The Middle East Cancer Consortium (MECC) was established in 1996, when the Ministers of Health of Egypt, Israel, Jordan, Cyprus, and the Palestinian Authority (PA) signed an agreement to work together to reduce the incidence and impact of cancer in the Middle East through collaborative research. Turkey joined the Consortium in 2004. One of the first steps taken by MECC was to set up a Joint Cancer Registration Project, in which a population-based cancer registry would be created (or enhanced if one already existed) in each member state, and data collected on the incidence of cancer. After some intense preparation, the project was launched in January 1998, and was guided and coordinated by a Steering Committee (chaired by myself) comprising members from the participating registries and outside advisors.

The registries were situated in Nicosia, Cyprus; Tanta, Egypt; Jerusalem, Israel; Gaza City, PA Gaza; Beit Jalla, PA West Bank; and Izmir, Turkey. From the outset, we paid close attention to data comparability and quality, creating a manual of standards for coding information and programs for checking the standardization of the coding and the completeness of registration. Staff at each registry received regular training in cancer registration. These activities were led by Dr. John Young of Emory University in Atlanta. In addition, we adopted the standard computer software known as CANREG, provided and supported by the International Agency for Research on Cancer, for entering and storing the registration data.

The coordination of the project has never been simple and has often been disrupted by political events in the region, but through persistence of purpose, patience, and goodwill, the major aims of the project - to produce an accurate picture of cancer incidence patterns in the region covered by MECC - are being realized. Ten years after its establishment, this year, MECC has published a monograph, Cancer Incidence in Four Member Countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East Cancer Consortium (MECC) Compared with US SEER. A few of the major findings are:

• Jordanians had the lowest overall incidence of cancer; the U.S. SEER population and Israeli Jews had substantially higher incidence, while Cypriots, Israeli Arabs, and Egyptians had intermediate incidence.
• Liver cancer incidence rates in Egyptians were five to seven times as high as those of the other MECC populations, and more than three times the U.S. SEER population, possibly related to the higher prevalence of hepatitis B and C in Egypt.
• Egyptians and Israeli Jews had rates of non-Hodgkin lymphoma higher than in the U.S. SEER population and considerably higher than in the other MECC populations. Further studies of risk factors for this malignancy are needed in this region of the world.
• Many more interesting results can be found in the monograph, which is available on the MECC Web site at http://mecc.cancer.gov under Cancer Registry Project.

This project represents a decade of hard work and collaboration between scientists from each of these countries and is a model for international scientific collaboration in troubled regions of the world. It would not have been possible without the leadership of the MECC Executive Director, Prof. Michael Silbermann, the support of NIH and NCI, and the guidance and encouragement of Dr. Joe Harford, Director of NCI's Office of International Affairs, and the primary liaison to MECC.

Dr. Laurence Freedman
Director, Biostatistics Unit
Sheba Medical Center
Tel Hashomer, Israel