Asian Pacific Journal of Cancer Prevention, Vol 10, 2009 891 Primary Malignancies of Bone and Cartilage in Karachi, Pakistan Asian Pacific J Cancer Prev, 10, 891-894 RESEARCH COMMUNICATION Primary Malignancies of Bone and Cartilage in Karachi Yasmin Bhurgri 1,2,3 *, Ahmed Usman 4 , Hadi Bhurgri 1 , Naveen Faridi 3 , Imtiaz Bashir 5 , Asif Bhurgri 1,6,7,8 ,Sheema H Hasan 2 , Mohammad Khurshid 2 , SMH Zaidi 9 Abstract Intr oduction: Primary sarcomas of bone and cartilage (BS) are a group of rare neoplasms, with limited information from Pakistan. The present population-based study was conducted with the objective of examining descriptive epidemiological characteristics of BS in Karachi. Materials and methods: Epidemiological data of 68 BS registered at Karachi Cancer Registry for Karachi South during 1st January 1995 to 31st December 1997 were reviewed. Results: Forty six (66.7%) cases were diagnosed in males and 23 (33.3%) in females. BS accounted for 2.2% and 1.1% of all cancers in males and females, respectively. The age standardized rate (ASR) world per 100,000 was 1.75 in males and 1.00 in females. Microscopic confirmation was 99.0%. The mean age of male and female patients were 26.7 years (SD ± 17.4) and 24.3 years (SD ±16.0) respectively. In males 14 (30.4%) BS were diagnosed in the 0-14 year age group and 23 (50.0%) cases in the below 20 years age group. The distribution in females was 31 (67.4%) and 8 (34.8%) cases, respectively. Approximately half the cases (34.8% males; 47.8% females) were observed in the lower limbs. The most common morphology was osteosarcoma (30.5% males; 43.4% females), followed by Ewing’s sarcoma (23.9%) in males and giant cell tumor (13.0%) in females. Age- specific curves showed a gradual increase in risk from the first until the fifth decade in males, and second to fourth decade in females. The age-specific curves were bimodal. In both genders the first peak was observed at 10-14 years but a second peak was observed at 70-74 years in males and 65-69 years in females. The cardinal symptoms that lead to the diagnosis of bone tumors were pain (22 cases; 32.4%) and spontaneous fractures (45 cases; 66.2%). Conclusion: Karachi falls into a high risk region for BS, which were observed in a relatively younger population, with a male predominance and a high frequency of osteosarcoma. The underlying factors for BS in Karachi need to be addressed considering the overwhelming proportion of youngsters at risk and the late presentation. Key words: Bone, cartilage - sarcoma - incidence - Karachi - Pakistan Introduction Primary sarcomas of bone and cartilage (BS) are a group of rare neoplasms, comprising 0.2 - 0.5% of all malignancies, with a higher involvement in children (Dorfman et al., 1995; Ries et al., 1999). They constitute 3% of all cancers in the 15-29 year age group and 6% of all childhood cancers below 20 years of age (Mascarenhas et al., 1998; Ries et al., 1999). The incidence of BS has remained stable in most countries with no tendency to increase or decrease. In the US during 1973-87 the incidence fluctuated around ASR 0.8 per 100,000 (Dorfman et al., 1995) and continued such till 1993-7, the study period (Parkin et al., 2002). Despite the low incidence, it is estimated that 2,570 men and women will be diagnosed with and 1,470 men and women will die of cancer of the bones and joints in 2009 in the US (Horner et al., 2009). It is likely that the burden of BS may be higher in developed countries but the incidence of cancer is not accurately assessed either because the health care systems are unavailable or are inaccessible. Moreover, there is limited documentation of diagnosed cases which do enter the health-care system, a result of apathy or financial constraints. Pakistan is a developing country in South-Central Asia. Like other developing countries there is limited population-based cancer data from Pakistan. The only available data is from Karachi South the southern-most district of Karachi, the largest city of Pakistan. It includes all ethnicities of the country, namely Sindhis, Punjabis, Pathans, Baluchs and Mohajirs with a fair representation of all socio-economic categories. Mohajirs are a multiethnic migrant group of Indian origin, subcategorized on the basis of language viz. the urdu, gujrati and memoni speaking Mohajirs. In the absence of a national cancer 1 Karachi Cancer Registry , 2 Aga Khan University Hospital, 3 Liaquat National Medical College and Hospital, 4 Jinnah Postgraduate Medical Centre, Radiotherapy Department, 5 Oncology , 6 Pathology, Zainab Punjwani Hospital, 7 Sindlab, Karachi , 8 Anklesaria Nursing Home , 9 Baqai Institute of Oncology, Karachi, Pakistan *For Correspondence: yasmin.bhurgri@gmail.com