Cancer burden in Africa and opportunities for prevention

Cancer is an emerging public health problem in Africa. About 715,000 new cancer cases and 542,000 cancer deaths occurred in 2008 on the continent, with these numbers expected to double in the next 20 years simply because of the aging and growth of the population. Furthermore, cancers such as lung, female breast, and prostate cancers are diagnosed at much higher frequencies than in the past because of changes in lifestyle factors and detection practices associated with urbanization and economic development. Breast cancer in women and prostate cancer in men have now become the most commonly diagnosed cancers in many Sub-Saharan African countries, replacing cervical and liver cancers. In most African countries, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This paper reviews the current patterns of cancer in Africa and the opportunities for reducing the burden through the application of resource level interventions, including implementation of vaccinations for liver and cervical cancers, tobacco control policies for smoking-related cancers, and low-tech early detection methods for cervical cancer, as well as pain relief at the palliative stage of cancer. Cancer 2012. © 2012 American Cancer Society.[1]

The Global Burden of Cancer 2013

Importance  Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies.

Objective  To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013.

Evidence Review  The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs.

Findings  In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries.

Conclusions and Relevance  Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.[2]

Cancer burden in the aged 

Sixty percent of all cancer occurs in persons aged ≥65 years. This article provides an overview of aspects of the burden of cancer in the elderly, highlighting certain demographic and epidemiologic data. It served as a frame of reference for participants in the Oncology Geriatric Education Retreat, San Juan, Puerto Rico, February 21-26, 1997. Information comes from several major sources: U. S. Bureau of the Census; National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program; National Center for Health Statistics; National Institute on Aging (NIA)/NCI SEER Study on Comorbidity and Cancer in the Elderly; and NCI cancer prevalence estimates. Data on the aging population demonstrate an unprecedented expansion of the segment of the population aged ≥65 years. By 2030, 1 in 5 Americans will be aged ≥65 years. Because cancer incidence and mortality rates are highest in persons aged ≥65 years, expansion of this age group takes on great importance for medical professionals who provide treatment to older aged cancer patients. In addition, older aged cancer patients are likely to have preexisting conditions at diagnosis, creating a special clinical challenge. There is an urgent need to better understand the influence of aging on the early detection, diagnosis, and treatment of cancer. Clinicians who treat older persons (geriatricians, oncologists, and other health professionals) can benefit from the integration of the knowledge and approaches of each others’ fields. The foundation for this multidisciplinary effort is linked with the education and training of future clinicians.[3]

Burden and Pattern of Cancer in the Sudan, 2000-2006

Aims: The aim of this study is to determine the number of newly diagnosed cancer cases and their distribution in two cancer-care providing facilities in Sudan.

Study Design: This is a retrospective descriptive study.

Methodology: Data was retrieved from patients’ records that were diagnosed and treated at the Radiation Isotope Center in Khartoum (RICK) and National Cancer Institute at Wadmadani (NCI -UG) in Sudan over the period between 2000 and 2006 and then statistically analyzed.

Results: A total of 26652 cancer cases were retrieved with a noticeable increase in numbers from year 2000 to 2006. The maximum cancer number was observed in 45-64 year age group in both male and female patients with a male to female ratio of 1.3:1.0. The most common cancer sites for females were: the breast (29.3%), cervix uteri (8.2%), leukemia (7.2%), ovary (6.8%), and esophagus (5.9%) and for males: were prostate (7.6%), followed by leukemia, (7.0%), NHL (6.8%), esophagus (5.4%) and bladder (4.4), while leukemia (25.2%), NHL (12.4%), lymphoma (10.8%), retinoblastoma (6.6%) and brain tumors (3.3%) dominated in younger patients (<14 years old).

Conclusions: This study provided some knowledge about the cancer situation in two institutions providing cancer care in Sudan that may draw attention of policy maker and aid in formulating appropriate cancer-control strategies in the country.[4]

Knowledge and Screening Practices of Cervical Cancer among Pregnant Women Attending Antenatal Clinic in Tertiary Hospitals in Enugu, South-Eastern Nigeria

Introduction: The burden of cervical cancer is more in developing world where it is a major killer among reproductive age group. Available evidence suggests factors responsible for this escalating mortality among Nigerian women as lack of awareness and poor use of early detection measures.

Materials and Methods: This study examined the knowledge and screening practices of cervical cancer among women attending antenatal clinics in tertiary hospitals in Enugu. The study utilized descriptive cross sectional design. A sample size of 250 pregnant women was proportionately selected from each study setting and convenience sampling used to select respondents for the study. Data was collected through researcher’s developed questionnaire. Descriptive statistics was used for the analysis of data collected and chi-square statistics was utilized to test the hypotheses at significance level of 0.05.

Results: There is poor knowledge of cervical cancer among pregnant women as only 8.1% knew that cervical cancer is caused by human papilloma virus and 39.5% identified pap smear as screening test. There is poor uptake of cervical cancer screening as only 2.8% had carried out screening test. Poor access to health education and invasion of patients’ privacy was the major factors that impaired the utilization of cervical cancer screening. There was no significance relationship between knowledge and practice of cervical cancer screening (P>0.24) and also between level of education and cervical cancer screening practices (P>0.14).

Conclusion: It was recommended that health stakeholders should intensify health education to reawaken the women’s consciousness on the importance of cervical cancer screening practices.[5]

Reference

[1] Jemal, A., Bray, F., Forman, D., O’Brien, M., Ferlay, J., Center, M. and Parkin, D.M., 2012. Cancer burden in Africa and opportunities for prevention. Cancer, 118(18), pp.4372-4384.

[2] Fitzmaurice, C., Dicker, D., Pain, A., Hamavid, H., Moradi-Lakeh, M., MacIntyre, M.F., Allen, C., Hansen, G., Woodbrook, R., Wolfe, C. and Hamadeh, R.R., 2015. The global burden of cancer 2013. JAMA oncology, 1(4), pp.505-527.

[3] Yancik, R., 1997. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer: Interdisciplinary International Journal of the American Cancer Society, 80(7), pp.1273-1283.

[4] Mohammed, M.E., Hassan, A.M., Elsadig, M.G., Adam, D.M., Abdelhadi, H.A., Elmamoun, K., Hamid, R., Elias, H., Abdallah, M., Abdelkarim, Z. and Elwali, N.E., 2014. Burden and pattern of cancer in the Sudan, 2000-2006. Journal of Advances in Medicine and Medical Research, pp.1231-1243.

[5] Ingwu, J.A., 2016. Knowledge and screening practices of cervical cancer among pregnant women attending antenatal clinic in tertiary hospitals in Enugu, South-Eastern Nigeria. Journal of Cancer and Tumor International, pp.1-9.

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