Cancer deaths and prevalence in SA showing a significant increase

The report supports information supplied by medical schemes in recent times that shows a significant increase in the number of medical scheme members diagnosed with cancer and the corresponding rise in expenditure on cancer-related treatment.

The report also shows that the biggest rise in cancer-related deaths was among Black South Africans with a 68.6% increase in the ten years the report covered, followed by the coloured population with a 68.3% increase. In the Asian and Indian populations, the increase was 53% while in the white population, the increase in deaths was much lower at 23.4%.

While the report doesn’t dwell on possible reasons for the upsurge, it emphasises the need for an increased focus on prevention, screening and treatment of cancer, and increasing awareness of associated risk factors such as tobacco use, harmful use of alcohol, unhealthy dietary practices and sedentary lifestyles.

“Although mortality due to cancer is lower compared to TB and HIV and other major communicable diseases, it is increasing at a much faster rate than deaths related to other diseases,” according to the report.

Here are some of the main findings of the report:

· In 2018, neoplasms, which include cancer and benign tumours – accounted for 9,7% of all mortality and were the fourth leading cause of mortality. The leading causes of mortality were diseases of the circulatory system such as stroke, hypertension and heart disease, which accounted for 18,5%, followed by certain infectious and parasitic diseases like pulmonary tuberculosis and HIV, which accounted for 16,4%, and external causes of mortality like accidents, assault and firearm-related deaths, which accounted for 12% of all mortality.

· In 2018, females accounted for 51,3% of cancers diagnosed while males accounted for 48,6%. Sex was not stated in 71 (0,1%) cases.

· The median age in years at diagnosis of cancer was 59 for females and 64 for males.

· The median age at death due to cancer was 62 for females and 64 for males. This suggests that cancer in males may be diagnosed at more advanced stages than in females, thus the shorter survival period.

· Among males, the most diagnosed cancers were those of the prostate, colorectal and lung. These jointly accounted for one-third of all cancers diagnosed among males. Prostate cancer accounted for 25,3% of cancers diagnosed among males, while colorectal cancer accounted for 5,6% and lung cancer accounted for 4,0%.

· Among females, the most diagnosed cancers were breast cancer, which accounted for 23,2% of all cancers diagnosed in women, followed by cervical cancer at 15,9%, and colorectal cancer at 4,5%. These leading cancers accounted for 43,5% of cancers diagnosed among females.

· In 2019, the age-standardised prostate cancer incidence rate, was 59,27 cases per 100,000 males, White males had the highest incidence at 79,03, followed by Coloured males at 64,47, Black African males at 51,52 and Indian/Asian males at 36,43.

· The age-standardised colorectal cancer incidence rate among males was 12,51 in 2019. White males had the highest incidence of 26,5, followed by Indian/Asian males at 18,68, Coloured males at 16,89 and Black African males at 5,49.

· Among females, the breast cancer age-standardised incidence rate was 37,37 in 2019. Breast cancer incidence was highest among White females at 92,02 in 2019, followed by Indian/Asian females at 53,39 and Coloured females at 50,01. Black African females had the lowest breast cancer incidence rate at 21,56 per 100,000 females.

 · The age-standardised cervical cancer incidence rate was 24,89 in 2019. Black African women had the highest cervical cancer incidence rates over all years, 2008 to 2019. Their age-standardised incidence rate was 29,14 in 2019. They were followed by White females at 17,37, Coloured females at 14,31 and Indian/Asian females at 8,69.

Cancer mortality:

 · Among females, in 2018, cancers of the cervix, breast, bronchus and lung, and colorectal accounted for 50,2% of cancer-related deaths. Cervical cancer accounted for 17,9%, breast cancer, 17,0%, bronchus and lung, 9,2% and colorectal, 6,1%.

· Between 2008 and 2018 deaths due to cervical cancer increased by 50,5% (from 2 653 in 2008 to 3 994 in 2018). Those due to breast cancer increased by 42,4% (from 2 665 in 2008 to 3 796 in 2018), while those due to bronchus and lung cancer increased by 38,2% (from 1 491 in 2008 to 2 060 in 2018), and colorectal by vbn45,1% (from 945 in 2008 to 1 371 in 2018).

· Among males, bronchus and lung cancer accounted for 18,7% of cancer-related deaths, prostate cancer contributed 16,7%, oesophagus, 7,5%, colorectal, 6,8% and liver and intrahepatic bile ducts, 5,2%. These leading cancers accounted for 54,8% of cancer-related deaths among men.

· Between 2008 and 2018, deaths due to bronchus and lung cancer increased by 29,1% (from 3 071 in 2008 to 3 964 in 2018). Those due to prostate cancer increased by 51,5% (from 2 332 in 2008 to 3 534 in 2018), while cancer of the oesophagus dropped by 11,0% (from 1 783 in 2008 to 1 587 in 2018). Colorectal cancer-related deaths increased by 38,2% (from 1 044 in 2008 to 1 443 in 2018) and liver and intrahepatic bile ducts increased by 11,2% (from 989 in 2008 to 1 100 in 2018). Age-standardised cancer mortality rates As was the case with incidence rates, there are considerable racial disparities in mortality rates.

· In 2018, the age-standardised breast cancer mortality rate was 13,83 per 100,000. Coloured females had the highest mortality rate at 21,83 followed by White females at 19,34, Indian/Asian females at 14,54 and Black African females at 10,36. In 2018, while White females had a higher breast cancer incidence rate of 10,86 compared to Coloured females at 8,2, Coloured females had a higher mortality rate. This is likely due to diagnosis of breast cancer at advanced stages among Coloured compared to White females, as well as risk factors such as smoking. Lack of access to cancer treatment, including medical aid also plays a major role in the outcome of treatment for cancer, as the private healthcare sector is better resourced, and patients are more likely to be diagnosed with early-stage cancer and to receive timely cancer treatments.

· The age-standardised cervical cancer mortality rate was 15,0 in 2018. Black African females had the highest mortality rate at 17,92, followed by Coloured females at 9,57. White and Indian/Asian females had much lower mortality rates at 4,11 and 4,42 respectively. As women living with HIV are more likely to develop cervical cancer (Ghebre R. et al. 2017) and Black African females aged 20-34 years were reported to have the highest incidence (Zuma K. et al. 2017), it may be assumed that the high cervical cancer mortality rate among Black African females is driven by HIV, as well as poor access to treatment for timely diagnosis and treatment.

· The age-standardised prostate cancer mortality rate rose from 20,9 in 2008 to 23,83. In 2018, Coloured males had the highest mortality rates at 35,81, followed by Black African males at 25,58 and White males at 14,85. Indian/Asian males had the lowest mortality rates at 11,69 in 2018.

· The lung cancer age-standardised mortality rate in males was 22,12 in 2018, a small increase from 22,08 in 2008, although it went up as high as 55,84 in 2016. Coloured males had the highest mortality rates, from 43,61 in 2008 to 49,21 in 2018. Other population groups had much lower mortality rates, from 20,02 in 2008 to 17,49 in 2018 for White males, 17,39 in 2008 to 18,56 for Indian/Asian males, and 10,72 in 2008 to 15,09 in 2018 for Black African males.

To read the full report, go to https://www.statssa.gov.za/publications/03-08-00/03-08-002023.pdf