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Akintola A, Odutola M, Olayinka T, et al., editors. Cancer in Nigeria: 2009 – 2016 [Internet]. Nigeria: Nigerian National System of Cancer Registries; 2021.
Enugu State is one of the states in the eastern part of Nigeria. The state shares borders with Abia State and Imo State to the south, Ebonyi State to the east, Benue State to the northeast, Kogi State to the northwest and Anambra State to the west.
Enugu state has an estimated population of 3,267,837 (1,596,042 males and 1,671,795 females) [4]. It accounts for 2.3% of Nigeria’s population (NPC, 2006).
Enugu State is located on coordinates 6°30′N 7°30′E. It covers a land mass of 7,753.9 square kilometres and has a population density of 480 people per square kilometres.
The State is predominately occupied by the Igbo ethnic group with some pockets of Igala speaking communities of Ette in Igbo-Eze-North LGA, Ogurugu and Ojjor in Uzo-Uwani LGA respectively.
The Enugu Cancer Registry (ECR) is a Population Based Cancer Registry domiciled at the Oncology Department of the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu. UNTH is a large tertiary and referral hospital with a 500-bed capacity and has facilities for cancer diagnosis and treatment including CT scan and radiotherapy. The registry began in 1988 as a Hospital Based Cancer Registry but became a Population Based Cancer Registry in 2012. Data from Enugu and Abuja Cancer Registry from 2012 to 2014 have been presented in previous publications [10, 11]
The registry covers Enugu-South, Enugu-East, Enugu-North, Nkanu-East Nkanu-West and Udi Local Government Areas of Enugu State with a population of 1,103,000 (NPC, 2006).
Figure 10.2 shows the age and sex distribution of the population covered by the Enugu Cancer Registry.
Pyramid of the Population Covered by the Enugu Cancer Registry.
The Enugu Cancer Registry reported 3,018 cases of cancer in the 5-year period from 2012 to 2016 giving an ASR of 78.4 per 100,000. Most of the cancers, 1,891 cases (ASR = 98.6 per 100,000; 62.6%) were in females while 1,127 cases (ASR = 58.1 per 100,000; 37.3%) were in males. The average number of cases observed per year during the 5-year period was 604.
The distribution of cases observed during the reporting period from 2012 to 2016 by age group and sex is shown in figure 10.3.
Proportion of cancer cases for each age group by sex.
Most of the incident cancer cases were seen in the age 50 to 69 years age group in both sexes (ASR = 497 per 100,000; 38.6% of all cancer cases in both sexes). In females, the highest incidence of cancers was in the 30 to 49 years age group (ASR = 143.6 per 100,000; 44.1% of all cancer cases occurring in females) followed by the 50 to 69 years age group (ASR = 312.0 per 100,000; 36.6% of all cancer cases occurring in females).
Among males, the highest incident cases of cancers occurred within the age 50 to 69 years age group (ASR = 185.4 per 100,000; 40.5% of all cancer cases occurring in males) followed by the 70+ years age group (ASR = 369.7 per 100,000; 25.7% of all cancer cases occurring in males).
Figure 10.4 shows the number of incident cancer cases per year. There is a notable drop in the incident cancer cases reported by the registry from 2014 to 2016 resulting from incomplete capturing of newly diagnosed cancer cases within the registry coverage area.
Incident cancer cases by year, 2012 to 2016 (per 100,000).
For both sexes, the Age-Standardized Incidence Rate (ASR) from ages 0 to 85+ years within the study period 2012 to 2016 was 78.4 per 100,000. The most common incident cancer in females was breast cancer (ASR = 42.2 per 100,000; 847 cases) followed by cancer of the cervix (ASR = 14.2 per 100,000; 232 cases) as shown in figure 10.5. Together, these two cancers account for 57.1% of all cancers occurring in females in the area covered by the Enugu Cancer Registry.
Top 10 Cancer sites in females, 2012 to 2016.
Figure 10.6 shows the Age-Standardized Incidence Rate (ASR) for cancers in males from ages 0 to 85+ years. The most common incident cancer by far was prostate cancer (ASR = 31.2 per 100,000; 352 cases) which singularly accounts for 45.6% of all cancers occurring in males in the area covered by the Enugu Cancer Registry.
Top 10 Cancer sites in males, 2012 to 2016.
Table 10.1 shows the incident cancer cases by age group among females from ages 0 to 85+ years within the 5-year period, while Table 10.2 shows the incident cancer cases by age group among males from ages 0 to 85+ years within the 5-year period.
Number of cancer cases by age group among females in Enugu Cancer Registry, 2012 to 2016.
Number of cancer cases by age group among males in Enugu Cancer Registry, 2012 to 2016.
Table 10.3 shows the crude and age standardized (ASR) incidence rates per 100,000, as well as the cumulative rate (%) of the female cancers reported by the Enugu Cancer Registry from 2012 to 2016 and their distribution by age groups. The highest cumulative incidence was for breast cancer, followed by cancer of the cervix.
Cancer Incidence in Enugu, 2012 to 2016 – Females.
Table 10.4 shows the crude and age standardised (ASR) incidence rates per 100,000, as well as the cumulative rate (%) of the male cancers reported by the Enugu Cancer Registry from 2012 to 2016 and their distribution by age groups. The highest cumulative incidence was for prostate cancer.
Cancer Incidence in Enugu, 2012 to 2016 – Males.
The figure below shows the age specific rates for the top 5 cancers in females (Figure 10.7). The incidence of the commonest cancer, which is breast cancer, starts to increase as early as 15 to 19 years of age and falls from 70+ years of age, while the incidence for cervical cancer, the second commonest cancer starts to increase from 25 to 29 years and began to drop from 80+ years of age.
Age specific incidence rates of the commonest cancers in females, 2012 to 2016.
Figure 10.8 shows the age specific cancer incidence for males. The incidence of prostate cancer rises suddenly from the age group 40 to 44 years of age and keeps rising up till the age group 75+ years.
Age specific incidence rates of the commonest cancers in males, 2012 to 2016.
The most common basis of diagnosis was histology of primary tumor (88.5%, 2745 cases). Clinical diagnosis was the basis of diagnosis for 5.0% (151 cancer cases).
Between 2013 and 2016, the annual number of cases recorded by the registry has nosedived due to challenges with the radiotherapy machine in the hospital which resulted in cancer patient going elsewhere to receive treatment, lack of sufficient manpower in the registry and poor funding.
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