Last week, we had a visitor from a nearby village in Bekaa, Lebanon. He kept apologizing for his not paying frequent visits, as the wont with typically Lebanese villagers, because his brother’s wife, Amal, was still undergoing excruciating larynx cancer treatment in Beirut. Amal is only 19, has a son, and her husband is only 20. The villagers call him ‘walad’, kiddo, because he got married at a young age. The doctor says that the cancer has spread in most parts of her larynx and that ostracizing the malign cells without killing the healthy ones is getting harder by the day. The doctor says, “ Don’t let your hopes high”. The listeners hearken at the story of Amal’s ordeals of the invasive, malignant cancer with compassion but not with surprise.
In this in-land Lebanese village, and many, many others in Lebanon, cancer incidences are ubiquitous. During my short summer stay, I incessantly hear about or know of the death of a man, the diagnosis of a woman, or the loss of a child with cancer. This ubiquity of cancer incidences has enshrouded the Lebanese people, the villagers at least, with normalization effect. They got used to its presence. They attribute it to Allah’s will. Everything is Allah’s will, of course, but the steady rise in cancer incidences in Lebanon is something that we need to really consider very soberly. It’s a socio-politically and socio-culturally fueled disease. Lebanon competes the developed countries in cancer ratios and exceeds developing countries and other Arab countries.
The National Cancer Registry (which was only established in 2003) shows a steady rise of cancer incidences in Lebanon since 1966. Shamseddine et al. (2014) and Shamseddine (2015) project that the cancer trends will only increase by 2020. There is an Increase of cancer incidence of third from 1966 of 102.8 for males and 104.1 for females by 1998. In 2003 National cancer registry reported 179.3 males and 190.3 female cancer incidents per 100,000. For males, bladder cancer was the most commonly reported cancer followed by cancers of the prostate and the lung. For females, breast cancer remained the most common cancer and accounted for one-third of all reported cases.
Shamseddine et al. (20014) reveal an increase in the incidence rates across time and a change in the epidemiology of the disease, a change in the cancer sites, between 2004 and 2018. Cancers of prostate, bladder, lung, colon, and non-Hodgkin were the most common among males, and cancers of the breast, colon, lung, non-Hodgkin, and ovary were the most common among females. Currently, Lebanon includes the highest proportion of older people in the Arab world (10% for those aged 60 years and over) . Whilst aging remains the most compelling explanation for the rise in cancer rates over the study period from 2009 until 2018, the study also notes a disproportionate rise in smoking-related cancers represented by malignancies of the lungs, trachea, and larynx. Females still lag behind males in the incidence of such cancers, but they are following a similar incremental increase. Females are progressively being exposed to more risk factors than before, with maturation of the smoking epidemic and an increase in the incidence of smoking-related cancers.
Tobacco and Cancer
Increased smoking trends especially among females and school children was 60% where cigarettes was 10% of other tobacco products, water pipe being the main tobacco product. In 2011, the Global Youth Tobacco Survey of Lebanese ages 13 - 15 show that
36.2% of students currently use any smoked tobacco products; 11.3% currently smoke cigarettes; 34.8% currently smoke water-pipe
SHS exposure– almost seven in 10 students live in homes where others smoke cigarettes; and two-thirds of the students are exposed to cigarette smoke around others outside of the home; over six in 10 students have at least one parent who smokes cigarettes
Three-quarters of the students think cigarette smoke from others is harmful to them
55.7% of current smokers want to stop smoking cigarettes
11.6% of students have an object with a cigarette brand logo on it
Close to seven in 10 students saw anti-smoking media messages in the past 30 days; more than eight in 10 students saw pro-cigarette ads on billboards and more than seven in 10 saw pro-cigarette ads in newspapers or magazines in the past 30 days
Smoking caused most cancer cases, and it will further add a total of 1800 new cases by 2018. Among adult risk factors, tobacco is number one with 42.7% of males and 21.9% of females using tobacco as of 2011.
Coffee and Cancer
Bladder cancer has been singled out as a cancer with an unusually high incidence, with a pattern that exceeds other regional and international estimates (see here). In a meta-analysis study, Wu et al. suggest that there was an “increased risk between coffee consumption and BC [bladder cancer]. Male coffee drinkers and non-smoking coffee drinkers were more likely to develop BC”. The study between smokers and non-smokers has revealed that the risk of the BC among non-smokers was higher than smokers. In most cases, coffee drinkers tended to smoke, lack enough exercises and possess high body mass index (BMI), which had been reported to be the potential risk factors of the BC. However, inn all, the study suggested a significantly increased risk between coffee consumption and the risk of BC.
Environmental Pollution and Cancer
Waste pollution with its adverse health risks, mainly cancer incidences, is one of the main issues present in Lebanon. Random disposal of wastes is instilling a complex and challenging situation that is affecting the entire population. Here, a comprehensive study is presented along with collected data addressing the correlation between long-term exposure to the different forms of pollution and the chances of being affected with cancer. Lebanon, a country currently facing an extensive garbage crisis, is undergoing alarming surges in pollution rates. Inevitably, these environmental factors become chief elements in influencing disease statistics.
Waste pollution in Lebanon has taken not only the national media but also international media. Waste pollution has adverse health effects by forming air and ground pollutions. Even the waste disposal in Lebanon drastically affects the environment. In a comprehensive conducted by Azar (2016), waste pollutants have an increased present effect on cancer incidences in Lebanon. Environmental Performance Index 2016 Report indicate that “according to EPI 2016 and based on 2014 data derived from satellite instruments in combination with chemical transport modeling, the Lebanese population is exposed to poor air quality, namely to high levels of NO2 and PM2.5 the latter benchmarked with the 10 micrograms/m3 threshold subscribed by the World Health Organization (WHO)thresholds”.
In a country where its people drink Turkish coffee from morning to evening. In a country where it's socially constructed that smoking cigarettes is fine, even sometimes a requirement in social gatherings, and social gatherings are very frequent in Lebanon. In a country where its Turkish coffee is more important than drinking water. In a country where nargileh, water pipe, is so rampant and home delivery services of nargileh are thriving. In a country where its government started a very modest action, incited by activists, to limit tobacco consumption but failed to due to political corruption. In a country where its air and water pollution has encroached the whole area, mainly through wastes and waste disposals. In country where diesel generators are abound. In a country like this, it is miraculous that the cancer incidences are in steady increase instead of an exponential increase.
Azar, S.K. and Azar, S.S. (2016) Waste Related Pollutions and Their Potential Effect on Cancer Incidences in Lebanon. Journal of Environmental Protection, 7, 778-783. http://dx.doi.org/10.4236/jep.2016.76070
Shamseddine, A., Saleh, A., Charafeddine, M., Seoud, M., Mukherji, D., Temraz, S., & Sibai, A. M. (2014, March 04). Cancer trends in Lebanon: A review of incidence rates for the period of 2003–2008 and projections until 2018. Retrieved July 12, 2017, from https://pophealthmetrics.biomedcentral.com/articles/10.1186/1478-7954-12-4
Shamseddine, A. (2015). Cancer Trends in Lebanon & Projections to 2020. Human & Health, (32), 9–11.
Wu, W., Tong, Y., Zhao, Q., Yu, G., Wei, X., & Lu, Q. (2015). Coffee consumption and bladder cancer: A meta-analysis of observational studies. Retrieved July 12, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356958/