Part I: cancer in Sudan—burden, distribution, and trends breast, gynecological, and prostate cancers

Phytochemical constituents, in-vitro anticancer activity and computational studies of Cymbopogon schoenanthus

The cytotoxic effects of Cymbopogon schoenanthus L. aerial part ethanol extract were examined against some cancer cell lines, and HUVEC normal cell lines using MTT assay. The ethanolic extract was prepared by ultrasonic-assisted extraction and analyzed by GC-MS and HPLC. The extract was found to be rich in terpene compounds. The extract proved to be highly selective and effective against breast and prostate cancer cell lines (MDA-MB-435, MCF-7, and DU 145) with IC50 as low as 0.7913 ± 0.14, 12.841 ± 0.21, and 30.51 ± 0.18 µg/ml, respectively. In silico modeling was performed to investigate the binding orientation and affinity of the major identified compounds against Polo-like kinase (PLK1 protein) a cancer molecular target using molecular docking and molecular dynamic whereas eudesm-5-en-11-ol, piperitone, and 2,3-dihydrobenzofuran displayed better binding affinity and stability against PLK1 compared to the reference drug. These findings encourage further in vivo studies to assess the anti-cancer effects of C. schoenanthus extract and its components.

Breast cancer awareness among Sudanese females in Omdurman city: 2021

BACKGROUND

Breast cancer is the most commonly diagnosed malignancy among women worldwide. In contrast to Europe, it presents generally very late in Africa. As with the rest of Africa, it is the most common primary malignancy of females in Sudan, and generally presents in stage III or IV disease. This study is intended to analyse the level of breast cancer awareness among women of Sudan.

OBJECTIVE

To assess the level of awareness of breast cancer among Sudanese females, and their attitude towards breast changes. Also, to establish possible associations between several variables: (education level, age, contact with a breast cancer patient, residence) on awareness.

METHODOLOGY

A descriptive cross-sectional community-based study of 385 females in Omdurman city, selected by convenience sampling. An interview based Arabic version of Breast Cancer Awareness Measure (BCAM) was used. Data was coded and analysed using Statistical Package for Social Sciences (SPSS) v.20.

RESULTS

A total of 385 females were included, of which 38.7% were 20-30 years, 47.8% were single, 53.8% had university education, 41% of them were currently unemployed, and 54.3% resided in Ummbadda's locality. When asked about the signs and risk factors of breast cancer, 55.06% and 55.8% failed to name any. The cumulative percentage of correct answers of close-ended question about signs, risk factors and Federal Ministry of Health (FMoH) screening program were 42.8%, 30.7% and 44.7% in that order. Only 38.2% knew the right method BSE, 48.2% of them rarely practiced it. 38.2% noticed a change in the breast tissue but didn't visit a doctor. The majority of them, though, said they would see a doctor if they noticed a change in the future.

CONCLUSION

There is a severe lack of awareness of breast cancer among females of the Sudanese society. Also, there was a clear ignorant attitude practiced by a significant proportion of the candidates.

RECOMMENDATIONS

Further research, to address the limitations of this study is to be done. FMoH has to improve its media massage and arrange targeted awareness campaigns.

Cancer diagnosis in areas of conflict

To date, many Arab countries within the Middle East are facing political, financial, and social instability from war and conflicts. These conflicts have led to severe resources shortages and sometimes complete breakdowns in cancer care and diagnosis. Cancer diagnosis at early stages is the most vital step in achieving optimal cancer care and outcomes. Shortages in cancer diagnostic services have meant that many people within areas of conflict are ultimately deprived of these services in their own countries. Therefore, many of these cancer sufferers must bear travel expenses to neighboring countries in order to seek these services. A lack of prevention, screening, and diagnostic services for this population is known to deepen the cancer care deficit within these areas. Additionally, the financial burden of traveling abroad alongside the need to secure childcare and time off work can be overwhelming. As a result, patients within areas of conflict are frequently diagnosed at later stages and are less likely to receive optimal management plans. Though conflict-affected regions encounter many similar challenges in delivering quality cancer care, pronounced region-specific differences do exist. Therefore, it is important to build a roadmap that can provide tailored solutions to deficits in instruments, manpower, and facilities for each and every region involved. Keeping in mind the importance of collaboration and coordination on national and international levels to address the ground disparity in cancer diagnostic services, the main objective of this review article is to examine the significant problems, shortages, and difficulties in providing cancer diagnosis with a focus on imaging to conflict-affected populations in the Middle East (mainly Iraq, Syria, Yemen, and Sudan). Finally, we discuss how access to cancer diagnostic imaging services has been impacted by these conflicts.

Impact of anticancer therapy on the quality of life of Sudanese patients with breast cancer at Khartoum oncology hospital

Background

Chemotherapy-related toxicity affects the quality of life (QOL) of patients with cancer. Measuring the QOL in breast cancer (BC) patients has been the focus of clinical practices and research in recent decades. This study aimed to assess the impact of BC medications on QOL of Sudanese patients with BC.

Methods

A cross-sectional study was conducted in Khartoum Oncology Hospital, Sudan, from November 2020 to March 2021. All patients diagnosed with BC were included in the study. QOL was assessed using the European Organization for Research and Treatment of Cancer quality of life (EORTC QLQ-C-30) and breast cancer supplementary module (QLQ-BR23). ANOVA, independent t-test and logistic regression analysis were used to assess the association between variables.

Results

Two hundred patients were enrolled in the study, with a mean age of 50 ± 11.7 years. 52.5% of the patients were on a conventional therapy whereas 40.5% and 7% received hormonal and HER2-targeted therapies, respectively. In QLQ-C30 scale, the global health-QOL status score was (53.2 ± 1.9), with 54.0% of patients having poor global health-QOL status. In the functional scale, the cognitive functioning was the highest score (80.7 ± 1.8). In QLQ-C30 symptom scale, the most distressing issue was financial difficulties (63.7 ± 2.9). In QLQ-BR23 scale, body image scored the worse functioning (47.7 ± 2.7), with 54.5% of patients having poor QOL. In QLQ-BR23 symptoms scale, “being upset by hair loss” was the highest disturbing symptom (62.1 ± 3.3), with 68.6% of patients having poor QOL. Global health status (P = 0.000), social (P = 0.000), emotional (P = 0.002) and role functioning (P = 0.000) were significantly higher in patients taking HER2-targeted or hormonal therapy compared to conventional therapy. The level of symptomatology was significantly low in patients taking HER2-targeted therapy or hormonal therapy (P = 0.000) than those on conventional therapy. Hormonal (OR = 3.7, p = 0.01) and HER2-targeted therapies (OR = 10.2, p = 0.04 ) were positive predictors of QOL.

Conclusion

BC survivors in Sudan had a low QOL/global health status. Hormonal and HER2-targeted therapies were predictors of good QOL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-02041-0.

Incidence Characteristics and Histological Types of Head and Neck Cancer among Adults in Central Sudan: A Retrospective Study

Head and neck cancers (HNCs) are prevalent in Sudan, but the reasons for this and the incidence of different types of HNCs are not well understood. A cross-sectional retrospective study was conducted to provide baseline data on the epidemiology of HNCs among patients treated at the National Cancer Institute (NCI) in central Sudan. All cancer cases from 2016 to 2020 were retrieved from the NCI records. Of the 9475 new cancer patients who were registered at the NCI during the study period, 1033 (11%) had HNCs, of whom 767 (74.2%) were adults. The mean age of the adult patients was 54.5 years (standard deviation 15.8) and 449 (58.5%) patients were male. The annual incidence in adults was 4/10⁵ population. The most common HNC sites were the nasopharynx (25.3%), hypopharynx (22.8%), and oral cavity (22.2%). Carcinoma was the most common diagnosis (87.6%), followed by lymphoma (5.6%). Most patients' tumors were at a locally advanced (22%) or metastatic stage (47%) of HNCs at the time of presentation. Further studies to identify risk factors for HNCs, particularly for the most prevalent types in central Sudan, are needed. In addition, Sudan requires capacity building for cancer, including a national cancer registry.

Women's cancers in Sudan with a focus on cervical cancer: turmoil, geopolitics and opportunities

Cancer is the leading cause of death worldwide and the second leading cause of death in Sudanese women. However, despite proven interventions for primary, secondary and tertiary prevention and the World Health Organization's call to action toward eliminating cervical cancer, there has been little progress in addressing the cervical cancer burden in Sudan. This short communication intends to shed light on the challenges facing women's cancers in Sudan, taking cervical cancer as an example. It also discusses the opportunities and suggests ways to improve the outcomes of women's cancers in Sudan. Sudan's government should urgently implement a broad public health strategy to improve outcomes for women with cancer. The cancer control plan should be aligned with international, evidence-based recommendations and adapted to local circumstances. It should strengthen health literacy, augment different health care interventions, including vaccination, committed screening programmes, early detection and proper diagnosis of symptomatic cases, a programmatic approach to active management and palliative care and ensure robust referral pathways. Policies are also needed in collaboration with the international community in addressing the cancer care needs of internally displaced and refugee women in Sudan. The strategy should consider overcoming the existing challenges and making the most opportunities available.

Genotoxic effects of Dukhan: A smoke bath from the wood of Acacia seyal used traditionally by Sudanese women

ETHNOBOTANICAL RELEVANCE

Smoke from the wood of Acacia seyal Delile has been used by Sudanese women for making a smoke bath locally called Dukhan. The ritual is performed to relieve rheumatic pain, smooth skin, heal wounds and achieve general body relaxation.

AIM OF THE STUDY

The present study was designed to investigate the in vitro anti-inflammatory effect of the smoke condensate using cyclooxygenase -1 (COX-1) and -2 (COX-2) as well as its potential genotoxic effects using the bacterial-based Ames test and the mammalian cells-based micronucleus/cytome and comet assays.

MATERIAL AND METHODS

The smoke was prepared in a similar way to that commonly used traditionally by Sudanese women then condensed using a funnel. Cyclooxygenase assay was used to evaluate its in vitro anti-inflammatory activity. The neutral red uptake assay was conducted to determine the range of concentrations in the mammalian cells-based assays. The Ames, cytome and comet assays were used to assess its potential adverse (long-term) effects.

RESULTS

The smoke condensate did not inhibit the cyclooxygenases at the highest concentration tested. All smoke condensate concentrations tested in the Salmonella/microsome assay induced mutation in both TA98 and TA100 in a dose dependent manner. A significant increase in the frequency of micronucleated cells, nucleoplasmic bridges and nuclear buds was observed in the cytome assay as well as in the % DNA damage in the comet assay.

CONCLUSIONS

The findings indicated a dose dependent genotoxic potential of the smoke condensate in the bacterial and human C3A cells and may pose a health risk to women since the smoke bath is frequently practised. The study highlighted the need for further rigorous assessment of the risks associated with the smoke bath practice.

Very poor practices regarding breast cancer screening among Sudanese female workers at a secondary-level hospital: a cross-sectional study

Introduction

breast cancer (BC) mortality and morbidity burden in African countries is higher compared to western countries due to late diagnosis produced by deficient screening. We aimed to assess the level of knowledge, attitude and practice regarding breast cancer screening among Sudanese female workers at a secondary-level hospital.

Methods

this is a cross-sectional study carried out at the largest governmental hospital of Ad-Damazin City (capital of Blue Nile State, south-eastern Sudan) in 2018. It surveyed female healthcare providers "group A" compared to the non-medical female staff at the same hospital "group B" to assess their awareness, beliefs and behavior concerning Breast Cancer Screening (BCS). Chi-squared and Student t-tests were used for analysis with a significant p value of <0.05.

Results

participants were 110, included 78 (70.9%), ("group A") and 32 (29.1%) ("group B") women. Good overall knowledge score (47.4%) vs (43.8%), for "group A" and "group B", respectively, p=0.000. Positive attitude was scored by 63 (80.8%) vs. 23 (71.9%) participants in "group A" and "group B" respectively, p= 0.305. Obvious denial trend regarding susceptibility to this disease was noted in both groups. BCS practices were seriously unsatisfactory in both groups. As "group A" vs "group B" regarding breast self-examination, n=13 (16.7%) vs n=10 (31.3%); clinical breast examination n=4 (5.1%) vs n=4 (12.5%) and mammography was not performed by any woman in both groups.

Conclusion

the modest knowledge and poor BCS practices of our study groups strongly recommends appropriate official and educational actions.

JC Polyoma Virus as a Possible Risk Factor for Prostate Cancer Development - Immunofluorescence and Molecular Based Case Control Study

BACKGROUND

In vitro studies have produced conflicting results about the significance of the JC Polyoma Virus (JCV) in the human cancers.

OBJECTIVES

Our study aims to detect the presence of JCV Large T antigen (LTag) together with viral load quantitation in the prostate tumor samples to assess if JCV harbors risk factor for prostate cancer (PCa).

METHOD

This was a case control-based study. A total of 110 patients participated in this study, including 55 patients with PCa and another 55 patients with benign prostatic hyperplasia (BPH) as cases and controls, respectively. Tissue, blood and urine samples were collected from each participant. Tissues samples were analyzed for the presence of JCV Ltag using a direct immunofluorescence assay (IF). Only positive IF tested samples were subjected to viral quantitation assay. Data were collected and managed using SPSS version 20.

RESULT

The JCV LTag in the cases group was 23.63% (13/55) which was higher than that of the controls group 5.45% (3/55) with a P. value of .006 and O.R of 5.76. The mean of viral load was significantly higher among cases tissue specimens 20156 ± 5450 copies/ml compared to controls group 6378 ± 2456copies/ml with P-value of .002. The virus was detected in 11/13 (84.6%) urine samples of cases with a mean viral load of 14068 ± 4590 copies/ml compared to 2/3 (66.6%) of controls viral load 2534 ± 1267 copies/ml.

CONCLUSION

In conclusion, a higher JCV LTag with more viral load were detected in cases group compared to controls. Our findings support a strong relationship between JCV infection and the probability of developing PCa.

National cancer control plans across the Eastern Mediterranean region: challenges and opportunities to scale-up

National cancer control planning is crucial for countries in the WHO Eastern Mediterranean region. This region is challenged with an increase in cancer incidence leading to substantial disease burden, premature deaths, and increasing health-care costs in most countries. Huge inequity in cancer control planning and implementation exists between and within the countries. Over half of the countries (12 [55%] of 22) have standalone comprehensive National Cancer Control Plans and six (27%) have non-communicable disease plans that include cancer. The implementation of cancer plans has common challenges related to weak governance structure, few coordination mechanisms within countries, and inadequate human and financial resources. In most countries, the plan is not costed. Yet, the majority of countries (20 [91%]) reported having fully or partially funded plans. Additionally, political instability and conflicts affecting over half of the countries in the Eastern Mediterranean region have enormously affected cancer planning and implementation, both among the affected countries and those that host large numbers of refugees. In this Policy Review, we used the WHO regional framework for action on cancer to systematically analyse the status of cancer control planning and implementation across the six domains of cancer control, from prevention to palliation. We highlight the gaps, and the opportunities for bridging these gaps, to achieve scale-up on implementation of cancer control programmes in the Eastern Mediterranean region.

Breast cancer awareness and screening practice amongst health personnel and general population of the littoral region of Cameroon

Introduction

Late diagnosis has been observed as the hallmark of breast cancer in Cameroonian women where over 70% of patients report with either stage III or IV of the disease, with high mortality and dire socioeconomic consequences. The present study was undertaken to assess the awareness of breast cancer, warning signs and screening methods among Health professionals and general population of Douala.

Methods

Participants included in this study were health practitioners and women randomly selected and enrolled in six health facilities in the city of Douala, Littoral Region, Cameroon. A self-administered questionnaire was designed for each group and aimed at assessing their knowledge about breast cancer, warning signs and screening practices. Then, 616 women underwent breast palpation, followed by fine needle aspiration (FNA) when a nodule was found.

Results

Out of a total of 737 participants (121 health personnel and 616 women) interviewed, a majority (96.3%) were aware of the disease with the main source of information being the hospital (76.0%), media (47.1%) and vocational training schools (45.4%) for health personnel; medias (39.9%), health professionals (26.1%) and their entourage (21.9%) for the population. Health workforce presented suitable awareness of the risk factors for breast cancer and its clinical signs even though 37.1% of them had misconceptions and myth-based ideas on the origin of the disease. Both the population and health personnel were aware of the possibility of early screening for breast cancer and cited breast self-examination, clinical breast examination and mammography as screening techniques. Nonetheless, screening practice amongst all women is very poor and mainly due to ignorance, high cost of mammography, together with a lack of mastery of the BSE technique and the fear of actually discovering signs of the disease.

Conclusion

Our findings show lack of awareness and low practice of breast cancer screening amongst women in Douala and highlight the need to raise awareness and provide the right information to the public for early detection of breast cancer.

Adherence to endocrine therapy and its relation to disease-free survival among breast cancer patients visiting an out-patient clinic at Khartoum Oncology Hospital, Sudan

RATIONALE

Adherence to endocrine therapy provides substantial reduction in breast cancer (BC) relapses and improve survival. Hence, non-adherence remains an under reported issue mainly in developing countries.

AIMS AND OBJECTIVES

The aim of this study is to evaluate the adherence to endocrine therapy (tamoxifen [TAM] and aromatase inhibitors [AIs]) among BC patients visiting an out-patient clinic (2015-2016) in Khartoum Oncology Hospital, Sudan.

METHODS

Adherence was assessed using pills count and self-reporting methods. A total of 172 patients were interviewed. Also, records were reviewed for demographic and other cancer characteristics.

RESULTS

The patients' mean age at diagnosis was 53 years, with the highest frequency at (41-60) years. Invasive ductal carcinoma 69.2% formed the main pathological diagnosis. T2 tumour size (51.2%) and lymph node involvement (N1) (31.4%) were most evident. Also, the majority of patients were stage III (45.9%) and grade II (48%). The studied women were postmenopausal (49.4%) and premenopausal (47.7%). Regarding hormonal receptors, about 68% were oestrogen (ER)+/progesterone (PR)+ and 23.3% were ER+/PR-. Studying adherence, almost (93%) of the studied group were ≥80% adherent to TAM and AIs. The hormonal therapy persistence mean was 27.2 ± 22.5 months (40-96). While adherence percentage mean was 93.7 ± 13.6% (0%-100%). Also disease-free survival (DFS) mean was 36.3 ± 32.7 months (4-312). Adherence to hormonal therapy and persistence were significantly correlated (P < .000). Also, statistically significant association was found between hormonal therapy adherence (≥80%) and patient poor to average economic status (P = .006), and the marital status "married" (P = .008).

CONCLUSIONS

A high rate of adherence (93%) to endocrine therapy was estimated in the present study. Also, a positive association was found between the hormonal therapy persistence, and the DFS year's groups (P = .000), and the hormonal therapy types (P = .000). Adherence to hormonal therapy and persistence were significantly correlated (P < .000).

Prostate cancer clinical characteristics and outcomes in Central Sudan

Background

Prostate cancer is the most common cancer among Sudanese men and most patients present at a late stage. Although the incidence of prostate cancer in Sudan is low compared to other African countries, studies on prostate cancer in Sudan are limited. This study addresses the clinical characteristics and outcomes of prostate cancer in Central Sudan and its prognostic factors.

Methodology

This study was conducted prospectively at the Gezira Hospital for Renal Disease and Surgery and at the National Cancer Institute at the University of Gezira, Sudan, for an 11-year period.

Results

During the study period, 543 patients participated in the study. Each one underwent a clinical examination, digital rectal examination and radiological staging using magnetic resonance imaging or computed tomography and provided blood samples for prostate-specific antigen (PSA) testing. The mean (SD) age of patients was 72.6 (9.9) years. At diagnosis, the majority of patients experienced lower urinary tract symptoms (LUTS; 54%), bladder outlet obstructions (OU) without (18%) or with urine retention (14%), PSA median was 100 ng/mL and the mean was 269 ng/mL, locally advanced disease (45%) or distant metastasis (46%). The age-adjusted hazard ratio (HR) of mortality was twofold, comparing patients presented with OU to patients with LUTS. Patients diagnosed with locally advanced and castration resistance prostate cancer had five times the HR compared to patients diagnosed with organ-confined prostate. On the contrary, the HR increased sevenfold for patients with distant metastasis. Gleason score did not show a significant association with survival (p = 0.249). Similarly, there was no apparent dose–response association between the PSA levels at diagnosis (p = 0.460).

Conclusion

The findings suggest that Sudanese men who are living in Central Sudan present at diagnosis with large tumours at late stages, and high PSA levels and Gleason scores. Improving awareness and building up the treatment capacity are key to achieving better outcomes.

Knowledge, attitude, and practice of breast cancer and breast self-examination among female detainees in Khartoum, Sudan 2018

Introduction

Breast cancer is the common cancer among females and a leading cause of mortality among them globally, its rates are three times higher in developing countries. Breast self-examination (BSE) had an important role in early detection, increasing the survival rate of breast cancer patients, despite these benefits, the rates of practicing BSE are low, especially in developing countries.

Objective

To assess the levels of awareness about breast cancer, and BSE among the detainees of Dar-Altaebat facility, a female's detention facility in Khartoum, Sudan.

Methods

A cross-sectional study conducted at Dar-Altaebat a female imprisonment facility in Khartoum, Sudan. 354 participants were randomly selected from the total population of the facility. Data was collected using a self-administered structured questionnaire, which was composed of socio-demographic section, knowledge section, attitude section, and breast self-examination section. Data was analyzed using statistical package for social sciences(SPSS) software.

Results

330 participants responded to the questionnaire, their mean age was (31, SD: 11.2) years, 126 (38.2%) of them were illiterate, 196 (59.4%) were married, and the majority of them 177 (76.3%) were housewives. their overall knowledge score revealed that 185(56.2%) of them had poor knowledge about breast cancer. 218 (66.3%) of them had poor knowledge about breast self-examination, however 314 (95.3%) thought that it was important. 315 (95.5%) of the participants had poor practice towards breast self-examination.

Conclusion

Poor levels of knowledge about breast cancer were reported among the detainees. Additionally, their level of knowledge and practice of breast self-examination was also low, thus more health education campaigns are recommended in such facilities.

A correlation study of BK Polyoma Virus infection and prostate Cancer among Sudanese patients - immunofluorescence and molecular based case-control study

Background

Polyomavirus hominis1, also called BK virus (BKV) is a well-known etiological agent of renal transplant nephropathy and cystitis. Recently, it got great attention from the researcher as a principal predisposing factor for different kinds of cancers including prostate cancer (PCa). Thus, this study aims to determine the correlation between BKV infection and PCa through a descriptive case-control based study.

Methods

A total of 55 paraffin-embedded tissue blocks of patients with PCa and another 55 tissue blocks from BPH patients were obtained. In parallel, respective urine samples were collected from all the cases and controls. The existence of BKV large T antigen (LTAg) was analyzed by Direct Immunofluorescence assay. Only BKV LTAg positive specimens were further analyzed for the presence of viral DNA by using a conventional PCR then subjected to viral load quantitation by using Q-PCR.

Result

BKV LTAg was identified in 30% (17/55) of cases tissue specimens and only in 7% (4/55) of the controls tissue specimens with P-value 0.002 and Odd ratio 5.7. The conventional PCR detects the BKV DNA in 16 out of 17 cases specimens while only two out of four controls specimens were identified with a viral DNA. The mean of the BKV DNA load was higher significantly among cases 6733 ± 6745 copies/ml when compared to controls 509.0 ± 792.9 copies/m with a p-value of 0.002.

Conclusion

More BKV prevalence with high viral load was observed in PCa patients tissue compared to BPH specimens. PCa Gleason scores 9 and 7 were the most cancer grades identified with the presence of BKV DNA. Our findings are thus consistent with a significant link between the BKV infection and the PCa risk. Prostate or seminal fluids should be selected as principal specimens for future studies and can, therefore, be designated as screening samples to find early virus evidence in the prostate tissue. Detection of early virus evidence may help to reduce the risk of PCa cancer due to BKV.

Spatial distribution of breast cancer in Sudan 2010-2016

BACKGROUND

Breast cancer is the most prevalent cancer among females worldwide including Sudan. The aim of this study was to determine the spatial distribution of breast cancer in Sudan.

MATERIALS AND METHODS

A facility based cross-sectional study was implemented in eighteen histopathology laboratories distributed in the three localities of Khartoum State on a sample of 4630 Breast Cancer cases diagnosed during the period 2010-2016. A master database was developed through Epi InfoTM 7.1.5.2 for computerizing the data collected: the facility name, type (public or private), and its geo-location (latitude and longitude). Personal data on patients were extracted from their respective medical records (name, age, marital status, ethnic group, state, locality, administrative unit, permanent address and phone number, histopathology diagnosis). The data was summarized through SPSS to generate frequency tables for estimating prevalence and the geographical information system (ArcGIS 10.3) was used to generate the epidemiological distribution maps. ArcGIS 10.3 spatial analysis features were used to develop risk maps based on the kriging method.

RESULTS

Breast cancer prevalence was 3.9 cases per 100,000 female populations. Of the 4423 cases of breast cancer, invasive breast carcinoma of no special type (NST) was the most frequent (79.5%, 3517/4423) histopathological diagnosis. The spatial analysis indicated as high risk areas for breast cancer in Sudan the States of Nile River, Northern, Red Sea, White Nile, Northern and Southern Kordofan.

CONCLUSIONS

The attempt to develop a predictive map of breast cancer in Sudan revealed three levels of risk areas (risk, intermediate and high risk areas); regardless the risk level, appropriate preventive and curative health interventions with full support from decision makers are urgently needed.

EBV Associated Breast Cancer Whole Methylome Analysis Reveals Viral and Developmental Enriched Pathways

Background: Breast cancer (BC) ranks among the most common cancers in Sudan and worldwide with hefty toll on female health and human resources. Recent studies have uncovered a common BC signature characterized by low frequency of oncogenic mutations and high frequency of epigenetic silencing of major BC tumor suppressor genes. Therefore, we conducted a pilot genome-wide methylome study to characterize aberrant DNA methylation in breast cancer.

Results: Differential methylation analysis between primary tumor samples and normal samples from healthy adjacent tissues yielded 20,188 differentially methylated positions (DMPs), which is further divided into 13,633 hypermethylated sites corresponding to 5339 genes and 6,555 hypomethylated sites corresponding to 2811 genes. Moreover, bioinformatics analysis revealed epigenetic dysregulation of major developmental pathways including hippo signaling pathway. We also uncovered many clues to a possible role for EBV infection in BC.

Conclusion: Our results clearly show the utility of epigenetic assays in interrogating breast cancer tumorigenesis, and pinpointing specific developmental and viral pathways dysregulation that might serve as potential biomarkers or targets for therapeutic interventions.

Patterns of Esophageal Cancer in the National Cancer Institute at the University of Gezira, in Gezira State, Sudan, in 1999-2012

BACKGROUND

Esophageal cancer (EC) is among the most common malignancies in Eastern Africa, but the occurrence of EC in Sudan has rarely been described in the scientific literature. This paper reports the results of a consecutive case series of all EC patients who visited one of the two public cancer treatment centers in the country in 1999-2012, providing a first description of this disease in a treatment center located in central Sudan.

MATERIALS AND METHODS

Clinical and demographic data for all EC patients who visited the Department of Oncology of the National Cancer Institute at the University of Gezira (NCI-UG) from 1999 to the end of 2012 were abstracted and tabulated by sex, tumor type and other characteristics.

RESULTS

A total of 448 EC patients visited NCI-UG in 1999-2012, and the annual number of EC cases increased steadily from 1999. Squamous cell carcinoma (SCC) was the predominant EC tumor type (90%), and adenocarcinoma (ADC) was reported in 9.4% of the EC cases. The overall male-to-female ratio for EC was 1:1.8, but the ratio was tumor type-dependent, being 1:2 for SCC and 2:1 for ADC. Only 20% of EC patients reported having ever used tobacco and/or alcohol, and the vast majority of these patients were male. At the time of EC diagnosis, 47.3% of the patients resided in Gezira State. Some EC patients from Gezira State seek out-of-state treatment in the national capital of Khartoum instead of visiting NCI-UG.

CONCLUSIONS

The annual number of EC patients visiting NCI-UG has increased in recent years, approximately half of these patients being from Gezira State. Although this consecutive series of EC patients who visited NCI-UG was complete, it did not capture all EC patients from the state. A population- based cancer registry would provide more complete data required to better understand EC patterns and risk factors.

Poverty, Health and Livelihoods

Developing countries, especially those in the tropical regions of the world, are known for poverty and infectious diseases (ID). People in developing countries carry on their day-to-day living amongst these two challenges. Between the years 1940–2004, over 300 emerging human ID have been reported worldwide. Infectious diseases have resulted in high mortality and morbidity in developing countries. Affecting more than 1 billion of the world’s population, neglected tropical diseases (NTD) are a group of infectious diseases that are endemic in the poorest regions of the world. Most of the affected populations live in rural areas with very minimal resources but at high risk of disease due to their livelihood. Non-communicable diseases are also on the increase in developing countries, further exacerbating public health challenges in these regions. With nearly 15 million people dying each year as a result of ID, most of them living in developing countries, there is need to find solutions to prevent and tackle infectious diseases in these communities. This book is devoted to infectious diseases and livelihoods in developing countries.