499
JOURNAL OF SCIENCE, Hue University, N
0
61, 2010 CANCER INCIDENCE IN THE POPULATION OF THUATHIEN HUE
PROVINCE, VIETNAM, 2001-2009
Nguyen Dinh Tung
Oncology Department of Hue Central Hospital
Lecturer of Hue College of Medicine & Pharmacy
SUMMARY
Hue Central Hospital is the place where the population-based cancer registry was
carried out in Thua thien Hue Province. The purpose of this research was to determine the
cancer incidence in the community, to contribute to the assessment of cancer burden in the
whole country and to analyse the epidemiology characters of some popular cancers in this area.
The active registering procedure has been performed, the data were collected from 14 hospitals
and disposed of according to the international classification for oncology (ICD-O3). The data
was stored in the CANREG software version 4 and was analyzed using EPI-INFO . It was
estimated that 7,324 new cancer cases were registered in the period 2001-2009, which included
55.54% and 44.46% males and females respectively. The highest rate of cancer diseases
belonged to Hue city (37.76%). There was 87.65% of cancer cases diagnosed by cytology or
pathology. The crude rate (CR) was 123.9, the age -standardized rate (ASR) was 173.5
per100,000 inhabitants; those in males and females were 95.3 and 103.9 respectively. The
cancers of liver, stomach, lung, oral cavity and non-Hodgkin lymphoma were the leading ones
in males. Of these, the liver cancer rate is the highest (ARS 34.8).The leading cancers in
females were breast, stomach, lung, liver and oral cavity; and the breast cancer rate is the
highest (ARS 21.7). Cancer diseases have increased among inhabitants after the age of 40
years old in Thua thien Hue. These increased more rapidly in males than in females and the

Middle area of Vietnam, but also in permitting a comparison with incidence rates from
the North and the South Regions of Vietnam.
2. Methodology
Thua Thien Hue is a place with diverse cultural heritage. Up to now,
there is no place in Vietnam where so many originally historical vestiges have survived
as in Hue - the ancient capital city. Hue is also one of the most important education
centers in Vietnam. In December 1993, Hue was approved to be a World Cultural
Heritage Site by UNESCO.
Thua thien Hue is located in central Vietnam. It covers 5,054 km
2
and is divided
into 8 districts and 1 capital city (Hue). The estimated population in 2008 was about
1,119,800, comprising 89.9% of Vietnamese (Kinh). Other main ethnicities are Catu
and Ta oi. The climate is tropical, with high humidity and an average temperature of
about 26°C. It’s season of equatorial rains is between October and February.
The population-based registry receives information from the Cancer Registry
division of Hue Central Hospital, the Planning Division of Hue University Hospital, 3
private hospitals, 1 Military hospital and 08 district hospitals (among a total of 14
hospitals). The principal data sources are medical records, including outpatient records
if they exist, logs and reports of diagnostic laboratories (including all histopathology
and cytology services in the city), and the patient logs from polyclinic departments.
Death certificates are not used as a source of information; since cause of death is very
poorly specified (certification by a medical doctor is not required and is relatively rare, 501
except for hospital deaths).
Any case with a permanent address in Thua thien Hue province which had a
diagnosis of 'malignancy' made for the first time was registered. This includes cases
diagnosed by clinical diagnosis alone, even in out patient departments of district


Total

%
Male 362 294 448 386 485 302 287 745 759 4,068

55.54
Female

311 226 280 321 450 312 219 573 564 3,256

44.46
Total 673 520 728 707 935 614 506 1,318

1,323

7,324

100.00

Table 2. Number of cases by year and Address Code
No. Location
2001-
2007
2008 2009 Total %
1 Hue 1,868 472 426 2,766 37.76
2 Phongdien 366 116 105 587 08.01
3 Quangdien 327 96 111 534 07.29
4 Huongtra 440 123 120 683 09.32
5 Phuvang 632 191 237 1,060 14.47

398 09'82 265 8.17 663 9.09
C15-C26 Digestive Organ 1789 43.97 909 27.91 2698 36.83
C30-C39
Bronchus, lung &
other thoracic
organs
580 14.25 292 8.96 872 11.90
C40,41,45-
49
Bone, Connective,
Soft tissue
166 04.08 173 5.31 339 4.62
C42,C77
Lympho malin &
Leukaemia
358 08.80 207 06.35 565 07.72
C44 Skin 42 01.03 31 00.95 73 01.00
C50 Breast 14 00.34 585 17.96 599 08.17
C51-C58
Cervix, Corpus
Uteri & others
0 00.00 458 14.06 458 06.25 503
C60-C63
Prostate, Testis ,
Penis
122 02.99 0 00.00 122 01.67
C64-C68

45-49: 26831 29669 : 6000
50-54: 23348 26522 : 5000
55-59: 15378 18025 : 4000
60-64: 10083 13540 : 4000
65-69: 8763 12762 : 3000
70-74: 7950 12163 : 2000
75 + : 10942 17948 : 2000
??? : 0 0 504

Tot. : 600105 600087: 100000
Table 6. Cancer incidence in Thua Thien Hue
Gender Population
N. of
Cases
%
Crude
Rate
Age
Standard
Rate
Males 600,105,000 745 56.52 123.9 173.5
Females 600,087,000 573 43.48 95.3 103.9
Table 7. Ten of leading cancers in males
No Sites
N. of
Cases
Crude
505
6 Cervix 30 05.0 05.8 C53
7 Rectum 24 04.0 04.3 C19-C20
8
Non- Hodgkin
Lymphoma
23 03.8 04.0 C82-C85
9 Ovary 19 03.2 03.3 C56
10 Soft Tissue 14 02.3 02.5 C47- C49

Figure 1. Age - specific incidence rates : all sites, males and females

Figure 2. Age- specific incidence rate for Liver cancer
506
0
50
100
150
200
250
300
350
Axis Title
Males
Females

To estimate the cancer incidence within a year in Thua Thien Hue, we have
chosen the year 2008 for representative data with 1,318 cases, including 745 men
(56.52% ) and 573 women (43.48%). The crude rate (CR) was 123.9 per 100,000 and
Age Standardized rate (ASR) was 173.5 per 100,000 for men; CR was 95.3 per 100,000
and ASR was 103.9 per 100,000 for women (table 1,5 & 6).The cancer registry in Hanoi
(1990) has found 1975 cases specified as 'malignant' (1163 men and 812 women) in the
3-year period ( 1988-1990). The estimated rates of incidence for all cancers were 86.7
per 100,000 (CR) and 105.1 per 100,000 (ASR)for men; 59.0 per 100,000 (CR) and
63.6 per 100,000 (ASR) for women. Additionally, the results from the population-based
cancer registry in Ho Chi Minh City in the two year period between 1995 and 1996
provided the first information on the incidence of cancer in Southern Vietnam. A total of
4,080 cancer cases in males and 4,338 in females were registered with CR as 89.0 per
100,000, ASR as 130.9 per 100,000 for men and CR as 85.8 per 100,000, ASR as 100.7
per 100,000 for women.
Table 3 shows the most valid basis of diagnosis of the cases registered by tumor
site. Overall, 87,65% of cases have had some microscopic confirmation of the diagnosis,
either histological or cytological and 3,65 % on the basis of clinical examination only.
The sites with the lowest percentages of morphologically were liver and lung cancer. In
1988, the ability of cancer diagnosis in several cancer registries was: Hanoi 53,8%,
Manila, Philippines 60,6%, and Khon Kean, Thailand 34, 5%. The low histological
verification in Khon Kaen is the result of very high rates of liver cancer in males but, in
general, is not very different from other Asian registries.
In men, lung cancer (18,52% of cases, ASR 34.8 per 100,000) was the most
frequent malignancy, followed by cancer of the stomach (18,38% of cancers, ASR 31.3).
Both showed a progressive increase of incidence with the maximum increase in the
oldest age-group. However, the liver cancer incidence was highest among the group
between 60-64 years old. (Figure 2&3). Lung cancer is the third highest in frequency
( 13.55% of cases, ASR 24.6), but for this tumor the average age of incidence is rather
less, with the maximum rate in the age-group 70-74 and a decline thereafter (Figure 4).
The fourth highest in frequency is cancer of the oral cavity and nasopharynx (ASR

with the reproductive factors accompanying previously high levels of fertility (early age
at first pregnancy, multiple births), low caloric intake (relatively late age at menarche,
low body mass) and prolonged breast feeding of infants.
5. Conclusions
The data on cancer incidence confirms the increase of crude rates and ASR
among the population in Thua thien Hue during the last 10 years. It also indicated a
genuine risk for certain cancers, particularly those associated with 'western' lifestyles or
consumption of alcohol and a certain relationship with some virus infection. Cancers of
the digestive organs was the most frequently seen cancer, followed by bronchus -lung
cancer. There was no difference, when compared with the whole country, in the
incidence of breast cancer (the leading cancer in women) and cervical cancer is in the 509
process of decreasing. The difference, comparing with the North, is its higher incidence
of liver cancer and, comparing with the South, is its higher incidence of nasopharynx,
stomach cancer and especially lower incidence of cervical cancer. These findings
provide useful clues for further etiological studies, as well as highlight current priorities
for the cancer control program: hepatitis B vaccination, tobacco control, and early
diagnosis and treatment of breast cancer.

REFERENCES
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Clinical Oncology, (09/2008) : 13-18
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Medicine Article, vol 12, N 4, (2008): 1-8
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