Patricia Kellett

The incidence and body site of skin cancers in the population groups of South Africa.

Data regarding basal cell carcinoma (BCC), squamous cell carcinoma of the skin (SSCC) and cutaneous melanoma (CM) in multiracial populations are sparse. Here the incidence and body site of these tumours in the South African population in 2000–2004 were analysed.

Racial Comparison of Receptor-Defined Breast Cancer in Southern African Women: Subtype Prevalence and Age–Incidence Analysis of Nationwide Cancer Registry Data

Background: Receptor-defined breast cancer proportions vary across Africa. They have important implications for survival prospects and research priorities. Methods: We studied estrogen receptor (ER), progesterone receptor (PR), and HER2 receptor statuses in two multiracial Southern African countries with routine diagnostic immunohistochemistry. A total of 12,361 women with histologically confirmed breast cancer diagnosed at age ≥20 years during (i) 2009–2011 from South Africas national cancer registry (public sector) and (ii) 2011–2013 from Namibias only cancer hospital were included. Crude, age, and age + laboratory–adjusted ORs of receptor status were analyzed using logistic regression, and age–incidence curves were analyzed using Poisson regression. Results: A total of 10,047 (81%) women had known ER status. Ranking of subtypes was consistent across races: ER+/PR+HER2− was most common (race-specific percentage range, 54.6%–64.8%), followed by triple-negative (17.4%–21.9%), ER+/PR+HER2+ (9.6%–13.9%), and ER−PR−HER2+ (7.8%–10.9%). Percentages in black versus white women were 33.8% [95% confidence (CI), 32.5–35.0] versus 26.0% (24.0–27.9) ER−; 20.9% (19.7–22.1) versus 17.5% (15.4–19.6) triple-negative; and 10.7% (9.8–11.6) versus 7.8% (6.3–9.3) ER−PR−HER2+. Indian/Asian and mixed-ancestry women had intermediate values. Age–incidence curves had similar shapes across races: rates increased by 12.7% per year (12.2–13.1) across ER subtypes under the age of 50 years, and thereafter slowed for ER+ (1.95%) and plateaued for ER− disease (−0.1%). Conclusions: ER+ breast cancer dominates in all Southern African races, but black women have a modest excess of aggressive subtypes. Impact: On the basis of the predominant receptor-defined breast tumors in Southern Africa, improving survival for the growing breast cancer burden should be achievable through earlier diagnosis and appropriate treatment. Cancer Epidemiol Biomarkers Prev; 23(11); 2311–21. ©2014 AACR.

Childhood cancer incidence patterns by race, sex and age for 2000-2006: a report from the South African National Cancer Registry.

Higher childhood cancer incidence rates are generally reported for high income countries although high quality information on descriptive patterns of childhood cancer incidence for low or middle income countries is limited, particularly in Sub‐Saharan Africa. There is a need to quantify global differences by cancer types, and to investigate whether they reflect true incidence differences or can be attributed to under‐diagnosis or under‐reporting. For the first time, we describe childhood cancer data reported to the pathology report‐based National Cancer Registry of South Africa in 2000–2006 and compare our results to incidence data from Germany, a high income country. The overall age‐standardized incidence rate (ASR) for South Africa in 2000–2006 was 45.7 per million children. We observed substantial differences by cancer types within South Africa by racial group; ASRs tended to be 3–4‐fold higher in South African Whites compared to Blacks. ASRs among both Black and White South Africans were generally lower than those from Germany with the greatest differences observed between the Black population in South Africa and Germany, although there was marked variation between cancer types. Age‐specific rates were particularly low comparing South African Whites and Blacks with German infants. Overall, patterns across South African population groups and in comparison to Germans were similar for boys and girls. Genetic and environmental reasons may probably explain rather a small proportion of the observed differences. More research is needed to understand the extent to which under‐ascertainment and under‐diagnosis of childhood cancers drives differences in observed rates.

South African National Cancer Registry: Effect of withheld data from private health systems on cancer incidence estimates

BACKGROUND The National Cancer Registry (NCR) was established as a pathology-based cancer reporting system. From 2005 to 2007, private health laboratories withheld cancer reports owing to concerns regarding voluntary sharing of patient data. OBJECTIVES To estimate the impact of under-reported cancer data from private health laboratories. METHODS A linear regression analysis was conducted to project expected cancer cases for 2005-2007. Differences between actual and projected figures were calculated to estimate percentage under-reporting. RESULTS The projected NCR case total varied from 53,407 (3.8% net increase from actual cases reported) in 2005 to 54,823 (3.7% net increase) in 2007. The projected number of reported cases from private laboratories in 2005 was 26,359 (19.7% net increase from actual cases reported), 27,012 (18.8% net increase) in 2006 and 27,666 (28.4% net increase) in 2007. CONCLUSION While private healthcare reporting decreased by 28% from 2005 to 2007, this represented a minimal impact on overall cancer reporting (net decrease of <4%).

Erratum to “Prostate Cancer in South Africa: Pathology Based National Cancer Registry Data (1986–2006) and Mortality Rates (1997–2009)”

Prostate cancer is one of the most common male cancers globally; however little is known about prostate cancer in Africa. Incidence data for prostate cancer in South Africa (SA) from the pathology based National Cancer Registry (1986–2006) and data on mortality (1997–2009) from Statistics SA were analysed. World standard population denominators were used to calculate age specific incidence and mortality rates (ASIR and ASMR) using the direct method. Prostate cancer was the most common male cancer in all SA population groups (excluding basal cell carcinoma). There are large disparities in the ASIR between black, white, coloured, and Asian/Indian populations: 19, 65, 46, and 19 per 100 000, respectively, and ASMR was 11, 7, 52, and 6 per 100 000, respectively. Prostate cancer was the second leading cause of cancer death, accounting for around 13% of male deaths from a cancer. The average age at diagnosis was 68 years and 74 years at death. For SA the ASIR increased from 16.8 in 1986 to 30.8 in 2006, while the ASMR increased from 12.3 in 1997 to 16.7 in 2009. There has been a steady increase of incidence and mortality from prostate cancer in SA.

Establishment of a cancer surveillance programme : the South African experience

Cancer is projected to become a leading cause of morbidity and mortality in low-income and middle-income countries in the future. However, cancer incidence in South Africa is largely under-reported because of a lack of nationwide cancer surveillance networks. We describe present cancer surveillance activities in South Africa, and use the International Agency for Research on Cancer framework to propose the development of four population-based cancer registries in South Africa. These registries will represent the ethnic and geographical diversity of the country. We also provide an update on a cancer surveillance pilot programme in the Ekurhuleni Metropolitan District, and the successes and challenges in the implementation of the IARC framework in a local context. We examine the development of a comprehensive cancer surveillance system in a middle-income country, which might serve to assist other countries in establishing population-based cancer registries in a resource-constrained environment.

Hematologic malignancies in South Africa 2000-2006: analysis of data reported to the National Cancer Registry.

Little is known about the incidence patterns of hematologic malignancies in Sub‐Saharan Africa, including South Africa. We estimated incidence rates of pathology‐confirmed adult cases of leukemia, myeloma and related diseases (myeloma), Hodgkin lymphoma (HL), and non‐Hodgkin lymphoma (NHL) reported to the National Cancer Registry of South Africa (NCR) between 2000 and2006, by age, gender, and population group (Black, White, Coloured, Asian/Indian). Gender‐specific age‐standardized rates were calculated overall and by population group and incidence rate ratios (IRRs) were estimated using Poisson regression models. Between 2000 and 2006, there were 14662 cases of leukemia, myeloma, HL, and NHL reported to the registry. Incidence rates of reported hematologic malignancies were generally 20–50% higher among males than females. Our analyses suggested marked differences in the rates of reported hematologic malignancies by population group which were most pronounced when comparing the White versus Black population groups (IRRs ranging from 1.6 for myeloma to 3.8 for HL for males and females combined). Challenges related to diagnosis and reporting of cancers may play a role in the patterns observed by population group while the set‐up of the NCR (pathology‐based) could lead to some degree of under‐ascertainment in all groups. This is the first country‐wide report of the incidence of hematologic malignancies in South Africa. Despite challenges, it is important to analyze and report available national cancer incidence data to raise awareness of the cancer burden and to characterize patterns by demographic characteristics so as ultimately to improve the provision of cancer‐related health care.

The South African National Cancer Registry: an update

We would like to take this opportunity to correct the misconception created by the News piece published in The Lancet Oncology regarding the “demise” of the South African National Cancer Registry (NCR). The NCR, a division of the National Health Laboratory Service, is the primary cancer surveillance system and largest repository of cancer data in South Africa. It was established in 1986 as a voluntary, pathologybased cancer surveillance system, and continues to operate; its database contains over 1·2 million cancer records with about 80 000 new cases added each year. The misconception about the NCR referred to above might have come about because the NCR has had diffi culties in the past due to changes in leadership, high staff turnover, and a lack of political and fi nancial prioritisation of cancer surveillance caused by competing national health priorities at the peak of the HIV epidemic. As a result of severe resource constraints, the NCR continued to obtain data but was unable to regularly produce reports. Additionally, between 2004 and 2010, some private laboratories withheld data because of concerns about voluntarily submitting confi dential patient information to the registry without the protection of government legislation. However, in 2011, Regulation 380 of the National Health Act (Act 61 of 2003) formally established the NCR as South Africa’s main cancer surveillance agency; the legislation makes reporting all confi rmed cancer diagnoses to the registry obligatory. Additionally, the Regulation mandated the NCR to implement population-based cancer registration in South Africa. With renewed political support, NCR has been revitalised. To expedite data processing, the registry has moved to electronic reporting of pathology data from laboratories. Cancer incidence reports for 2000–07 have been published online with further reports in progress. After great eff ort from NCR staff , we aim to soon report cancers within timeframes similar to those of leading international cancer registries. The NCR has developed a 10-year business plan for the implementation of both new population-based and existing pathology-based registration for the country. Fundraising activities have started, and a pilot populationbased registry is operational in one district of the country (Ekurhuleni District, Gauteng), with more to follow. In view of the concern among stakeholders about the decline in reporting from private laboratories in the past, our researchers did a thorough investigation to quantify the eff ect of withheld reports on national cancer surveillance. We found a marginal eff ect on overall reporting; NCR will submit these fi ndings for peer-reviewed publication soon. The NCR remains the main source of cancer data for South Africa, with laboratory-based reporting yielding high specifi city. With the imminent implementation of national health insurance, it is vital for the country to be able to quantify the burden of cancer for national resource planning. Increased investment in the NCR will assist the organisation to improve South African cancer surveillance.

The South African paediatric tumour registry - 25 years of activity

The South African Childrens Tumour Registry was established 25 years ago as it was essential to collect data on malignant disease in the paediatric population that can be used for statistical research in an efficient and sustainable way. The Registry is a useful and significant repository of specific paediatric data, along with the recently revitalised National Cancer Registry, to serve the needs of the cancer research community.We appreciate Drs Stefan and Stones highlighting the value of cancer registries. Establishing a comprehensive population-based cancer registry in South Africa is most important and long overdue. This does not preclude specialised registries, provided that all cancers are reported to the main, statutory registry. Best practice is inclusive reporting of all cancers to a single registry for all age groups, which enables national trends to be described for the entire South African population, including rural areas.