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. 1995 Jan;88(1):5–13.

Cancer outlook: an African perspective.

A R Walker 1
PMCID: PMC1295065  PMID: 7884774

Abstract

In all western populations, mortality rates from cancer are high and even increasing: moreover, incidence rates of some cancers are also rising. As to propitiousness of preventive factors, genetic, gender, and age are beyond alteration: much the same applies to certain protective factors, e.g. late menarche, teenage pregnancy, high parity, long lactation, and greater physical activity. Influential dietary factors, i.e. intakes of energy, fat and fibre, often do not lend themselves to major alteration. Although reductions in smoking have occurred, the practice remains widespread and the intake of alcohol remains high. In developing countries, such as Africa, life-style changes are occurring and the population is incurring all risk factors mentioned. Whereas cancer is relatively uncommon in rural dwellers in developing countries, it is increasing in the huge peri-urban and urban populations due to changes in diet and way of life. Although knowledge should enable us to halve cancer's burden, hopes for meaningful changes are meagre. Survival time can be lengthened by more effective screening, especially of the very susceptible, and by further advances in treatment. Since known risk factors account for only half or less of occurrences of cancer, further rises, or, hopefully, welcome falls, could conceivably occur in the future. We must continue to try to educate the public regarding cancer avoidance: compliance by even a small proportion of those at risk could benefit huge numbers.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adami H. O. What is progress against cancer? Cancer Causes Control. 1993 Sep;4(5):483–487. doi: 10.1007/BF00050868. [DOI] [PubMed] [Google Scholar]
  2. Astrow A. B. Rethinking cancer. Lancet. 1994 Feb 26;343(8896):494–495. doi: 10.1016/s0140-6736(94)91454-0. [DOI] [PubMed] [Google Scholar]
  3. Bah E., Hall A. J., Inskip H. M. The first 2 years of the Gambian National Cancer Registry. Br J Cancer. 1990 Oct;62(4):647–650. doi: 10.1038/bjc.1990.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bailar J. C., 3rd, Smith E. M. Progress against cancer? N Engl J Med. 1986 May 8;314(19):1226–1232. doi: 10.1056/NEJM198605083141905. [DOI] [PubMed] [Google Scholar]
  5. Banach L., Stepien A. The most common cancers in Transkeian adults by histological diagnosis. S Afr Med J. 1993 Oct;83(10):808–808. [PubMed] [Google Scholar]
  6. Bonett A., Roder D., Esterman A. Cancer case-survival rates for South Australia: a comparison with US rates and a preliminary investigation of time trends. Med J Aust. 1988 Jun 6;148(11):556–559. doi: 10.5694/j.1326-5377.1988.tb93810.x. [DOI] [PubMed] [Google Scholar]
  7. Boring C. C., Squires T. S., Tong T. Cancer statistics, 1992. CA Cancer J Clin. 1992 Jan-Feb;42(1):19–38. doi: 10.3322/canjclin.42.1.19. [DOI] [PubMed] [Google Scholar]
  8. Bourne L. T., Langenhoven M. L., Steyn K., Jooste P. L., Laubscher J. A., Van der Vyver E. Nutrient intake in the urban African population of the Cape Peninsula, South Africa. The Brisk study. Cent Afr J Med. 1993 Dec;39(12):238–247. [PubMed] [Google Scholar]
  9. Boyle P., Levi F., Lucchini F., La Vecchia C., Kevi R [corrected to Levi F. ]., Lucchuni F [corrected to Lucchini F. ]. Trends in diet-related cancers in Japan: a conundrum? Lancet. 1993 Sep 18;342(8873):752–752. doi: 10.1016/0140-6736(93)91748-b. [DOI] [PubMed] [Google Scholar]
  10. Chinyadza E., Moyo I. M., Katsumbe T. M., Chisvo D., Mahari M., Cock D. E., Mbengeranwa O. L. Alcohol problems among patients attending five primary health care clinics in Harare city. Cent Afr J Med. 1993 Feb;39(2):26–32. [PubMed] [Google Scholar]
  11. Choice of patient in Ireland. Lancet. 1994 Mar 5;343(8897):594–594. [PubMed] [Google Scholar]
  12. Coggon D., Inskip H. Is there an epidemic of cancer? BMJ. 1994 Mar 12;308(6930):705–708. doi: 10.1136/bmj.308.6930.705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Cotugna N., Subar A. F., Heimendinger J., Kahle L. Nutrition and cancer prevention knowledge, beliefs, attitudes, and practices: the 1987 National Health Interview Survey. J Am Diet Assoc. 1992 Aug;92(8):963–968. [PubMed] [Google Scholar]
  14. Crespi M., Muñoz N., Grassi A., Qiong S., Jing W. K., Jien L. J. Precursor lesions of oesophageal cancer in a low-risk population in China: comparison with high-risk populations. Int J Cancer. 1984 Nov 15;34(5):599–602. doi: 10.1002/ijc.2910340503. [DOI] [PubMed] [Google Scholar]
  15. Dent O., Goulston K. Geographic distribution and demographic correlates of colorectal cancer mortality in Sydney, New South Wales. Soc Sci Med. 1984;19(4):433–439. doi: 10.1016/0277-9536(84)90201-6. [DOI] [PubMed] [Google Scholar]
  16. El-Bolkainy M. N., Mokhtar N. M., Ghoneim M. A., Hussein M. H. The impact of schistosomiasis on the pathology of bladder carcinoma. Cancer. 1981 Dec 15;48(12):2643–2648. doi: 10.1002/1097-0142(19811215)48:12<2643::aid-cncr2820481216>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  17. Eng C., Stratton M., Ponder B., Murday V., Easton D., Sacks N., Watson M., Eeles R. Familial cancer syndromes. Lancet. 1994 Mar 19;343(8899):709–713. doi: 10.1016/s0140-6736(94)91585-7. [DOI] [PubMed] [Google Scholar]
  18. Evans I. The challenge of breast cancer. Lancet. 1994 Apr 30;343(8905):1085–1086. doi: 10.1016/s0140-6736(94)90187-2. [DOI] [PubMed] [Google Scholar]
  19. Gastrin G., Miller A. B., To T., Aronson K. J., Wall C., Hakama M., Louhivuori K., Pukkala E. Incidence and mortality from breast cancer in the Mama Program for Breast Screening in Finland, 1973-1986. Cancer. 1994 Apr 15;73(8):2168–2174. doi: 10.1002/1097-0142(19940415)73:8<2168::aid-cncr2820730822>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  20. Gibbons A. Does war on cancer equal war on poverty? Science. 1991 Jul 19;253(5017):260–260. doi: 10.1126/science.1857961. [DOI] [PubMed] [Google Scholar]
  21. Grossman D. C., Krieger J. W., Sugarman J. R., Forquera R. A. Health status of urban American Indians and Alaska Natives. A population-based study. JAMA. 1994 Mar 16;271(11):845–850. [PubMed] [Google Scholar]
  22. Guo W., Zheng W., Li J. Y., Chen J. S., Blot W. J. Correlations of colon cancer mortality with dietary factors, serum markers, and schistosomiasis in China. Nutr Cancer. 1993;20(1):13–20. doi: 10.1080/01635589309514266. [DOI] [PubMed] [Google Scholar]
  23. Harris J. R., Lippman M. E., Veronesi U., Willett W. Breast cancer (1) N Engl J Med. 1992 Jul 30;327(5):319–328. doi: 10.1056/NEJM199207303270505. [DOI] [PubMed] [Google Scholar]
  24. Henschke U. K., Leffall L. D., Jr, Mason C. H., Reinhold A. W., Schneider R. L., White J. E. Alarming increase of the cancer mortality in the U.S. black population (1950-1967). Cancer. 1973 Apr;31(4):763–768. doi: 10.1002/1097-0142(197304)31:4<763::aid-cncr2820310401>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  25. Herrero R., Brinton L. A., Reeves W. C., Brenes M. M., Tenorio F., de Britton R. C., Gaitan E., Garcia M., Rawls W. E. Sexual behavior, venereal diseases, hygiene practices, and invasive cervical cancer in a high-risk population. Cancer. 1990 Jan 15;65(2):380–386. doi: 10.1002/1097-0142(19900115)65:2<380::aid-cncr2820650234>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  26. Higgins M. W., Enright P. L., Kronmal R. A., Schenker M. B., Anton-Culver H., Lyles M. Smoking and lung function in elderly men and women. The Cardiovascular Health Study. JAMA. 1993 Jun 2;269(21):2741–2748. [PubMed] [Google Scholar]
  27. Howson C. P., Hiyama T., Wynder E. L. The decline in gastric cancer: epidemiology of an unplanned triumph. Epidemiol Rev. 1986;8:1–27. doi: 10.1093/oxfordjournals.epirev.a036288. [DOI] [PubMed] [Google Scholar]
  28. Hsing A. W., McLaughlin J. K., Zheng W., Gao Y. T., Blot W. J. Occupation, physical activity, and risk of prostate cancer in Shanghai, People's Republic of China. Cancer Causes Control. 1994 Mar;5(2):136–140. doi: 10.1007/BF01830259. [DOI] [PubMed] [Google Scholar]
  29. Juntunen J., Asp S., Olkinuora M., Aärimaa M., Strid L., Kauttu K. Doctors' drinking habits and consumption of alcohol. BMJ. 1988 Oct 15;297(6654):951–954. doi: 10.1136/bmj.297.6654.951. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Kawachi I., Colditz G. A., Stampfer M. J., Willett W. C., Manson J. E., Rosner B., Hunter D. J., Hennekens C. H., Speizer F. E. Smoking cessation in relation to total mortality rates in women. A prospective cohort study. Ann Intern Med. 1993 Nov 15;119(10):992–1000. doi: 10.7326/0003-4819-119-10-199311150-00005. [DOI] [PubMed] [Google Scholar]
  31. Kew M. C., Houghton M., Choo Q. L., Kuo G. Hepatitis C virus antibodies in southern African blacks with hepatocellular carcinoma. Lancet. 1990 Apr 14;335(8694):873–874. doi: 10.1016/0140-6736(90)90474-j. [DOI] [PubMed] [Google Scholar]
  32. Kobayashi T., Kawakubo T. Prospective investigation of tumor markers and risk assessment in early cancer screening. Cancer. 1994 Apr 1;73(7):1946–1953. doi: 10.1002/1097-0142(19940401)73:7<1946::aid-cncr2820730728>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  33. Lloyd H. M., Paisley C. M., Mela D. J. Changing to a low fat diet: attitudes and beliefs of UK consumers. Eur J Clin Nutr. 1993 May;47(5):361–373. [PubMed] [Google Scholar]
  34. Lyon J. L., Gardner K., Gress R. E. Cancer incidence among Mormons and non-Mormons in Utah (United States) 1971-85. Cancer Causes Control. 1994 Mar;5(2):149–156. doi: 10.1007/BF01830261. [DOI] [PubMed] [Google Scholar]
  35. Mandelblatt J. S., Fahs M. C. The cost-effectiveness of cervical cancer screening for low-income elderly women. JAMA. 1988 Apr 22;259(16):2409–2413. [PubMed] [Google Scholar]
  36. Marshall E. Epidemiology. Search for a killer: focus shifts from fat to hormones. Science. 1993 Jan 29;259(5095):618–621. doi: 10.1126/science.8430308. [DOI] [PubMed] [Google Scholar]
  37. McNamee D. The darkest ages of tobacco. Eur J Cancer. 1992;28A(12):1940–1941. doi: 10.1016/0959-8049(92)90231-p. [DOI] [PubMed] [Google Scholar]
  38. Miller A. B. How do we interpret the 'bad news' about cancer? JAMA. 1994 Feb 9;271(6):468–468. [PubMed] [Google Scholar]
  39. Muir C. S., Sasco A. J. Prospects for cancer control in the 1990s. Annu Rev Public Health. 1990;11:143–163. doi: 10.1146/annurev.pu.11.050190.001043. [DOI] [PubMed] [Google Scholar]
  40. Nelson D. E., Giovino G. A., Emont S. L., Brackbill R., Cameron L. L., Peddicord J., Mowery P. D. Trends in cigarette smoking among US physicians and nurses. JAMA. 1994 Apr 27;271(16):1273–1275. [PubMed] [Google Scholar]
  41. Pollack E. S., Nomura A. M., Heilbrun L. K., Stemmermann G. N., Green S. B. Prospective study of alcohol consumption and cancer. N Engl J Med. 1984 Mar 8;310(10):617–621. doi: 10.1056/NEJM198403083101003. [DOI] [PubMed] [Google Scholar]
  42. Reddy E. K., Mansfield C. M., Hartman G. V., Masterson B. J. Carcinoma of the uterine cervix: review of experience at University of Kansas Medical Center. Cancer. 1981 Apr 1;47(7):1916–1919. doi: 10.1002/1097-0142(19810401)47:7<1916::aid-cncr2820470733>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  43. Reeds P. J., Hay S. M., Dorwood P. M., Palmer R. M. Stimulation of muscle growth by clenbuterol: lack of effect on muscle protein biosynthesis. Br J Nutr. 1986 Jul;56(1):249–258. doi: 10.1079/bjn19860104. [DOI] [PubMed] [Google Scholar]
  44. Schlicker S. A., Borra S. T., Regan C. The weight and fitness status of United States children. Nutr Rev. 1994 Jan;52(1):11–17. doi: 10.1111/j.1753-4887.1994.tb01348.x. [DOI] [PubMed] [Google Scholar]
  45. Shimizu H., Mack T. M., Ross R. K., Henderson B. E. Cancer of the gastrointestinal tract among Japanese and white immigrants in Los Angeles County. J Natl Cancer Inst. 1987 Feb;78(2):223–228. [PubMed] [Google Scholar]
  46. Sirott M. N., Bajorin D. F., Wong G. Y., Tao Y., Chapman P. B., Templeton M. A., Houghton A. N. Prognostic factors in patients with metastatic malignant melanoma. A multivariate analysis. Cancer. 1993 Nov 15;72(10):3091–3098. doi: 10.1002/1097-0142(19931115)72:10<3091::aid-cncr2820721034>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  47. Smart R. G. World trends in alcohol consumption. World Health Forum. 1991;12(1):99–103. [PubMed] [Google Scholar]
  48. Statland B. E. Nutrition and cancer. Clin Chem. 1992 Aug;38(8B):1587–1594. [PubMed] [Google Scholar]
  49. Strebel P. M., Kuhn L., Yach D. Smoking practices in the black township population of Cape Town. S Afr Med J. 1989 May 6;75(9):428–431. [PubMed] [Google Scholar]
  50. Takei N. Is tobacco smoking still fashionable in Japan? Lancet. 1993 Dec 11;342(8885):1491–1491. doi: 10.1016/0140-6736(93)92972-v. [DOI] [PubMed] [Google Scholar]
  51. Thornton J. R. High colonic pH promotes colorectal cancer. Lancet. 1981 May 16;1(8229):1081–1083. doi: 10.1016/s0140-6736(81)92244-3. [DOI] [PubMed] [Google Scholar]
  52. Wabinga H. R., Parkin D. M., Wabwire-Mangen F., Mugerwa J. W. Cancer in Kampala, Uganda, in 1989-91: changes in incidence in the era of AIDS. Int J Cancer. 1993 Apr 22;54(1):26–36. doi: 10.1002/ijc.2910540106. [DOI] [PubMed] [Google Scholar]
  53. Wald N. J., Law M., Watt H. C., Wu T., Bailey A., Johnson A. M., Craig W. Y., Ledue T. B., Haddow J. E. Apolipoproteins and ischaemic heart disease: implications for screening. Lancet. 1994 Jan 8;343(8889):75–79. doi: 10.1016/s0140-6736(94)90814-1. [DOI] [PubMed] [Google Scholar]
  54. Walker A. R. Survival of black patients with oesophageal cancer. S Afr Med J. 1987 Mar 21;Suppl:4–5. [PubMed] [Google Scholar]
  55. Walker A. R., Walker B. F. Faecal pH and colon cancer. Gut. 1992 Apr;33(4):572–572. doi: 10.1136/gut.33.4.572. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Walker A. R., Walker B. F., Glatthaar I. I. Preventive measures against breast cancer: but when? Eur J Cancer Prev. 1993 May;2(3):283–284. doi: 10.1097/00008469-199305000-00016. [DOI] [PubMed] [Google Scholar]
  57. Walker A. R., Walker B. F., Segal I. Cancer patterns in three African populations compared with the United States black population. Eur J Cancer Prev. 1993 Jul;2(4):313–320. doi: 10.1097/00008469-199307000-00005. [DOI] [PubMed] [Google Scholar]
  58. Walker A. R., Walker B. F., Siwedi D., Isaacson C., Van Gelderen C. J., Andronikou A., Segal I. Low survival of South African urban black women with cervical cancer. Br J Obstet Gynaecol. 1985 Dec;92(12):1272–1278. doi: 10.1111/j.1471-0528.1985.tb04875.x. [DOI] [PubMed] [Google Scholar]
  59. Wells B. L., Horm J. W. Stage at diagnosis in breast cancer: race and socioeconomic factors. Am J Public Health. 1992 Oct;82(10):1383–1385. doi: 10.2105/ajph.82.10.1383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Williams J., Clifford C., Hopper J., Giles G. Socioeconomic status and cancer mortality and incidence in Melbourne. Eur J Cancer. 1991;27(7):917–921. doi: 10.1016/0277-5379(91)90147-6. [DOI] [PubMed] [Google Scholar]
  61. Williams P. O. Europe and the tropics--how benevolence can lead to disaster. J R Soc Med. 1992 Oct;85(10):628–631. doi: 10.1177/014107689208501014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Yach D., Townshend G. S. Smoking and health in South Africa. S Afr Med J. 1988 Apr 2;73(7):391–399. [PubMed] [Google Scholar]
  63. Zavertnik J. J., McCoy C. B., Robinson D. S., Love N. Cost-effective management of breast cancer. Cancer. 1992 Apr 1;69(7 Suppl):1979–1984. doi: 10.1002/1097-0142(19920401)69:7+<1979::aid-cncr2820691719>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  64. de Koning H. J., van Ineveld B. M., van Oortmarssen G. J., de Haes J. C., Collette H. J., Hendriks J. H., van der Maas P. J. Breast cancer screening and cost-effectiveness; policy alternatives, quality of life considerations and the possible impact of uncertain factors. Int J Cancer. 1991 Oct 21;49(4):531–537. doi: 10.1002/ijc.2910490410. [DOI] [PubMed] [Google Scholar]

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