• Muzahem Al-Hashimi Department of Statistics and Informatics, College of Computer science & Mathematics, University of Mosul, Mosul, Iraq
  • Edrees M. Nori Mahmood Department of Operation Research and Intelligent Techniques, College of Computer science & Mathematics, University of Mosul, Mosul
Keywords: Hotspots, Coldspots, Spatial Outliers, Breast Cancer, Iraq


The spatial statistical analysis of breast cancer incidences across Iraq has not been explored in Iraq. This paper aimed to explore the spatial pattern and risk clusters of female breast cancer incidence from 2000 to 2015 in Iraq (except the Kurdish region). To enhance statistical stability and to access the changes over time, we split the data according to the geographical district into three periods (2000-2004, 2005-2009, and 2010-2015). The age-standardized incidence rates (ASRs) were calculated using the world standard population. Having obtained estimates ASRs, the global index of spatial autocorrelation (Moran’s  statistic) was used to assess spatial dependence across districts for ASRs. Anselin local Moran’s  statistic was used to identify spatial outliers. Additionally, we used Getis-Ord  statistic to detect hotspots and coldspots over entire Iraq that represent clusters of districts with significantly high or low ASRs. A total of 44,496 cases were reported in 2000-2015 in Iraq, with an ASR of incidence of (32.81/100,000). The ASR incidence of breast cancer showed a significant average percentage change of 5.40% from 2002 to 2015. The spatial autocorrelation analysis showed insignificant positive spatial autocorrelation in 2000-2004, and significant positive spatial autocorrelation in 2005-2009, and in 2010-2015. This study identified four districts as high-risk areas for breast cancer during the two periods 2005-2009 and 2010-2015, including Al-Karkh, Al-Adhamia, Al-Rissafa, and Al-Sadir. This information can assist the allocation of health care resources and expand cancer prevention efforts.


Hyuna S, Jacques F, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;0:1-41.

DeSantis CE, Bray F, Ferlay J, Lortet-Tieulent J, et al. International variation in female breast cancer incidence and mortality rates. Cancer Epidemiology and Prevention Biomarkers. 2015 Oct 1;24(10):1495-506.

Annual Statistical Report 2018. Planning Directorate, Ministry of Health/Environment, Republic of Iraq, 2019. Available from:

Ibp I 2012 Iraq Country Study Guide Volume 1 Strategic Information and Developments. International Business Publications, Inc.; 5th Edition (June 30, 2019)

Su SC, Kanarek N, Fox MG, Guseynova A, Crow S, Piantadosi S. Spatial analyses identify the geographic source of patients at a National Cancer Institute Comprehensive Cancer Center. Clinical Cancer Research. 2010 Feb 1;16(3):1065-72.

Lawson AB. Statistical methods in spatial epidemiology. John Wiley & Sons; 2013 Jul 8.

Boscoe FP, Ward MH, Reynolds P. Current practices in spatial analysis of cancer data: data characteristics and data sources for geographic studies of cancer. International journal of health geographics. 2004 Dec 1;3(1):28.

Khan D, Rossen LM, Hamilton BE, He Y, Wei R, Dienes E. Hot spots, cluster detection and spatial outlier analysis of teen birth rates in the US, 2003–2012. Spatial and spatio-temporal epidemiology. 2017 Jun 1;21:67-75.

Anselin L, Sridharan S, Gholston S. Using exploratory spatial data analysis to leverage social indicator databases: the discovery of interesting patterns. Social Indicators Research. 2007 Jun 1;82(2):287-309.

Getis A, Ord JK. The analysis of spatial association by use of distance statistics. In Perspectives on spatial data analysis 2010 (pp. 127-145). Springer, Berlin, Heidelberg.

Karim SA, Ghalib HH, Mohammed SA, Fattah FH. The incidence, age at diagnosis of breast cancer in the Iraqi Kurdish population and comparison to some other countries of Middle-East and West. International Journal of Surgery. 2015 Jan 1;13:71-5.

Majid RA, Hassan HA, Muhealdeen DN, et al. Breast cancer in Iraq is associated with a unimodally distributed predominance of luminal type B over luminal type A surrogates from young to old age. BMC women's health. 2017 Dec 1;17(1):27.

Nasr N. Breast cancer in Basrah governorate: Pattern of geographical distribution. IRAQI JOURNAL OF COMMUNITY MEDICINE. 2016;29(1):1-4.

Baslaim M, Baroum IH, Salman BA, Baghlaf BS, Al-Farsi MA. Breast Cancer Screening Program in Jeddah, Saudi Arabia: Is There a Need for a National Program. Int J Womens Health Wellness. 2016;2:042.

Mehdi I, Monem EA, Al Bahrani BJ, Al Kharusi S, Nada AM, Al Lawati J, Al Lawati N. Age at diagnosis of female breast cancer in Oman: Issues and implications. South Asian journal of cancer. 2014 Apr;3(2):101.

Ahmadi A, Ramazani R, Rezagholi T, Yavari P. Incidence pattern and spatial analysis of breast cancer in Iranian women: Geographical Information System applications. Eastern Mediterranean Health Journal. 2018;24(4):360-7.

Fares MY, Salhab HA, Khachfe HH, Khachfe HM. Breast cancer epidemiology among Lebanese women: an 11-year analysis. Medicina. 2019 Aug;55(8):463.

Abdel-Razeq H, Attiga F, Mansour A. Cancer care in Jordan. Hematology/oncology and stem cell therapy. 2015 Jun 1;8(2):64-70.

Al Awadhi MA, Abulfateh NM, Abu-Hassan F, Fikree MA, Janahi E, Carlo R. Cancer incidence and mortality in the Kingdom of Bahrain statistics and trends. Bahrain Medical Bulletin. 2016 Mar;158(5877):1-5.

Chouchane L, Boussen H, Sastry KS. Breast cancer in Arab populations: molecular characteristics and disease management implications. The lancet oncology. 2013 Sep 1;14(10):e417-24.

Al Ramadhan MA. Eradicating breast cancer: longevity impact on Kuwaiti women. Asian Pacific journal of cancer prevention: APJCP. 2017;18(3):803.

Won YJ, Jung KW, Oh CM, Park EH, Kong HJ, Lee DH, Lee KH. Geographical variations and trends in major cancer incidences throughout Korea during 1999-2013. Cancer research and treatment: official journal of Korean Cancer Association. 2018 Oct;50(4):1281.

[National Institute of Environmental Health Sciences. Breast cancer risk and environmental factors.

How to Cite
Al-Hashimi, M., & M. Nori Mahmood, E. (2021). SPATIAL STATISTICAL ANALYSIS OF FEMALE BREAST CANCER INCIDENCE IN IRAQ DURING 2000-2015. Malaysian Journal of Public Health Medicine, 21(2), 75-87.