Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(15)00223-5.pdf

Global cancer surgery: delivering safe, affordable, and timely cancer surgery

Background
Breast cancer is estimated to be the most common cancer worldwide. We sought to assemble publicly available data from Africa to provide estimates of the incidence of breast cancer on the continent.
Methods
A systematic search of Medline, EMBASE, Global Health and African Journals Online (AJOL) was conducted. We included population- or hospital-based registry studies on breast cancer conducted in Africa, and providing estimates of the crude incidence of breast cancer among women. A random effects meta-analysis was employed to determine the pooled incidence of breast cancer across studies.
Results
The literature search returned 4648 records, with 41 studies conducted across 54 study sites in 22 African countries selected. We observed important variations in reported cancer incidence between population- and hospital-based cancer registries. The overall pooled crude incidence of breast cancer from population-based registries was 24.5 per 100 000 person years (95% confidence interval (CI) 20.1-28.9). The incidence in North Africa was higher at 29.3 per 100 000 (95% CI 20.0-38.7) than Sub-Saharan Africa (SSA) at 22.4 per 100 000 (95% CI 17.2-28.0). In hospital-based registries, the overall pooled crude incidence rate was estimated at 23.6 per 100 000 (95% CI 18.5-28.7). SSA and Northern Africa had relatively comparable rates at 24.0 per 100 000 (95% CI 17.5-30.4) and 23.2 per 100 000 (95% CI 6.6-39.7), respectively. Across both registries, incidence rates increased considerably between 2000 and 2015.
Conclusions
The available evidence suggests a growing incidence of breast cancer in Africa. The representativeness of these estimates is uncertain due to the paucity of data in several countries and calendar years, as well as inconsistency in data collation and quality across existing cancer registries.

/pdf/estimating-the-incidence-of-breast-cancer-in-africa-a-1va87llsoi.pdf

Estimating the incidence of breast cancer in Africa: a systematic review and meta-analysis.

The epidemiological transition in sub-Saharan Africa (SSA) has given rise to a concomitant increase in the incidence of non-communicable diseases including cancers. Worldwide, cancer registries have been shown to be critical for the determination of cancer burden, conduct of research, and in the planning and implementation of cancer control measures. Cancer registration though vital is often neglected in SSA owing to competing demands for resources for healthcare. We report the implementation of a system for representative nation-wide cancer registration in Nigeria - the Nigerian National System of Cancer Registries (NSCR). The NSCR coordinates the activities of cancer registries in Nigeria, strengthens existing registries, establishes new registries, complies and analyses data, and makes these freely available to researchers and policy makers. We highlight the key challenges encountered in implementing this strategy and how they were overcome. This report serves as a guide for other low- and middle-income countries (LMIC) wishing to expand cancer registration coverage in their countries and highlights the training, mentoring, scientific and logistic support, and advocacy that are crucial to sustaining cancer registration programs in LMIC.

/pdf/developing-national-cancer-registration-in-developing-1g9nlsg20h.pdf

Developing National Cancer Registration in Developing Countries - Case Study of the Nigerian National System of Cancer Registries.

During the Last two decades the incidence of cancer has increased in an ascending pattern worldwide. The type and pattern of cancer varies with between geographical region location, people’s life style and socio-economic development status of a given country. Some types of cancers are more common in the developed world and others occur more frequently in developing countries. It is expectable that with increase in life expectancy, adapting western life style and increasing growth of industrialization, the burden of cancer in sub-Saharan African countries is likely to increase in the new millennium. Objective: The objective of this study is to identify the pattern and type of cancer in Ethiopia based on the hospital registry for the last 14 years from 1998 up to 2010 in the only Oncology Center for the country in Tikur Anbessa Specialized Hospital. Methodology: This is a retrospective study aims to determine the pattern of cancer based on hospital registry in Tikur Anbessa Specialized Hospital, Oncology Center. All data was carefully reviewed from the registration log book, if any inadequate information was counter checked from the file and excluded from analysis if proven to be in adequate. Any correction or additional information of data was done based on the file and then SPSS statistical package was used to analyze the pattern of cancer, type and other variable. Result: According to our study we found that 72.8% are females and the rest 27.2 % are males. Among all patients only 10% of patients did come to the center in early stage I and II. The most common malignancy in female was gynecological malignancy 47% followed by breast carcinoma 26%. Ca uterine cervix found the most common malignancies among all gynecological malignancies. Head and Neck malignancy is found to be the leading malignancy in male 22% followed by sarcoma 15%, Gastrointestinal 12%, Hematology malignancies and urogenital 9% each and Thyroid 5%. Conclusion: Cancer has been increasingly recognized as a critical public health problem in Ethiopia, Despite this increasing burden, cancer continues to receive low public health priority in Africa, largely because of the overwhelming burden of communicable diseases and limited resources. In this study summarized the available information on cancer occurrence in Ethiopia, this should be helpful to raise cancer awareness and promote cancer prevention and control in this country. We highly recommended establishing functional population-based cancer registries within the country to facilitate cancer control strategic plan and to improve insight to policymaker about pattern and type of cancer. Pattern of cancer in Tikur Anbessa Specialized Hospital Oncology center in Ethiopia from 1998 to 2010

Pattern of Cancer in Tikur Anbessa Specialized Hospital Oncology Center in Ethiopia from 1998 to 2010

Objective: To critically appraise the quality of sub-Saharan African cancer registration systems that submitted data to GLOBOCAN 2008 with respect to population coverage using publicly available information and to show the use of GLOBOCAN statistics in determining global health priorities. Design: Sources of cancer registration data for twenty-six sub-Saharan African cancer registries were identified from GLOBOCAN 2008 factsheets. Additional information was extracted from International Agency for Research on Cancer publications. A literature search was conducted to identify studies that reported additional information on data collection methods and provided 27 studies. The websites of the 10 largest funders of development assistance for health were searched for GLOBOCAN citations. Setting and participants: Twenty-six sub-Saharan African cancer registration systems submitting data to GLOBOCAN 2008 in relation to 21 countries. Main outcome measures: Information on 15 quality variables were extracted and compared with the international gold standard for cancer registration systems. Results: Population coverage of the cancer registries ranged from from 2.3% of the population in Kenya to 100% in The Gambia, with a heavy urban bias in all countries. However, 20 countries (300 million people) had no cancer registration systems. Nineteen of the 26 registries failed to meet more than five of the 15 quality criteria and only one country met more than 10. Seven of the 10 largest funders of development assistance for health cite GLOBOCAN statistics in support of policy priorities. Conclusions: GLOBOCAN 2008 estimates are based on data drawn from poor quality cancer registration systems, with limited or no population registry coverage. It is essential the GLOBOCAN 2012 estimates should provide information on the quality of the data collection and explain the limitations of the estimates. Development organisations and the World Health Organization need to take a more cautious approach when using these data to determine priorities and allocating resources.

/pdf/appraising-the-quality-of-sub-saharan-african-cancer-3v9az5eez4.pdf

Appraising the quality of sub-Saharan African cancer registration systems that contributed to GLOBOCAN 2008: a review of the literature and critical appraisal:

The role of hospital-based cancer registries in low and middle income countries—The Nigerian Case Study

Results The commonest cancer at all sites is Prostate in men and Breast in women. There was a gradient in the incidence that paralleled the socio-economic development of the regions of the country. The ASR for breast cancer ranged from 101.1 in Abuja to 7.5 in less cosmopolitan areas. For Prostate the ASR ranged from 73 in Abuja to 1.7. The other common cancers were Kaposi Sarcoma and Colo-Rectal in men, and cervix in women. Additional data collection and analysis is ongoing.

https://link.springer.com/content/pdf/10.1186%2F1750-9378-7-S1-P3.pdf

Creating a nationwide cancer registration system to support AIDS-cancer match studies in Nigeria

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The role of hospital-based cancer registries in low and middle income countries—The Nigerian Case Study

Creating a nationwide cancer registration system to support AIDS-cancer match studies in Nigeria