Background: Cancer remains an under-recognized health condition throughout most of Africa, and improved surveillance systems for determining cancer incidence, mortality, and prevalence of risk factors are in dire need. Collection of epidemiologic data through cancer registration is the first step in positioning a population to address its cancer burden.
Currently, only 11% of the population on the African continent is covered by cancer registries many of which are of suboptimal quality.
In 2010, Tanzania Cancer Registry Steering Committee was formed to begin to address these surveillance issues in Tanzania with the aim to rebuild a population based cancer registry in Dar-es-salaam.
On July 1st, 2014, Cancer Registry Program was established at Aga Khan Health Services, Tanzania.
The projected cancer burden in Tanzania demands a comprehensive surveillance strategy in developing a population based cancer registry in a private hospital setting and a national setting in order to understand and compare the cancer cases seen at both institutions.
Purpose: To understand the cancer cases seen in a private hospital setting in East Africa and to compare this with the national cancer registry data.
Method: Cancer Registry Program was established on July 1st, 2014, at Aga Khan Health Services, Tanzania (AKHST), a private, non-profit organization located in Dares Salaam. Initial 389 cases were captured, and compared this with the government’s cancer registry data to know the difference.
Results: Top three cancers in male were Prostate, Colorectal, and Non-Hodgkin’s lymphoma. Top three cancers in females were Breast, Cervix and Colorectal Cancers. Most common age group was between 50 and 69 years, accounting for 48% of all cases. This is older than the median age recorded in cancer cases in Tanzania.
Findings: Breast Cancer was the most common in women, and prostate cancer in men. Most (61%) of all cases were stage III/IV. Fewer Kaposi Sarcoma and Cervical Cancers seen in our private hospital, as compared to that noted in National Cancer registry, is secondarily to higher socioeconomic status, noted in the patients visiting our hospital. It has been noted somewhat older patients than that seen in our national cancer registry, similar to that seen in the west. However, most of the cases were advanced; 33% were stage IV, and 28% were stage III. Advanced cancers are also seen in other areas of East Africa as well. Only a few (<10%) were picked up via cancer screening methods, the rest, being picked up due to physical findings or symptoms, necessitating workup. Cancer prevention and screening East Africa are mainstay in future control of the potential cancer epidemic expected in the years ahead.
Report: Nearly 60% of all cancers seen were treated with chemotherapy; surgery was offered to 34% of cases, whereas radiotherapy was received by 15% of all patients. Some 22% of our patients were treated with supportive/palliative care only.
It was found that esophageal cancers, Kaposi sarcoma, and lymphomas, were fewer those reported elsewhere in the region. This is owing to fewer seropositive cases we see, and better socioeconomic and education levels of patients we see in our private hospital. And lung cancer, reported high globally, were also fewer. This was similar to the other cancer centers here, and we think that this is because of lower tobacco consumption here in East Africa. Also, this might however change over time, as the flow of tobacco consumption into this region is expected to raise. So the raise in tobacco related malignancies in East Africa is just a matter of time.
However, chewing tobacco is quite common and 6% of all cancers, both in men and women, were head and neck cancers. In some recently conducted cancer screening camps in various regions conducted by the hospital, in collaboration of the Ismaili community, we did include buccal cancer screening and used the opportunity to counsel the patients against the hazards of tobacco use.
A relatively more percentage of colorectal cancers are seen (25% on men, and 18% in women) in our hospital as compared to the government hospitals; thanks to our robust Gastroenterology services. The better socio-economic status leading to life style modification as potential risk factor to colorectal cancers might be another reason. We’ve recently concluded colorectal cancer screening in a community in Dar, with stool for blood test checking. This camp also screened for other cancers, including prostate, cervix, breast and mouth/buccal.
There were 3% myelomas, 5% lymphomas, 5% sarcomas, and 7% lymphomas noted in our pathology breakdown. Nearly 78% were carcinomas. I would have expected to see more KS and HIV related lymphomas, but the truth is we see fewer HIV related malignancies that the government hospitals. That reflects on better economical and education levels of the patients seen in this private hospital.
Leukemias/Myelomas were high, 14% in men and 15% in women. This might be explainable to better laboratory capacity we have at the Aga Khan Hospital.