The NCR staff used passive and active approaches to collect data on cancer diagnosed by all means in Khartoum State. Rates were age standardized to the Sudan Standard Population and and World Standard Population and expressed per , populations.
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During —, new cancer cases were registered. Of those, The most commonly diagnosed cancer among women was breast followed by leukemia, cervix, and ovary, and among men it was prostate cancer followed by leukemia, lymphoma, oral, colorectal, and liver. The overall age-standardized rate ASR per , population was higher in women Similarly, it was higher in women The data from NCR indicated that prostate and breast as the most commonly diagnosed cancer sites in men and women in Khartoum, while cancer of the cervix trailed behind portraying a cancer picture similar to that of the developed world.
Despite the study limitations, the NCR data gave a fair representation of cancer profile of Khartoum State and underscored the need for high-quality cancer registries in Sudan. Cancer is becoming a global health problem and the number of cancer cases in sub-Saharan Africa is rising. Being an African country, Sudan has its share of cancer burden.
Sudan Demographics
However, population-based data in cancer incidence, prevalence, and mortality in Sudan were not available and most published cancer cases were based on estimates from hospital-based information sources. Most of these sources are maintained by individual health institutions and are mostly paper based. The National Health Laboratories is the main diagnostic laboratory in Khartoum and its cancer database captures histopathologically confirmed cases 1. Recently the center expanded to include nuclear as well as clinical departments with all necessary cancer expertise.
The center receives referrals from all over the country. It provides medical care for cancer patients from Gezira State as well as the surrounding states in the central region of Sudan.
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NCR is to develop a system that will facilitate creation and maintenance of local and regional data and assemble these data into a single centrally accessible system. In the hope, that the NCR will provide data on burden of cancer in Sudan allowing policy makers to implement cancer control measures and prevention strategies.
In this study, we present the results from the Cancer Registry for Khartoum State for the period — The Sudan is consisted of 15 states with varying population densities Fig. The public sector health services in Sudan are organized at three levels primary, secondary, and tertiary. The states' general hospitals are the referral centers for the entire state. Specialized centers and Khartoum General Hospital, located in capital Khartoum, constitute the tertiary level.
After exhausting all the medical attempts for treatment at the primary and secondary care facilities as well as local healers, patients are referred to RICK. The registry building is located in the medical complex neighboring the Khartoum Teaching Hospital, RICK, and other clinics and laboratories that provide cancer management and diagnosis services.
The Sudan NCR abstracts and collects cancer data from all public and private health institutions that provide cancer laboratory diagnosis and treatment, as well as the data from RICK. The registry uses two methods for data collection, active and passive case finding, covering about 79 private and governmental heath facilities and pathological laboratories 18 histopathological laboratories, 33 private, and 28 public hospitals. Sources of data include laboratory reports histopathology, hematology, and biochemistry , medical record ledgers, theater books, patient case notes, and ward admission.
Following variables are collected for each case: name, age, gender, nationality, tribe, residence, state of residence, date of diagnosis, tumor site, tumor histology, basis of diagnosis, occupation, medical record number, and place of referral. The data used for this study were obtained from the patients residing in Khartoum State during the 2-year period — Care was taken to distinguish residents of Khartoum from out-of-state patients that used relatives' addresses.
NCR team applies different methods of data checking, communication, field visits, and reviewing prior entering the data electronically, in order to complete missing data on cancer collected from different health sectors and to avoid multiple registrations and duplication. The software has a duplicate entry checking capability and validity checks. The data were checked again for out-of-range values, typos, and incompatible records by two independent investigators. Crude as well as gender- and age-specific incidence rates for each cancer site were derived.
Age was categorized into five groups as previously described for age-specific rates. Total of incident cases of cancer were recorded among Khartoum residents in — Among them, The majority Registrations were considered MV where diagnosis was based on malignant histological or cytological reports. About 4. The cancer sites of cases 3.
These cancers together made up Top 10 most common primary sites in Khartoum, Sudan: — Most common primary cancer sites by gender in Khartoum, Sudan. A positive association between incidence rate of the top five most common cancer sites and age was observed in both adult women and men. A Top most common primary cancer sites in women by age group, Khartoum, Sudan: — B Top five most common primary cancer sites in men by age group, Khartoum, Sudan: — During the study period in Khartoum, women had a higher ASR The differences in the ASRs derived from the three standard populations indicate that the age distributions are different among these populations.
Our results suggest that the World Standard Population is slightly older than the World Standard Population, while the Sudan Population is much younger than the two. Age-standardized rate ASR and estimated number of incident cancer cases for the most common cancer sites by gender in Khartoum, Sudan: — Sudan estimated population, both sexes combined, was used as the standard population in computing ASR.
Age-standardized rates per , for the most common cancer sites by gender in Khartoum, Sudan: —, using the and World Standard Population WSP. This study focused on the cancer cases diagnosed and treated in Khartoum State during the period — It is the first study to report on incident cancer cases abstracted and recorded by the first Sudan National Cancer Registry. During the study period, cases were recorded for Khartoum State. Although, the NCR provided the best available population-based estimations to the cancer profile in Khartoum State, different sources of bias may have occurred.
First, stigmatization and poverty contribute to patients seeking other alternative treatments before pursuing treatment at proper cancer treatment institutions; leading to some cases to remain undiagnosed or untreated. Second, most of cancer-treating facilities, particularly radiotherapy facility, are at Khartoum city. Hence, some of these registered cases may have come from out of the state.
Most out-of-state patients may use in-state relative's address or phone number in Khartoum for convenience. This may have led to overestimation of the cancer incidences. Third, most patients do not have birth certificates and therefore their age were approximations.
This is especially true for elderly patients. Further, there was a possibility of under registration of clinically diagnosed cases in older individuals as well. Elderly patients were often not fully examined and were only treated symptomatically at the primary care level as outpatients or die before reaching a cancer specialized institution. Therefore, their medical records, if available, may not be complete or accurate. These limitations, such as limited accessibility to health care and inaccuracy of residency and age were reported as well from cancer registries of other African countries 5 — 8 , There are several means to measure the quality and completeness of data from a cancer registry 9.
These include the percentages of registered cancer cases by death certificate only, and morphological verification, and percent missing. This value is less than internationally recommended, that is, the registry did not meet international data quality requirements. Many reasons could be cited and may include the young age of the registry, leaning curve required by the staff for data entry, and processing or different diagnostic sources were used for case accrual.
However, it is lower than that reported by West African countries. Similarly, it was lower compared to North Africa countries' cancer registries. During the study period, more women have cancer than men.
Sudan Demographics
The women to men ratio were 1. The increase in the number of women cancer incidence may be attributed to the number of breast cancer registered and under diagnosis of prostate cancer. Breast cancer is the most common cancer in Sudanese women living in Khartoum State. However, our findings were similar to those reported in Nigerian women living in Abuja Additionally, the ASR of breast cancer estimated in our study was higher than that estimated by Globocan for the entire Sudan Previous studies have found breast cancer incidence is lower in East African women than that in West African women 18 , therefore the relatively high incidence rate of breast cancer in Khartoum is quite surprising.
Many risk factors associated with urbanization and economic development were cited to contribute to increase in breast cancer and these include early menarche, late childbearing, having fewer children, obesity, and increased awareness and detection Khartoum population, on average, has high percentage of educated women.
Increase in infertility and overweight which till recently is a sign of beauty and wealth in these communities may contribute to the increase in the breast cancer incidence in Khartoum. Prostate cancer in sub-Saharan Africa emerged as the most common cancer and registries record suggests that the disease is increasing in prevalence. Prostate cancer ranked fourth among all cancer sites in Khartoum. However, by gender it ranked first among Sudanese men. Therefore, most African populations reported higher rates of prostate cancer compared to Khartoum State.
However, our data agrees with the low incidence rates reported in Red Sea and Western states of the Sudan 19 , The low incidence rate may reflect less diagnosis and lack of screening programs than disease occurrence. Risk factors for prostate cancer in Sudan was examined by Hamad and Abuidris in Gezira state and found to include age, education level, occupation, unhealthy habit such as smoking and high fat intake and obesity, and were found to be similar to other parts of Africa Although cervical cancer used to be the most common cancer among women in sub-Saharan African countries, currently the picture is changing and surpassed by breast cancer.
Similarly, in Khartoum State cervical cancer was the second most diagnosed cancer in women after breast cancer. The ASRs were However, compared to the neighboring countries in East African, the incidence rate of cervical cancer in Khartoum was low. Furthermore, it was lower than what were reported by West African countries. This may have contributed to under reporting as Sudanese women in that age group is usually not open about their gynecological problems with family husband or sons are the ones financially responsible party for treatment.
Furthermore, other factors such as lack of screening tests and awareness, and low prevalence of Human Papilloma Virus HPV and human immunodeficiency virus HIV infection in general population may contribute to this low level of cervical cancer cases. Similarly, there is a knowledge gap about the association between HIV infection and cervical cancer. The Editors of Encyclopaedia Britannica Encyclopaedia Britannica's editors oversee subject areas in which they have extensive knowledge, whether from years of experience gained by working on that content or via study for an advanced degree See Article History.
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Sudan Population () - Worldometer
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