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Journal of Cancer Biology & Research
Cite this article: Morounke SG, Ayorinde JB, Benedict AO, Adedayo FF, Adewale FO, et al. (2017) Epidemiology and Incidence of Common Cancers in Nigeria.
J Cancer Biol Res 5(3): 1105.
*Corresponding author
Saibu G. Morounke, Department of Biochemistry, Lagos
State University, P.M.B 0001 LASU Post Ofce, Ojo, Lagos,
Nigeria, Tel: 2348182184036; Email:
Submitted: 12 October 2017
Accepted: 06 November 2017
Published: 09 November 2017
Copyright
© 2017 Morounke et al.
OPEN ACCESS
Keywords
• Cancer; Nigeria; Trend; Incidence; Screening
Review Article
Epidemiology and Incidence of
Common Cancers in Nigeria
Saibu G. Morounke1*, James B. Ayorinde2, Adu O.
Benedict1, Faduyile F. Adedayo3, Fadaka O. Adewale4, Iyapo
Oluwadamilare5, Soyemi S. Sokunle3, and Adekunle Benjamin1
1Department of Biochemistry, Lagos State University, Nigeria
2Department of Biochemistry, University of Lagos, Nigeria
3Department of Forensic Pathology, Lagos State University, Nigeria
4Department of Biochemistry, Afe Babalola University, Nigeria
5Department of Pathology, University College Hospital, Nigeria
Abstract
Cancer is a public health problem worldwide affecting all ages. It is the second commonest cause of death in developed countries and among the three
leading causes of death in developing countries. WHO reported that about 24.6 million people live with cancer world-wide. There are 12.5% of all deaths are
attributable to cancer and if the trend continues, it is estimated that by 2020, 16 million new cases will be diagnosed per annum out of which 70% will be in
the developing countries. There are 11 cancer registries in Nigeria; located in various tertiary hospitals in various parts of the country. Most of these Registries
are poorly funded and cancer screening program is at minimal level except probably The Ibadan Cancer Registry, however they all produce hospital-based
data. This review focuses on the current trend of cancer in Nigeria which may be used to adjust the cancer control programs in order to reduce cancer deaths
in the country and also to call the attention of both the clinical research based organization, institution and in individual researchers and the government to use
the trend of cancer in Nigeria for setting priorities in cancer control programs/researches.
ABBREVIATIONS
WHO: World Health Organization; ASR: Age Standardized
Incidence Rates
INTRODUCTION
Cancer is a malignant disease condition arising from
uncontrolled division of cells in the body to form mass of tissues
or surrounding structures or spread to distant site in the body
where they can go on proliferating uncontrollably thus, causing
human cancers. They derive their names either based on the cell
of origin or site in the body. For example we have anal cancer,
bladder cancer, bone cancer, breast cancer, cervical cancer, colon
cancer, endometrial cancer, kidney cancer, leukemia, liver cancer
lymphoma, ovarian cancer, pancreatic cancer and so on. The
menace of cancer in our society today cannot be over emphasized.
It has become such a chronic disease and it claims lots of lives
every year to the tune of millions globally. The incidence of this
disease keeps on rising from year to year and cancer death rate
follows the same pattern. This review focuses on the current
control programs in order to reduce cancer deaths in the country.
World Health Organization (WHO) reported in its fact sheet
of February 2017, that cancer is one of the leading causes of
morbidity and mortality worldwide, with nearly 14 million new
cases in 2012, which is expected to rise by about 70% over the
next two decades. With 8.8 million deaths recorded in 2015 as a
result of cancer, WHO rated cancer as the second leading cause
of death globally. Seventy percent of these deaths were from low
and middle-income countries [2]. In 2008, a global estimation
of 12.7 million new cases and 7.6 million cancer deaths were
and 8.2 million cancer deaths in 2012 [4], 14.9 million cases and
8.2 million deaths in 2013 [5] and 8.8 million deaths in 2015 [2].
These records showed a worrisome increase in the trend of new
cancer cases and deaths worldwide.
Cancer was ranked as the 7th leading cause of death in Africa
in 2004, with an expected annual incidence of 1.28 million cases
and 970,000 deaths by 2030 [3]. Cancer is becoming a public
health problem in Africa because of the following factors: aging,
growth of the population and increased incidence of economic
transition-associated cancer risk factors such as smoking,
Figure 1 Cancer cells growing within normal cells [1].
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obesity, physical inactivity, poor diet, and reproductive factors
[6]. Despite the increasing rate of cancers in Africa, there is no
enough public policy about the disease [7]. According to WHO,
over 71,000 people died from cancer related causes, with
about 102,000 new cases reported that year (Table 1) [8]. It
was reported that in developed countries like United States of
America and other western countries, incidence and mortality
rates of most cancers are decreasing, but in developing countries
like Nigeria the situation is on the contrary [9]. For instance, in
Kano state of Nigeria, the pattern of cancer recorded in its cancer
registry for a period of ten years noted a progressive increase in
number of cancer cases [10]. This increase is in agreement with
cancer incidence and mortality in developing countries [11].
CANCER-CAUSING RISK FACTORS
agents that lead to development of cancer (Figure 2). Long
exposure to one or more of these factors may result in damage
of deoxyribonucleic acid (DNA) causing mutation in the gene.
Whenever gene controlling cell division is affected and the
damage to the gene cannot be repaired, then unregulated cell
division occurs which may leads to cancer.
These cancer-causing agents are:
1. Physical carcinogens, such as ultraviolet and ionizing
radiation
2. Chemical carcinogens, such as asbestos, components
arsenic (a drinking water contaminant) and
3. Biological carcinogens, such as infections from certain
viruses, bacteria, or parasites.
4. Ageing is another fundamental factor for the development
of cancer. The incidence of cancer rises dramatically
with age, most likely due to a build-up of risks for
accumulation is combined with the tendency for cellular
repair mechanisms to be less effective as a person grows
older.
5. Heredity: Though most cancers are sporadic (non-
hereditary), A small number of cancers occur due to
inherited genetic defects. Most of these cancers often
occur in a syndromic manner (involves more than one
form or cancers or conditions in more than one organs
of the body). Examples include Li-Fraumeni syndrome
associated with development of breast cancer, sarcoma,
brain tumour and leukemia; and Lynch syndrome which
is associated with increased risk of colon, ovarian and
endometrial cancers.
6. Hormones: Some hormones have been implicated in the
development of some malignancies such as the cancer
of the breast, prostate and endometrium. For instance,
increased incidence of prostate in black men compared
higher levels of testosterone in black men. High level of
oestrogen in females is associated with increased risk of
breast and endometrial cancers.
7. Immunological defects: immunological defects such
as autoimmune diseases and immunosuppression are
associated with increased risk for some cancers such as
cancer of colon, stomach and liver etc.
WHO, in its 2006 report, listed high body mass index, low fruit
Table 1: Estimate of cancer incidence, mortality and most common cancers in Nigeria as reported by GLOBOCAN, 2012.
Nigeria Male Female Both Sexes
Population 84,398,000 82,231,000 166,629,000
Number of New Cancer Cases 37,400 64,700 102,100
Age Standardised rate (W) 79.0 121.7 100.1
Number of cancer deaths 30,900 40,600 71,600
Age Standardised rate (W) 67.4 78.0 72.1
5- year prevalent cases, adult population 67,000 165,000 232,000
proportion (per 100,000) 139.8 348.6 243.6
First five common cancers
Prostate Breast Breast
Liver Cervix Uteri Cervix Uteri
Non Hodgkin Lymphoma Liver Liver
Colorectum Colorectum Prostate
Pancreas Non Hodgkin Lymphoma Colorectum
Figure 2
and /or potentially preventable factors (Harvard report on cancer
prevention, 1996).
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Table 2: Shows some of risk factors in Nigeria as reported by WHO, 2014.
Adult Risk Factors
Males Females Total
Current Tobacco Smoking 9.8% 2.3% 6.10%
Total Alcohol per Capita consumption, in liters of pure alcohol (2010) 14.9 5.1 10.1
Physical inactivity (2010) 17.7% 21.9% 19.8%
Obesity (2014) 5.3% 14.3% 9.7%
Household solid Fuel use (2012) 75.0%
Table 3: Shows cancer incidence for some states in Nigeria based on National system of cancer registries (2016).
States Years Cancer cases in males Cancer Cases in Females Total
Anambra 2009-2013 857(42.3%) 1167(57.7%) 2024
Bayelsa 2009-2013 53(37.9%) 87(62.1%) 140
Borno 2009-2010 251(45.6%) 299(54.4%) 550
Edo 2009-2010 923(41.4%) 1307(58.6%) 2230
Ekiti 2009-2010 126(33.1%) 225(66.9%) 381
Enugu 2009-2012 1323(40%) 1959(60%) 3282
Gombe 2009-2013 298(39.1%) 464(60.9%) 762
Kaduna 2009-2013 474(40.5%) 696(59.5%) 1170
Kogi 2009-2013 103(55.1%) 84(44.9%) 187
Kwara 2009-2013 612(41.5%) 864(58.5%) 1476
Lagos (LU) 2009-2013 596(26.5%) 1651(73.5%) 2247
Lagos (LA) 2009-2013 493(25.1%) 1469(74.9%) 1962
Nasarawa 2009-2013 109(32.4%) 227(67.6%) 336
Osun 2009-2010 262(44.7%) 325(55.3%) 587
Rivers 2009-2013 526(47.0%) 592(53.0%) 1118
Sokoto 2013 60(40.8%) 87(59.2%) 147
and vegetable intake, lack of physical activity, tobacco use, alcohol
use and infections as the chief risk factor around the world [12].
solid fuel caused 75% of cancer in 2012, tobacco smoking 6.1% in
2011 and physical inactivity 19.8% in 2010 as shown in the Table
2 below. In Nigeria, the estimated number of cancer cases of all
ages is 12,079 showing the commonest with percentage (Figure
3). 4172 cases (ASR=4.2 per 100,000) and 3175 deaths (ASR= 3.3
per 100,000) were estimated in Nigeria in 2012 [8].
CANCER INCIDENCE IN NIGERIA
Nigeria recorded 102079 cases of cancer, out of which 27,304
(26.7%) cases were for breast cancer, 14089 (13.8%) for cervix
uteri, 12,047 (11.8%) for liver and 11,944 (11.7%) for prostate
cancer as incidence (Figure 4) (Globocan, 2012).
The age standardized incidence rates (ASR) for these common
cancers; breast, cervix uteri, liver and prostate were 50.4, 29.0,
11.5, and 30.7 per 100,000 respectively.
A 5-year prevalence study in Nigeria also showed almost the
same trend. Breast cancer being the leading cases with 87,579
(37.7%), followed by cervix uteri 35,644 (15.4%), prostate
31062 (13.4%) and then liver 8,447 (3.7%) (Figure 5).
The mortality as recorded by Globocan (2012) showed that
breast cancer caused 13,960 (19.5%) deaths, cervix uteri 8,240
(11.5%) deaths, liver 11,663 (16.3%) deaths and prostate 9628
(13.5%) deaths in Nigeria. The ASR for mortality are; breast cancer
25.9 per 100,000, cervix uteri 17.5 per 100,000, liver 11.0 per
100,00 and prostate 25.3 per 100,000 (Figure 6). The cumulative
risk for these common cancers in Nigeria are on the high side,
breast cancer being the highest followed by cervix uteri, prostate
and the liver cancer. Nigeria like many other African countries
lacked accurate data on cancer incidence and mortality. Some
of the estimates by WHO are gotten from extrapolating data of
few populations- based cancer registries in Nigeria and therefore
may not be accurate. The recent publication by Nigeria National
System of Cancer Registries (2016) gave the cancer incidence
and pattern in Nigeria for 5 years i.e. from 2009-2013.
BREAST CANCER
and its incidence continues to rise especially in the sub-Saharan
Africa [13]. It was described as the most common cancer in
women worldwide [14]. It accounted for 24.45% of all the
cancer types (Figure 3). Huge differences have been observed
in the behavior of the tumour, clinical manifestation, treatment
response and prognosis across the various regions of the world
especially between the developed and the developing world [15].
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Figure 3 Estimated number of Nigerian most common cancer cases, all
Figure 4 Cancer incidence in Nigeria (GLOBOCAN 2012).
Figure 5 Cancer 5-year prevalence in Nigeria (GLOBOCAN 2012).
Figure 6 Cancer mortality in Nigeria (GLOBOCAN 2012).
About 92,600 cases of breast cancer and 50,000 breast cancer
deaths were recorded in Africa in 2008, making it the most
commonly diagnosed cancer and the second leading cause of
cancer death among women [3]. Southern African women have
the highest breast cancer incidence rates of all African regions,
in part because of a higher prevalence of reproductive risk
factors for breast cancer, including early menarche and late child
Nigeria, the prevalence of breast cancer is 116 per 100,000 and
27,840 new cases were expected to develop yearly [17]. Cancer
incidence data from two population based cancer registries in
Nigeria suggested substantial increase in incidence of breast
cancer in recent times [18]. Recent observations also showed
that the frequency of breast cancer had risen over that of cervical
cancer in Nigeria [19]. In 2012, WHO also estimated 27,304 cases
with age standardized incidence rates (ASR) of 50.4 per 100,000
and 13960 deaths with ASR 25.9 per 100,000. Nggada et al., in
2008 suggested public enlightenment, were screening all women
at risk, early detection of the lesion, and proper management in
our health institution as the ways to slow down the progressive
increase in breast cancer cases and deaths in our environment,
Nigeria [13].
CERVICAL CANCER
Cervical cancer is a cancer of the women. Its frequency in
Africa is second to breast cancer and it is the leading cause
of cancer death (50,300) in women with ASR of 25.2 cases
per 100,000 [3]. North America on the other hand had 7.7 per
100,000 as its ASR [20]. This value is low when compared with
that of Africa. In Nigeria, the incidence and the trend are not
different. In 2012, WHO also named cervical cancer as the second
common cancer in Nigerian women with estimated 14,080 cases
and ASR of 29.0 per 100,000 and 8,240 deaths and ASR of 17.5
per 100,000 [21]. Cervical cancer is caused by Human papilloma
virus infection which is transmitted during sexual intercourse.
So, it is preventable and remains one of the most preventable
cancers. Its slow development offers an opportunity for easy
risk factors in African women are early age of sexual initiation
and multiple sex partners [22,23].
PROSTATE CANCER
Prostate cancer is the most common cancer among men
in southern Africa and western Africa in which Nigeria and
Cameroon are good examples [9,24]. A study showed that the ASR
of 17.5 per 100,000 in Africa was lower than those of developed
antigen (PSA) screening in Africa [25]. In Nigeria, prostate cancer
is also the most common cancer among men. 11944 cases with
ASR of 30.7 per 100,000 and 9628 deaths with ASR of 25.3 per
100,000 were estimated in 2012 [8].
LIVER CANCER
Liver cancer is common to both male and female. It is ranked
as the second common cancer and the leading cause of death in
men and the third common cancer and the third leading cause of
cancer death women in Africa. The ASR of 11.6 per 100,000 in
Africa was higher than that of the developed countries with 8.2
per 100,000 [3].
Middle Africa had the highest incidence and mortality rates
while western African was next in rank [3]. Incidence rate was
also common in western Africa countries like Gambia and Guinea
[26]. In Nigeria, 12047 cases of liver cancer were estimated in
2012 (ASR=11.5 per 100,000), out of which 7,875 were males
and 4,172 were females. Also a total of 11663 deaths with ASR
of 11.0 per 100,000 were estimated for both sexes in the same
year [8].
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COLORECTAL CANCER
The rate of colorectal cancer in Africa was not as high as that of
developed countries as recorded in 2008. The ASR for Africa was
6.9 per 100,000 compared to 37.7 per 100,000 for the developed
countries [3]. In central Tunisia, colorectal cancer accounted for
and 2007 [27].
Some risk factors like smoking, alcohol consumption, and
unhealthy diets that are high in excess calories such as meats,
starches, fats, and sugars are associated with development of
colorectal cancer [28].
NATIONAL CANCER INCIDENCE BASED ON
POPULATION BASED REGISTRIES DATA (2012-
2013)
National cancer incidence statistics were derived from the
-based cancer registries and are
reported below:
Enugu population-based cancer registries in 2012-2013. Out
of these 3215 cases, 1977 (61.5%) were in women and 1238
(38.5%) in men. The age standardized incidence rates (ASR)
for all cancers in women was 160.2 per 100,000 and 94.2 per
100,000 in men.
cancers of the Breast 871 cases, ASR= 65.8 per 100,000, Cervix
290 cases ASR= 31.2 per 100,000, Ovary 86 cases ASR=6.9 per
100,000, Colo-rectal67 cases ASR 6.8 per 100,000 and Connective/
cancers in Nigerian men in 2012-2013 were cancers of the
Prostate 412 cases ASR= 42.5 per 100,000, Colorectal 84 cases
ASR= 5.9 per 100,000, Non-melanoma Skin 73 cases ASR= 4.0 per
100,000, Liver 63 cases ASR 3.9 per 100,000 and Connective/Soft
Tissue 56 cases ASR 3.1 per 100,000 [29].
CANCER PATTERNS IN NIGERIA STATES
Cancer pattern in Nigeria as extracted from Nigeria National
System of Cancer Registries (2016) is shown in Table 3 below.
There were 4209 cases of cancer recoded from two registration
centers in Lagos State between 2009 and 2013 (Table 3). 25.9%
Lagos centers is Enugu center with total cancer cases of 3282 in
which 40% is male and 60% is female. Edo and Anambra are the
next with 2230 and 2024 cases of cancer respectively.
The least cases of cancer were recorded in Bayelsa and Kogi
with 140 and 187 cancer cases respectively [29]. The common
cancer recorded in LUTH (LU), one of Lagos cancer registries,
for period of 2009 to 2013 for male were prostate (7.1%) and
colorectal (3.4%) while that of female were breast (41.2%),
cervix (14.5%) and colorectal (3.1%). In LASUTH (LA), the
second center in Lagos, prostate (5.3%), connective, soft tissue
(4.4%), and colorectal (3.3%) for male and breast (38.9%), cervix
(9.2%) and uterus (6.6%) were recorded.
The record from Enugu cancer registry showed similar trend:
prostate (33.9%) and colorectal (6.0%) and non-melanoma skin
(4.1%) in male while that of female were breast (60.3%), cervix
(22.2%), ovary (5.5%) and colorectal (5.3%).
The most common cancers in men in Anambra for all ages
were of the prostate (15.1%), colorectal (3.4%) and liver (2.6%).
For women of all ages in rank order were breast (20.1%), cervix
(8.3%) and ovary (4.0%).
In Edo state where the lowest cancer cases were recorded
within 2009-2013, the common cancers reported were prostate
(13.4%), and colorectal (2.0%) for male and breast (19.6%), and
cervix (3.9%) for female [29].
DIAGNOSIS AND TREATMENT OF CANCER IN
NIGERIA
Early diagnosis is very important to the control of cancer.
Standard screening methods are available for detecting different
types of cancers. These methods include mammography for
breast cancer, fecal occult blood testing and sigmoidoscopy/
colonoscopy for colorectal cancer, and Pap smear for cervical
cancer [30]. Whereas pap smear-based screening program was
unsuccessful in Africa, other approaches like on visual inspection
using Lugol’s iodine or acetic acid, and low-cost DNA tests to detect
HPV infections, have been shown to be feasible and effective in
many parts of Africa, including Kenya and South Africa [31,32].
Screening one or two times in life time between the ages of 35-55
years would reduce cancer by about 30% [33]. Increasing public
awareness of early signs and symptoms of cancers of the breast,
cervix, oral cavity, urinary bladder, colorectal, and prostate
should increase the detection of these diseases at earlier stages
when there are more effective options for treatment leading to
better prognosis [34].
Different treatment options are available. Four common
types are:
1. Chemotherapy: The use of a combination of drugs to
destroy cancer cells to cure or to control cancer.
2. Radiation therapy: The use of various forms of radiation
to safely and effectively treat cancer and other diseases.
Radiation therapy remains an important component of
cancer treatment with approximately 50% of all cancer
patients receiving radiation therapy during their course of
illness; it contributes towards 40% of curative treatment
for cancer [35]. The main goal of radiation therapy is to
deprive cancer cells of their multiplication (cell division)
potential.
3. Surgery: Removal of the tumor and the area surrounding
the tumour.
4. Antologous/allogenic Bone Marrow Transplant: Used to
treat diseases that damage or destroy the bone marrow.
Also used to restore bone marrow that has been damaged
during cancer treatment [36].
Cancer treatment is facing serious challenges in Nigeria. The
treatment facilities are inadequate or unavailable, especially
radiotherapy machines. Most of the few ones in Nigeria are in bad
conditions without hope of repairing them. This has contributed
to high cancer deaths recorded in Nigeria. Therefore, the
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government of Nigeria need to show more commitment towards
needs urgent improved funding and research from government
and other stakeholders.
CONCLUSION
The prevalence of symptoms of cancer and cancer treatment
available in Nigeria are hospital based; it is obvious that cancer
incidence and deaths in Nigeria are increasing from year to year.
curable if detected early. Despite these, Nigeria government
is putting very little effort towards cancer diagnosis and
management. This review was conducted in order to call the
attention of the government and research based organizations to
use the trend of cancer in Nigeria for setting priorities in cancer
control programs. It is obvious that the implementation of the
National Cancer Registry could facilitate the study of the evolution
of the tendency of cancer by age group in the future, to achieve
an appropriate screening system and provide training to people
community. Also, as novel cytotoxic, radiation, immunotherapy,
and combination therapies evolve, there is a continued need
for research evaluating strategies for preventing or mitigating
current treatment regimens needs further validation in well-
treatment regimens. Future studies using personalized medicine
valuable.
RECOMMENDATIONS
Many suggestions and recommendations have been put
forward by different authors on how to reduce the incidence and
death rates. Some of these are below:
1. There is need to develop national screening program for
2. There is need for regular nationwide surveys [37].
3. There is need to intensify effort on creating public
awareness on the importance of lifestyle and dietary
4. Current cancer registries in Nigeria need to be re-
structured in order to meet the challenges of burden
posed by cancer in Nigeria [37].
5. Proper implementation of programs like tobacco control,
vaccination of liver and cervical cancers and others will
go a long way to reduce the incidence of cancer in Nigeria
[6].
6. Early detection and treatment, as well as public health
campaigns promoting physical activity and healthier
With the increasing incidence, the clinical management of
cancer continues to be a challenge for the 21st century. Remarkable
progress should be made towards the understanding of proposed
hallmarks of cancer development and treatment in Nigeria.
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