title: Geographic trends of tobacco-related cancers in Cyprus.
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.
authors.affiliation: Department of Life and Health Sciences, University of Nicosia, 46 Makedonitissas Ave, P.O. Box 24005, Nicosia, 1700 Cyprus ; Mediterranean Center for Cancer Research, 46 Makedonitissas Ave, P.O. Box 24005, Nicosia, 1700 Cyprus.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Farazi
authors.affiliation: Department of Epidemiology, 984395 University of Nebraska Medical Center, Omaha, NE 68198-4395 USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Lander
authors.affiliation: Cyprus Cancer Registry, Ministry of Health, Corner of Prodromou 1 and Chilonos 17, 1448 Nicosia, Cyprus.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Pavlou
authors.affiliation: Department of Epidemiology, 984395 University of Nebraska Medical Center, Omaha, NE 68198-4395 USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Watkins
authors.affiliation: Department of Epidemiology, 984395 University of Nebraska Medical Center, Omaha, NE 68198-4395 USA.
authors.forename: Lynne
authors.initials: L
authors.lastname: Le
authors.affiliation: Department of Epidemiology, 984395 University of Nebraska Medical Center, Omaha, NE 68198-4395 USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Soliman
keywords: Cancer; Cyprus; Epidemiology; Geographic; Tobacco; Trend