BACKGROUND Cervix cancer is the second most common cancer and the leading cause of cancer death in women in sub-Saharan Africa (SSA). Data on trends in cervix cancer incidence are scarce on the continent owing to lack of appropriate long-term data across many regions in SSA.
METHODOLOGY In this study, we investigate trends of cervix cancer incidence spanning periods of 10-25 years in 10 population-based cancer registries across 8 SSA countries (The Gambia, Kenya, Malawi, Mauritius, Seychelles, South Africa, Uganda, and Zimbabwe) through the African Cancer Registry Network. Join point regression was used to analyse and present data for registries in which a simple linear trend did not properly describe the data.
RESULTS A total of 22,066 cases of cervix cancer were registered and included in our analyses. Incidence rates were noted to have increased in all registries, except for Mauritius, where a statistically significant decline of 2.5% per year was noted. The highest average annual percentage increase was reported in Blantyre, Malawi (7.9%) and the least in Harare, Zimbabwe (1.2%). The highest incidence rates of cervical cancer in all the registries were reported in the 60-64 and 65-69 year age groups, compared to other ages. Eastern Cape and Malawi registries showed significant increase in incidence over time, however, this trend was less clear for the Gambia.
CONCLUSION Overall, our findings show that cervix cancer incidence is on the increase in SSA. There is obvious high-level advocacy to reduce the burden of cervix cancer in SSA. However, to achieve results in reducing mortality from cervix cancer in the region, this advocacy needs to be translated into actual support for the development and maintenance of population-based cancer registries, widespread (Human Papilloma Virus) HPV vaccination and population wide cervix cancer screening in SSA.

BACKGROUND Cervical cancer is the most common cause of cancer death in African women. We sought to estimate population-based survival and evaluate excess hazards for mortality in African women with cervical cancer, examining the effects of country-level Human Development Index (HDI), age and stage at diagnosis.
METHODS We selected a random sample of 2760 incident cervical cancer cases, diagnosed in 2005-2015 from 13 population-based cancer registries in 11 countries (Benin, Cote d’Ivoire, Ethiopia, Kenya, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Uganda and Zimbabwe) through the African Cancer Registry Network. Of these, 2735 were included for survival analyses. The 1, 3 and 5-year observed and relative survival were estimated by registry, stage and country-level HDI. We used flexible Poisson regression models to estimate the excess hazards for death adjusting for age, stage and HDI.
RESULTS The mean age at diagnosis for the study cohort was 53.4 years, and among patients with known stage, 65.8% were diagnosed with late-stage disease. The 5-year relative survival for early-stage cervical cancer patients from high HDI registry areas was 67.5% (42.1–83.6) while it was much lower [42.2% (30.6–53.2)] for low HDI registry areas. Independent predictors of mortality were late-stage disease, medium to low country-level HDI and age >65 years at cervical cancer diagnosis. The estimated average relative survival from cervix cancer in the 11 countries was 69.8%, 44.5% and 33.1% at 1, 3, and 5 years, respectively.
CONCLUSION Factors contributing to the human development index (such as level of education and a country’s financial resources) are critical for cervical cancer control in SSA and there is need to strengthen health systems with timely and appropriate prevention and treatment programmes.

OBJECTIVE Breast cancer (BC) is the most common cancer in sub-Saharan Africa (SSA). However, little is known about the actual health service received by women with BC and their survival outcome. Our study aimed to describe the cancer-directed therapy (CDT) and diagnostics received by patients with BC at population-level in SSA, compare this to the National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for Sub-Saharan Africa and evaluate the impact on survival.
METHODS Random samples of breast cancer patients (≥40 cases per registry) diagnosed from 2009-15, were drawn from 11 population-based cancer registries: Abidjan-Cote d’Ivoire, Addis Ababa-Ethiopia, Bamako-Mali, Brazzaville-Congo, Bulawayo-Zimbabwe, Cotonou-Benin, Eldoret-Kenya, Kampala-Uganda, Maputo-Mozambique, Namibia and Nairobi-Kenya. Active methods were used to update therapy and outcome data of newly diagnosed patients (“traced cohort”).
RESULTS We included a total of 809 patient records. Additional information on therapy or outcome was obtained for 518 patients (63.8%). There was no record of any cancer-directed therapy received for 20.1% (n=104) of traced patients. In the traced cohort, stage was known for 402 patients, amongst which 320 had non-metastatic disease. Of these 320 patients with curable BC, 104 patients (32.5%), met the minimum diagnostic criteria (stage and hormone-receptor status known) for use of the NCCN guidelines; and 85 of these (26.5%) initiated guideline adherent therapy. Less than a third of traced patients had either hormone-receptor status (HRS) testing, endocrine therapy or radiotherapy. There was a 2-3-fold increased hazard of death among patients without NCCN-guided therapy after adjusting for stage and registry area.
CONCLUSIONS Both diagnostic and therapeutic NCCN guideline recommendations for SSA are followed for less than a third of known curable breast cancer patients. Our findings suggest substantial underutilization of effective, affordable and well-tolerated endocrine therapy. Improving diagnostic service for HRS testing may be the first step to increase NCCN guideline adherence and improve survival.

We estimate the fractions of cancer attributed to infections in Africa in 2018. The number of new cancer cases occurring were taken from Globocan2018 with some additional estimations based on data from African population-based registries. Population attributable fractions were calculated using prevalence of infection and relative risk in exposed versus non-exposed. The greatest share of infection-associated cancers is due to the human papilloma viruses (12.1% of all cancers in Africa and 15.4% in sub Saharan Africa); of these, cervical cancer is by far the most common. Kaposi Sarcoma associated Herpes Virus is responsible for 3.1% of all cancers in Africa, the hepatitis viruses (B and C) for 2.9% and Helicobacter pylori for 2.7% (non-Cardia Gastric cancer and primary gastric lymphomas) . 2% of cancers are attributable to the Epstein-Barr virus, Schistosoma haematobium increases the risk of bladder cancer resulting in 1.0% of all cancers. HIV-related NHL and squamous cell carcinoma of the conjunctiva account for 0.6% of cancers. All together 24.5% of cancers in Africa and 28.7% in sub Saharan Africa are due to infectious agents. Infections are by far the most common cancer risk factor for cancer in Africa - the traditional risk factors (smoking, alcohol and unhealthy diet) probably cause only one in eight cancers in Africa. Prevention should focus on those infectious diseases preventable through vaccination (HPV and hepatitis B) which could reduce two thirds of the burden. Helicobacter pylori and schistosomiasis are treatable with antibiotics and praziquantel, with a potential reduction of one in eight infection-associated cancers.

BACKGROUND/OBJECTIVES Information on occurrence and survival of cancer at the population level can only be obtained through cancer registries. Studies of cancers in children in sub-Saharan Africa are even more difficult than those of adults, because of their relative rarity (only 4.6% of cancers occur before age 15), and the fact that registries in sub Saharan Africa cover limited – usually urban – populations. In partnership with the My Child Matters programme (Sanofi Foundation), the African Cancer Registry Network is piloting a project to enhance childhood cancer registration on the continent.
DEIGN/METHODS In the first year, the registries of two countries (Cote d’Ivoire and Republic of Congo) have expanded their scope to become national registries for paediatric cancer, and a new registry – national paediatric registry of Burkina Faso, has been established. The staff of all 3 registries were trained to record stage at diagnosis for childhood cancers, using the “Tier 1” classification of the Toronto consensus principles (as in TNM-8) for which a special coding manual has been developed. Two long-standing Anglophone registries (Harare and Kampala) were also trained in the staging of cancers, and follow-up of patients registered was carried out in 4 centers, to estimate population-level survival.
RESULTS The childhood cancer profile differed between the centers. Kaposi sarcoma remains a common childhood tumour in East Africa, Burkitt lymphoma is very common in Uganda and Cote d’Ivoire, and while the most common solid tumour in West Africa was retinoblastoma, Wilms tumours were more common in East Africa. Survival is rather poor – less than half of the cases were alive 3 years after diagnosis. The role of the stage in determining these poor outcomes is being investigated.
CONCLUSIONS Registration of childhood cancer is feasible in Africa, with proper training and support, and can provide valuable data on incidence, stage, and survival.