Prostate cancer incidence rates have evidenced a substantial increase in Iraq over the past sixteen years. Geographic variation of prostate cancer in Iraq has not been explored. We examine the geographic incidence patterns of prostate cancer in Iraq using the global index of spatial autocorrelation, Getis-Ord Gi* and Anselin Local Moran’s to detect hotspots, coldspots, and spatial outliers of prostate cancer rates. We calculated the age-adjusted incidence rates (AAIRs) according to district level for three periods (2000-2004, 2005-2009, and 2010-2015). Disease maps were produced to explore whether prostate cancer incidence clusters by district, and where hotspots and coldspots occur. Results highlight several districts of Iraq where the burden of prostate cancer incidence is especially high. In 2005-2009, the spatial autocorrelation analysis revealed a prostate cancer incidence hotspot in Al-Rissafa, Al-Manathera, Al-Kufa, Al-Hilla, Al-Hindiya, and Kerbela district. In 2010-2015, hotspots were seen in Al-Mussyab, Al-Hilla, Al-Hindiya, Al-Rissafa, Al-Adhamiya, Al-Sadir, and Daquq district. Examining spatial pattern of prostate cancer AAIRs is critical to government efforts to focus on those regions, and to understanding and targeting prostate cancer

The spatial statistical analysis of breast cancer incidences across Iraq hasnot been explored in Iraq. This paper aimed to explore the spatial pattern and risk clusters of female breast cancer incidence from 2000 to 2015in Iraq (except the Kurdishregion). To enhance statistical stabilityand 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 𝐼statistic) was used to assess spatial dependence across districts forASRs. Anselin local Moran’s 𝐼statistic was used to identify spatial outliers. Additionally, we used Getis-Ord 𝐺𝑖∗statistic to detect hotspots and coldspots over entire Iraq that representclusters 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% from2002 to 2015.The spatial autocorrelation analysis showed insignificant positive spatial autocorrelation in2000-2004, and significant positive spatial autocorrelation in2005-2009, and in2010-2015. This study identified fourdistricts 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.

Brain and other CNS cancers have evidenced increase in Iraq over the study period (2000-2015). Spatial variation of brain and CNS cancers in Iraq at the district level has not been explored. This study aimed to explore the spatial patterns of the Age-Standardized Incidence Rates (ASIRs) of brain and CNS cancers throughout Iraq (except Kurdish region) during 2000-2015 using spatial autocorrelation analyses. Data were obtained from the Iraqi Cancer Registry. The ASIRs were calculated according to geographical region (provinces and districts) for each period (2000-2004, 2005- 2009, and 2010-2015). spatial statistical tools were employed to evaluate hotspots, cold spots, spatial clustering and outliers for each period. Results showed a spatial correlation with hotspots, cold spots, and detecting spatial outliers. This study identified 7 districts as high-risk areas for brain and CNS cancers during 2010-2015, including Al-Sadir, Al-Kadhimiyah, Adhamia, Al-Karkh, Al-Rissafa, and Al-Madain districts in Baghdad province) and southern region (Abu-Al-Khaseeb district in Al-Basrah provinces, and we have evidenced an increase of brain and CNS cancers incidence rates during 2010-2015. The government efforts should focus on those regions, and the factors related to the spatial pattern of the brain and CNS cancers incidence in Iraq should be investigated.