The shifting epidemiology of colorectal cancer in sub-Saharan Africa

Katsidzira, Leolin; Gangaidzo, Innocent T.; Thomson, Sandie; Rusakaniko, Simbarashe; Matenga, Jonathan; Ramesar, Raj

doi:10.1016/s2468-1253(16)30183-2

Cited by 66 publications

(84 citation statements)

References 56 publications

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“…Their findings are consistent with several independent analyses demonstrating a rising incidence of CRC in ssAfrica. [4][5][6][7][8] Given the lack of organized CRC screening in most LMICs, these trends are notable and warrant further attention.…”

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confidence: 99%

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Colon cancer in Africa: Primetime for screening?

May

Anandasabapathy

2019

Gastrointestinal Endoscopy

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confidence: 99%

“…They are supported as well by data from both East and West Africa that point to a shifting epidemiology of CRC. 4,5 So, is it time to screen for CRC in ssAfrica? With rising disease burdens, Kenya and other resource-limited countries are considering such programs.…”

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confidence: 99%

Colon cancer in Africa: Primetime for screening?

May

Anandasabapathy

2019

Gastrointestinal Endoscopy

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“…[7,[23][24][25] The increase in ASIR is linked to changes in individual behaviour, in particular, lifestyle changes in uenced by westernisation. [26] These lifestyle factors include excessive tobacco smoking, excessive alcohol consumption, lack of physical activity leading to obesity and poor diet, consumption of fast food and red meat, among other factors. [26][27][28][29][30] The increase in ASMR might be associated with quality of care within the country's health system, for example, ine cient resource allocation (human resources, equipment and medical supplies), lack of access to cancer treatment and or management, and poor health infrastructures may affect mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…[26] These lifestyle factors include excessive tobacco smoking, excessive alcohol consumption, lack of physical activity leading to obesity and poor diet, consumption of fast food and red meat, among other factors. [26][27][28][29][30] The increase in ASMR might be associated with quality of care within the country's health system, for example, ine cient resource allocation (human resources, equipment and medical supplies), lack of access to cancer treatment and or management, and poor health infrastructures may affect mortality rates. [26,[31][32][33][34][35][36][37] Other factors include low or lack of awareness, and screening and early detection to detect and remove precancerous polyps as early as possible before they progress into cancerous lesions, as well as late diagnosis, translating into poor prognosis and ultimately increased mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…[26][27][28][29][30] The increase in ASMR might be associated with quality of care within the country's health system, for example, ine cient resource allocation (human resources, equipment and medical supplies), lack of access to cancer treatment and or management, and poor health infrastructures may affect mortality rates. [26,[31][32][33][34][35][36][37] Other factors include low or lack of awareness, and screening and early detection to detect and remove precancerous polyps as early as possible before they progress into cancerous lesions, as well as late diagnosis, translating into poor prognosis and ultimately increased mortality rates. [38][39][40][41] Stable ASIR and ASMR were observed among the Asian population group and females of the Coloured population group over the study period.…”

Section: Discussionmentioning

confidence: 99%

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Colorectal Cancer Incidence and Mortality Trends by Sex and Population Group in South Africa: 2002-2014.

Motsuku

Chen

Muchengeti

et al. 2020

Preprint

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BackgroundSouth 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.MethodsIncidence 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.ResultsA 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.ConclusionsThe 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.

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Cost‐effectiveness of adjuvant chemotherapy for high‐risk stage II and stage III colon cancer in South Africa

et al. 2023

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BackgroundColon cancer incidence is rising in low‐ and middle‐income countries (LMICs), where resource limitations and cost often dictate treatment decisions. In this study, we evaluate the cost‐effectiveness of adjuvant chemotherapy for high‐risk stage II and stage III colon cancer treatment in South Africa (ZA) and illustrate how such analyses can inform cancer treatment recommendations in a LMIC.MethodsWe created a decision‐analytic Markov model to compare lifetime costs and outcomes for patients with high‐risk stage II and stage III colon cancer treated with three adjuvant chemotherapy regimens in a public hospital in ZA: capecitabine and oxaliplatin (CAPOX) for 3 and 6 months, and capecitabine for 6 months, compared to no adjuvant treatment. The primary outcome was the incremental cost‐effectiveness ratio (ICER) in international dollars (I$) per disability‐adjusted life‐year (DALY) averted, at a willingness‐to‐pay (WTP) threshold equal to the 2021 ZA gross domestic product per capita (I$13,764/DALY averted).ResultsCAPOX for 3 months was cost‐effective for both patients with high‐risk stage II and patients with stage III colon cancer (ICER = I$250/DALY averted and I$1042/DALY averted, respectively), compared to no adjuvant chemotherapy. In subgroup analyses of patients by tumor stage and number of positive lymph nodes, for patients with high‐risk stage II colon cancer and T4 tumors, and patients with stage III colon cancer with T4 or N2 disease. CAPOX for 6 months was cost‐effective and the optimal strategy. The optimal strategy in other settings will vary by local WTP thresholds. Decision analytic tools can be used to identify cost‐effective cancer treatment strategies in resource‐constrained settings.ConclusionColon cancer incidence is increasing in low‐ and middle‐income countries, including South Africa, where resource constraints can impact treatment decisions. This cost‐effectiveness study evaluates three systemic adjuvant chemotherapy options, compared to surgery alone, for patients in South African public hospitals after surgical resection for high‐risk stage II and stage III colon cancer. Doublet adjuvant chemotherapy (capecitabine and oxaliplatin) for 3 months is the cost‐effective strategy and should be recommended in South Africa.

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The shifting epidemiology of colorectal cancer in sub-Saharan Africa

Cited by 66 publications

References 56 publications

Colon cancer in Africa: Primetime for screening?

Colon cancer in Africa: Primetime for screening?

Colorectal Cancer Incidence and Mortality Trends by Sex and Population Group in South Africa: 2002-2014.

Cost‐effectiveness of adjuvant chemotherapy for high‐risk stage II and stage III colon cancer in South Africa

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