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Monday, June 1, 2015

Prostate and Cervical cancer incidence on the rise in Uganda

By Esther Nakkazi

The number of new cases of prostate and cervical cancer in Uganda is on the rise. Cases of prostate cancer increased from only 850 to 4,400 from 1990 to 2013 and cervical cancer cases in women increased from 2,000 to 3,400 and it remained the leading cause of cancer deaths in Uganda.

This is according to a new study “The Global Burden of Cancer 2013,” in the journal JAMA Oncology, published on May 28, and conducted by an international consortium of researchers coordinated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Overall, Uganda has a substantial cancer burden, and six out of 10 of the most common cancers there are caused by infectious diseases. Uganda's very high cancer rate is fueled largely by the HIV epidemic and the increasing figures are also due to population growth, which has more than doubled since 19990 and ageing.

According to the U.S. National Cancer Institute, people infected with HIV are several thousand times more likely than uninfected people and HIV-positive women are at least five times more likely to be diagnosed with cervical cancer, which is caused by the human papillomavirus.

“Cancer remains a major threat to people’s health in Uganda and around the world,” said oncologist Dr. Christina Fitzmaurice, a Visiting Fellow at IHME and lead author of the study in a press release. “Controlling cancer will ensure that as life expectancy continues to climb, people’s lives are not just longer but healthier.”

In Uganda, among the leading cancers, the number of new cases of mouth cancer in men was the lowest at 230 in 2013, up from 120 in 1990. Within the top 10 causes of cancer incidence for women, uterine cancer showed the lowest number of new cases at 360 in 2013, up from 210 in 1990 says this study  http://www.healthdata.org/research-article/global-burden-cancer-2013

Concerning the leading causes of cancer death among Ugandans, deaths from prostate cancer were the highest for men, nearly tripling in number to 1,100 in 2013, up from 390 in 1990. Deaths from cervical cancer were the highest for women, nearly increasing from 1,400 in 1990 to 2,300 in 2013 says the study.

Among the top 10 causes of cancer death in Uganda, leukemia led to the lowest number of male deaths in 2013, 180, up from 85 in 1990, and lung cancer resulted in the lowest number of deaths for women at 310 in 2013, up from 170 in 1990.

Uganda differed from most other countries with respect to new cases of prostate and cervical cancers. 

Prostate cancer ranked fourth in the top 10 for incident cases globally but ranked first in Uganda. In addition, cervical cancer was ranked seventh in top incident cases globally but ranked second in Uganda.

Also unlike most countries, Uganda was one of 62 countries in which the age-standardized death rates for all cancers increased rather than decreased between 1990 and 2013.

In 2013, there were 14.9 million new cancer cases and 8.2 million cancer deaths worldwide. The leading cause of cancer incidence for men was prostate cancer, which caused 1.4 million new cases and 293,000 deaths. Lung cancer remained one of the leading causes of incident cancer cases among men between 1990 and 2013, but prostate cancer cases have increased more than threefold during this period due in part to population growth and aging.

For women, similar factors contributed to the global rise in breast cancer incidence. In 2013 there were 1.8 million new cases of breast cancer and 464,000 deaths. Breast cancer has remained the leading cause of incident cancer cases for women between 1990 and 2013, but the number of new cases more than doubled during this period.

Other leading causes of incident cases globally include cervical cancer, up 9% since 1990, lymphoma, up 105%, and colon and rectum cancer, which has increased 92%.

The death toll from cancer is also changing as new cases increase. In 2013 cancer was the second-leading cause of death globally after cardiovascular disease, and the proportion of deaths around the world due to cancer has increased from 12% in 1990 to 15% in 2013.

Lung cancer, stomach cancer, and liver cancer have remained the three leading causes of cancer for both sexes combined during this time period. Lung cancer deaths have increased by 56%, stomach cancer deaths by 10%, and liver cancer deaths by 60%.

Cancer is often seen as a problem primarily in more affluent nations, but the disease is an issue in developing countries as well as developed countries, says the press release. Even though breast cancer remains the leading cause of incident cancer cases for women globally, in developed countries incidence rates have been stable or declining since the early 2000s. The reverse is true in developing countries, where incidence rates are lower but rising faster than in developed countries. 

The rankings for developed and developing countries are largely the same when it comes to number of cancer deaths for both sexes, though there are some notable differences. Cervical cancer ranks seventh in developing countries, compared to 17th in developed countries, and prostate cancer ranks 12th in developing countries but sixth in developed countries.

Cervical cancer has a particularly significant impact in sub-Saharan Africa, where it’s the most commonly diagnosed cancer in almost two dozen countries in the region, including Ghana, Nigeria, and Zambia, and the most common cause of cancer death for women in 40 countries, such as Ethiopia, Kenya, and Tanzania. 

Although cancer is a global phenomenon, countries around the world show important variations. In China, stomach cancer, not breast cancer, is the second-most common cause of cancer death for women. 

Non-Hodgkin lymphoma is the most commonly diagnosed cancer for men in United Arab Emirates and Qatar rather than prostate cancer. Mouth cancer, which is not prominent globally, is the second-most diagnosed cancer in India. Japan, Norway, Portugal, Spain, and Sweden are the only countries in the world where colon and rectum cancer was the most deadly form of cancer for women.

“The most effective strategies to address cancer will be tailored to local needs,” said IHME Director Dr. Christopher Murray. “Country-specific data can drive policies aimed to reduce the impact of cancer now and in the future.”

Leading causes of cancer deaths in Uganda for both sexes, with the number of deaths, 2013

1
Cervical cancer
2,293
2
Esophageal cancer
1,859
3
Lymphoma
1,731
4
Liver cancer
1,517
5
Other neoplasms
1,474
6
Prostate cancer
1,136
7
Colorectal cancer
1,097
8
Breast cancer
1,067
9
Stomach cancer
897
10
Lung cancer
757


Leading causes of cancer deaths in Uganda for men, with the number of deaths, 2013

1
Prostate cancer
1,136
2
Esophageal cancer
1,071
3
Lymphoma
1,054
4
Liver cancer
910
5
Other neoplasms
662
6
Colorectal cancer
510
7
Stomach cancer
500
8
Lung cancer
444
9
Bladder cancer
218
10
Leukemia
179


Leading causes of cancer deaths in Uganda for women, with the number of deaths, 2013

1
Cervical cancer
2,293
2
Breast cancer
1,031
3
Other neoplasms
812
4
Esophageal cancer
788
5
Lymphoma
677
6
Liver cancer
607
7
Colorectal cancer
587
8
Ovarian cancer
556
9
Stomach cancer
396
10
Lung cancer
312



Cancer and infection-related malignancies: on the rise in the developing world


The global burden of cancer is estimated to increase by nearly 70 percent by 2030.
More than two-thirds of all cancer deaths occur in low- and middle-income countries (LMICs).
More people die from cancer than HIV, tuberculosis, and malaria combined.

Up to 25 percent of the world’s cancers are caused by infectious diseases, with higher percentages in many LMICs compared to high-income countries (approximately 23 percent and 7 percent, respectively); with approximately 33 percent of cancers in sub-Saharan Africa caused by infectious diseases.

Cancers caused by infectious diseases include (but are not limited to) lymphoma from Epstein-Barr virus, sarcomas associated with HIV and liver cancer from hepatitis B and C.

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