Cancer incidence in Nigeria: A report from population-based cancer registries
Introduction
Cancer has become a major source of morbidity and mortality globally [1]. In 2008, there were 12.7 million new cases and 7.6 million cancer-related deaths [2]. Most, 56% of these newly reported cancer cases occurred in developing countries and it is projected that by 2030, 70% of all new cases of cancer will be found in developing countries [3]. Most of this increase in incidence is a result of population growth and increased life expectancy [4].
In Nigeria, some 100 000 new cases of cancer occur every year, with high case fatality ratio [2]. With approximately 20% of the population of Africa and slightly more than half the population of West Africa, Nigeria contributed 15% to the estimated 681 000 new cases of cancer that occurred in Africa in 2008 [1]. Similar to the situation in the rest of the developing world, a significant proportion of the increase in incidence of cancer in Nigeria is due to increasing life expectancy, reduced risk of death from infectious diseases, increasing prevalence of smoking, physical inactivity, obesity as well as changing dietary and lifestyle patterns [1].
Despite the threat that cancer poses to public health in sub-Saharan Africa (SSA), few countries in this region have data on cancer incidence [5]. Most of the cancer incidence data in SSA in recent times is based on reports from registries in The Gambia, Zimbabwe and Uganda [5]. These cancer registries have consistently provided incidence data for the last 10–20 years despite the difficulties of sustaining cancer registration in developing countries [6], [7], [8], [9], [10].
In recent times, information on cancer incidence, prevalence and mortality in Nigeria has been based on estimates from case series, medical records, mortality records, hospital based cancer registries and the Ibadan Population Based Cancer Registry (IBCR) [11]. IBCR, located at the University College Hospital Ibadan and set up in 1962, is the first cancer registry in Nigeria. Cancer incidence data from this registry were published for the time periods 1960–1962, 1960–1965, and 1960–1969 in the first three volumes of Cancer Incidence in 5 Continents (CIV). However, due to logistic problems the registry suffered some setbacks from the 1970s to 2000s [12].
Since 2009, the Nigerian Federal Ministry of Health (FMOH) and the Institute of Human Virology Nigeria (IHVN) have initiated a program, the Nigerian National System of Cancer Registries (NSCR) to strengthen existing cancer registries and establish new ones through provision of baseline training for newly established registries; continuing education for older registries; mentoring, computer hardware and software provision and support; data management and analysis. In this paper, we present estimates of cancer incidence in Nigeria based on data from 2 population-based cancer registries in the system. These registries cover defined populations and use multiple source reporting (we discuss the data from the other Nigerian registries in a separate publication).
The Ibadan Cancer Registry is located in one of the oldest cities in Nigeria, Ibadan, a small city in Oyo state, Southwestern Nigeria (Fig. 1). The major ethnic group in this region is Yoruba, one of the largest ethnic groups in Africa. The common religions in this area are Islam and Christianity. The major source of income is agriculture and industries. In contrast, the Abuja Cancer Registry (ABCR) is located in the modern capital city of Abuja Nigeria which is centrally located and home to people of varied ethnic groups and religions (Fig. 1). Abuja is the more developed of the two cities and houses major multinational companies, foreign embassies, the legislative and executive arms of government, and is attractive to young people seeking job opportunities and career advancement.
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Materials and methods
We analyzed data from 2 population based cancer registries in Nigeria, the Ibadan Population Based Cancer Registry (IBCR) and the Abuja Population Based Cancer Registry (ABCR). These registries cover a combined population of 3 955 504 which is approximately 2.5% of the total Nigerian population. Ibadan is located in the South West while Abuja is in the North Central part of the country (Fig. 1). The data in this report covers the period 2009–2010 for both registries.
Both registries use
Ibadan Cancer Registry
The IBCR began in 1960 as a Population Based Cancer Registry. It covers the city of Ibadan and the surrounding 11 local government areas. The registry covers rural and urban populations with a slightly higher proportion in the rural areas. IBCR is a major unit within the department of pathology at the University College Hospital Ibadan. Proactive methods are used for data collection with over 30 sources of notification including general and specialist hospitals, pathology laboratories and
Discussion
Our study shows that the commonest cancers in Nigeria in 2009–2010 were breast and cervical cancer among women and prostate cancer among men. We found significant increase in the incidence of breast cancer compared to historical records while the incidence of cervical cancer was relatively stable. There was very little disparity in the cancer incidence reported by registries in the northern and southern parts of the country regardless of differences in ethnicity and level of urbanization.
Our
Conclusion
We report cancer incidence from 2 regions in Nigeria showing that the most common cancers in women were cancer of the breast and cervix; and cancer of the prostate in Nigerian men. We also report an increase in incidence of breast cancer in recent times. Our study highlights the need for high quality regional cancer registries to serve a large country like Nigeria in order to adequately inform policy and allocation of resources for cancer treatment.
Conflicts of interest statement
The authors declare no conflict of interest.
Acknowledgements
This research was supported by the IHV-UM Capacity Development for Research into AIDS Associated Malignancies (NIH/NCI D43CA153792-01) and IHV-UM AIDS International Training and Research Program (NIH/FIC D43TW001041-11).
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All these authors contributed equally to the writing of this paper. CAA obtained funding and guided all aspects of this report.