Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002–2014

Abstract

Background South Africa (SA) has experienced a rapid transition in the Human Development Index (HDI) over the past decade, which had an effect on the incidence and mortality rates of colorectal cancer (CRC). This study aims to provide CRC incidence and mortality trends by population group and sex in SA from 2002 to 2014. Methods Incidence data were extracted from the South African National Cancer Registry and mortality data obtained from Statistics South Africa (STATS SA), for the period 2002 to 2014. Age-standardised incidence rates (ASIR) and age-standardised mortality rates (ASMR) were calculated using the STATS SA mid-year population as the denominator and the Segi world standard population data for standardisation. A Joinpoint regression analysis was computed for the CRC ASIR and ASMR by population group and sex. Results A total of 33,232 incident CRC cases and 26,836 CRC deaths were reported during the study period. Of the CRC cases reported, 54% were males and 46% were females, and among deaths reported, 47% were males and 53% were females. Overall, there was a 2.5% annual average percentage change (AAPC) increase in ASIR from 2002 to 2014 (95% CI: 0.6–4.5, p-value < 0.001). For ASMR overall, there was 1.3% increase from 2002 to 2014 (95% CI: 0.1–2.6, p-value < 0.001). The ASIR and ASMR among population groups were stable, with the exception of the Black population group. The ASIR increased consistently at 4.3% for black males (95% CI: 1.9–6.7, p-value < 0.001) and 3.4% for black females (95% CI: 1.5–5.3, p-value < 0.001) from 2002 to 2014, respectively. Similarly, ASMR for black males and females increased by 4.2% (95% CI: 2.0–6.5, p-value < 0.001) and 3.4% (, 95%CI: 2.0–4.8, p-value < 0.01) from 2002 to 2014, respectively. Conclusions The disparities in the CRC incidence and mortality trends may reflect socioeconomic inequalities across different population groups in SA. The rapid increase in CRC trends among the Black population group is concerning and requires further investigation and increased efforts for cancer prevention, early screening and diagnosis, as well as better access to cancer treatment.

Colorectal Cancer in Uganda: A 10-Year, Facility-Based, Retrospective Study

“…39 Related studies have used difference in life expectancy among males and females as an explanation for gender disparity. 40,41 Remarkably, marital status was found to be associated with CRC in our study. Widowed patients were 2.5 times more likely to have CRC compared to married patients.…”

Modeling the Cost-Effectiveness of Adjuvant Chemotherapy for Stage III Colon Cancer in South African Public Hospitals

“…Our model simulated the disease progression following curative resection in a hypothetical cohort of 60-year-old male and female patients with stage III colon cancer. The hypothetical cohort start age of 60 years was chosen to reflect the average age of patients with CRC in the South African National Cancer Registry 32 and is comparable to the median age of participants in the randomized controlled clinical trials (RCTs) used to derive model inputs (Data Supplement). 8 - 11 All patients entered the model in the disease-free state (defined as free of colon cancer recurrence) and either remained disease-free or transitioned to colon cancer recurrence, death from colon cancer, or death from all other causes excluding colon cancer (Fig 1 ).…”

Bile Acids, Gut Microbes, and the Neighborhood Food Environment—a Potential Driver of Colorectal Cancer Health Disparities

“…In the United States, AA/Bs have the highest rates of CRC incidence and mortality among the racial/ethnic groups ( 3 , 4 ). Native South African Blacks have a nearly negligible CRC risk, although rates have been increasing over time in response to dietary changes and increased access to health care screening ( 29 ). Intriguingly, a traditional native South African diet is high in fiber and low in animal protein and fat, while AA/Bs are likely to consume a western-type diet.…”

“…It has been posited that this inconsistency is due to underreporting of CRC incidence as a consequence of poor CRC screening access. Indeed, rates of CRC incidence for people living in Inner Mongolia and South Africa have increased with urbanization and education level ( 29 , 35 ). In addition, urbanization in these and other nonindustrialized societies has shifted dietary patterns to include more market-ready foods higher in saturated fat and simple carbohydrates.…”