isfahan province is one of the biggest and the most important area that is located in center of iran .
it is a population based cancer registry based on iran ministry of health guideline.6 data was collected from all hospitals , pathology lab , physician office , radiography centers , and radiotherapy centers .
histopathologic diagnosis were coded based on international classification of diseases for oncology ( icd - o).7 data entry was performed by special software named canreg which was designed by cancer department of ministry of health . the history of cancer registry in iran was described previously by mohagheghi and mosavi - jarrahi.8 the population based data of isfahan cancer registry has been completed since 2005 . it was tried to cover all centers in isfahan university of medical sciences district area . for checking sensitivity of data gathering , ten percent of data
we decided to enter data from 2005 to 2010 because of confidence in gathering information to prevent sampling bias .
we calculated crude incidence rate and the average annual adjusted specific incidence rate ( asr ) per 100000 persons .
we obtained population of isfahan province and then adjusted it based on who standard population tables .
afterwards , the incidence rates regarding calculated standard populations were calculated.9 trend of yearly cancer incidences and asrs were compared by poisson regression analysis and were presented as incidence rate ratios ( irr ) with % 95 confidence interval ( ci ) . the poisson regression model is a method for multiple regression analysis of data with a dichotomous outcome and one or more categorically define predictors .
the asrs were defined as dependent variable while age sex and years were considered as independent variable and irr was calculated by stata 10 software .
during 5-year period from 2005 to 2010 , 24771 new cases of cancer were registered in isfahan cancer registry center . of these ,
54.6% of patients were male and 45.4% were female aged 56.1  18.03 years ( mean  sd ) .
the mean age of cancer patients in men and women frequency of cancers based on their topography is shown in figure 2 .
the most prevalent cancers were gastrointestinal system , skin , breast and urinary system neoplasms .
the most frequent cancer in men was gastrointestinal but in women it was breast cancer .
frequency of cancers by organs after direct standardization , it was demonstrated that the incidence rate of cancer is increasing in isfahan province .
poisson regression analysis determined the rate of cancer increased approximately 4 per 1000 population ( irr = 1.004 95%ci : 1.002 - 1.005 ) .
table 1 shows the incidence rate ratio ( irr ) of cancer in each year adjusted for sex and age .
trend of cancer incidence from 2005 to 2010 annual incidence rate ratio of cancer from 2005 to 2010
the findings of this study showed that incidence of cancer in isfahan province has been increasing in recent years ( 4 per 1000 population ) .
it is important for policy makers and health manager to seriously consider cancer in future plan in this district area -isfahan .
there was a gender difference in cancer incidence and most people were involved in middle ages with mean age of 56 years .
the most prevalent cancer was gastrointestinal and breast cancers in male and female , respectively .
the mean age of cancer patients in other reports in iran was around 56 - 57 years old.15 the world population data shows the most frequent cancer in men is respiratory system cancers and gi cancers are after that .
the serial studies by moore and colleagues showed the contribution of cancer in asia - pacific area .
our recent data was comparable with incidence rates from different population of the world.1320 one of differences in iran in contrast to other countries was respiratory system cancers . in iran
, the smoking pattern in iran differs from other country and it seems to be lower than other countries , although it has been progressing .
more important reason was an information defect regarding respiratory cancers in our cancer registry data .
many cases with lung cancer are undiagnosed and some of them did not have any biopsy . they have been diagnosed only by radiographic procedures .
colorectal cancer in our data was the most frequent and after that stomach cancer was in the second order .
however , it is notable that iran is located in esophageal cancer belt of asia.10 in women , breast cancer was on the top of list .
our rates was the same as asian countries but it was lower than north american and european countries.21 enhancement in breast cancer incidence should be taken into consideration .
existence of early detection programs of breast cancer plays the leading role in reducing mortality and improving the patient 's prognosis .
the comparison between our data and countrywide data which published by ministry of health determined the incidence of bladder cancer was high in isfahan province .
we presented 5-year analysis and will try to report ten - year or more in future .
we did not have data from 2 cities of isfahan province -kashan and aran - bidgol- because they are covered by kashan medical sciences university .
however , we have been conducting some research project to find cancer risk factors and distribution in the district area . as discussed in aforementioned paragraphs , our cancer registry had defect in lung cancer .
we have tried to solve this problem to call on all medical center like oncology , radiology , surgery and respiratory disease centers .
fm designed and edited manuscript , mar designed , analyzed and wrote manuscript , kh and mt supported the project and edited manuscript and ht helped in data collection and entry and managed data .
 background : cancer incidence rate is increasing in the world particularly in developing countries . the awareness regarding cancer incidence and distribution helps policy makers and researchers to design comprehensive plan for controlling cancer . the aim of this study was to determine the incidence rate and trend of cancer in isfahan area , one of the most importance provinces of iran.methods:data of isfahan cancer registry were derived from 2005 to 2010 . 
 direct standardization through world standard population produced by the world health organization was used and adjusted standard rate ( asr ) was calculated . 
 the poisson regression analysis was employed to estimate cancer incidence trend during 5 years.results:the new cases of cancer were 24771 patients from 2005 to 2010 . 
 mean age of these patients was 56.1  18.0 years and 54.6% were male . 
 male patients were approximately 7 years older than females . 
 the most frequent cancer was gastrointestinal in men and breast cancer in women . 
 the rate of cancer increased approximately 4 per 1000 population and incidence rate ratio ( irr ) was 1.004 ( 95%ci : 1.002 - 1.005).conclusions : the rate of cancer is increasing rapidly in isfahan province . cancer control and comprehensive prevention plan for isfahan is necessary . 
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Authors Contributions