Incidence and mortality of cancer in the Volta Region of Ghana

Gastric cancer in Sub-Saharan Africa - a systematic review of primary data

Introduction

Gastric cancer (GC) is the third leading cause of global cancer-related mortality. Despite the shifting burden of GC to low-and middle-income countries, the data regarding incidence, treatment, and outcomes in these settings are sparse. The primary aim of this systematic review was to aggregate all available data on GC in sub-Saharan Africa (SSA) to describe the variability in incidence across the region.

Methods

Studies reporting population-based primary data on GC in SSA were considered. The inclusion was limited to primary studies published between January 1995 and March 2022 which comprised of adult patients in SSA with GC. Studies without accessible full text in either French or English language were excluded. Unadjusted GC incidence rates with their standard errors for each study were recalculated from the crude numerators and denominators provided in individual studies.

Results

A total of 5,626 articles were identified in the initial search, of which, 69 studies were retained. Reported incidence rates ranged from a high of 5.56 GC cases per 100,000 in Greater Meru Kenya to a low of 0.04 GC cases per 100,000 people in Benin City Nigeria. The overall crude pooled incidence was 1.20 GC cases per 100, 000 (95%CI 1.15-1.26) with a variability of 99.83% (I2 p < 0.001). From the 29 high-quality population-based registry studies the crude pooled incidence was 1.71 GC cases per 100,000 people (95%CI 1.56-21.88) with a variability of 99.60%.

Conclusion

This systemic review demonstrates that GC incidence is highly variable across SSA. The limited data on GC treatment, mortality, and survival presents a significant challenge to providing a complete epidemiologic description of the burden of GC in SSA. There is a need for further robust data collection, exploration, and research studies on cancer care in SSA, with continued assessment of primary data availability.

Factors Influencing the Practice of Breast Self-Examination among Female Tertiary Students in Ho, Ghana

Background. Despite the implementation of various interventions towards the reduction of breast cancer prevalence, many women still report late symptoms to health facilities, and this decreases their chances of survival. Breast self-examination (BSE) is the most convenient form of examination to detect the development of breast cancer. We examined the factors that influence the practice of breast self-examination among female tertiary students in Ho, Volta Region of Ghana. Methods. This was a descriptive cross-sectional study that recruited 506 female students from four tertiary institutions in the Ho Municipality in Ghana using questionnaires. Descriptive and inferential statistics comprising frequency, percentage, Chi-square, and binary logistic regression were used in analyzing the data. Results. About 73% of the respondents had ever practised BSE. Out of the respondents who have ever practiced BSE, 79% were practising it at the time of the study. Students in their fourth year were above 4 times more likely (95% CI = 1.73–9.29, $p=0.014$ ) to practise BSE than those in their first year. Also, students with good knowledge of BSE were 4 times more likely to practice BSE [(95% CI = 1.1–13.46), $p=0.036$ ] and students with good perception about BSE were 12 times more likely to practice BSE [(95% CI = 1.21–122.73), $p=0.034$ ]. Conclusion. The study found that 27% of the female students had never practised BSE. Those who practice BSE did not practice regularly and appropriately. Also, good knowledge and perception are associated with the practice of BSE. The implication of this result is the late presentation of breast cancer cases to health facilities and increases in breast cancer-related deaths in the country. Therefore, it is recommended that the Ministry of Health, the Ghana Health Service, and other stakeholders in Ghana’s healthcare should develop and implement innovative approaches and policies such as peer and support groups’ learning, and mass media BSE awareness aimed at ensuring better understanding and access to BSE education. This should be intensified during the foundation years such as the secondary and tertiary education levels to ensure the adoption of breast self-examination practice. It is also recommended that another study must be done using a qualitative approach to get an in-depth understanding of the steps and ways, by which female students practice BSE.

Improving Global Surgical Oncology Benchmarks: Defining the Unmet Need for Cancer Surgery in Ghana

BACKGROUND

The Lancet Commission on Global Surgery (LCoGS) recommended an annual surgical rate at which low- and middle-income countries (LMICs) could achieve most of the population-wide benefits of surgery. However, condition-specific guidelines were not proposed. To inform rates of surgery for cancer, we sought to assess the current met and unmet need for oncologic surgery in Ghana.

METHODS

Data on all operations performed in Ghana over a one-year period (2014-15) were obtained from representative samples of 48/124 first-level and 12/16 referral hospitals and scaled-up for nationwide estimates. Procedures for cancer were identified by indication. Using modified LCoGS methodology with disease prevalence, Ghana's annual rate of cancer surgery was compared to that of New Zealand to quantify current unmet needs.

RESULTS

232,776 surgical procedures were performed in Ghana; 2,562 procedures (95%UI 1878-3255) were for cancer. Of these, 964 (37%) were surgical biopsies. The annual rate of procedures treating cancer was 2115 surgeries/100,000 cancer cases, or 21% of the New Zealand benchmark. Cervical, breast, and prostate cancer were found to meet 2.1%, 17.2%, and 32.1% of their respective surgical need.

CONCLUSIONS

There is a large unmet need for cancer surgery in Ghana. Cancer surgery constitutes under 2% of the total surgeries performed in Ghana, an important proportion of which are used for biopsies. Therapeutic operative rate is deficient across most cancer types, and may lag behind improvements in screening efforts. As cancer prevalence and diagnosis increase in LMICs, cancer-specific surgical capacity must be increased to meet these evolving needs.