Preventable cancer incidence in Nigeria, a case study of Borno State

1. HOSPITAL SEMINAR
PRESENTATION BY THE
DEPARTMENT OF
HISTOPATHOLOGY
PRESENTER
DR. AB ZARAMI
1

2. The Incidence of Preventable cancer in
Borno State.
2

3. Seminar outline
• Introduction
• Cancer Biology
• The global cancer incidence
• The incidence of cancer in Borno state
• Conclusion
• Recommendation
• References
3

4. Introduction
• Cancer is a public health problem world-wide
affecting all categories of persons.
• It is the second common cause of death in
developed countries and among the three
leading causes of death in developing countries
(WHO 2015)
• Cancers are defined by the National Cancer
Institute (NCI) as a collection of diseases in
which abnormal cells can divide and spread to
nearby tissue. 4

5. Introduction cont.
• WHO reported that about 24.6 million people
live with cancer worldwide
• 12.5% of all deaths are attributable to cancer
and if the trend continues, It is estimated that
by 2020, 16 million new cases will be
diagnosed per annum out of which 70% will be
in developing countries
5

6. Introduction conti.
• Recent report by Globacan 2018 has shown
that there are an estimated 18.1 million new
cancer cases and 9.6 million cancer deaths.
• In both sexes combined, lung cancer is the
most commonly diagnosed cancer and the
leading cause of cancer death
• Closely followed by female breast cancer,
prostate cancer and colorectal cancer
6

7. Introduction conti.
• Cancer incidence and mortality are rapidly growing
worldwide.
• Several of which are associated with socioeconomic
development
• In Africa there were an estimated 681,000 new cancer
cases and 512,000 deaths in 2008.
• Projections to 2030 show a startling rise, with
corresponding figures of 1.27 million cases and 0.97
million deaths resulting
• The reasons are complex but reflect both aging and
growth of the population, as well as changes in the
prevalence and distribution of the main risk factors for
cancer 7

8. 8

9. Globocan 2018 statistics
Male Female
Cancers
incidence
Lungs cancer Breast cancer
Prostate cancer Colorectal cancer
Colorectal
cancer
Lung cancer
Cervical cancer
Mortality Lung cancer Breast cancer
Liver cancer Lung cancer
Gastric cancer Colorectal cancer9

10. The cancer incidence in Nigeria
• The burden of cancer in Nigeria is unknown;
mainly because of lack of statistics or under-
reporting.
• This is not peculiar to Nigeria but most parts
of Africa.
• In a meta-analysis of cancer registry update
from all over the world has shown that only
1% of the literature emanated from Africa
compared to 34% from Europe and 42% from
Asia.
10

11. Conti.
• Lack of cancer statistics in Nigeria may be due
to inaccurate population statistics which makes
age specific incidence rates impossible or if
available inaccurate.
• And large proportion of the population still
never seek orthodox medical care and so are
not recorded.
11

12. Cont.
• There are 11 cancer registries in Nigeria; located
in various tertiary hospitals in various parts of
the country
• Most of the Registries are poorly funded and
except probably The Ibadan Cancer Registry,
they all produce hospital-based data.
12

13. CANCER REGISTRY IN
NIGERIA
1 Cancer Registry, Ilorin TH
2 Cancer Registry, UMTH
3 Cancer Registry, ABUTH
4 Cancer Registry, Kano- AKTH
5 Cancer Registry, Jos -JUTH
6 Cancer Registry, Sokoto UDUTH
7 Ibadan Cancer Registry UCH
8 Cancer Registry, Lagos - LUTH
9 Cancer Registry, Benin - UBTH
10 Cancer Registry, Calabar -UCTH
11 Cancer Registry, Nnewi-NUTH
12 Ife/Ijesha Cancer Registry, OAUTH
13 Cancer Registry, Enugu-UNTH
13

14. Current Cancer incidence in
Nigeria
• Data (2001-2005) from Ibadan showed increasing
incidence rate of 65.9% and 34.1% in females and
males respectively.
• From Kano, of 1001 cancers recorded for period
1995-2004, male cancers accounted for 50.3%
and 49.7% in females.
• Mandong et al recorded 1162 and 1657 cancer
cases respectively for males and females for the
period between 1995 and 2002 .
• Report from University of Benin Teaching
Hospital showed 2258 cases over a 20year period
with female cancers predominating(64%)
14

15. • MCR Nggada et al reported 1,216 from 2001-
2005 with breast cancer having 490(13.9%)
• Pindiga et al reported 2,341 cancer cases from
1989 to 2003.
• Yawe et al 1987-2004(7yrs) had found 165
prostate cancer accounting for 6.15% of all
cancers
15

16. Distribution of cancer incidence from
1989 to 2003-Pindiga et al
RANK CANCER
TYPES
NO OF CASES %
1. CERVIX 457 19.5
2. BREAST 293 12.5
3. GIT 245 10.5
4. SOFT TISSUE 214 9.1
5. SKIN(NM) 146 6.3
6. PROSTATE 145 6.2
7. URINARY
TRACT
128 5.5
8. HEAD AND
NECK
105 4.5
9. ORO-DENTAL 78 3.3
10. LYMPHOID 69 2.9
16

17. MCR-Most common cancer in male and
female from 1989-2003 Pindiga et al
Rank Males % Female %
1 Prostate 6.2(145) Cervix 19.5(457)
2 Skin (Nm) 5.2(117) Breast 12.5(293)
3 Bladder 4.4(102) Skin(Nm) 4.1(97)
4 CRC 3.8(88) Ovary 3.1(73)
5 Soft tissue 3.6(85) Soft tissue 2.6(61)
6 Upper airway 2.7(63) Colorectal 2.3(54)
7 PLCC 1.8(43) Stomach 1.0(24)
17

18. Maiduguri Cancer Registry 2014-
2018
Type of Cancer 2014 2015 2016 2017 2018 Total %
1 Breast 35 36 55 35 40 201 17.3
2 Prostate 38 22 40 26 22 148 12.7
3 Cervix 25 27 24 29 35 140 12.1
4 Skin 17 20 19 18 13 87 7.5
5 Colon 10 11 17 15 16 69 5.9
6 Bladder 15 14 6 8 9 52 4.4
7 Ovary 4 1 9 7 10 31 2.6
8 Liver 4 5 4 4 4 21 1.8
9 Uterus 4 2 7 2 3 18 1.6
10 Soft Tissue 1 1 4 6 5 17 1.5
11 Lymphoma 0 1 3 4 1 9 0.7
12 Others 40 31 97 113 86 367 31.6
Total 193 171 285 267 244 1,160 100 18

19. Regional distribution of cancer in
Nigeria in relation to sex
Registry Period Male Female Total
Ibadan 2001-2005 2185 4214 6399
Ife-Ijesha 1993-95 187 213 400
Benin 1980-1999 810 1448 2258
Kano 1995-2004 1001 989 1990
Jos 1995-2002 1162 1657 2813
Maiduguri 2014-2018 467 693 1160
19

20. Ibadan Cancer Registry-Incidence
2001-2005(showing steady increase)
Year Female Male Grand
Total
2001 697 396 1093
2002 809 387 1196
2003 658 345 1003
2004 989 542 1531
2005 1061 515 1576
Total 4214 2185 6399
20

21. Regional distribution of female cancer
in Nigeria and Globocan 2018
Ibadan
(2001-05)
Jos
(1995-02)
Kano
(1995-04)
Calabar
(2004-06)
Lagos
(2002-07)
Globocan
2018
Maidugur
2014-18
Breast Cervix Cervix Breast Breast Breast Breast
Cervix Breast Breast Cervix Cervix Lungs cervix
CRC NHL Ovary others CRC cervix Skin
Ovary Uterus Nm Skin blood Uterus Thyroid CRC
Uterus CRC Uterus liver Ovary CRC Bladder
21

22. 22

23. Conti.
• Thus data from various parts of the country
show that cancer incidence is increasing with
female cancers leading
• changing pattern has also been noticed from all
the regions of the country
• Increasing incidence has been attributed to
poor awareness about the risk factors, changes
in lifestyle
23

24. Relative Frequencies of 5 most common
cancers in MCR and Globocan 2018
Globocan 2018 MCR-2014-2018
Ran
k
Male % Female % Male % Female %
1 Lungs 31.5 Breast 46.3 Prostate 12.
7
Breast 17.3
2 Prostate 29.3 Lungs 14.6 Skin 7.5 Cervix 12.1
3 Stomach 15.7 Cervix 13.1 CRC 5.9 Skin 7.5
4 Nms/Liver 13.9 Thyroid 10.2 Bladder 4.4 CRC 5.9
5 CRC 13.1 CRC 10.1 Liver 1.8 Bladde
r
4.4
24

25. AGE DISTRIBUTION OF CANCER
IN MCR-2017
0
5
10
15
20
25
30
<15 15-24 25-34 35-44 45-54 55-64 65+
Male
Female
25

26. Cont.
• Patient within age group <15 were predominantly
paediatric tumours
• 15-24 yr age grp were soft tissue sarcoma/lymphoma
• 25-34 yr age grp-Mix cases/head and neck
• 35-44 yr age grp-CRC/Breast/Cx/skin
• 45-54 yr Breast/ Prostate/Bladder
• 65+-Prostate/Ovarian cancer/skin
26

27. The five most common paediatric cancers from
134 cases recorded in MCR, 1990-1999 (pindiga
et al)
Rank Types of cancer %
1 Burkitt Lymphoma 32.8 (29)
2 Nephroblastoma 22.4(16)
3 Acute Lymphoblastic leukemia 17.9(15)
4 Retinoblastoma 7.4(10)
5 Rhabdomyosarcoma 6.7(9)
27

28. AGE DISTRIBUTION OF CANCERS IN
LUTH; 2007
28

29. Conclusion
 Although available data are hospital based, it is
obvious that cancer incidence is rising in Nigeria
 In the near future, it is estimated that more than
two in every three cancer deaths will occur in
less developed countries and that African
countries will pay a high price because we are ill-
prepared to face this impending tragedy.
 There is much that could be done and an
effective collaboration with international
institutions and agencies, is a key step for
success.
 Africa’s problem is the world’s problem.
29

30. Cont.
• However, majority of the Common Cancers
are preventable or curable if detected early.
• Setting up screening programmes can aid in
increasing public awareness and early
detection
• Training of personnel and provision of up-to-
date facilities for cancer diagnosis/registration
will improved treatment of cancer and data
collection.
30

31. Recommendation
1. Establishment of functional National Cancer Institute is
mandatory which will promote Research and Training in
Cancer
2. The existing cancer registry in UMTH should be up
graded to population base cancer registry
3. Establishment of cancer screening programme for
preventable cancer in Borno state should be encourage
e.g. prostate cancer, breast cancer, CRC, cervical
cancer and bladder cancer.
4. Up-grading diagnostic equipment and reagents such as
immunohistochemistry especially in the era of targeted
therapy.
5. Basic treatment of cancer should be part of NHIS
6. Mgt should enhance collaboration and partnership with
state government, NGO and other international lab in
research on cancer 31

32. Priorities for cancer research
1. More extensive and accurate description of the
cancer burden.
2. Prioritized research into the causes, prevention and
problem solving
3. Planned training and retention of health care
professionals and researchers
4. Promotion of international collaborations in
partnerships on cancer research.
32

33. References
1. Freddie Bray. Global cancer statistics 2018: GLOBOCAN
estimates of incidence and mortality worldwide for 36
cancers in 185 countries.
2. Globacan 2002
3. Jedy-Agba E, Curado P, Ogunbiyi O, Oga E, Fabowale T,
Igbinoba F, et al. Cancer Incidence in Nigeria: A Report
from Population-based Cancer Registries. Cancer
Epidemiol. 2012; 36(5): 271–278.
4. Sylla BS, Wild CP. A million Africans a year dying from
cancer by 2030: What can cancer research and control
offer to the continent? Int J Cancer. 2011 [PMC free
article] [PubMed]
5. MCR 2014-2018
33

34. Thank you for your attention
34