Cancer is an under-emphasised issue in Africa, partly because of the overwhelming burden of communicable diseases. However cancer is a common disease in Africa with 650 000 people, of a population of 965 million, diagnosed annually. Furthermore, the lifetime risk in females (between 0 and 64 years) of cancer is about 10%, which is only about 30% lower than the risk in developed countries. In females, the lifetime risk of dying from cancer in Africa is almost double the risk in developed countries. This Review is the first of two papers and focuses on the current knowledge of the distribution and trends of the most common cancers in Africa. The cancers with the highest incidence are cervical, breast, and now HIV-associated Kaposi's sarcoma. The top five cancers in males--Kaposi's sarcoma (constituting 12.9% of all cancers in males) and cancer of the liver (14.8%), prostate (9.5%), bladder (6.1%), and non-Hodgkin lymphoma (5.7%)--and in females--cancer of the cervix (constituting 23.3% of all cancers in females) and breast (19.2%), Kaposi's sarcoma (5.1%), cancer of the liver (5.0%), and non-Hodgkin lymphoma (3.7%)--are discussed in detail. The second paper will focus on the causes and control of cancer in Africa. The cancer burden in Africa is likely to increase as a result of increases in HIV-associated cancers, changes in lifestyles associated with economic development, and the increasing age of the population (despite AIDS). Although the knowledge of cancer in this region is improving, better surveillance of cancer incidence, mortality, and prevalence of risk factors is urgently needed to monitor the development of the cancer epidemic, formulate appropriate cancer-control strategies, and assess the outcomes of these strategies.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(08)70175-X.pdf

Part I: Cancer in Indigenous Africans—burden, distribution, and trends

Introduction Prostate cancer is the most frequently diagnosed non-skin cancer in the United States and the third leading cause of cancer deaths International trends in the incidence, mortality and prevalence of prostate cancer are assessed Methods Databases from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute and the International Agency for Research on Cancer (IARC), and the literature on autopsy studies on prostate cancer were reviewed and summarized in the article Results Prostate cancer remains an important public health concern in Western countries and an emerging malignancy in developing nations Prostate cancer incidence is dependent on efforts to detect the disease Autopsy studies provide accurate and useful information regarding comparative prevalence rates of the disease among regions of interest Conclusions Improved cancer registration is needed in developing nations The prevalence of prostate cancer must be established to predict the expected incidence of the disease and in order to plan rational detection and treatment strategies Clinically significant disease should be distinguished from insignificant disease which may pose little or no biological danger to the patient

The Worldwide Epidemiology of Prostate Cancer: Perspectives from Autopsy Studies

Socioeconomic factors are associated with cancer incidence through complex and variable pathways. We assessed cancer incidence for all cancers combined and 27 major types according to national human development levels. Using GLOBOCAN data for 184 countries, age-standardized incidence rates (ASRs) were assessed by four levels (low, medium, high, very high) of the Human Development Index (HDI), a composite index of life expectancy, education, and gross national income. A strong positive relationship between overall cancer incidence and HDI level was observed. When comparing the ASR in very high HDI regions with that in low HDI regions, we observed a positive association ranging from 2 to 14 and 2 to 11 times higher in males and females, respectively, depending on the cancer type. Positive dose–response relationships between the ASR and HDI level were observed in both sexes for the following cancer types: lung, pancreas, leukemia, gallbladder, colorectum, brain/nervous system, kidney, multiple myeloma, and thyroid. Positive associations were also observed for testicular, bladder, lip/oral cavity, and other pharyngeal cancers, Hodgkin lymphoma, and melanoma of the skin in males, and corpus uteri, breast, and ovarian cancers and non-Hodgkin lymphoma in females. A negative dose–response relationship was observed for cervical and other pharyngeal cancers and Kaposi sarcoma in females. Although the relationship between incidence and the HDI remained when assessed at the country-specific level, variations in risk within HDI levels were also observed. We highlight positive and negative associations between incidence and human development for most cancers, which will aid the planning of cancer control priorities among countries undergoing human development transitions.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.30382

A global view on cancer incidence and national levels of the human development index.

Aims: This review examines the links between human development and cancer overall and for specific types of cancer, as well as cancer-related risk-factors and outcomes, such as disability and life ...

The global cancer burden and human development: A review:

Prostate cancer screening is a fait acomplis in the United States at this time. Regardless of whether it is justifiable from a scientific standpoint, it is occurring. The evidence for this statement can be found in the incidence rates of prostate cancer before and after the advent of prostate-specific antigen (PSA) screening. Figure 1 graphically demonstrates this phenomenon. PSA became widely available in 1987–1988, and screening for prostate cancer increased dramatically shortly thereafter.

/pdf/screening-for-prostate-cancer-43ghjome4a.pdf

Nicolas B. Delongchamps

Papers

Epidemiology of Prostate Cancer in Africa: Another Step in the Understanding of the Disease?