Skip to main content
NCBI home page
Lippincott Open Access logoLink to Lippincott Open Access
. 2023 Nov 24;33(3):192–199. doi: 10.1097/CEJ.0000000000000852

Cancer mortality patterns in selected Northern and Southern African countries

Margherita Pizzato a, Claudia Santucci a, Fabio Parazzini a, Eva Negri b, Carlo La Vecchia a,✉
PMCID: PMC10965137  PMID: 37997906

Abstract

Background

Non-communicable diseases have been rapidly increasing in African countries. We provided updated cancer death patterns in selected African countries over the last two decades.

Methods

We extracted official death certifications and population data from the WHO and the United Nations Population Division databases. We computed country- and sex-specific age-standardized mortality rates per 100 000 person-years for all cancers combined and ten major cancer sites for the periods 2005–2007 and 2015–2017.

Results

Lung cancer ranked first for male cancer mortality in all selected countries in the last available period (with the highest rates in Réunion 24/100 000), except for South Africa where prostate cancer was the leading cause of death (23/100 000). Prostate cancer ranked second in Morocco and Tunisia and third in Mauritius and Réunion. Among Egyptian men, leukemia ranked second (with a stable rate of 4.2/100 000) and bladder cancer third (3.5/100 000). Among women, the leading cancer-related cause of death was breast cancer in all selected countries (with the highest rates in Mauritius 19.6/100 000 in 2015–2017), except for South Africa where uterus cancer ranked first (17/100 000). In the second rank there were colorectal cancer in Tunisia (2/100 000), Réunion (9/100 000) and Mauritius (8/100 000), and leukemia in Egypt (3.2/100 000). Colorectal and pancreas cancer mortality rates increased, while stomach cancer mortality rates declined.

Conclusion

Certified cancer mortality rates are low on a global scale. However, mortality rates from selected screening detectable cancers, as well as from infection-related cancers, are comparatively high, calling for improvements in prevention strategies.

Keywords: Africa, cancer mortality, joinpoint analysis, Northern African countries, Southern African countries

Introduction

The burden of cancer has been growing in Africa due to population aging and growth, as well as to the increased prevalence of risk factors associated with the economic transition (Mayosi et al., 2009; Parkin et al., 2014). However, infrastructures for cancer management are limited, struggling to meet the rising cancer demand (Znaor et al., 2018). In addition, epidemiologic data are scant, due to death certification and cancer registration systems of inadequate quality and coverage (Zanetti et al., 2010; Kantelhardt et al., 2015).

Over the last decades, we published cancer mortality assessments for selected European, Latin American and Australasian countries based on the WHO database (Santucci et al., 2023; Malvezzi et al., 2023; Pizzato et al., 2022), while we have not provided corresponding figures for the African continent. Despite some inherent uncertainties in the African estimates, the calculation of mortality rates, along with their trends, is useful for risk factors monitoring and health planning.

We here consider cancer mortality patterns in selected African countries, using data from the WHO. We included three Northern African countries (i.e. the Arab Republic of Egypt, the Kingdom of Morocco, the Republic of Tunisia), the Republic of South Africa, as well as two Southern African Islands (i.e. the Republic of Mauritius, and Réunion).

Material and methods

We extracted official death certifications and population data from the WHO and the United Nations Population Division databases for all available calendar years starting from 1990 (United Nations DoEaSA, 2017; World Health Organization Statistical Information System, 2022). We computed country- and sex-specific age-standardized mortality rates (ASMRs) using the world standard population per 100 000 persons at all ages for all cancers combined and for 10 major cancer sites (see Supplementary Table 1, Supplemental digital content 1, http://links.lww.com/EJCP/A417 for the list of cancers and the corresponding International Classification Codes used). We reported rates for the periods 2005–2007 and 2015–2017, along with the corresponding percent changes. We carried out a joinpoint regression analysis on mortality data for all cancers combined over the whole available period for each country except for Tunisia where only a few calendar years were available (Joinpoint Regression Program April, 2022). We thus identified the time point(s), called ‘joinpoints’, when a change in the linear slope of the temporal trend occurred, by testing up to a maximum of four joinpoints. As a summary measure, we showed the estimated annual percent change (APC) for each identified linear segment, and the weighted average APC (AAPC) over the entire available study period (Kim et al., 2000; Clegg et al., 2009).

For analyses, we used the software R version 4.2.2 (R Development Core Team, 2017), SAS version 9.4 (SAS Institute Inc., Cary, NC, USA), and Joinpoint Regression Program version 4.9.1.0.

Results

Table 1 shows the ASMRs in 2005–2007 and 2015–2017 with the average annual certified deaths in 2015–2017, along with the percent change between the two periods in the Arab Republic of Egypt, the Kingdom of Morocco, and Tunisia. Corresponding data along with the trends in ASMRs (dots) from all cancers and the corresponding joinpoint models (lines) since 2000 are shown in Fig. 1. In Egypt, the most recent ASMR for all cancers was 55/100 000 for men and 40/100 000 for women. Corresponding values were 33/100 000 men and 17/100 000 women in Tunisia, and 18/100 000 men and 12/100 000 women in Morocco. Among men, lung cancer was the first ranking site in all selected countries, with the latest ASMRs of 10.3/100 000 in Tunisia, 7.1/100 000 in Egypt (+15% vs. 2005–2007), and 4.1/100 000 in Morocco. Prostate cancer was the second leading cause of cancer-related death both in Morocco (1.8/100 000 in 2015–16, −16% vs. 2005–2007) and Tunisia (3.1/100 000 in 2017, −28% vs. 2013), while in Egypt leukemia ranked second (with a stable ASMR of 4.2/100 000). Among women, ASMRs from breast cancer exceed those from any other sites; the most recent rates were 6.6/100 000 in Egypt (+12% vs. 2005–2007), 3.2/100 000 in Tunisia (−3% vs. 2009), and 2.0/100 000 in Morocco (−6% vs. 2005–2007). The second leading causes of cancer death were leukemia in Egypt (3.2/100 000), uterus in Morocco (0.9/100 000), and colorect colorectum in Tunisia (1.8/100 000).

Table 1.

Age-standardized (world population) mortality rates and annual average deaths from selected cancer sites and all cancer combined per 100 000 person-years in 2005–2007 and 2015–2017 (unless indicated) for both sexes, along with the corresponding change in rates (Δ%) in the selected Northern African countries

Cancer site Men Women
ASMR 2005–2007a Annual average deaths 2015–2017b ASMR 2015–2017b Δ% 2015–2017 vs. 2005–2007 ASMR 2005–2007a Annual average deaths 2015–2017b ASMR 2015–2017b Δ% 2015–2017 vs. 2005–2007
The Arab Republic of Egypt
 Stomach 2.19 883 2.53 15.5 1.56 743 1.88 20.5
 Colorectum 2.51 1064 3.01 19.9 1.93 942 2.38 23.3
 Pancreas 1.57 777 2.28 45.2 0.78 474 1.24 59.0
 Lung 6.15 2440 7.09 15.3 2.38 1169 2.98 25.2
 Breast 0.17 52 0.15 −11.8 5.88 2573 6.60 12.2
 Uterus - - - - 1.21 586 1.52 25.6
 Ovary - - - - 0.65 284 0.73 12.3
 Prostate 2.15 793 2.62 21.9 - - - -
 Bladder 5.57 1119 3.45 −38.1 1.21 270 0.69 −43.0
 Leukemias 4.16 1660 4.16 0.0 3.17 1351 3.20 0.9
 All cancers 53.20 19 110 54.72 2.9 37.23 15 823 40.10 7.7
The Kingdom of Morocco
 Stomach 1.44 185 1.04 −27.8 0.58 98 0.49 −15.5
 Colorectum 0.92 172 0.96 4.3 0.70 151 0.76 8.6
 Pancreas 0.60 129 0.73 21.7 0.30 101 0.52 73.3
 Lung 4.14 751 4.05 −2.2 0.68 147 0.74 8.8
 Breast 0.25 14 0.08 −68.0 2.14 395 2.02 −5.6
 Uterus - - - - 1.45 179 0.89 −38.6
 Ovary - - - - 0.28 71 0.35 25.0
 Prostate 2.17 277 1.82 −16.1 - - - -
 Bladder 0.74 94 0.56 −24.3 0.13 15 0.07 −46.2
 Leukemias 0.73 125 0.70 −4.1 0.50 106 0.58 16.0
 All cancers 22.28 3173 18.01 −19.2 13.92 2319 11.80 −15.2
Tunisia
 Stomach 1.31 95 1.23 −6.1 0.81 75 0.89 9.9
 Colorectum 2.39 205 2.61 9.2 1.54 165 1.81 17.5
 Pancreas 1.25 100 1.30 4.0 0.65 57 0.66 1.5
 Lung 11.10 753 10.29 −7.3 1.33 134 1.49 12.0
 Breast 0.09 17 0.17 88.9 3.31 263 3.21 −3.0
 Uterus - - - - 1.11 84 1.06 −4.5
 Ovary - - - - 0.55 37 0.49 −10.9
 Prostate 4.25 236 3.06 −28.0 - - - -
 Bladder 1.41 97 1.32 −6.4 0.12 22 0.22 83.3
 Leukemias 1.63 112 1.49 −8.6 0.90 72 0.90 0.0
 All cancers 35.98 2473 32.95 −8.4 18.24 1462 17.37 −4.8
Open in a new tab

ASMR, age-standardized mortality rate.

a

2009 for Tunisia.

b

2015–2016 for The Arab Republic of Egypt and The Kingdom of Morocco and 2017 for Tunisia.

Fig. 1.

Fig. 1

Open in a new tab

Age-standardized mortality rates (ASMRs) for major cancer sites in the Arab Republic of Egypt, the Kingdom of Morocco, and the Republic of Tunisia, along with the trends in ASMRs (dots) from all cancers and the corresponding joinpoint models (lines) over the available period.

The trends in mortality from major cancer sites in Egypt and Morocco are reported in Supplementary Figures 1 and 2, Supplemental digital content 1, http://links.lww.com/EJCP/A417 while the corresponding results of the joinpoint regression analysis are reported in Supplementary Table 2, Supplemental digital content 1, http://links.lww.com/EJCP/A417. During the whole period 2000–2019 in Egypt, we observed a significant increase in rates in both sexes from stomach cancer (AAPC: +1.1% in men and +1.6% in women), lung cancer (+1.8% in men and +2.9% in women), and among women from pancreatic cancer (+2.7%). Mortality from bladder cancer showed favorable patterns in both sexes (AAPC: −5.2% in men and −4.1% in women). Among Moroccan men, during the period 2000–2016, no favorable patterns were observed. We registered significant AAPC of +3.7% for colorectum, +7.3% for pancreas, and +4.3% for lung cancer. In the same calendar years, women showed significant increases in mortality trend from cancer of colorectum (AAPC: +4%), pancreas (+7.5%), lung (+5.4%), breast (+6.4%), uterus (+4%), and leukemias (+3.9%).

Table 2 reports the ASMRs in 2005–2007 and 2015–2017 with the average annual deaths in 2015–2017, along with the percent change between the two periods in the Republic of South Africa, the Republic of Mauritius, and Réunion. Corresponding data along with the trends in ASMRs (dots) from all cancers and the corresponding joinpoint models (lines) since 2000 are shown in Fig. 2. Mortality trends for all cancers have been favorable since 2000 for all selected countries in both sexes. Lung cancer, albeit generally declining, remained the leading cause of male cancer death in Réunion (24.3/100 000 in 2015–16, −11% vs. 2005–2007) and Mauritius (14.3/100 000 in 2015–2017, −7% vs. 2005–2007), and the second one in South Africa (20.8/100 000 in 2015, −4% vs. 2005–2007). Prostate cancer was the first ranking site in South Africa (23/100 000 in 2015, + 19% vs. 2005–2007), while it ranked third in Réunion and Mauritius (10.1/100 000 and 8.8/100 000 respectively). Among women, the leading cancer cause of death was breast in Mauritius (19.9/100 000 in 2015–2017, +52% vs. 2005–2007) and Réunion (10.6/100 000 in 2015–16, +4% vs. 2005–2007), uterus in South Africa (16.5/100 000 in 2015, +5% vs. 2005–2007). Colorectal cancer rates increased in both sexes, reaching ASMRs of 15.2/100 000 men and 9/100 000 women in Réunion, and 10.0/100 000 men and 7.6/100 000 women in Mauritius. Stomach cancer mortality declined in all the three selected countries and both sexes. ASMRs from ovarian cancer increased both in Réunion (+65%) and Mauritius (+51%).

Table 2.

Age-standardized (world population) mortality rates and annual average deaths from selected cancer sites and all cancer combined per 100 000 person-years in 2005–2007 and 2015–2017 (unless indicated) for both sexes, along with the corresponding change in rates (Δ%) in the selected Southern African countries

Cancer site Men Women
ASMR 2005–2007 Annual average deaths 2015–2017a ASMR 2015–2017a Δ% 2015–2017 vs. 2005–2007 ASMR 2005–2007 Annual average deaths 2015–2017a ASMR 2015–2017a Δ% 2015–2017 vs. 2005–2007
The Republic of South Africa
 Stomach 5.06 749 4.32 −14.6 2.68 512 2.10 −21.6
 Colorectum 8.11 1466 8.60 6.0 5.44 1377 5.74 5.5
 Pancreas 4.25 750 4.32 1.6 3.11 725 3.08 −1.0
 Lung 21.68 3746 20.78 −4.2 7.83 1852 7.71 −1.5
 Breast 0.42 57 0.36 −14.3 13.20 3297 13.41 1.6
 Uterus - - - - 15.63 4171 16.47 5.4
 Ovary - - - - 3.11 776 3.14 1.0
 Prostate 19.26 3033 23.00 19.4 - - - -
 Bladder 2.62 415 2.77 5.7 0.81 179 0.77 −4.9
 Leukemias 2.87 609 3.23 12.5 2.00 447 1.82 −9.0
 All cancers 122.32 20 710 120.82 −1.2 87.34 21 032 85.23 −2.4
The Republic of Mauritius
 Stomach 9.34 48 6.08 −34.9 4.51 32 3.10 −31.3
 Colorectum 9.61 88 10.93 13.7 6.85 78 7.60 10.9
 Pancreas 3.94 36 4.46 13.2 2.23 28 2.75 23.3
 Lung 15.30 115 14.27 −6.7 5.12 44 4.39 −14.3
 Breast 0.66 1 0.22 −66.7 13.11 188 19.88 51.6
 Uterus - - - - 8.31 72 7.30 −12.2
 Ovary - - - - 2.94 41 4.45 51.4
 Prostate 8.03 68 8.80 9.6 - - - -
 Bladder 3.18 22 2.81 −11.6 0.49 7 0.69 40.8
 Leukemias 3.22 26 3.47 7.8 2.67 20 2.23 −16.5
 All cancers 85.72 644 80.86 −5.7 64.62 690 71.30 10.3
Réunion
 Stomach 10.90 37 6.05 −44.5 5.23 23 2.69 −48.6
 Colorectum 11.02 95 15.21 38.0 8.20 67 8.99 9.6
 Pancreas 4.63 39 6.24 34.8 3.33 28 3.62 8.7
 Lung 27.31 149 24.33 −10.9 4.80 47 6.36 32.5
 Breast 0.55 1 0.16 −70.9 10.25 75 10.62 3.6
 Uterus - - - - 5.23 41 5.60 7.1
 Ovary - - - - 1.85 24 3.05 64.9
 Prostate 13.21 64 10.14 −23.2 - - - -
 Bladder 3.27 15 2.26 −30.9 0.70 7 0.73 4.3
 Leukemias 4.61 23 3.68 −20.2 2.28 23 3.10 36.0
 All cancers 135.94 702 114.04 −16.1 67.67 487 63.96 −5.5
Open in a new tab

ASMR, age-standardized mortality rate.

a

2015 for The Republic of South Africa and 2015–2016 for Réunion.

Fig. 2.

Fig. 2

Open in a new tab

Age-standardized mortality rates (ASMRs) for major cancer sites in the Republic of South Africa, the Republic of Mauritius and Réunion, and the trends in ASMRs (dots) from all cancers and the corresponding joinpoint models (lines) over the available period.

The trends in mortality from major cancer sites in South Africa, Mauritius and Réunion are reported in Supplementary Figures 3–5, Supplemental digital content 1, http://links.lww.com/EJCP/A417 while the corresponding results of the joinpoint regression analysis are reported in Supplementary Table 3, Supplemental digital content 1, http://links.lww.com/EJCP/A417. During the available period (i.e. 1993–2019) in South Africa, we observed a significant decrease in rates in both sexes from stomach cancer (AAPC: −2.8% in men and −3.6% in women), lung cancer among men (−0.8%), and bladder cancer among women (−1.1%). Significant unfavorable mortality patterns were reported among males for colorectal (+1.2%), pancreatic (+0.6%), prostate cancer (+2.3%), and leukemia (+0.6%) as well as among females for breast (+1%) and ovarian cancer (+2%). In Mauritius, during the period 2001–2017, we registered a significant increase for both sexes in mortality trend for colorectal cancer (AAPC was +1.3% in male and +1.5% in female), pancreas (+2% in male and +1.9% in female), and breast (+2%) and ovarian cancer (+3.3%) among women. Decreasing pattern in mortality was observed in both sexes for stomach cancer (AAPC was −4.1% in male and −4% in female), among men for lung cancer (−1.7%), and among women for uterus (−1.8%). In Réunion, during the period 2001–2016, stomach cancer showed a decrease in rates for both sexes (AAPC: −4% among men and −3.1% among women). Significant downward trends were registered among men for leukemias (AAPC: −3%), lung (−1.3%) and prostate (−2.6%) cancers. Women showed a significant increase in trend for lung cancer (AAPC: +4%), while the other cancer sites showed stable mortality rates over the analyzed years.

Discussion

Certified mortality rates for all cancers combined were mostly stable or favorable in the selected African countries over recent decades. The leading causes of cancer-related death were lung, prostate and colorectal cancers in men, breast, uterus, and colorectal cancers in women.

Breast cancer has been rising in many transitioning countries, representing to date a leading cause of cancer mortality (about 1 in every 6 female cancer deaths in the selected African countries) (Arnold et al., 2022). Changes in reproductive behaviors (e.g. delayed age at first pregnancy, lower parity, and shorter duration of breastfeeding), as well as in lifestyle factors (e.g. higher alcohol consumption and physical inactivity) exposed women from these areas to a higher breast cancer risk (Corbex et al., 2014; Joko-Fru et al., 2020). Further, as compared to other ethnicities, hormone receptor-negative breast cancers, the histotypes characterized by early onset and aggressive behavior are more frequent in Black women (Chouchane et al., 2013; Lukong et al., 2017). Despite sporadic efforts have been devoted over the last decade to implement screening and early diagnosis programs, to ensure broader access to high-quality health services, and raise breast cancer awareness (Stefan et al., 2013; Basu et al., 2018; Mrabti et al., 2021), African women still face relevant delays in breast cancer detection, as well as limited access to affordable treatments (Harford, 2011; DeSantis et al., 2015).

Differences in smoking patterns explained most of the variation in lung cancer rates across geography and time (Cheng et al., 2016). In the selected countries, smoking prevalence, albeit declining over the last decades, remained notably high among men (especially in Egypt, Tunisia and Mauritius), while are comparatively low among women (especially in the Arab countries) (Azagba et al., 2015; Jazieh et al., 2019). Decreased exposure to occupational carcinogens, as well as to indoor and outdoor pollution, may have had a role in the decline of lung cancer rates (Bello et al., 2011). Chronic Pulmonary Infections namely tuberculosis (whose reported prevalence in South Africa remained one of the highest worldwide), may contribute to the lung cancer burden, even in non-smokers (Corrales et al., 2020).

Favorable stomach cancer mortality trends can be attributed to improvements in the control of Helicobacter pylori (Hp) infection, advancements in food preservation and a better and more varied diet (Ogundipe et al., 2018; Shokouhi et al., 2021). As compared to the selected Southern African countries (whose ASMRs were in line with those observed in Europe), stomach cancer mortality rates were lower in the Northern African countries. In these latter areas, beyond possible under-reporting, and despite historically high levels of Hp infection, genetic and environmental (dietary) factors could act as possible protective determinants (Elghali et al., 2018).

Unfavorable changes in identified risk factors (e.g. increased sedentariness, high-fat dietary patterns) at times not counterbalanced by broad access to high-quality health services, may explain pancreas and colorectum cancer increasing trends (Katsidzira et al., 2017). The prevalence of overweight has been also rising in the selected African countries reaching to date levels similar to those observed in high-income countries, especially among women (Finucane et al., 2011; Selmouni et al., 2018). Except for Réunion, where screening services retraced those implemented in France, other selected countries lacked early detection programs for colorectal cancer (Laiyemo et al., 2016). Moreover, the lower alcohol consumption reported among both sexes in the Arab countries, as compared to the Southern African is, represented a favorable factor in these areas (Bryazka et al., 2022).

Prostate cancer mortality rates were over two times higher in South Africa than in Réunion and Mauritius (whose rates were in line with the European ones) (Culp et al., 2020). Black African ancestry was associated with higher prostate cancer mortality rates, which, at least in part, is thought to reflect a genetic susceptibility to develop prostate malignancies characterized by aggressive biology and unfavorable anatomical localization (Adeloye et al., 2016; Seraphin et al., 2021). Disparities in prostate cancer mortality rates also reflected geographic differences in the availability of facilities for the detection of early-stage lesions and to adequate management and treatment (McGinley et al., 2016).

While cervical cancer deaths have been declining in several high-income countries over recent decades, the its burden remained extremely high in Africa countries, reaching 20% of female cancer-related deaths in South Africa (Jedy-Agba et al., 2020). Even in those African countries where programs for cervical cancer prevention have been implemented over the last decades, the national coverage of both cervical screening and HPV vaccination, as well as the attendance to second-line diagnosis and management after positive screening results, remained comparatively low (Elmajjaoui et al., 2016; Olorunfemi et al., 2018). HIV infection, whose prevalence in South Africa is among the highest globally has been found to increase the rate of HPV infection and its persistence (Mboumba Bouassa et al., 2017).

The westernization of lifestyle (including reduced parity and breastfeeding, late age at first pregnancy, and increase in obesity and type 2 diabetes) justify, at least in part, the ovarian cancer increases in death rates (Koon Sun Pat et al., 2019; Zheng et al., 2020; Gizaw et al., 2023). Ovarian cancer clinical characteristics (i.e. insidious onset with nonspecific symptoms, early resistance to conventional treatment and high recurrence) hinder its clinical management in low-resource countries (Cabasag et al., 2022).

The eradication programs of schistosomiasis, through praziquantel mass drug administration and sanitation measures implemented in the selected Northern African countries over the last decades, explain the declining trends observed for bladder cancer (Adeloye et al., 2019; Parkin et al., 2020). The male-to-female ratio (M: F) was in the Southern African countries in line with that observed in Europe (around 4 : 1); the wider gender gap seen in Northern African countries (up to 8 : 1 in Morocco) reflects the strong gender disparities in smoking consumption and possibly occupational exposure to aromatic amines (Felix et al., 2008; El Sayed et al., 2018).

The high burden of leukaemia and other lymphatic malignancies in Egypt is likely driven by the spread of the Hepatitis C Virus (HCV), whose infection has been associated with haematological cancers (Goldman et al., 2009; Dey et al., 2011). The parenteral anti-Schistosoma mass campaign, which was carried out during the 1950s–80s before the praziquantel administration, established a very large reservoir of HCV in this country (Herzog et al., 2012; El Kassas et al., 2018). Poor infection control, transfusion of unscreened blood, and inadequate sterilization procedures in medical and dental settings continue to fuel the epidemic, in particular in rural areas (Hussein et al., 2016).

African patients faced multiple barriers in seeking and accessing adequate healthcare services (Harford, 2015). Needing to travel long distances to obtain cancer care facilities, concentrated in urban centers, hindered effective cancer management. Financial constraints, lower levels of cancer symptom awareness, reliance on traditional healers, embarrassment towards a still stigmatized disease, and fatalistic beliefs about death also account for the delay in seeking diagnosis (Pourette et al., 2022). In addition, language barriers have a potential role in suboptimum management: while health providers may be fluent only in the official language, patients are better expressed in sublanguages and dialects (Hayes and Bornman, 2017). Health systems remained generally understaffed and underfinanced, especially in the public health care system, where patients are managed with the use of simpler techniques and basic therapies. Effective health care is also limited by the lack of trained medical personnel, insufficient modern equipment, poor infrastructure, and the high cost of cancer drugs, including targeted therapies that remain prohibitively expensive in most low-resource settings (Kingham et al., 2013; Vanderpuye et al., 2017). The facilities equipped and empowered to ensure prevention are struggling to develop; whether offered, prevention services are primarily opportunistic and out-of-pocket paid (Made et al., 2017). Suboptimum pathology, as well as poor availability of adjuvant radiotherapy and chemotherapy, resulted in the underuse of conservative surgery (Jemal et al., 2012; Adesina et al., 2013). Underrepresentation of certain ethnicities in cancer trials may account for worse survival rates in those population subgroups (Odedina et al., 2020).

Data quality remains a major limitation in understanding and estimating the mortality of the African continent (Pace and Shulman, 2016; Belbaraka et al., 2022). Cancer registration and death certification faced multiple obstacles in these areas, including low resource allocation, inadequate health infrastructures and informatic systems, and lack of specialized technical staff (Bray et al., 2022). Given the modest coverage and the inaccuracy in death certification, especially in Northern African countries, reported mortality rates must be interpreted with caution (Elidrissi Errahhali et al., 2017). The major strength of this study lies in the fact that it provides one of the few appraisals of mortality patterns across different areas of the African continent, based on a WHO data source.

Conclusion

The wide African heterogeneity in terms of ethnic and genetic backgrounds, demographic characteristics, and economic status is reflected in the epidemiological patterns observed. Genetic characteristics in Africans modulate their risks to specific cancer types, particularly breast and prostate cancers, and influence the clinical manifestation of these malignancies. Some of the observed increases in rates likely reflect the adoption of transitional countries lifestyles in selected African areas. The burden of infection-related cancers still endured in all selected contexts. Coupling this with the lack of screening, treatment facilities and resources, a greater focus is needed on primary and secondary prevention.

Acknowledgements

This work was supported by the Foundation of the Italian Association for Cancer Research (AIRC Foundation, project N. 22987). CS and CLV are also supported by EU funding within the NextGenerationEU-MUR PNRR Extended Partnership initiative (Project no. PE00000007, INF-ACT). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

The data that support the findings of this study are openly available in the WHO database at https://platform.who.int/mortality/themes/theme-details/topics/topic-details/MDB/malignant-neoplasms.

Conflicts of interest

There are no conflicts of interest.

Supplementary Material

ejcp-33-192-s001.pdf (1.2MB, pdf)
Open in a new tab

Footnotes

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.eurjcancerprev.com).

References

  1. Adeloye D, David RA, Aderemi AV, Iseolorunkanmi A, Oyedokun A, Iweala EEJ, et al. (2016). An estimate of the incidence of prostate cancer in Africa: a systematic review and meta-analysis. PLoS One 11:e0153496. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Adeloye D, Harhay MO, Ayepola OO, Dos Santos JP, David RA, Ogunlana OO, et al. (2019). Estimate of the incidence of bladder cancer in Africa: a systematic review and Bayesian meta-analysis. Int J Urol 26:102–112. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Adesina A, Chumba D, Nelson AM, Orem J, Roberts DJ, Wabinga H, et al. (2013). Improvement of pathology in sub-Saharan Africa. Lancet Oncol 14:e152–e157. [DOI] [PubMed] [Google Scholar]
  4. Arnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, et al. (2022). Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast 66:15–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Azagba S, Burhoo P, Chaloupka FJ, Fong GT. (2015). Effect of cigarette tax increase in combination with mass media campaign on smoking behaviour in Mauritius: findings from the ITC Mauritius Survey. Tob Control 24:iii71–iii75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Basu P, Selmouni F, Belakhel L, Sauvaget C, Abousselham L, Lucas E, et al. (2018). Breast Cancer Screening Program in Morocco: Status of implementation, organization and performance. Int J Cancer 143:3273–3280. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Belbaraka R, Benhima N, Laatabi A, El Fadli M, Essâdi I. (2022). Incidence trends of cancer in morocco: the tale of the oncological center of marrakech (morocco) over 8 years. J Cancer Epidemiol 2022:3307194. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Bello B, Fadahun O, Kielkowski D, Nelson G. (2011). Trends in lung cancer mortality in South Africa: 1995-2006. BMC Public Health 11:209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bray F, Parkin DM, Gnangnon F, Tshisimogo G, Peko J-F, Adoubi I, et al. (2022). Cancer in sub-Saharan Africa in 2020: a review of current estimates of the national burden, data gaps, and future needs. Lancet Oncol 23:719–728. [DOI] [PubMed] [Google Scholar]
  10. Bryazka D, Reitsma MB, Griswold MG, Abate KH, Abbafati C, Abbasi-Kangevari M, et al. (2022). Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020. The Lancet 400:185–235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cabasag CJ, Fagan PJ, Ferlay J, Vignat J, Laversanne M, Liu L, et al. (2022). Ovarian cancer today and tomorrow: a global assessment by world region and human development index using GLOBOCAN 2020. Int J Cancer 151:1535–1541. [DOI] [PubMed] [Google Scholar]
  12. Cheng T-YD, Cramb SM, Baade PD, Youlden DR, Nwogu C, Reid ME. (2016). The international epidemiology of lung cancer: latest trends, disparities, and tumor characteristics. J Thorac Oncol 11:1653–1671. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Chouchane L, Boussen H, Sastry KSR. (2013). Breast cancer in Arab populations: molecular characteristics and disease management implications. Lancet Oncol 14:e417–e424. [DOI] [PubMed] [Google Scholar]
  14. Clegg LX, Hankey BF, Tiwari R, Feuer EJ, Edwards BK. (2009). Estimating average annual per cent change in trend analysis. Stat Med 28:3670–3682. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Corbex M, Bouzbid S, Boffetta P. (2014). Features of breast cancer in developing countries, examples from North-Africa. Eur J Cancer 50:1808–1818. [DOI] [PubMed] [Google Scholar]
  16. Corrales L, Rosell R, Cardona AF, Martín C, Zatarain-Barrón ZL, Arrieta O. (2020). Lung cancer in never smokers: The role of different risk factors other than tobacco smoking. Crit Rev Oncol Hematol 148:102895. [DOI] [PubMed] [Google Scholar]
  17. Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. (2020). Recent Global Patterns in Prostate Cancer Incidence and Mortality Rates. Eur Urol 77:38–52. [DOI] [PubMed] [Google Scholar]
  18. DeSantis CE, Bray F, Ferlay J, Lortet-Tieulent J, Anderson BO, Jemal A. (2015). International variation in female breast cancer incidence and mortality rates. Cancer Epidemiol Biomarkers Prev 24:1495–1506. [DOI] [PubMed] [Google Scholar]
  19. Dey S, Zhang Z, Hablas A, Seifeldein IA, Ramadan M, El-Hamzawy H, et al. (2011). Geographic patterns of cancer in the population-based registry of Egypt: possible links to environmental exposures. Cancer Epidemiology 35:254–264. [DOI] [PubMed] [Google Scholar]
  20. Elghali MA, Gouader A, Bouriga R, Mahjoub M, Jarrar MS, Ziadi S, et al. (2018). Gastric adenocarcinomas in central tunisia: evolution specificities through two decades and relation with helicobacter pylori. Oncol 95:121–128. [DOI] [PubMed] [Google Scholar]
  21. Elidrissi Errahhali M, Elidrissi Errahhali M, Ouarzane M, Boulouiz R, Bellaoui M. (2017). Cancer incidence in eastern Morocco: cancer patterns and incidence trends, 2005–2012. BMC Cancer 17:587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. El Kassas M, Elbaz T, Elsharkawy A, Omar H, Esmat G. (2018). HCV in Egypt, prevention, treatment and key barriers to elimination. Expert Rev Anti Infect Ther 16:345–350. [DOI] [PubMed] [Google Scholar]
  23. Elmajjaoui S, Ismaili N, El Kacemi H, Kebdani T, Sifat H, Benjaafar N. (2016). Epidemiology and outcome of cervical cancer in national institute of Morocco. BMC Womens Health 16:62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. El Sayed I, Elkhwsky F, La Vecchia C, Alicandro G. (2018). The frequency of bladder cancer in alexandria, egypt, over the last two decades. Eur J Cancer Prev 27:477–478. [DOI] [PubMed] [Google Scholar]
  25. Felix AS, Soliman AS, Khaled H, Zaghloul MS, Banerjee M, El-Baradie M, et al. (2008). The changing patterns of bladder cancer in Egypt over the past 26 years. Cancer Causes Control 19:421–429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al.; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index) (2011). National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet 377:557–567. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Gizaw M, Parkin DM, Stöter O, Korir A, Kamate B, Liu B, et al. (2023). Trends in the incidence of ovarian cancer in sub-Saharan Africa. Int J Cancer 152:1328–1336. [DOI] [PubMed] [Google Scholar]
  28. Goldman L, Ezzat S, Mokhtar N, Abdel-Hamid A, Fowler N, Gouda I, et al. (2009). Viral and non-viral risk factors for non-Hodgkin’s lymphoma in Egypt: heterogeneity by histological and immunological subtypes. Cancer Causes Control 20:981–987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Harford JB. (2011). Breast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits all. Lancet Oncol 12:306–312. [DOI] [PubMed] [Google Scholar]
  30. Harford JB. (2015). Barriers to overcome for effective cancer control in Africa. Lancet Oncol 16:e385–e393. [DOI] [PubMed] [Google Scholar]
  31. Hayes VM, Bornman MSR. (2017). Prostate cancer in southern Africa: does Africa hold untapped potential to add value to the current understanding of a common disease? J Glob Oncol 4:1–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Herzog CM, Dey S, Hablas A, Khaled HM, Seifeldin IA, Ramadan M, et al. (2012). Geographic distribution of hematopoietic cancers in the Nile delta of Egypt. Ann Oncol 23:2748–2755. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Hussein WM, Anwar WA, Attaleb M, Mazini L, Försti A, Trimbitas R-D, et al. (2016). A review of the infection-associated cancers in North African countries. Infect Agent Cancer 11:35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Jazieh AR, Algwaiz G, Errihani H, Elghissassi I, Mula-Hussain L, Bawazir AA, et al. (2019). Lung cancer in the middle east and north Africa region. J Thorac Oncol 14:1884–1891. [DOI] [PubMed] [Google Scholar]
  35. Jedy-Agba E, Joko WY, Liu B, Buziba NG, Borok M, Korir A, et al. (2020). Trends in cervical cancer incidence in sub-Saharan Africa. Br J Cancer 123:148–154. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Jemal A, Bray F, Forman D, O'Brien M, Ferlay J, Center M, et al. (2012). Cancer burden in Africa and opportunities for prevention. Cancer 118:4372–4384. [DOI] [PubMed] [Google Scholar]
  37. Joinpoint Regression Program (2022). Version 4.9.1.0-; Statistical Methodology and Applications Branch, Surveillance Research Program. National Cancer Institute. [Google Scholar]
  38. Joko-Fru WY, Jedy-Agba E, Korir A, Ogunbiyi O, Dzamalala CP, Chokunonga E, et al. (2020). The evolving epidemic of breast cancer in sub-Saharan Africa: Results from the African Cancer Registry Network. Int J Cancer 147:2131–2141. [DOI] [PubMed] [Google Scholar]
  39. Kantelhardt EJ, Muluken G, Sefonias G, Wondimu A, Gebert HC, Unverzagt S, et al. (2015). A review on breast cancer care in Africa. Breast Care (Basel) 10:364–370. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Katsidzira L, Gangaidzo I, Thomson S, Rusakaniko S, Matenga J, Ramesar R. (2017). The shifting epidemiology of colorectal cancer in sub-Saharan Africa. Lancet Gastroenterol Hepatol 2:377–383. [DOI] [PubMed] [Google Scholar]
  41. Kim HJ, Fay MP, Feuer EJ, Midthune DN. (2000). Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 19:335–351. [DOI] [PubMed] [Google Scholar]
  42. Kingham TP, Alatise OI, Vanderpuye V, Casper C, Abantanga FA, Kamara TB, et al. (2013). Treatment of cancer in sub-Saharan Africa. Lancet Oncol 14:e158–e167. [DOI] [PubMed] [Google Scholar]
  43. Koon Sun Pat M, Manraj M, Fauzee J, Sewsurn S, Parkin DM, Manraj S. (2019). Trends in cancer incidence in the Republic of Mauritius, 1991–2015. Cancer Epidemiology 63:101616. [DOI] [PubMed] [Google Scholar]
  44. Laiyemo AO, Brawley O, Irabor D, Boutall A, Ramesar RS, Madiba TE. (2016). Toward colorectal cancer control in Africa. Int J Cancer 138:1033–1034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Lukong KE, Ogunbolude Y, Kamdem JP. (2017). Breast cancer in Africa: prevalence, treatment options, herbal medicines, and socioeconomic determinants. Breast Cancer Res Treat 166:351–365. [DOI] [PubMed] [Google Scholar]
  46. Made F, Wilson K, Jina R, Tlotleng N, Jack S, Ntlebi V, et al. (2017). Distribution of cancer mortality rates by province in South Africa. Cancer Epidemiol 51:56–61. [DOI] [PubMed] [Google Scholar]
  47. Malvezzi M, Santucci C, Boffetta P, Collatuzzo G, Levi F, La Vecchia C, et al. (2023). European cancer mortality predictions for the year 2023 with focus on lung cancer. Ann Oncol 34:410–419. [DOI] [PubMed] [Google Scholar]
  48. Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D. (2009). The burden of non-communicable diseases in South Africa. Lancet 374:934–947. [DOI] [PubMed] [Google Scholar]
  49. Mboumba Bouassa R-S, Prazuck T, Lethu T, Jenabian M-A, Meye J-F, Bélec L. (2017). Cervical cancer in sub-Saharan Africa: a preventable noncommunicable disease. Expert Rev Anti Infect Ther 15:613–627. [DOI] [PubMed] [Google Scholar]
  50. McGinley KF, Tay KJ, Moul JW. (2016). Prostate cancer in men of African origin. Nat Rev Urol 13:99–107. [DOI] [PubMed] [Google Scholar]
  51. Mrabti H, Sauvaget C, Benider A, Bendahhou K, Selmouni F, Muwonge R, et al. (2021). Patterns of care of breast cancer patients in Morocco – a study of variations in patient profile, tumour characteristics and standard of care over a decade. The Breast 59:193–202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Odedina FT, Shamley D, Okoye I, Ezeani A, Ndlovu N, Dei-Adomakoh Y, et al. (2020). Landscape of oncology clinical trials in Africa. JCO Glob Oncol 6:932–941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Ogundipe T, Mustafa M, Gillum R. (2018). Levels and trends of esophageal and stomach cancer mortality in sub-saharan Africa and the caribbean. J Glob Oncol 4:1–2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Olorunfemi G, Ndlovu N, Masukume G, Chikandiwa A, Pisa PT, Singh E. (2018). Temporal trends in the epidemiology of cervical cancer in South Africa (1994–2012). Int J Cancer 143:2238–2249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Pace LE, Shulman LN. (2016). Breast cancer in sub-saharan Africa: challenges and opportunities to reduce mortality. Oncologist 21:739–744. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Parkin DM, Bray F, Ferlay J, Jemal A. (2014). Cancer in Africa 2012. Cancer Epidemiol Biomarkers Prev 23:953–966. [DOI] [PubMed] [Google Scholar]
  57. Parkin DM, Hämmerl L, Ferlay J, Kantelhardt EJ. (2020). Cancer in Africa 2018: the role of infections. Int J Cancer 146:2089–2103. [DOI] [PubMed] [Google Scholar]
  58. Pizzato M, La Vecchia C, Malvezzi M, Levi F, Boffetta P, Negri E, et al. (2022). Cancer mortality and predictions for 2022 in selected Australasian countries, Russia, and Ukraine with a focus on colorectal cancer. Eur J Cancer Prev 32:18–29. [DOI] [PubMed] [Google Scholar]
  59. Pourette D, Cripps A, Guerrien M, Desprès C, Opigez E, Bardou M, et al. (2022). Assessing the acceptability of home-based HPV self-sampling: a qualitative study on cervical cancer screening conducted in reunion island prior to the RESISTE trial. Cancers (Basel) 14:1380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Santucci C, Malvezzi M, Levi F, Camargo MC, Boffetta P, La Vecchia C, et al. (2023). Cancer mortality predictions for 2023 in Latin America with focus on stomach cancer. Eur J Cancer Prev 32:310–321. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Selmouni F, Zidouh A, Belakhel L, Sauvaget C, Bennani M, Khazraji YC, et al. (2018). Tackling cancer burden in low-income and middle-income countries: Morocco as an exemplar. Lancet Oncol 19:e93–e101. [DOI] [PubMed] [Google Scholar]
  62. Seraphin TP, Joko-Fru WY, Kamaté B, Chokunonga E, Wabinga H, Somdyala NIM, et al. (2021). Rising prostate cancer incidence in sub-saharan Africa: a trend analysis of data from the African cancer registry network. Cancer Epidemiol Biomarkers Prev 30:158–165. [DOI] [PubMed] [Google Scholar]
  63. Shokouhi F, Amiripour A, Raeisi Shahraki H. (2021). The main patterns in the trend change of stomach cancer incidence amongst selected African countries. Glob Health Epidemiol Genom 2021:5065707. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Stefan DC, Elzawawy AM, Khaled HM, Ntaganda F, Asiimwe A, Addai BW, et al. (2013). Developing cancer control plans in Africa: examples from five countries. Lancet Oncol 14:e189–e195. [DOI] [PubMed] [Google Scholar]
  65. United Nations DoEaSA , Population Division (2017). World Population Prospects: The 2017 Revision, DVD Edition. [Google Scholar]
  66. Vanderpuye V, Grover S, Hammad N, Pooja P, Simonds H, Olopade F, et al. (2017). An update on the management of breast cancer in Africa. Infect Agent Cancer 12:13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. World Health Organization Statistical Information System (2022). WHO mortality database. Geneva: World Health Organization. https://www.who.int/data/data-collection-tools/who-mortality-database. [Accessed September 2022].
  68. Zanetti R, Tazi MA, Rosso S. (2010). New data tells us more about cancer incidence in North Africa. Eur J Cancer 46:462–466. [DOI] [PubMed] [Google Scholar]
  69. Zheng L, Cui C, Shi O, Lu X, Li Y-K, Wang W, et al. (2020). Incidence and mortality of ovarian cancer at the global, regional, and national levels, 1990-2017. Gynecol Oncol 159:239–247. [DOI] [PubMed] [Google Scholar]
  70. Znaor A, Eser S, Anton-Culver H, Fadhil I, Ryzhov A, Silverman BG, et al. (2018). Cancer surveillance in northern Africa, and central and western Asia: challenges and strategies in support of developing cancer registries. Lancet Oncol 19:e85–e92. [DOI] [PubMed] [Google Scholar]

Articles from European Journal of Cancer Prevention are provided here courtesy of Wolters Kluwer Health

RESOURCES