A summary data of the  national registry of cancer in Zimbabwe in the period  1986 to 1989.The Zimbabwe National Cancer Registry began operation in 1986. Between 1986-1989, a total of 8 276 cases were identified. Among men of African descent, oesophageal (11,2 pc) and liver cancer (11,0 pc) were most common. Cervical cancer was by far the most common among women of African descent (34,5 pc). Among both males and females of non-African descent, skin cancers (other than melanoma) accounted for one-third of cancers followed by prostate cancer (7,7 pc) in males and breast cancer (18,5 pc) in females. These findings arc comparable to earlier reports of the epidemiology of cancer in Zimbabwe

Bassett, M.T.

Chetsanga, C.

Chokunonga, E.

Levy, L.M.

National Cancer Registry Advisory Committee

Central African Journal of Medicine

English

IDS OpenDocs

The
Central African 
Journal 
of
Medicine
Supplementary Issue to 1992 Volume 38,
1991 University of Zimbabwe Annual Research Day
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 38, No. 3, March, 1992
THE CENTRAL AFRICAN 
JOURNAL OF MEDICINE
ORIGINAL ARTICLES
Zimbabwe National 
Cancer Registry: 
Summary data 1986-1989
M T BASSETT, L M LEVY, C CHETSANGA, E 
CHOKUNONGA, NATIONAL CANCER 
REGISTRY ADVISORY COMMITTEE*
SUMMARY
The Zimbabwe National Cancer Registry began 
operation in 1986. Between 1986-1989, a total of 8 
276 cases were identified. Among men of African 
descent, oesophageal (11,2 pc) and liver cancer (11,0 
pc) were most common. Cervical cancer was by far 
the most common among women of African descent 
(34,5 pc). Among both males and females of 
non-African descent, skin cancers (other than 
melanoma) accounted for one-third of cancers 
followed by prostate cancer (7,7 pc) in males and 
breast cancer (18,5 pc) in females. These findings arc 
comparable to earlier reports of the epidemiology of 
cancer in Zimbabwe.
INTRODUCTION
The majority of cancer deaths occur in developing 
countries.1 Population rates may underestimate the 
health impact of cancer in these settings, particularly
in older age groups, because most of the population 
has not yet reached an age vulnerable to common 
cancers.
Some cancers occur mainly in developing 
countries: most cases of cervical, oro-pharyngcal, 
oesophageal and liver cancer come from these areas.2 
In contrast, lung cancer, colon cancer and breast 
cancer arc common in Europe and North America.
Such geographic variation in cancer occurrence 
lends support to the view that most cancer is 
environmental in origin (and hence preventable). 
Indeed, it is widely believed that cancer incidence in 
developing countries will change as urbanisation and 
economic development result in both environment 
and personal lifestyle changes. For all these reasons, 
documentation of cancer occurrence in developing 
countries is important.
Cancer registries seek to determine the magnitude 
and pattern of cancer occurrence, to provide a 
framework for research and to monitor the possible 
impact of intervention programmes.
Before 1980, Zimbabwe had a cancer registry in 
Bulawayo run by Dr M E Skinner which reported 
cancer incidence rates for the greater Bulawayo area 
to the International Agency for Research on Cancer 
(IARC)overa 15-ycarperiod(1963-1978). In 1986, 
the new computerised Zimbabwe National Cancer 
Registry was established with the assistance of a 
grant from the World Health Organisation. Its initial 
goal is the collection of data from the central referral 
hospitals in Harare by active case identification. The 
Registry relies on passive case identification for other 
areas. Eventually, the catchment area will be 
expanded so that population rates of cancer for 
Zimbabwe can be established.4
We report here a summary of data collected during 
the first four years of operation of the Zimbabwe 
National Cancer Registry.
91
Data Collection: The registry relics on three main 
sources for the active identification of cancer cases: 
the Harare Central Hospital and Parircnyatwa 
Hospital wards and medical records departments, the 
governm ent h isto lo g y  laboratory and the 
radiotherapy department. Registry clerks visit each 
of these areas on a regular basis to identify patients 
with cancer diagnoses. Routine rounds of the 
in-patient wards, in addition to the histology records, 
yield the majority of cases. Staging and histological 
type arc confirmed by a doctor on the basis of record 
review.
Passive data collection takes place in several ways. 
Special registry cancer notification forms have been 
sent to Harare-based private practitioners. In 
addition, a large private histology laboratory in 
Harare provides the Registry with regular reports of 
cancer diagnoses.
The notification  form records: 1) patient 
demographic data, such as birth date, age, sex, race, 
mariul status, address and occupation, 2) information 
on cancer diagnosis, including date of diagnosis, 
basis of diagnosis, histology and stage and 3) current 
vital status. All data are entered on a personal 
computer using the CANREG software package 
developed by the IARC.5
Data Presentation: The cancer cases reported here 
represent data collected during the years 1986,1987, 
1988 and 1989. Because of staffing problems at the 
Registry, registration of cases actually fell during the 
first three years of this period. A total of 3 663 cases 
were reported in 1986; 1 384 in 1987; 981 in 1988. 
In 1989, 2 448 cases were identified reflecting 
improved staffing and data collection procedures. A 
year-by-ycar review of cases showed that the 
proportion of leading cancers remained relatively 
stable, with greater variability as numbers became 
small.
We present the data for the 1986-1989 year period 
in aggregate, tabulated by sex and race group, both 
of which have a bearing on cancer risk. For race 
classification, we use two categories: persons of 
“African descent” and persons of “non-African 
descent” . The latter includes the categories 
“European” , “Coloured” , “ Asian” , “Other” and 
“unknown”. Inspection of the “unknown” category 
showed that more than 80 pc had English surnames, 
justifying the inclusion of this group in the “persons 
of non-African descent” category.
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Registration is not yet complete enough to 
generate population rates. We present the numbers of 
cases with the proportion that each cancer represents 
of the total number of reported cancers. Results arc 
reported using the ICD-9 format.6 
Cancer Cases — 1986-1989: Of the toml of 8 276 
cases reported to the Registry between 1986-1989,8 
232 could be analysed in the ICD-9 format. As shown 
in Table I, over 75 pc of cases were identified in the 
government central hospitals (Harare Central 
Hospital, Parircnyatwa Hospital) or Harare private 
hospitals. Histology reports formed the basis for 
diagnosis in the majority of cases (see Table II).
Table I: Place o f diagnosis of cancers reported to the 
National Cancer Registry: 19B6-I9B9.
Vol. 38, No. 3, March, 1992
Black Non-Blacks
(N = 7 277) (N = 998)
N pc N pc
Harare Central Hospital 2 824 38,8 26 2,6
Parirenyatw a Hospital 2 548 35.0 178 17,8
Private Doctor 21 0,2 162 16.2
Private Hospital 'C linic 46 0,6 480 48,0
Table II: Basis o f diagnosis o f cases identified by the 
National Cancer Registry: I986-I9S9
Basis Number pc
Histology 7 1 8 8 86,6
Necropsy 2 0,0
C ytology 134 1,6
Haem ato logy 36 0,4
Surgery 111 1.3
Radiology 4 3 0,5
Clinical 5 9 6 7,2
Lab Test 26 0.3
O ther 1 4 0 1,6
Total 8 276 1 0 0 ,0
Cases were about equally divided between males and 
females. Eighty-nine percent of cases were classified 
as “persons of African descent” (n = 7 263). This 
percentage is lower than the national proportion of 
people classified as “African” (96 pc).7 There are 
possible biases in diagnosis and referral which may 
lead to over-representation of persons of non-African 
descent in the Registry. Table III—VI show cancers by 
site for four sex and race groups.
92
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 38, No. 3, March. 1997
Table III: Top ten causes of cancer among men of Table VI: Top ten causes of cancer among women of 
African descent 1986-1989 non-African descent 1986-1989
Site Number pc S ite Number pc
Oesophagus 481 13,2 Skin other than melanoma 105 19,0
Liver 401 11,0 Breast 102 18,5
Skin other than melanoma 399 11,0 Cervix uteri 44 8,0
Primary site uncertain 333 9,2 Primary site uncertain 34 6,2
Prostate 298 8,2 Colon 26 4,7
Bronchus/Lung 209 5,7 Uterus 23 4,2
Stomach 172 4,7 Melanoma of skin 18 3,3
Bladder 163 4,5 Rectum 14 2,5
Other reticuloses 86 2,4 Ovary etc. 13 2,4
Bone 81 2,2 Other reticuloses 10 1,8
Total 2 623 72,1 Total 389 70,6
Table IV: Top ten causes of cancer among women of 
African descent 1986-1989
She Number pc
Cervix uteri 1 249 34,5
Breast 310 8,6
Primary site uncertain 243 6,7
Skin other than melanoma 168 4,6
Bladder 119 3,3
Liver 111 3,1
Ovary etc. 93 2,6
Stomach 91 2,5
Uterus 66 1,8
M elanoma of skin 65 1,8
Total 2515 69,5
Table V: Top ten causes of cancer among men of 
non-African descent 1986-1989
She Number pc
Skin other than melanoma 160 38,4
Prostate 32 7,7
Bladder 28 6,7
Bronchus/Lung 24 5,8
Pnmary site uncertain 23 5,5
Colon 21 5,0
Rectum 14 3,4
Larynx 13 3,1
Other reticuloses 13 3,1
Melanoma of skin 11 2,6
Total 339 84,4
These data show that there is variation in the common 
cancers by race-sex group among cancer cases 
reported to the National Cancer Registry between 
1986 and 1989. Among males of African descent, the 
most common cancers are oesophageal (13,2 pc) and 
liver cancer 11,0 pc). Among women of African 
descent, cervical cancer is by far the most common 
cancer (34,5 pc). Skin cancer (other than melanoma) 
was the most common cancer among both men and 
women of non-African descent, accounting for nearly 
one-third of all cancers. Most of these cancers were 
basal cell carcinomas (168/265, 63 pc). After skin 
cancer, the common cancers in males of non-African 
descent prostate (7,7 pc), bladder (6,7 pc) and lung 
(5,8 pc). After skin cancer, breast cancer was the most 
common among females of non-African descent 
(18,5 pc).
DISCUSSION
The most recent cancer incidence rates for Zimbabwe 
were reported for 1963 -1967, based on the Bulawayo
g
Registry. These showed liver cancer, oesophageal 
cancer and cancer of the bronchus/trachca to be the 
leading cancers among African men, while cervical 
cancer, followed by breast cancer, was the most 
common cancer among African women.
Data for 1973-1977 were not adequate to generate 
rates, but the proportions of cancer cases by site 
suggest a similar pattern. Liver cancer accounted for 
18,1 pc of male cancers, followed by oesophageal 
cancer (12,8 pc) and lung cancer (11,3 pc).
Among women, cervical cancer accounted for 35,4 
pc of cancers, followed by breast cancer (8,5 pc).9
93
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 38, No. 3, March, 1992
The most recent data, based on the Central 
Histology Laboratory in Harare in 1981-1982 also 
show the leading male cancers to be liver and 
oesophageal cancer. Cervical cancer was by far the 
most common cancer among women of African 
descent.9
These earlier findings on the epidemiology of 
cancer in Zimbabwe are similar to those reported to 
the National Cancer Registry between 1986-1989. 
This suggests that, despite obvious possibilities of 
bias in reporting, reported cancer cases reasonably 
reflect the incidence of various cancers.
Bias arises from the urban base of the Registry. 
Although the central hospitals serve as referral 
centres, 80 pc or more of cancer cases may not be 
referred from prov in cia l or d istrict lev e ls  
(Loewenson et al. unpublished data). In addition, 
some cancer diagnoses are more likely to result in 
patient referral than others.10
For example, it seems likely that the category 
“other skin cancers” is over-represented in the 
Registry. This may be a result of the fact that patients 
with this cancer are likely to be referred, biopsied and 
henefc identified by the Registry.
On the other hand, patients with liver cancer may 
be more likely to be diagnosed clinically and less 
likely to be referred, because of the poor prognosis of 
this cancer. Such patients are thus less likely to be 
identified by the National Cancer Registry. This may 
account for the fact that oesophageal cancer is more 
common among reported cancer cases in this data set, 
although previous studies have found liver cancer to 
be more common than oesophageal cancer. It is also 
possible that the incidence of oesophageal cancer 
actually has increased and has surpassed that of liver 
cancer.
Despite the shortcomings in case identification, the 
consistency in the proportional distribution of cases 
between 1986-1989 in comparison with earlier data 
from different sources suggests that most common 
cancers identified in the Registry do indeed reflect 
population incidence rates. These findings will be 
useful in monitoring future trends and identifying 
intervention strategies.
ACKNOWLEDGEMENTS
We wish to thank Professor Martin and Professor D 
Savage for their assistance in case registration and the 
Registry staff for diligent hard work. The Zimbabwe
National Cancer Registry is supported by the
M inistry o f  H ealth and the W orld H ealth
Organisation.
REFERENCES
1. Parkin, D M, Stjensward, J, Muir. C S: 
Estimates of the world-wide frequency of 12 
major cancers. Bull World Health Organ, 
1984; 62: 163-182.
2. Parkin, D M, Laara, E, Muir C S: Estimates of 
world-wide frequency of 16 major cancers in 
1980. IntJ Cancer 1980; 41: 184-197.
3. Doll, R, Peto, R: The causes of cancer. Oxford, 
Oxford University Press; 1981.
4. Parkin, D M: Report on the procedures of the 
cancer registry Mimeo, 24 March 1986.
5. Bieber, A: “CANREG” a statistical package 
for cancer registries, May 26, 1989, IARC, 
Lyon, France.
6. World Health Organisation: Manual of the 
international statistical classification of 
diseases, injuries and causes of death, Nincth 
revision. 1 Geneva, 1977.
7. Central Statistical Office: Main demographic 
features of the population of Zimbabwe. An 
advance report based on a 10 pc sample. 
Government Printers, Harare 1985.
8. Doll, R, Muir, C M, Waterhouse J (Eds): 
Cancer in cid en ce in fiv e  continents. 
International Union Against Cancer 1970; II.
9. Parkin, D M (cd.): Cancer occurrence in 
developng countries. IARC Scientific 
Publication 75, IARC, Lyon, France.
10 Sanders, D S, Loewenson, R L, McKeen, M, 
Kravitz, J: Utilisation of different levels of 
health care and the operation of the referral 
system in Zimbabwe. Abstract presented to 
the International Epidemiology Association, 
Africa Regional Conference. Harare, August 
7-12,1989.
ZIMBABWE NATIONAL CANCER 
REGISTRY ADVISORY COMMITTEE 
MEMBERS
B G Mauchaza (Chairman), L M Levy (Secretary), N J T
Gwavava (Treasurer), E Chokunonga, M T Bassett, T
Watts, C F Kiire, C Martin, C J Chetsanga, Gomo, Mlambo,
Mutema, I Nyandoro, C Muronda, S Murugusampillay, A
Harid, E Loewenson.
94
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Zimbabwe National Cancer Registry: summary data, 1986-1989

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Zimbabwe National Cancer Registry: summary data, 1986-1989

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