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Open Access 01-12-2021 | Colorectal Cancer | Research article

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

Authors: Lactatia Motsuku, Wenlong Carl Chen, Mazvita Molleen Muchengeti, Megan Naidoo, Tamlyn Mac Quene, Patricia Kellett, Matshediso Ivy Mohlala, Kathryn M. Chu, Elvira Singh

Published in: BMC Cancer | Issue 1/2021

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.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRef

International Agency for Research on Cancer World Health Organization. GLOBOCAN Cancer Fact Sheets: lung Cancers. 2012. Available from: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. [cited 2018 Jun 15]

Wild CP, BWS EW, editors. World Cancer Report: Cancer Research for Cancer Prevention, vol. 199. Lyon: International Agency for Research on Cancer; 2020. p. 512. Available from: http://publications.iarc.fr/586, Cancer Control

WHO. GLOBOCAN 2018 REPORT WHO Africa (AFRO), vol. 179; 2019. p. 2018–9.

World Health organisation. The Global Cancer Observatory -South Africa. WHO, Press vol. 097. Lyon, France. 2019. http://globocan.iarc.fr/Default.aspx.

National Cancer Registry. National Cancer Registry 2016 South Africa. National Cancer Regsirty Statistics 2016. 2016. Available from: https://www.nicd.ac.za/centres/national-cancer-registry/ [cited 2020 Aug 1].

Brand M, Gaylard P, Ramos J. Colorectal cancer in South Africa: an assessment of disease presentation, treatment pathways and 5-year survival. S Afr Med J. 2018;108(2):118–22.CrossRef

Mccabe M, Perner Y, Magobo R, Mirza S, Penny C. Descriptive epidemiological study of South African colorectal cancer patients at a Johannesburg hospital academic institution; 2019.CrossRef

Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391(10125):1023–1075. Available from: http://www.thelancet.com/article/S0140673617333263/fulltext [cited 2021 Jan 18]

10.

UN. Human Development Indices and Indicators. 2018 Statistical Update. United Nations Dev Program. 2018;27(4):123. Available from: http://www.hdr.undp.org/sites/default/files/2018_human_development_statistical_update.pdf%0Ahttp://hdr.undp.org/en/2018-update

11.

Crosbie AB, Roche LM, Johnson LM, Pawlish KS, Paddock LE, Stroup AM. Trends in colorectal cancer incidence among younger adults—disparities by age, sex, race, ethnicity, and subsite. Cancer Med. 2018;7(8):4077–86.CrossRef

12.

American Cancer Society. Colorectal Cancer Facts&Figures 2017–2019. Am Cancer Soc. 2017:1–40 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24225001.

13.

Davison P. The World Bank South Africa Overview. 2010. Available from: https://www.worldbank.org/en/country/southafrica/overview [cited 2020 Aug 13]

14.

Assessment A. Overcoming poverty and inequality in South Africa an Assessment of drivers, Constraints and Opportunities.

15.

Ataguba JE, Akazili J, McIntyre D. Socioeconomic-related health inequality in South Africa: Evidence from General Household Surveys. Int J Equity Health. 2011;10:48. Available from: /pmc/articles/PMC3229518/?report=abstract. [cited 2020 Aug 13]

16.

Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet. 2009;374:817–34.CrossRef

17.

Gilson L, McIntyre D. Post-apartheid challenges: household access and use of health care in South Africa. Int J Health Serv. 2007;37(4):673–91.CrossRef

18.

Singh E, Ruff P, Babb C, Sengayi M, Beery M, Khoali L, et al. Establishment of a cancer surveillance programme: the South African experience, Lancet Oncol; 2015. Vol. 16. p. e414–e421. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26248849. NIH Public access. [cited 2017 Dec 4]

19.

Fritz April, Percy Constance, Jack Andrew, Shanmugaratnam Kanagaratnam, Sobin LH et al. International classification of diseases for oncology / editors, April Fritz ... [et al.], 3rd ed. World Heal Organ. 2000; Available from: https://apps.who.int/iris/handle/10665/42344

20.

Boniol M, Heanue M. Chapter 7: age-standardisation and denominators. Cancer Incid Five Cont Vol IX. 2007:99–101.

21.

Segi M, Fujisaku S, Kurihara M. Geographical observation on cancer mortality by selected sites on the basis of standardised death rate. Gan. 1957;48(2):219–225. Available from: http://www.ncbi.nlm.nih.gov/pubmed/13474150 [cited 2019 Jul 8].

22.

Vaughan AS, Kramer MR, Waller LA, Schieb LJ, Greer S, Casper M. Comparing methods of measuring geographic patterns in temporal trends: An application to county-level heart disease mortality in the United States, 1973 to 2010. Ann Epidemiol. 2015;25(5):329–335.e3. Available from: /pmc/articles/PMC4397179/?report=abstract. [cited 2021 Jan 17]

23.

Bray F, Guilloux A, Sankila R, Parkin DM. Practical implications of imposing a new world standard population. Cancer Causes Control. 2002;13(2):175–82.CrossRef

24.

Armitage P, Doll R. The age distribution of cancer and a multi-stage theory of carcinogenesis. Br J Cancer. 1954;8(1):1–12.CrossRef

25.

Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335–351. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10649300. [cited 2019 Jul 9]

26.

National Cancer Institute (NCI). Joinpoint Help Manual. 2016:1–147. Available from: https://seer.cancer.gov/seerstat/ [cited 2021 Jan 17]

27.

American Cancer Society. Colorectal Cancer Facts & Figures 2020–2022. Am Cancer Soc Inc. 2020:1–32.

28.

Kim SE, Paik HY, Yoon H, Lee JE, Kim N, Sung MK. Sex- and gender-specific disparities in colorectal cancer risk. World J Gastroenterol. 2015;21(17):5167–5175. Available from: http://www.wjgnet.com/1007-9327/full/v21/i17/5167.htm [cited 2020 Feb 7]

29.

White A, Ironmonger L, Steele RJC, Ormiston-Smith N, Crawford C, Seims A. A review of sex-related differences in colorectal cancer incidence, screening uptake, routes to diagnosis, cancer stage and survival in the UK. BMC Cancer. 2018;18(1):906. Available from: https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-4786-7 [cited 2020 Feb 7]

30.

Laiyemo AO, Badurdeen D, Kibreab A, Scott VF, Lee EL, Brim H, et al. Su1677 Sex Disparity in Colorectal Cancer Burden Among Us Adults: The Role of Colon Cancer Screening Compliance. Gastrointest Endosc. 2017;85(5):AB390–AB391. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0016510717310957 [cited 2020 Feb 7]

31.

NCR. National Cancer Registry 2012 annual report. 2012. Available from: http://www.nioh.ac.za/wp-content/uploads/2018/03/NCR-2012-results.pdf [cited 2019 Sep 3]

32.

NCR. National Cancer Registry 2013 annual report. 2013; Available from: http://www.nioh.ac.za/wp-content/uploads/2018/03/2013NCR.pdf [cited 2019 Sep 3]

33.

NCR. National Cancer Registry 2014 annual report. 2014. Available from: http://www.nicd.ac.za/wp-content/uploads/2017/03/2014-NCR-tables-1.pdf

34.

Katsidzira L, Gangaidzo I, Thomson S, Rusakaniko S, Matenga J, Ramesar R. The shifting epidemiology of colorectal cancer in sub-Saharan Africa. Lancet Gastroenterol Hepatol. 2017;2(5):377–383. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28397702 [cited 2019 Oct 1].

35.

Wei EK, Colditz GA, Giovannucci EL, Wu K, Glynn RJ, Fuchs CS, et al. A comprehensive model of Colorectal Cancer by risk factor status and subsite using data from the nurses’ Health study. Am J Epidemiol. 2017;185(3):224–37.PubMedPubMedCentral

36.

Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250–281. Available from: http://doi.wiley.com/10.3322/caac.21457 [cited 2019 Jul 31]

37.

Katsidzira L, Thomson SR, South African Gastroenterology Society. South African Gastroenterology Review. In House Publications; 2015. Vol. 13. 25–28 p. Cape Town, South Africa. Available from: https://journals.co.za/content/medgas/13/2/EJC174015 [cited 2019 Oct 1].

38.

Vajdic CM, MacInnis RJ, Canfell K, Hull P, Arriaga ME, Hirani V, et al. The future Colorectal Cancer burden attributable to modifiable behaviors: a pooled cohort study. JNCI Cancer Spectr. 2018;2(3):1–9.CrossRef

39.

OECD. “Survival and mortality for colorectal cancer”, in Health at a Glance 2015. Paris: OECD Indicators, OECD Publishing; 2015. https://doi.org/10.1787/health_glance-2015-55-en.

40.

Magaji BA, Moy FM, Roslani AC, Law CW. Survival rates and predictors of survival among colorectal cancer patients in a Malaysian tertiary hospital. BMC Cancer. 2017;17(1):339. Available from: http://bmccancer.biomedcentral.com/articles/10.1186/s12885-017-3336-z [cited 2019 Oct 1]

41.

Aryaie M, Roshandel G, Semnani S, Asadi-Lari M, Aarabi M, Vakili MA, et al. Predictors of Colorectal Cancer Survival in Golestan, Iran: A Population-based Study. Epidemiol Health. 2013;35:e2013004. Available from: http://e-epih.org/journal/view.php?doi=10.4178/epih/e2013004 [cited 2019 Oct 1]

42.

Carethers JM. Clinical and Genetic Factors to Inform Reducing Colorectal Cancer Disparitites in African Americans. Front Oncol. 2018;8:531. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30524961. [cited 2019 Oct 1]

43.

Watlington AT, Byers T, Mouchawar J, Sauaia A, Ellis J. Does having insurance affect differences in clinical presentation between Hispanic and non-Hispanic white women with breast cancer? Cancer. 2007;109(10):2093–2099. Available from: http://doi.wiley.com/10.1002/cncr.22640 [cited 2019 Oct 1]

44.

Quintana JM, Antón-Ladislao A, González N, Lázaro S, Baré M, Fernández-de-Larrea N, et al. Predictors of one and two years’ mortality in patients with colon cancer: A prospective cohort study. PLoS One. 2018;13(6):e0199894 Available from: https://dx.plos.org/10.1371/journal.pone.0199894. Nagasaka T, editor [cited 2019 Oct 1].CrossRef

45.

Gimeno Garcia AZ, Hernandez Alvarez Buylla N, Nicolas-Perez D, Quintero E. Public awareness of Colorectal Cancer screening: knowledge, attitudes, and interventions for increasing screening uptake. ISRN Oncol. 2014;2014:1–19.CrossRef

46.

Gede N, Reményi Kiss D, Kiss I. Colorectal cancer and screening awareness and sources of information in the Hungarian population. BMC Fam Pract. 2018;19(1):106. Available from: https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-018-0799-1 [cited 2019 Oct 1]

47.

Stupart DA, Goldberg PA, Algar U, Ramesar R. Surveillance colonoscopy improves survival in a cohort of subjects with a single mismatch repair gene mutation. Color Dis. 2009;11(2):126–130. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19143775. [cited 2019 Oct 1]

48.

Anderson DW, Goldberg PA, Algar U, Felix R, Ramesar RS. Mobile colonoscopic surveillance provides quality care for hereditary nonpolyposis colorectal carcinoma families in South Africa. Color Dis. 2007;9(6):509–514. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17477847. [cited 2019 Oct 1]

49.

Release S. Mid-year population estimates; 2019.

50.

South African Human Rights Commission. Equality Report : Achieving substantive economic equality through rights-based radical socio-economic transformation in South Africa 2017/18. 2018; Available from: https://www.sahrc.org.za/home/21/files/SAHRC Equality Report 2017_18.pdf.

51.

Mcintyre D. Private sector involvement in funding and providing health services in South Africa : Implications for equity and access to health care. Equinet Discuss Pap 84. 2010:1–52.

52.

Statistics South Africa. Use of health facilities and levels of selected health conditions in South Africa: Findings from the General Household Survey, 2011. Vol. 05, Report No. 03–00–05 (2011). 2011. 22 p. Available from: http://www.statssa.gov.za/publications/report-03-00-05/report-03-00-052011.pdf

53.

Van Beck KC, Jasek J, Roods K, Brown JJ, Farley SM, List JM. Colorectal Cancer incidence and mortality rates among New York City adults ages 20–54 years during 1976–2015. JNCI Cancer Spectr. 2018;2(4):48–50.

54.

Lee W, Nelson R, Mailey B, Duldulao MP, Garcia-Aguilar J, Kim J. Socioeconomic Factors Impact Colon Cancer Outcomes in Diverse Patient Populations. J Gastrointest Surg. 2012;16(4):692–704. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22258868. [cited 2019 Jul 31]

55.

Tawk R, Abner A, Ashford A, Brown CP. Differences in colorectal cancer outcomes by race and insurance. Int J Environ Res Public Health. 2015;13(1):ijerph13010048. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26703651. [cited 2019 Jul 31]

56.

MartinVA. General Household survey 2017 Statistical Release. J Thorac Cardiovasc Surg. 2015;149(1):A33–A34. Available from: www.statssa.gov.za [cited 2020 Aug 13]

57.

Delobelle P. The health system in South Africa. Historical perspectives and current challenges. S Afr Focus Econ Polit Soc Iss. 2013:159–205.

58.

R Lalloo, M J Smith, N G Myburgh GCS. Access to health care in South Africa — the influence of race and class. S Afr Med J. 2012;102(7):599–601. Available from: http://www.samj.org.za/index.php/samj/article/view/5789/4270 [cited 2019 Dec 2]

59.

Gazette G. GOVERNMENT NOTICE. Heal (San Fr. 2008;(10505):2–6.

60.

Singh E, Underwood JM, Nattey C, Babb C, Sengayi M, Kellett P. South African National cancer registry: Effect of withheld data from private health systems on cancer incidence estimates. South African Med J. 2015;105(2):107–109. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591919/pdf/nihms724320.pdf [cited 2017 Dec 4]

61.

Brandt HM, Dolinger HR, Sharpe PA, Hardin JW, Berger FG. Relationship of colorectal cancer awareness and knowledge with colorectal cancer screening. Color cancer. 2012;1(5):383–396. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26257828. [cited 2019 Oct 2]

62.

Singh GK, Jemal A. Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950-2014: Over Six Decades of Changing Patterns and Widening Inequalities. J Environ Public Health. 2017;2017:2819372. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28408935. [cited 2020 Feb 10]

63.

Irabor D. Emergence of colorectal cancer in West Africa: Accepting the inevitable. Niger Med J. 2017;58(3):87. Available from: http://www.nigeriamedj.com/text.asp?2017/58/3/87/234076 [cited 2019 Oct 1]

64.

Wallace M, Pentz-kluyts M. Addressing obesity as a risk factor for Cancer in South Africa Size does matter. Cancer Control. 2017;(7):93–98. Available from: https://www.cansa.org.za/addressing-obesity-as-a-risk-factor-for-cancer-in-south-africa-size-does-matter/ [cited 2019 Oct 1]

65.

Irabor DO. Emergence of Colorectal Cancer in West Africa: Accepting the Inevitable. Niger Med J. 2017;58(3):87–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29962648. [cited 2019 Oct 1]

66.

Presidency of the Government of South Africa. Twenty Year Review (1994-2014). 2014;166.

67.

Ataguba JE, McIntyre D. Paying for and receiving benefits from health services in South Africa: is the health system equitable? Health Policy Plan. 2012;27(SUPPL.1):35–45.CrossRef

68.

Joubert J, Rao C, Bradshaw D, Vos T, Lopez AD. Evaluating the quality of National Mortality Statistics from civil registration in South Africa, 1997-2007. PLoS One. 2013;8(5):1997–2007.CrossRef

69.

Release S. Mortality and causes of death in South Africa, 2016: Findings from death notification. Statistical Release P0309.3. 2018:138. Available from: http://www.statssa.gov.za/publications/P03093/P030932016.pdf

70.

Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–91.CrossRef

71.

Graham A, Adeloye D, Grant L, Theodoratou E, Campbell H. Estimating the incidence of colorectal cancer in Sub-Saharan Africa: A systematic analysis. J Glob Health. 2012;2(2):020404. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23289079. [cited 2020 Feb 10]

Title: Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002–2014
Authors: Lactatia Motsuku
Wenlong Carl Chen
Mazvita Molleen Muchengeti
Megan Naidoo
Tamlyn Mac Quene
Patricia Kellett
Matshediso Ivy Mohlala
Kathryn M. Chu
Elvira Singh
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-07853-1

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