Cancer cases on the rise in Zim

Lifestyle

Sifelani Tsiko
Cancer is on the rise in Zimbabwe - especially those linked to bad habits associated with the modern lifestyle, infections including smoking and eating too much.

According to the latest available figures of the Zimbabwe National Cancer Registry (ZNCR) from two years ago, 7 018 people were diagnosed with cancer, up from 6 548 in 2013.

This marks an increase of nearly 7 per cent. One of the major drivers for these numbers, said registrar of the Zimbabwe National Cancer Registry Eric Chokunonga, are infections.

The ZNCR is the country's leading cancer research and documentation centre.

"In Zimbabwe, just like in most other developing countries, the majority of our cancers are infection – related in general,” Chokunonga said.

“Most of the cancers are “lifestyle cancers” and related more to diet, smoking and drinking.”

Concurred Dr Ntokozo Ndlovu, an oncologist, in an interview with Zimpapers Syndication: “We now know the causes of cancers. Most of them are infection – related and are also largely due to our lifestyles – smoking, environmental pollution and our high fat and high sugar diet.

“Our population is becoming more obese and sedentary. HIV is still with us and it’s also driving up cancers.”

The total number of new cancer cases recorded among Zimbabweans in 2014 was 7 018 comprising 2 981 (42.5%) males and 4 037 (57.5%) females.

Harare recorded the highest figures with a total of 2 557 malignant tumours in 2014. These comprised 1 195 (46.7%) males and 1 362 (53.3%) females.

According to the latest available figures, the most frequently occurring cancers among Zimbabweans of all races in 2014 were cervix uteri (19%), prostate (9%), breast (7%), Kaposi sarcoma (7%), non-Hodgkin lymphoma (6%), non-melanoma skin cancer (6%), oesophagus (5%), liver (4%), colo-rectal (4%).

The other cancers accounted for 33% of the registered cancers.

The leading cause of cancer among Zimbabwean black men in 2014 was prostate cancer (23.1%). This was followed by Kaposi sarcoma (KS) (11.5%), non-Hodgkin lymphoma (NHL) (7.8%), oesophagus (6.9%), liver (6.3%), stomach (4.1%), eye (3.6%), non-melanoma skin cancer (3.5%), lung (3.2%), and colon (2.2%).

In Zimbabwean black women, the most common cancers were cervical cancer (35.5%), breast (11.8%), NHL (4.8%), KS (4.3%), oesophagus (3.7%), stomach (2.9%) eye (2.9%), non-melanoma skin cancer (2.8%) liver (2.6%) and ovary (2.4%).

Non-melanoma skin cancer was the most frequent cancer among Zimbabwean non-black men (54.4%) in 2014.

This was followed by colon (6.5%), prostate (5.7%), melanoma of skin cancer (4.2%), bladder (4.2%), rectum (2.3%), non-Hodgkin lymphoma (1.9%), lung (1.9%), kidney (1.5%) and brain and nervous system (1.5%).

The leading cancers in non-black Zimbabwean women were non-melanoma skin cancer (41.7%), breast (17.7%), non-Hodgkin lymphoma (4.3%), lung (3.5%), melanoma of skin cancer (3.5%), cervix uteri (2.8%), bladder (2.8%), colon (2.8%), brain, nervous system (2.4%) and ovary (2.0%).

Chokunonga said, as in other countries in the developing world, the majority of cancers in Zimbabwe are related to infections such as HPV (cervical cancer), HIV (Kaposi sarcoma, non-Hodgkin lymphoma and squamous cell carcinoma of the conjunctiva), Hepatitis B and C (liver cancer) and bladder cancer (schistosomiasis).

A total of 252 childhood cancers (age 0-14) of all races were registered in 2014. These comprised 147 (58.3%) boys and 105 (41.7%) girls. Paediatric cancers represented 3.6% of all the cancers recorded in 2014, according to the ZNCR.

Cancer experts say although childhood cancers (age 0-14) are a rare condition worldwide, the incidence in Zimbabwe is rather high.

These cancers accounted for more than 3% of all the cancers recorded in 2014. HIV-related paediatric Kaposi sarcoma is one of the leading soft tissue tumours in both males and females.

Cancer is now a major killer in Zimbabwe and a total of 2 474 cancer deaths comprising 1 192 (48.2%) males and 1 282 (51.8%) females were recorded in Harare and Bulawayo in 2014.

The leading causes of the deaths were cervical cancer (12%), prostate (10%), liver (8%), oesophagus (8%), breast (7%), non-Hodgkin lymphoma (6%), Kaposi sarcoma (6%) stomach (4%), lung (4%).

The other cancers constituted 35% of the recorded deaths, according to the 2014 ZNCR report.

A total of 126 childhood cancer deaths were recorded in 2014. These consisted of 76 (60.3%) boys and 50 (39.7%) girls.

Leukemias, which are cancers of the bone marrow and blood, are the most common childhood cancers.

The leading causes of mortality among children in Zimbabwe were: leukaemia (21%), lymphoma (14%), tumours of the brain and nervous system (14%), renal tumours (12%), soft tissue tumours (11%), bone tumours (6%). The other cancers constituted 22% of the deaths.

The collection of cancer data has improved significantly in Zimbabwe and the registry has expanded its sources to the Island Hospice and Healthcare, the Cancer Association of Zimbabwe (CAZ), Kidzcan Zimbabwe and the Premier Services Clinical Laboratories.

ZNCR documentation staff visited these institutions and facilities to gather data manually and electronically.

The registry now handles over 10 000 notifications each year.

“The report is much better now and national coverage has improved significantly,” said Chokunonga. “Our data collection system is improving and we want to continuously improve to help our decision-makers to make informed decisions.”

Said Dr Ndlovu, also an advisor to the ZNCR: “Our cancer registry is doing a sterling job. We need to raise awareness of the gravity of the cancer problem in our country. Increased awareness and increased diagnosis is what we hope to achieve.

“More cancers are still recorded outside the registry and we want to improve our coverage so that we can get a more accurate picture of the burden of the disease in Zimbabwe.”

Cancer experts say the most notable observation in the data for 2014 is the striking increase in the incidence of prostate cancer.

“Cancer of the prostate is now by far the leading cause of cancer among Zimbabwean males. It was also the second leading cause of cancer mortality after cervical cancer in 2014,” the registry said.

“As observed in recent reports, the continuing dramatic increase in the incidence of this tumour warrants serious epidemiological investigation.”

The incidence of HIV-related Kaposi sarcoma (KS) continues to decline. The incidence of KS was half that of prostate cancer among Zimbabwean males in 2014.

“It is important to note that other than these two cancers (prostate and KS), the pattern of occurrence of cancer has hardly changed in recent years,” the report further noted.

In Zimbabwe and most other African countries, cancer services are failing to meet growing demand due to lack of adequate equipment, decades of under-investment alongside outdated practices which have reduced survival rates for patients on the continent.

Cancer treatment and care is lagging behind the rest of the world due to poor investment in cancer technology and laboratory infrastructure.

In addition, oncologists bemoan that the poor are still far more likely to get cancer than the rich and their chances of survival are lower too.

Furthermore, they say, there are too many variations in the quality of care and treatment across Africa, leaving cancer patients frustrated by poor service delivery and lack of laboratory infrastructure.

According to the World Health Organisation’s International Agency for Research on Cancer (IARC) the global death toll from cancer rose to 8,2 million, and breast cancer killed 522,000 women, in 2012.

A total of 14,1 million adults in the world were diagnosed with cancer in 2012 while out of this there were 8,2 million deaths from cancer worldwide in this period.

Africa and most other developing countries continue to record high cancer deaths because the disease is often not detected and diagnosed early enough due to a lack of screening and access to treatment.

Cervical cancer, for example, kills hundreds of thousands of women in Africa each year but can be largely avoided with a vaccine or successfully treated if it is detected early enough.

In Zimbabwe, cancer is now the second biggest killer disease after HIV and official health figures indicate that the disease is killing at least 1 500 every year.

Out of this figure, 80 percent of the victims visit health institutions late for treatment when the disease is already at an advanced stage. Oncologists in Zimbabwe attributed this to either poverty or lack of knowledge about the disease.

In sub-Saharan Africa, 34,8 new cases of cervical cancer are diagnosed per 100,000 women annually, and 22,5 women per 100,000 die from the disease while the rates stood at 6,6 and 2,5 per 100,000 women respectively in North America.

Cancer experts say Africa needs to scale up strategies for tackling cancer by increasing the number of healthcare personnel, providing more equipment for cancer care and modernising cancer treatment and care to meet global standards. -Zimpapers Syndication

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Cancer cases on the rise in Zim

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