Trends in cancer incidence in rural Eastern Cape Province; South Africa, 1998–2012

There are few cancer trend data reported in sub‐Saharan Africa notably due to the scarcity of population‐based cancer registries (PBCRs). The Eastern Cape Province PBCR is amongst the few registries in sub‐Saharan Africa that reports data for a rural population. Trends in cancer incidence are reported for the period 1998–2012. Registered cases, age‐standardized rates (ASRs) and standardized rate ratios are presented for the most common cancers in both males and females in three periods (1998–2002, 2003–2007 and 2008–2012). In males, the most commonly diagnosed cancer during the 15 year period was cancer of the oesophagus; incidence rates showed a significant decline over the 15 year period, entirely due to a 30% decrease between 2003–2007 and 2008–2012, to an ASR of 23.2 per 100,000 population. This was followed by prostate cancer, the incidence of which was more than doubled to a level of 9.9/100,000. In women, cancer of the cervix uteri has become the most common malignancy, with a significant increase in incidence during the period to 29.0/100,000. Oesophageal cancer is second in frequency, with (as in males) a significant decline in the final 10 years to an incidence of 14.5/100,000 in 2008–2012. The incidence of breast cancer increased by 61%, although the absolute rate remains low (12.2/100,000). The incidence rates of colorectal cancer are low, and the increases in incidence, although relatively large (35% in men, 63% in women) were not statistically significant. Kaposi sarcoma showed a dramatic increase in incidence in both sexes (3.5‐fold in men, 11‐fold in women) although the incidence remains relatively low by southern African standards. Cancer prevention and control activities in the area need to be informed by these data and strengthened.     

Trends in the incidence of cancer in the Sousse region,Tunisia, 1993–2006

In this article, we analyzed trends in incidence rates of the major cancer sites for a 14‐year period, 1993–2006, in the Sousse region localized in the centre of Tunisia. Five‐year age‐specific rates, crude incidence rates (CR), world age‐standardized rates (ASR), percent change (PC) and annual percent change (APC) were calculated using annual data on population size and its estimated age structure. A total of 6,975 incident cases of cancer were registered, with a male to‐female sex ratio of 1.4:1. ASRs showed stable trends (?0.1% in males, and +1.0% in females). The leading cancer sites in rank were lung, breast, lymphoma, colon‐rectum, bladder, prostate, leukemia, stomach and cervix uteri. For males, the incidence rates of lung, bladder and prostate cancers remained stable over time. While, cancers of colon‐rectum showed a marked increase in incidence (APC: +4.8%; 95% CI: 1.2%, 8.4%) and non‐Hodgkin's lymphoma (NHL) showed a notable decline (APC: ?4.4%; 95% CI: ?8.2, ?0.6). For females, cancers of the breast (APC: +2.2%; 95% CI: 0.4%, 4.0%) and corpus uteri (APC: +7.4%; 95% CI: 2.8%, 12.0%) showed a marked increase in incidence during the study period, while the cervix uteri cancer decreased significantly (APC: ?6.1%; 95% CI: ?9.2%, ?3.0%). The results underline the increasing importance of cancer as a cause of mortality and morbidity in Tunisia. Our findings justify the need to develop effective program aiming at the control and prevention of the spread of cancer amongst Tunisian population.     

Cancer incidence in eastern Libya: the first report from the Benghazi Cancer Registry, 2003

Cancer registration in Northern Africa is still limited and, until now, there have been no population-based data available for Libya. In this paper, we present the first data collected and analyzed by the Benghazi Cancer Registry. Registration was carried out by active data collection; the registry staff routinely visited all hospitals and pathological laboratories in eastern Libya (1.6 million inhabitants) and collected information from all death registration offices. A huge archive of prevalent cases was established before the 2003 data were collected. A total of 997 cases of primary cancers were registered among residents in 2003. The world age-standardized incidence rate for all sites combined (except nonmelanoma skin) was 118 per 100,000 for men and 95 per 100,000 for women. The most frequently diagnosed malignancies in males were lung cancer (19%) and colorectal cancer (10%), followed by cancers of the head and neck (9%) and bladder (9%). Among females, they were breast cancer (26%), cancer of the colon and rectum (9%), uterus (7%) and non-Hodgkin lymphoma (5%). Our study provides data on cancer incidence in eastern Libya, and confirms that cancer incidence is much lower than in western countries. Moreover, observed patterns indicate that the incidence of many cancers, including those of the lung, breast, colon, rectum and bladder is quite different from previous estimates based on the data available from the neighboring countries.     

Cancer risks in Nairobi (2000–2014) by ethnic group

We investigated the ethnic differences in the risk of several cancers in the population of Nairobi, Kenya, using data from the Nairobi Cancer Registry. The registry records the variable “Tribe” for each case, a categorisation that includes, as well as 22 tribal groups, categories for Kenyans of European and of Asian origin, and non‐Kenyan Africans. Tribes included in the final analysis were Kikuyu, Kamba, Kisii, Kalenjin, Luo, Luhya, Somalis, Asians, non‐Kenyans, Caucasians, Other tribes and unknown. The largest group was taken as the reference category for the calculation of odds ratios; this was African Kenyans (for comparisons by race), and Kikuyus (the tribe with the largest numbers of cancer registrations (38% of the total)) for comparisons between the Kenyan tribes. P‐values are obtained from the Wald test. Cancers that were more common among the white population than in black Kenyans were skin cancers and cancers of the bladder, while cancers that are more common in Kenyan Asians include colorectal, lung, breast, ovary, corpus uteri and non‐Hodgkin lymphoma. Cancers that were less common among Asians and Caucasians were oesophagus, stomach and cervix cancer. Within the African population, there were marked differences in cancer risk by tribe. Among the tribes of Bantu ethnicity, the Kamba had higher risks of melanoma, Kaposi sarcoma, liver and cervix cancer, and lower risks of oesophagus, stomach, corpus uteri and nervous system cancers. Luo and Luhya had much higher odds of Kaposi sarcoma and Burkitt lymphoma.     

Incidence of cancer in Nairobi,Kenya (2004–2008)

Cancer incidence rates are presented for the Nairobi Cancer Registry, a population‐based cancer registry (PBCR) covering the population of the capital city of Kenya (3.2 million inhabitants in 2009). Case finding was by active methods, with standard and checks for accuracy and validity. During the period 2004–2008 a total of 8,982 cases were registered comprising 3,889 men (an age standardized incidence rate (ASR) of 161 per 100,000) and 5,093 women (ASR 231 per 1,00,000). Prostate cancer was the most common cancer in men (ASR 40.6 per 100,000) while breast cancer was the most common among women (ASR 51.7 per 100,000). Cervical cancer ranked the second most common cancer among women in Nairobi with an ASR of 46.1 per 100,000, somewhat lower than those of other registries in East Africa region. Breast and cervical cancers accounted for 44% of all cancers in women. Cancer of the oesophagus was common in both sexes, with a slight excess of cases in men (sex ratio 1.3). Unlike other regions in East Africa, the rate of Kaposi sarcoma was relatively low during the period (men 3.6/100,000; women 2.0/100,000). Although incidence rates cannot be calculated for the early years of the registry, the increase in relative frequency of prostate cancer and declines in frequency of Kaposi sarcoma may indicate underlying trends in the risk of these cancers.     

Childhood cancers in Chennai, India, 1990-2001: incidence and survival

Childhood cancers (age at diagnosis: 0-14 years) comprise a variety of malignancies, with incidence varying worldwide by age, sex, ethnicity and geography, that provide insights into cancer etiology. A total of 1,334 childhood cancers registered in population-based cancer registry, Chennai, India, during 1990-2001 and categorized by International Classification of Childhood Cancer norms formed the study material. Cases included for survival analysis were 1,274 (95.5%). Absolute survival was calculated by actuarial method. Cox proportional hazard model was used to elicit the prognostic factors for survival. The age-standardized rates for all childhood cancers together were 127 per million boys and 88 per million girls. A decreasing trend in incidence rates with increasing 5-year age groups was observed in both sexes. The top 5 childhood cancers were the same among boys and girls: leukemias, lymphomas, central nervous system neoplasms, retinoblastomas and renal tumors. The highest 5-year absolute survival was observed in Hodgkin's disease (65%) followed by Wilm's tumor (64%), retinoblastomas (48%), non-Hodgkin's lymphomas (47%), osteosarcomas (44%), acute lymphoid leukemia and astrocytoma (39%). Multifactorial analysis of age at diagnosis and sex showed no differences in the risk of dying for all childhood cancers. Completeness of treatment and type of hospital combination emerged as a prognostic factor for survival for all childhood cancers together (p < 0.001), acute lymphoid leukemia (p < 0.001) and non-Hodgkin's lymphoma (p = 0.04). A Childhood Cancer Registry with high-resolution data collection is advocated for in-depth analysis of variation in incidence and survival.     

Cancer incidence and mortality: A cohort study in China, 2008–2013

The National Central Cancer Registry of China (NCCR) was the only available source of cancer monitoring in China, even though only about 70% of cancer registration sites were qualified by now. In this study, based on a national large prospective cohort‐the China Kadoorie Biobank (CKB), we aimed to provide additional cancer statistics and compare the difference of cancer burden between urban and rural areas of China. A total of 497,693 cancer‐free participants aged 35–74 years were recruited and successfully followed up from 2004 to 2013 in 5 urban and 5 rural areas across China. Except for traditional registration systems, the national health insurance system and active follow‐up were used to determine new cancer incidents and related deaths. The mortality‐to‐incidence ratio (MIR) was used to compare the differences of cancer burden between urban and rural areas of China. We found that cancer mortality coincided well between our cohort and NCCR, while the incidence was much higher in our cohort. Based on CKB, we found the MIR of all cancers was 0.54 in rural areas, which was approximately one‐third higher than that in urban areas with 0.39. Cancer profiles in urban areas were transiting to Western distributions, which were characterized with high incidences of breast cancer and colorectal cancer; while cancers of the esophagus, liver and cervix uteri were still common in rural areas of China. Our results provide additional cancer statistics of China and demonstrate the differences of cancer burden between urban and rural areas of China.     

Trends in the incidence of cancer in the black population of Harare,Zimbabwe 1991–2010

Incidence rates of different cancers have been calculated for the black population of Harare, Zimbabwe for a 20‐year period (1991–2010) coinciding with continuing social and lifestyle changes, and the peak, and subsequent wane, of the HIV‐AIDS epidemic. The overall risk of cancer increased during the period in both sexes, with rates of cervix and prostate cancers showing particularly dramatic increases (3.3% and 6.4% annually, respectively). By 2004, prostate cancer had become the most common cancer of men. The incidence of cancer of the esophagus, formerly the most common cancer of men, has remained relatively constant, whereas rates of breast and cervix cancers, the most common malignancies of women, have shown significant increases (4.9% and 3.3% annually, respectively). The incidence of Kaposi sarcoma increased to a maximum around 1998–2000 and then declined in all age groups, and in both sexes The incidence of squamous cell cancers of the conjunctiva is relatively high, with temporal trends similar to those of Kaposi sarcoma. Non‐Hodgkin lymphoma, the fifth most common cancer of men and fourth of women, showed a steady increase in incidence throughout the period (6.7–6.9% annually), although rates in young adults (15–39) have decreased since 2001. Cancer control in Zimbabwe, as elsewhere in sub‐Saharan Africa, involves meeting the challenge of emerging cancers associated with westernization of lifestyles (large bowel, breast and prostate), while the incidence of cancers associated with poverty and infection (liver, cervix and esophagus) shows little decline, and the residual burden of the AIDS‐associated cancers remains significant.     

Three‐year cancer incidence in Blantyre,Malawi (2008–2010)

In this paper, we present incidence rates of different cancers calculated for the population of Blantyre, Malawi for the period 2008–2010, using data from the Malawi Cancer Registry. Active methods were used for case finding, with standard checks for accuracy and validity performed in CanReg 4. During this 3‐year period, a total of 3,711 cases were registered comprising 1,643 men (an estimated age‐standardized incidence rate (ASR) of 169.8 per 100,000) and 2,068 women (ASR 238.7 per 10⁵). Kaposi sarcoma (KS) was the most common cancer in men (40.5% of all cancers in men; ASR 54.0 per 10⁵) while cervical cancer was the commonest in women (33.3%; ASR 88.6 per 10⁵). The incidence rates for esophageal cancer remain one of the highest in the world (ASR 30.9 per 100,000 in men, 22.1 per 100,000 in women). Incidence of cancer of the prostate is relatively low in Blantyre (5.1%; ASR 16.4 per 10⁵), compared with elsewhere in Africa. In childhood, the cancer spectrum is dominated by Burkitt lymphoma (32.5% ASR 90.9 per 10⁶) followed by Wilms tumor (11.3%; ASR 35.9 per 10⁶) and pediatric KS (11.0%; ASR 31.1 per 10⁶). The overall percentage of cases with histological verification was 47.5%, a slight improvement from 42.4% in late 1990s also indicating successful case finding outside laboratories.     

Cancer survival in China, 2003–2005: A population‐based study

Limited population‐based cancer registry data available in China until now has hampered efforts to inform cancer control policy. Following extensive efforts to improve the systematic cancer surveillance in this country, we report on the largest pooled analysis of cancer survival data in China to date. Of 21 population‐based cancer registries, data from 17 registries (n = 138,852 cancer records) were included in the final analysis. Cases were diagnosed in 2003–2005 and followed until the end of 2010. Age‐standardized relative survival was calculated using region‐specific life tables for all cancers combined and 26 individual cancers. Estimates were further stratified by sex and geographical area. The age‐standardized 5‐year relative survival for all cancers was 30.9% (95% confidence intervals : 30.6%‐31.2%). Female breast cancer had high survival (73.0%) followed by cancers of the colorectum (47.2%), stomach (27.4%), esophagus (20.9%), with lung and liver cancer having poor survival (16.1% and 10.1%), respectively. Survival for women was generally higher than for men. Survival for rural patients was about half that of their urban counterparts for all cancers combined (21.8% vs. 39.5%); the pattern was similar for individual major cancers except esophageal cancer. The poor population survival rates in China emphasize the urgent need for government policy changes and investment to improve health services. While the causes for the striking urban‐rural disparities observed are not fully understood, increasing access of health service in rural areas and providing basic health‐care to the disadvantaged populations will be essential for reducing this disparity in the future.     

Cancer incidence and cancer control in Mongolia: Results from the National Cancer Registry 2008–12

Mongolia has a high burden from noncommunicable diseases, with cancer now the second leading cause of mortality. Given the paucity of situation analyses from the country, this study reports cancer data based on new cases 2008–12 from the National Cancer Registry of Mongolia covering the entire population (2.87 million). New cancer cases of 21,564 were diagnosed over the 5‐year period, with a slight predominance of cases (52%) in men. Liver cancer was the leading cancer site in both sexes (ASRs of 114.7 and 74.6 per 100,000 males and females), and responsible for almost two‐fifths of all cancer diagnoses, followed by cancers of stomach, lung and oesophagus in men and cervix, stomach and oesophagus in women. The cumulative risk of incidence for all cancers (27.7% and 20.8% in men and women, respectively) positions Mongolia above China (20.2% and 13.3%), below the United States (34.1% and 28.5%) and similar to Russia (26.1% and 19.1%). These figures shed light on the considerable magnitude of cancer in the country and the large fraction of cancers that can be prevented by lifestyle modifications and vaccine implementation. An expansion of activities of the cancer registry and the continued development of research are necessary steps in support of national cancer control planning in Mongolia.     

Cancer incidence in South Asian migrants to England, 1986–2004: Unraveling ethnic from socioeconomic differentials

Studies on cancer in migrants are informative about the relative influence of environmental and genetic factors on cancer risk. This study investigates trends in incidence from colorectal, lung, breast and prostate cancer in England among South Asians and examines the influence of deprivation, a key environmental exposure. South Asian ethnicity was assigned to patients recorded in the population‐based National Cancer Registry of England during 1986–2004, using the computerized algorithm SANGRA: South Asian Names and Groups Recognition Algorithm. Population denominators were derived from population censuses. Multivariable flexible (splines) Poisson models were used to estimate trends and socioeconomic differentials in incidence in South Asians compared to non‐South Asians. Overall, age‐adjusted cancer incidence in South Asians was half that in non‐South Asians but rose over time. Cancer‐specific incidence trends and patterns by age and deprivation differed widely between the two ethnic groups. In contrast to non‐South Asians, lung cancer incidence in South Asians did not fall. Colorectal and breast cancer incidence rose in both groups, more steeply in South Asians though remaining less common than in non‐South Asians. The deprivation gaps in cancer‐specific incidence were much less marked among South Asians, explaining some of the ethnic differences in overall incidence. Although still lower than in non‐South Asians, cancer incidence is rising in South Asians, supporting the concept of transition in cancer incidence among South Asians living in England. Although these trends vary by cancer, they have important implications for both prevention and anticipating health‐care demand.     

Changing cancer incidence in Kampala,Uganda, 1991–2006

Incidence rates of different cancers have been calculated for the population of Kyadondo County (Kampala, Uganda) for a 16‐year period (1991–2006). This period coincides with continuing social and lifestyle changes and the peak and subsequent wane of the epidemic of HIV‐AIDS. There has been an overall increase in the risk of cancer during the period in both sexes, with the incidence rates of cancers of the breast and prostate showing particularly marked increases (4.5% annually). Prostate cancer is now the most common cancer in men. The incidence of cancer of the esophagus, formerly the most common cancer in men and second in frequency in women, has remained relatively constant, whereas the incidence of cancer of the cervix, the most common malignancy in women, continues to increase. Since the early 1990s the incidence of Kaposi sarcoma (KS) in men has declined, and while remaining relatively constant in women, it has been diagnosed at progressively later ages. The rates of pediatric KS have declined by about 1/3rd. The incidence of squamous cell cancers of the conjunctiva has also declined since the mid 1990s. Cancer control in Uganda, as elsewhere in sub‐Saharan Africa, involves meeting the challenge of emerging cancers associated with westernization of lifestyles (large bowel, breast and prostate); although the incidence of cancers associated with poverty and infection (liver, cervix, esophagus) shows little decline, the residual burden of the AIDS‐associated cancers remains a major burden.     

Childhood cancer incidence and survival in Japan and England: A population‐based study (1993‐2010)

The present study aimed to compare cancer incidence and trends in survival for children diagnosed in Japan and England, using population‐based cancer registry data. The analysis was based on 5192 children with cancer (age 0‐14 years) from 6 prefectural cancer registries in Japan and 21 295 children diagnosed in England during 1993‐2010. Differences in incidence rates between the 2 countries were measured with Poisson regression models. Overall survival was estimated using the Kaplan–Meier method. Incidence rates for Hodgkin lymphoma, renal tumors and Ewing sarcomas in England were more than twice as high as those in Japan. Incidence of germ cell tumors, hepatic tumors, neuroblastoma and acute myeloid leukemia (AML) was higher in Japan than in England. Incidence of all cancers combined decreased in Japan throughout the period 1993 to 2010, which was mainly explained by a decrease in registration of neuroblastoma in infants. For many cancers, 5‐year survival improved in both countries. The improvement in survival in chronic myeloid leukemia (CML) was particularly dramatic in both countries. However, 5‐year survival remained less than 80% in 2005‐2008 in both countries for AML, brain tumors, soft tissue sarcomas, malignant bone tumors and neuroblastoma (age 1‐14 years). There were significant differences in incidence of several cancers between countries, suggesting variation in genetic susceptibility and possibly environmental factors. The decrease in incidence for all cancers combined in Japan was related to the cessation of the national screening program for neuroblastoma. The large improvement in survival in CML coincided with the introduction of effective therapy (imatinib).     

Trends in the incidence of cancer in Kampala,Uganda 1991–2010

The Kampala cancer registry is the longest established in Africa. Trends in incidence rates for a 20‐year period (1991–2010) for Kyadondo County (Kampala city and a rural hinterland) illustrate the effects of changing lifestyles in urban Africa, and the effects of the epidemic of HIV‐AIDS. There has been an overall increase in the risk of cancer during the period in both sexes, with incidence rates of major cancers such as breast and prostate showing particularly marked increases (3.7% and 5.2% annually, respectively). In the 1960s cancer of the oesophagus was the most common cancer of men (and second in women), and incidence in the last 20 years has not declined. Cancer of the cervix, always the most frequent cancer of women, has shown an increase over the period (1.8% per year), although the rates appear to have declined in the last 4 years. HIV prevalence in adults in Uganda fell from a maximum in 1992 to a minimum (about 6%) in 2004, and has risen a little subsequently, while availability of antiretroviral drugs has risen sharply in recent years. Incidence of Kaposi sarcoma in men fell until about 2002, and has been relatively constant since then, while in women there has been a continuing decline since 2000. Other HIV related cancers—non‐Hodgkin lymphoma of younger adults, and squamous cell carcinoma of conjunctiva—have shown major increases in incidence, although the former (NHL) has shown a small decline in incidence in the most recent 2 years.     

中国部分市县1998～2002年肺癌的发病与死亡

[目的]探讨中国居民肺癌的发病、死亡流行特征。[方法]分析中国30个肿瘤登记处1998-2002年肺癌登记资料。[结果]肺癌新病例69597例，死亡病例61090例。肺癌世界人口调整发病率介于116．9／10万～9．9／10万之间。肺癌世界人口调整死亡率介于43．9／10万～8．1／10万之间。[结论]肺癌是威胁我国居民身体健康的主要恶性肿瘤，应作为当前肿瘤防治工作的重点。     

中国部分市县1998～2002年食管癌发病与死亡

[目的]探讨中国居民食管癌的发病和死亡特征。[方法]分析中国30个肿瘤登记处1998～2002年食管癌登记资料。[结果]食管癌新病例38339例，死亡30116例。食管癌粗发病率在0.3/10万～115.1/10万之间，世界人口调整发病率在0.3/10万～132.7/10万之间。食管癌粗死亡率在1.3/10万～90.9/10万之间，世界人口调整死亡率在2.7/10万～110.6/10万之间。[结论]各地的食管癌发病率差异较大。在不少地区尤其是农村，食管癌是严重威胁居民健康的主要恶性肿瘤，应积极开展防治工作。     

中国部分市县1998～2002年恶性肿瘤的发病与死亡

[目的]探讨中国人群肿瘤发病、死亡的流行特征.[方法]分析中国30个肿瘤登记处1998～2002年的肿瘤登记资料.[结果]全国30个肿瘤登记处覆盖人口37813997人,覆盖3.04%的全国人口.1998～2002年新病例386 910例,死亡病例266 033例.世界年龄结构调整恶性肿瘤发病率在78.4/10万～623.8/10万间;世界人口调整死亡率在78.9/10万～260.1/10万之间.[结论]中国最常见的恶性肿瘤,男性为肺癌、胃癌、肝癌和食管癌;女性为乳腺癌、食管癌、胃癌、肺癌、肝癌和子宫颈癌.