, are key elements of action for achieving the global target of a 25% reduction in premature mortality from NCDs by 2025.
Promoting Early Detection Tests
Ensuring the availability and accessibility of early detection programs for cancer, may significantly reduce the cancer burden in all countries.
Treatment for All
All individuals are entitled to access quality, effective cancer treatment and services on equal terms, regardless of geographical location and without suffering economic hardship as a consequence.
Optimizing Quality of Life for Cancer PatientsUnderstanding and responding to the full impact of cancer on emotional, mental and physical wellbeing, will optimize quality of life for patients, their families and caregivers.
The Israel Cancer Association Information Center Presents New Research Studies
Are there differences between the sexes among non-Hodgkin's
lymphoma patients?
Non-Hodgkin's lymphoma (NHL) is one of the most common malignancies worldwide. In Israel, as reflected in the report of the National Cancer Registry of the Ministry of Health, morbidity has been on the rise for several decades, while over the past 10 years, there has been stability in disease incidence among the Jewish and Arab population, women and men alike. Incidence is defined as the number of new patients diagnosed with the disease each year, per every 100,000 individuals in the population.
There is insufficient knowledge regarding the causes of the disease, and as this is an illness that has a large number of sub-types, it is assumed that there are several factors involved, or several combinations of these factors.
The investigators Dr. Nurit Horesh and Dr. Netanel Horowitz, of Rambam Healthcare Campus in Haifa and the Faculty of Medicine at the Technion, surveyed a large number of research studies that have been published worldwide, with the objective of "mapping" the differences between women and men in morbidity rates, during the clinical process of the disease and its sub-types, and in their response to various treatments provided.
The researchers indicate the following:
According to the National Cancer Registry statistics, NHL morbidity among males is significantly higher than in females.
Among young adolescent patients, more boys are diagnosed each year than girls.
Pregnancy emerged as a factor that has a protective role against the risk of NHL.
There is a difference between men and women in the clinical characteristics of the disease, while among women, the disease is diagnosed more often in specific body organs: the breast, thyroid, and respiratory system.
NHL during pregnancy is associated with unique clinical behavior, and it is usually diagnosed during the second or third trimester of the pregnancy, and in the advanced stage of the disease.
The different sub-types of the disease in women are more aggressive, and reproductive organ involvement is common.
Women respond better to treatment for B-Cell Non-Hodgkin's Lymphoma.
Among older adults who have B-Cell Non-Hodgkin's Lymphoma, women had a treatment advantage with the combined therapy of Mabthera and chemotherapy (the standard treatment), as opposed to men who received the identical treatment.
Among Mantle Cell Lymphoma patients, women treated with Revlimid, responded better to treatment than men treated with the same preparation.
The researchers explain that reduced hodgkin's lymphoma morbidity, and the unique clinical behavior among women, may be explained by the impact of the female hormone, estrogen, on the inflammation of the lymph cells, or the impact of estrogen on the anti-cancer arm of the immune system.
The researchers explain the women's superior response to combined treatment consisting of Mabthera and chemotherapy with a hypothesis that due to the body's 'cleansing' mechanism to remove Mabthera from the system, which emerged to be slower among older adult women, as opposed to older adult men, the drug remains in the body for a longer period of time, and its effect is longer and more effective.
The researchers emphasize that despite several hypotheses which associate certain factors with the differences indicated above, many questions still remain unanswered and a better understanding of the mechanism responsible for the difference between the genders will help provide better "patient-tailored" treatment, so that their responsiveness to treatment will improve, and their cure rates will also increase respectively.
This research study was published in the Rambam Maimonides Medical Journal, October 2014 issue.
International Consortium Probes Risk Factors for New Lymphoma Subtypes
Non-Hodgkin's lymphoma (NHL), a group of cancers of the immune system, has many subtypes. An international consortium of about 100 researchers from across the globe - biologists, bio-statisticians, epidemiologists, and pathologists - surveyed the characteristics of 11 Non-Hodgkin's Lymphoma subtypes to probe their risk factors. Prof. Ora Paltiel, a Senior Hematologist and Professor of Epidemiology of the Dept. of Hematology at the Hadassah Medical Center and the School of Public Health of Hebrew University of Jerusalem, is also a member of this Consortium.
The Consortium members pooled data from 20 research studies from North America, Europe, and Australia which document statistics on 17,500 patients and about 23,000 healthy individuals who served as a control group. The researchers compiled data regarding medical history (including precise documentation of the disease subtype), lifestyle, family history and occupation of the documented subjects.
The statistical analysis uncovered several significant findings:
Risks factors differed among NHL subtypes: autoimmune diseases, hepatitis C virus, blood transfusions, alcohol consumption, tobacco use, and more figured among the varying risk factors among the subtypes.
Risks were generally similar among subtypes: family history of NHL overall, sun exposure, allergies such as hay fever, and socioeconomic status.
2 main cell types comprise the lymphatic system, B-cells and T-cells, while patients who had a history of an autoimmune disease involving B-cells, had an elevated risk for B-cell lymphomas, and when there was a history of an illness involving T-cells, the risk for T-cell lymphoma increased.
The collaborative research demonstrated for the first time that there are several risk factor patterns for different subtypes of NHL (T-cell lymphoma, sporadic Burkitt lymphoma, and marginal zone B-cell lymphoma), including: obesity, cigarette smoking, eczema and occupational exposure in various areas such as the paint industry and woodwork.
The findings of the Consortium were published in the Journal of the National Cancer Institute, August 2014 issue.
Lower Cancer Rates Among Druze Compared to Arab and Jewish Populations in Israel
The Druze are a small ethnic minority in Israel amounting to about 1.7 % of the total population of the country (an estimated 130,000). While data exists on morbidity among the Jewish and Arab populations in Israel, there is little data on morbidity rates among the Druze population, which is known as a closed community that strives to keep its own traditions.
Researchers from Haifa University, Rambam Healthcare Campus and the Ministry of Health, were assisted by the Israel National Cancer Registry of the Ministry of Health, for the period 1999-2009, and conducted a comparison between morbidity rates among this population and those of the Jewish and Arab populations.
Based on an analysis of the research findings, it emerges that the morbidity rates among the Jewish and Arab populations are high compared to the morbidity rates among the Druze population, while among Jewish men, the morbidity rates, for all types of cancers, in an overall weighted calculation, were 39% higher than those of Druze men, and among Jewish women, they were 53% higher than among Druze women.
Among men, for specific types of cancer, the research results indicated that the lung cancer morbidity rates were 84% higher among Arab men than among Druze men, and 18% higher among Jewish men as opposed to Druze men. Similarly, the findings indicated that prostate cancer morbidity rates were 22% higher among Arab men as opposed to Druze men, and 2 fold higher among Jewish men versus Druze men.
Among women, for specific types of cancer, morbidity rates among Jewish women were 2 fold higher for invasive breast cancer, 4-fold higher for in situ cervical cancer and 3-fold higher for lung cancer, compared to Druze women. Similarly, among Arab women, morbidity rates were 36% higher for invasive breast cancer, and 2-fold higher and more for lung cancer compared to Druze women. Conversely, higher morbidity rates were not observed for in situ cervical cancer among Arab women compared to Druze women.
The researchers indicate that one of the reasons behind the differences in morbidity rates may possibly be related to the eating habits of the Druze, who for the most part still consume unprocessed foods. The investigators maintain that there may be additional reasons for these differences, but they have yet to be identified.
The research study was conducted by Iris Atzmon and additional investigators from Haifa University, Hebrew University and Rambam Medical Center, under the direction of Dr. Lital Keinan-Boker, of Haifa University.
The article was published in the December 2014 issue of the Journal of Religion and Health.
Do a healthy weight and physical activity potentially reduce the risk of breast cancer in BRCA mutation carriers?
Women and men who inherit a BRCA mutation face a high lifetime risk of developing breast cancer. However, there are hypotheses that assert that adopting a healthy lifestyle may significantly reduce the risk.
Researchers from the University of Toronto in Canada surveyed research studies that investigated the correlation between body weight and physical activity, on the one hand, and the risk of developing breast cancer among BRCA carriers, on the other.
The investigators surveyed 13 research studies: 6 studies investigated the impact of body weight on the risk of developing breast cancer: for example, one of the studies, which monitored 1,073 female carriers, showed that a drop of at least 4.5 kg in body weight between the ages of 18 and 30, reduced the risk of breast cancer by 34%, while among female BRCA1 carriers, there was a 65% decrease, and among female BRCA2 carriers, there was a 12% decrease.
Another 7 research studies that are reported in the article, examined various aspects related to physical activity and the risk of developing breast cancer. For example, a research study that examined 725 women of different ages who were carriers, who engaged in different forms of physical activity. The research results indicated a 42% decline in the risk of developing breast cancer among women who engaged in regular physical activity prior to the age of 30. Additional testimonies from other studies indicate the protective impact of physical activity, particularly when the individuals engaging therein do so during adolescence, or early adulthood - between the ages of 18-25.
Additional studies investigated, inter alia, the impact of physical activity on various biochemical activities in the body, among BRCA carriers, women and men alike. For example, one of the studies investigated the impact of physical activity on the levels of hormones in the body among women after menopause. It is known that high levels of hormones may elevate the risk for breast cancer among genetic carriers. The subjects in this study participated in a program that entailed aerobics as a physical activity for 5 hours a week, and hormone levels were measured using urine samples. The research results showed an 18.9% decline in estrogen levels, and a 23.7% decline in progesterone levels among these women.
The researchers assume that the association of a healthy body weight and regular physical activity with a decreased risk derives from these activities which contribute to the maintenance of normal cells and keep the body's hormonal levels constant. The disruption of these mechanisms may lead to processes that cause cancer.
In short, the researchers indicate that it is of utmost importance that BRCA mutation carriers adopt the healthy lifestyle recommendations which have proven to potentially reduce the risk of developing breast cancer. Maintaining a healthy lifestyle is very important for women who would like to avoid, or delay mastectomy and ovary removal surgeries.
This research study was published in the January 2015 edition of the Cancer Causes & Control Journal.