Cancer cases in South Africa are rising, with projections that numbers could reach 120 000 within the next five years – double what was recorded in 2019, say concerned health experts, who also warn about the increased burden, financial and otherwise, on an already creaking public health sector.
They also suggest that cases are, in fact, under-reported – possibly by as much as 40% – and that cancer is not regarded by authorities as a priority disease, despite killing thousands of people every year.
A decade or so ago, cancers and tumours accounted for almost 10% of all deaths, but with cases climbing, these statistics are likely to be even higher in five years, said Dr Judith Mwansa-Kambafwile, a senior epidemiologist at the National Cancer Registry (NCR).
News24 reports that the figures are based on modelling studies.
According to data from Statistics SA, in 2018, neoplasms (which include cancer and benign tumours) accounted for 9.7% of all mortality. They were the fourth leading cause of mortality. And while overall mortality dropped by 24% between 2008 and 2018, cancer-related deaths increased by 29% over the same period.
Mwansa-Kambafwile said although the pathology registry had existed since 1986, entities were mandated to report all cancer diagnoses to the NCR only in 2011, after Regulation 380 of the National Health Act, resulting in an increase in reporting as of 2011.
In 2011, 67 434 cancer cases were reported, rising to 77 099 in 2021 before jumping to 87 874 in 2023.
Melomed Group oncologist Dr Adnaan Sayed said the increase could be attributed to factors that could include an ageing population and lifestyle changes.
“Age is one of the strongest risk factors… In South Africa, people are living longer, and so the cancer risk naturally increases. A longer life also means prolonged exposure to carcinogenic risk factors, like smoking and alcohol use,” he added.
While lifestyle changes are also increasing our risk of cancer, there is also more awareness, which could translate to increased diagnosis.
Some cancers also have been linked to HIV, which would be more prevalent in countries like South Africa.
Sayed said in his experience, lung cancer remained a burden in this country, while women are more likely to be diagnosed with breast and cervical cancer – the latter being linked to the high prevalence of HPV – and men are more often diagnosed with prostate cancer.
Mwansa-Kambafwile said the cancer types with the highest burden were prostate, breast, cervix, colorectal and lung cancer.
Colorectal cases increased from 3 073 in 2011 to 4 239 in 2021 and 4 680 in 2023. Lung cancer increased from 2 434 in 2011 to 2 322 in 2021 and 2 492 in 2023.
“Prostate, breast and colorectal cancers have increased, while lung and cervical cancers have seen an apparent decline. The cervical cancer decrease, when critically analysed, has in actual fact remained constant. This despite its association with HIV and HIV-associated cancers having decreased since the introduction of antiretroviral therapy,” she said.
In 2011, 7 376 cases of breast cancer were reported, rising to 9 642 in 2021 and 11 192 in 2023. This cancer accounts for around 24% of the cancers diagnosed in women in 2023, while cervical cancer accounts for almost 17%. In 2011, 5 263 cases of cervical cancer were reported, increasing to 6 274 in 2021 and 7 644 in 2023.
Prostate cancer remains the most diagnosed cancer among men overall, comprising 13% of all cases in 2023. In 2011, 6 449 cases were reported, rising to 8 653 in 2021 and 10 798 in 2023.
Mwansa-Kambafwile said: “Prostate cancer is the most diagnosed cancer among men overall and in each population group. White males ranked top, followed by black men. This finding is different from what is known – that black ancestry is a risk factor for this cancer. However, this difference could also be due to less access to diagnostic services among black men.”
Cancer Alliance director Salome Meyer said there was an under-reporting of cancer cases because the NCR was a pathology-based register.
“Not all cancers are diagnosed through pathology, and even though the cancer regulation stipulates it is a registrable disease, not all practices report cancers. It is estimated that there could be a 40% under-reporting – maybe even more than 40% if we consider information from treatment in the private sector.”
High-risk cancers
The Cancer Alliance’s Percept Study projected an estimated incidence increase for high-risk cancers from 75 636 in 2019 to 154 451 in 2030.
The associated cost for the public sector alone would be around R75bn, Meyer added.
“This expenditure would cripple the health sector, which is already challenged, and with cancer care already in the emergency room. With the expected increases, we will move to the cemetery. This is similar to what we had with HIV/Aids some 20 years ago. Cancer is the new HIV.”
Cancer was not regarded as a priority disease, added Meyer.
“The reality is also that cancer is a costly, complex disease and has more than one treatment regime. Every cancer is managed differently… there is no one-size-fits-all solution. Unlike HIV, diabetes and heart disease, it cannot be managed with oral therapies.”
Sayed said the rising number of cases was likely to significantly burden the government healthcare sector.
Many public oncology departments already saw patients facing long waiting times and pressure on their services, which vary between provinces – while patients might wait two weeks for radiation treatment in one province, it can be considerably longer in another.
“The increased burden leads to more frequent equipment breakdowns, like the radiotherapy machine, which delays treatment,” he added.
Escalating costs
Econometrix director and chief economist Azar Jammine said there were several economic impacts from increased cancer numbers.
“If those people diagnosed with cancer are formally employed and working, the impact will be significant, as the illness will affect their ability to contribute to the economy,” he added.
If those diagnosed with cancer were covered by medical aid, it could lead to an increased financial outlay by medical aid schemes, translating to an increase in tariffs above inflation, he said.
“This means people who contribute towards medical aid will be negatively affected. In terms of the public sector, additional cases put additional pressure on public hospitals. The sector is already struggling from budget cuts.”
Sayed said the disparity in prostate cancer could point to an under-diagnosis due to difficulty in accessing healthcare.
“So many black men may only present with symptoms when the disease is already advanced and not captured in the early-stage cancer statistics.”
White men were also more likely to have screening routinely, especially those with medical aid.
“Many black men don’t have that opportunity, so the true burden is probably under-estimated.”
Meyer said the disparity between care in the public and private sectors was evidenced by the private sector having 80% of the cancer care workforce and equipment, yet serving only 16% of the population.
“We cannot afford to wait for the NHI to be implemented. By then, many more people will have died from cancer,” she added.
News24 article – Cancer cases on the rise – it’s the ‘new HIV’, experts warn (Restricted access)
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