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There are no population-based studies on cancer in Saudi Arabia, where lung cancer is readily emerging as a common cancer-related death. This work is aimed at describing the incidence of lung cancer in the population of the Eastern Region of Saudi Arabia. A population-based tumor registry was established in 1987. Data on all cancer sites were captured from all 22 hospitals in the Eastern Region. The population census for 1988 was derived from a doorto-door survey. Relative frequency rates were used to compare our data with nationally reported data derived from hospital-based registries. Crude incidence rates, age-specific incidence rates, age-standardized rates adjusted to the world standard population, and relative age-standardized rates were used for international comparisons. A total of 107 cases of primary lung cancer were registered in 1987 and 1988. Saudis constituted 80% of these cases. The observed overall relative frequency rate of 6.9% was the highest in Saudi Arabia. Similarly, the relative frequency rates among males of all nationalities (9.8%), Saudi males (10.7%), and Saudi males registered from the Dhahran Health Center (15%) were higher than those reported in other regions in Saudi Arabia. The relative frequency rate among Saudi females registered from the Dhahran Health Center (7.3%) was significantly higher than that from other regions in Saudi Arabia. Among Saudi males, lung cancer was the leading cause of cancer death (25.6%), and the second cause (9.7%) among Saudi females in the Eastern Region. The crude incidence rate of lung cancer per 100,000 population per year was 6.5 for Saudi males and 1.3 for Saudi females. The age-standardized rates per 100,000 population per year were 16.5 for Saudi males and 4.0 for Saudi females. Among Saudi males, cancer of the lung was the leading cause of morbidity and mortality from cancer of all sites. The relative frequency rate of lung cancer has increased among cancer patients from Saudi ARAMCO's Dhahran Health Center during the past 40 years. This is attributed to an increased number of tobacco smokers and increased environmental pollutants from industry and gasoline-driven vehicles. The crude incidence rate and age-standardized rate of lung cancer in the Eastern Region are very low compared with those reported from developed countries. This can be explained by the young Saudi population in the Eastern Region, and the relatively recent history of cigarette smoking and industrialization in Saudi Arabia. A plea is made for a smoke-free society and a cleaner environment to prevent the incoming creeping epidemic of lung cancer.

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Hemoptysis is a potentially serious condition that requires thorough investigation. The amount of bleeding is no index to the underlying pathology [1], and important causes include pulmonary tuberculosis, bronchiectasis, and chronic cardiorespiratory problems [2,3]. An inhaled foreign body as a cause of recurrent hemoptysis has received little attention in the English medical literature. Recently, Pattison et al [4] reported a case in a teenage girl. We present a case in a 67-year-old man and discuss aspects of management. Case ReportA 67-year-old farmer was seen because of recurrent hemoptysis of 8 months' duration, associated with chest pain and dyspnea of recent onset (5 days). He had no fever or night sweats. He was a heavy smoker and a diabetic, controlled on glyburide. He had coarse crepitations over the right lower zone, where chest x-ray study showed a consolidation that was confirmed by computed tomography (CT). Repeated cytological examination of sputum and bronchial lavage findings suggested an inflammatory process but were negative for malignant cells, except for some atypical cells that suggested malignancy. Fiberoptic bronchoscopy revealed a polypoid structure in the medial basal segment of the right lower lobe which was difficult to biopsy adequately. Multiple semiblind biopsy specimens showed chronic inflammatory changes. PPD test was positive but sputum examinations were negative for acid-fast bacilli.In view of the suspicion of malignancy because of cytological findings, a right lower lobectomy was performed. Dissection of the specimen revealed a foreign body with a leaf-like appearance embedded in a basal bronchus (Figure 1), with surrounding inflammation. Histopathological examination showed squamous metaplasia and dysplasia of the epithelium, with severe chronic inflammation and scarring in the surrounding lung tissue. The plant nature of the foreign body was confirmed by histological analysis and later identified as the skin of a pepper fruit by the Institute of Agriculture. The patient made an uneventful recovery and has had no further hemoptysis over 2 years of follow-up. DiscussionForeign body inhalation is more common in children and may thus be suspected as a cause of hemoptysis in that age group. In adults, however, it is less common and easily ignored, once the acute manifestations have subsided. The resultant hemoptysis may thus suggest a more sinister condition, making thorough investigation mandatory. Johnston et al [1] have stressed the importance of bronchoscopy as part of the initial investigation in men over the age of 40 who present with hemoptysis, in view of the increased likelihood of carcinoma. Our patient fell into this category.The difficulty of obtaining an adequate biopsy from the mass, together with the suspicion of malignancy based on cytological evidence, made thoracotomy mandatory. Lobectomy was indicated by the localization of the consolidation to the right lower lobe. The presence of a foreign body accounts for the dysplasia which was thought to be malignancy be...