Colorectal cancer increase reflects socioeconomic inequalities across different population groups in South Africa
Colorectal cancer (CRC) is the third most common cancer and one of the leading causes of illness and death worldwide. In South Africa (SA), CRC is the second most common cancer among men and third most common cancer among women. Survival data for colorectal cancer in SA are limited, although a study among adults aged 15 to 99 years reported that the 5-year survival rate in SA was less than 20% for the period 2010-2014.
Researchers at Stellenbosch University who published their findings in BMC Cancer showed that there are disparities in the incidence of CRC between population groups with a consistent and rapid increase among the South African black population group. This finding opens the door to the development of programs to reduce the risk of CRC in SA, including promoting healthier behaviours such as reducing alcohol intake, reducing tobacco smoking, and increasing physical activities.
Ms. Lactatia Motsuku, a PhD student under the supervision of Dr. Mazvita Muchengeti, within the Department of Global Health, South African Centre for Epidemiological Modelling and Analysis (SACEMA) and Prof. Kathryn Chu, Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences all at Stellenbosch University, were collaborators on this national study to determine trends in CRC incidence and mortality between 2002 and 2014 in SA by sex and population groups. Of 33,232 incident CRC cases and 26,836 CRC deaths, 54% were men and 46% were women; however, among the reported deaths, 47% were men and 53% were women. Most cases are diagnosed at a late stage because the age of diagnosis (61 years) is close to the age at death (65 years).
There are disparities in CRC between countries based on the Human Development Index (HDI) which is a composite score of life expectancy, education and per capita income of countries. Countries with the highest CRC incidence have a high HDI. CRC deaths are higher in low-income countries due to lack of appropriate screening and early detection programmes, and poor access to cancer treatment. Although the HDI of SA has increased, there is still considerable socioeconomic inequality. Thus, there is a need to appropriately plan for interventions, prevention, and control of CRC in the era of epidemiologic and economic transition, the evaluation of CRC patterns across population groups, and sex are necessary.
The outcome of investigations into factors that are driving the increasing rates of CRC among the black population group will have implications for policy and practice. Universal health coverage, targeted screening, early detection, and high-quality cancer care provision will go a long way toward reducing inequalities, especially for previously disadvantaged population groups. This study underlines the importance of cancer surveillance and population-based cancer registration that will provide insights into the priority areas that should be targeted for cancer prevention and control in SA.
Motsuku L, Chen WC, Muchengeti MM, et al. Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002–2014. BMC Cancer 2021; 21. DOI: 10.1186/s12885-021-07853-1