|Year : 2019 | Volume
| Issue : 2 | Page : 81-86
Changing patterns in trend of top 10 cancers in the Jos University Teaching Hospital’s (JUTH) cancer registry (1996–2018), Jos, north-central Nigeria
Olugbenga Akindele Silas1, Agabus Nanfwang Manasseh1, Jonah Musa2, Ayuba Madachi Dauda1, Ayuba Ibrahim Zoakah3, Barnabas Mafalal Mandong1, Chad Achenbach4, Atiene Solomon Sagay2, Lifang Hou5, Robert Leo Murphy4
1 Department of Pathology, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Plateau State, Nigeria
2 Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Plateau State, Nigeria
3 Department of Community Medicine, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Plateau State, Nigeria
4 Department of Medicine Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
5 Department of Medicine Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL, USA
|Date of Submission||20-Jun-2019|
|Date of Decision||02-Aug-2019|
|Date of Acceptance||19-Aug-2019|
|Date of Web Publication||13-Dec-2019|
Olugbenga Akindele Silas
Department of Pathology, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Plateau State
Source of Support: None, Conflict of Interest: None
Introduction: Changes in the epidemiology of cancers in some African countries due to demographic shift and change in lifestyle is well documented. Availability of screening, diagnostic and treatment facilities for the population serving a registry overtime is likely to impact on parameters of collated and stored data. We therefore sought to document changes in trends observed in the data stored at the Jos University’s (JUTH’s) cancer registry over the period of years in focus and highlight the role of certain local factors on these changes. Methodology: This is a 22 year retrospective descriptive study of top ten common cancers documented at the cancer registry at JUTH. JUTH is a tertiary health center located at Jos, North-Central Nigeria. Variables such as age, topography of cancer and sex were obtained and their proportions described. Results: A total of 4,279 top ten cancers were recorded during the period of study of which years 1996-2005 accounted for 2,035(47.56 %), 2006–2015; 1,606 (37.53 %) and January 2016–June 2018; 638 (14.91 %). In the different periods considered prostate cancer was the commonest in males (1996-2005:226(28.83%); 2006-2015:224(37.27%) and January 2016-June 2018:136(37.99%). While among females breast cancer was commonest 491(39.25%) from 1996-2005, 2006-2015 cervical cancer 371 (36.92%) and 2016-2018 breast cancer 140 (50.00%). In the period 2016-2018 liver cancer became the third commonest cancer while cervical cancer came to fifth position 35(5.49%). Conclusion: Changing trends in the registry’s data to provide conclusions useful for policy formulation and implementation.
Keywords: cancer, cancer registry, JUTH, trends
|How to cite this article:|
Silas OA, Manasseh AN, Musa J, Dauda AM, Zoakah AI, Mandong BM, Achenbach C, Sagay AS, Hou L, Murphy RL. Changing patterns in trend of top 10 cancers in the Jos University Teaching Hospital’s (JUTH) cancer registry (1996–2018), Jos, north-central Nigeria. J Med Trop 2019;21:81-6
|How to cite this URL:|
Silas OA, Manasseh AN, Musa J, Dauda AM, Zoakah AI, Mandong BM, Achenbach C, Sagay AS, Hou L, Murphy RL. Changing patterns in trend of top 10 cancers in the Jos University Teaching Hospital’s (JUTH) cancer registry (1996–2018), Jos, north-central Nigeria. J Med Trop [serial online] 2019 [cited 2020 Jan 25];21:81-6. Available from: http://www.jmedtropics.org/text.asp?2019/21/2/81/272913
| Introduction|| |
Globally cancer has led to high incidence of morbidity and mortality and was responsible for 8.8 million deaths in 2015. In low and middle-income countries (LMICs), chronic infections are responsible for causing over 22% of cancers whereas tobacco remains the most important risk factor worldwide. Human papillomavirus, Helicobacter pylori, hepatitis B virus, hepatitis C virus, and Epstein-Barr virus are common cancer-causing infections prominent in sub-Saharan Africa worsened by high HIV prevalence.
Adoption of Western lifestyle consequent to socioeconomic transition and increased aging population has also contributed to an increased incidence of cancers in LMICs.,
Cancer management is bedeviled by numerous challenges in Africa such as poverty, illiteracy, lack of governmental will in implementing viable cancer prevention policies and programs, inadequate cancer screening and treatment facilities, and late-stage presentation by cancer patients.,,
The impact of cancers on the economy of most countries worldwide including the developed countries is alarming with LMICs worst hit.
Cancer registry data is a veritable source of information on cancer prevalence, information on associated risk factors, and other information necessary for genetic, epigenetic, and epidemiological studies useful for policy formulation. The impact of cancer screening, availability of treatment facilities, and changes in notable risk factors which could be either genetic, epigenetic, or environmental overtime will cause changes in the demographic data of cancers captured in the registries.,,,,, Results of epidemiological studies from data obtained from such registries have helped in better understanding changing patterns of risk factors associated with various cancers.,,,,, We therefore sought to highlight any changing trend in prevalence of top 10 cancers from data in the cancer registry of the Jos University Teaching Hospital (JUTH) and identify local factors that might have attributed to these changing trend over time.
| Methods|| |
Study setting and design
This is a 21-year (January 1996 to June 2018) retrospective study of prevalent cancers documented at the cancer registry at JUTH. JUTH is a tertiary health center located at Jos in Plateau State, north-central Nigeria. It houses the cancer registry that grew from being pathology/hospital-based to a population-based registry with the capacity to serve the teaming population of about 3.5 million people covering an area of 26,899 square meters. The registry now receives data from many governmental, private, and faith-based health institution in the state and its immediate environs. JUTH has in the recent past initiated various cancer screening projects, acquired diagnostic and treatment equipment, and is benefiting from international collaborative grants focusing on cancers. Variables such as age, topography of cancer, and sex were obtained. Discrete variables were sex and topography whereas age was a continuous variable. Age was also categorized into age groups.
The inclusion criteria were all cancers documented and captured in the registry from January 1996 to June 2018. This included hematologic malignancies (e.g., leukemia and myelodysplastic syndrome) whose capture in this registry started from January 2016 onward.
The exclusion criteria exclude hematologic malignancies (e.g., leukemia and myelodysplastic syndrome) from January 1996 to December 2015. Also, data with missing, incomplete, or ambiguous information were excluded.
Statistical focus of this study was to describe the frequencies and proportions of these cancers. Statistical tool used was SPSS (IBM corporation Mac OS, linux and unix 2015).
| Results|| |
January 1996 to December 2005
A total of 6915 cancers were recorded during this period. Of this, a total of 1977 (29.4%) constituted the top 10 most common cancers of which breast cancers were the most common 498 (24.5%), followed by cervical cancers 390 (19.2%), and then prostate cancers 266 (13.1%). Bladder cancers were the least frequent 71 (3.5 %). Of these, males accounted for 784 (38.5%) whereas 1251 (61.5%) were females. The highest frequency was in 1996 (14.6%) with 376 cases whereas the least frequency of cancer cases [177 (6.9%)] was recorded in 1997 [Table 1], [Figure 1].
|Figure 1: Bar chart of top 10 cancers from January 1996 to December 2005.|
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The top five male cancers were prostate cancers 266 (33.92%), non-Hodgkin’s lymphomas 108 (13.8%), liver cancers 101 (12.9%), bladder cancers 61 (7.8%), and soft-tissue sarcomas 59 (7.5%). Out of the total 497 breast cancers recorded, males accounted for only seven (1.4%) cases. Among the females, breast cancers 490 (39.2%) was the most common followed by cervical cancers 390 (31.2%), then non-Hodgkin’s lymphomas 81 (1.5%) and liver cancers 78 (1.4%). Skin cancers were the least frequent 53 (4.2%) among the top five female cancers.
January 2006 to December 2015
A total of 2329 cancers were recorded in this 10-year period. Of these 1606 (68.9%), top 10 common cancers were observed out of which cervical cancers accounted for the highest frequency [371 (23.1%)] followed closely by breast cancers 358 (22.3%) and then prostate cancers 224 (13.9%). Bladder cancers accounted for the least frequency 43 (2.7%). Females accounted for 1005 (62.6%) whereas males were 601 (37.4%). Age group 39 to 48 years accounted for the highest frequency 336 (20.9%). The age group with the least cancers was 89 years and above that accounted for only six (0.4%) cases. The highest frequency of cancers 305 (19.5%) was recorded in 2006 whereas only 32 (2.0%) cases were recorded in 2010. Of the 10 ten male common cancers, prostate cancers accounted for the highest frequency 224 (37.3%), followed by skin cancers 76 (12.7%) and stomach cancers 70 (11.7%). Cervical cancers accounted for the highest frequency 371 (36.9%) among the top 10 female cancers followed closely by breast cancers 350 (34.8%). Of the 358 total breast cancers documented, males accounted for eight (2.2%) cases [[Table 2] and [Table 3], [Figure 2].
|Figure 2: Bar chart of top 10 cancers from January 2006 to December 2015.|
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January 2016 to June 2018
A total of 751 cancers were recorded during this period. Of these, 638 (84.9%) accounted for the top 10 common cancers of which breast cancers were the most common 147 (23.0%), followed closely by prostate cancers 136 (21.3%) and liver cancers 111 (17.4%). Cervical cancers accounted for only 33 (5.2%) and pancreatic cancers were least common with 16 (2.5%) [[Table 4] and [Table 5], [Figure 3] and [Figure 4]. Males had the highest frequency 358 (56.1%) whereas females were 280 (43.9%). Age group with the highest frequency was 49 to 58 years (20.4%), followed by 39 to 48 years (19.4%). Age group 0 to 18 years had the least frequency 44 (6.9%). The highest frequency of cancers 481 (64.1%) was recorded in the year 2017. Out of the 147 breast cancers documented during this period of review, seven (4.76%) were accounted for by males. Males also had highest frequencies for bladder cancers [5 (83.3%)], liver cancers [86 (77.5%)], rectal cancers [11 (68.8%)], and skin cancers [12 (66.7%)]. Breast cancers was the most common among females accounting for 140 (50.0%), blood cancers 40 (14.3%), and cervical cancers 33 (11.8%). The highest cancer frequency of 376 was recorded in 2016 [Figure 4].
| Discussion|| |
The period 1996 to 2005 recorded a higher total frequency (6915) of cancers than the total figure of 2329 recorded during the period 2006 to 2015 [Table 1],[Table 2],[Table 3]. This could be due to the movement of the hospital (JUTH) from its temporary to its permanent site resulting in decreased patronage due to its far distance and difficulty in getting means of transportation to the new hospital site with the consequent high cost. Thus, most patients rather choose to patronize the closer private histopathology laboratories for tissue diagnosis (Meena and Soteria histopathology laboratories, Jos, Nigeria).
The proportion of cervical cancer increased from the period 1996–2005 (19.16%) to 2006–2015 (23.1%) probably because of increased patient presentation due to improved referral from the many private and faith-based hospitals and the increased population of Plateau State from about 2.1 million (year 2001 census) to 3.5 million (year 2006 census). The Increased prevalence of cervical cancer observed was also probably as a result of massive immigration into Plateau State as an aftermath of communal crises in neighboring states and insurgency in northeastern Nigeria., Also this period coincided with increased prevalence of HIV in the state which is said to be associated with increased progression of premalignant cervical lesions to cervical cancers. The prevalence of HIV infection in Plateau State increased from 2.6% in 2008 to 7.7% in 2010. Increased cervical cancer detection due to increased uptake of Pap smear More Details screening uptake by the populace in the current new JUTH site (preliminary study) could also have contributed to increased frequency in the later years. This could be as a result of increased awareness on cervical cancer screening by eligible women though in variance with report by Oyebode et al., who reported poor uptake of pap smear by eligible female hospital workers and students of higher institutions in Jos, respectively.
The proportion of breast cancers dropped from 24.5% to 22.3% in the same periods considered probably due to decreased referral to JUTH, as a result of availability of other government and private hospitals with the capability of managing such cases [Table 1],[Table 2],[Table 3]. It could also be due to the unavailability of adequate number of functional mammogram machines for screening in JUTH and the proliferation of such services in centers outside JUTH.
During the periods compared above, prostate cancer prevalence increased from 13.1% to 13.9% probably due to increased screening among men as a result of increased awareness. Number of specialists in JUTH has also increased from the earlier to the later period being compared to perform needle biopsies as diagnostic procedure [Table 1],[Table 2],[Table 3].
The year 2016 to 2018 showed prevalence of cervical cancer (5.2%) being distant from that of breast cancers (23.0%) among the top 10 cancers (male and female) [[Table 4] and [Table 5]]. The prevalence of cervical cancers (11.8%) during this period is also distant from that for breast cancers (50.0%) among the top 10 female cancers. This obvious sharp drop could be attributed to improved pap smear screening and colposcopy service that helps not only to diagnose premalignant lesions but to treat them. This facility might be responsible for the decreased incidence of cervical cancers seen in our facility currently. This is in variance to a very recent publication in the same registry covering the period 1987 to 2014 before the availability of screening facility where cervical cancer prevalence was second among the top 10 cancers.
A notable change in this period of study is the increased prevalence of liver cancers 111 (17.4%) to third most common among the top 10 cancers during this 2-year period. This is from being the fifth [179 (8.8%)] of the 10 most common cancers in 1996 to 2005 [Table 1] and not even being among the top 10 common cancers in the period 2006 to 2015 [Table 2] and [Table 3]. This sharp increase in prevalence might be due to improved referral of patients to JUTH and the availability of the recently acquired screening fibro-scan machine in JUTH that is helping to detect early liver cancer in patients who have not started having symptoms.It is also observed that the age group with the highest cancer frequency has increased upward from 39–48 years (2006–2015) to 49–58 years (2016–2018) [Tables 2–6]. This could be as a result of increased longevity as more patients live long enough to develop numerous cancers associated with increased age (demographic shift). According to global aging, by 2050, the number of people over 60 years living in Africa will increase from just under 50 million to just under 200 million. Also, according to WHO, estimated at 43 million in 2010, the population of elderly people in sub-Saharan Africa is projected to reach 67 million by 2025 and 163 million by 2050. This might be due to a relatively better economic power of the populace, decreased infectious diseases with more people living longer than before. Furthermore, availability of screening procedures has resulted in early detection and treatment of premalignant lesions at earlier ages.,
| Conclusion|| |
Cancer prevalence has remained high in our region with changes in trends influenced mainly by population drift, unstable functional health systems, and availability of diagnostic tools and specialists managing various cancer types. These changes in trends underscores the need to enhance cancer registry’s efforts in periodic analysis of collated data for epidemiological studies useful for policy implementation.
This work and publication was supported by the National Institute of Health (NIH) Fogarty “Northwestern University, University of Lagos and Jos University” Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria grant (U54CA221205-01) and D43 grant (D43 TW009575). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH Fogarty International Center. The authors would like to thanks to Mr. C. Wambuda, Mr. Chidi Okpara, Miss Ju Gye, and Mrs Florence Oyerimba of the Cancer Registry for their support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]