The incidence of prostate cancer in Africa

Our knowledge about the true incidence of prostate cancer in Africa is still extremely limited. But we know that the risk for prostate cancer among men of African ancestry in the Caribbean and in the Americas is much higher that that of men of European ancestry.

It must also be recognized that, in most of Africa, the vast majority of prostate cancer patents still get diagnosed with advanced forms of prostate cancer because PSA testing is not even available (let alone widespread) and health services generally do not approach the quality of the health services available even in very rural parts of America (or Australia).

And then there is the issue of male life expectancy in most African nations. Again, this does not approach male life expectancy in the average “Western” nation — for all sorts of reasons.

So it is important to see a new paper by Adeloye et al. within that context.

Adeloye and his colleagues have attempted to provide us with a current estimate of the incidence of prostate cancer across all of Africa. The results they come up with are:

  • A pooled incidence rate of 22.0 per 100,000 population
  • A median incidence rate of 19.5 per 100,000 population
  • An increasing trend in prostate cancer incidence with advancing age (over the main years covered by their study)

To place those data in context, it is important to give that context, so here are some of the other currently available data:

  • The current, estimated incidence of prostate cancer in some specific nations is as follows:
    • Here in the USA: 129 per 100,000 population [as of 2012]
    • In Australia: 167 per 100,000 population [as of 2011]
    • In South Africa: 19 per 100,000 [as of 2010]
    • In Egypt: 8.5 per 100,000 [date of data estimate unknown]
    • In Uganda and Zimbabwe: 38 per 100,000 [date of data estimate unknown]

Even to a non-statistician and a non-epidemiologist, it has to be clear that widespread access to PSA testing profoundly impacts the reported incidence of prostate cancer in these nations.

This is only confirmed when you look at the data in Table 2 of the paper by Adeloye et al. Within different parts of Nigeria alone, over the past 20 or so years, incidence rates for prostate cancer have been reported that vary from 0.38 per 100,000 up to > 150 per 100,000.

Given that the highest known incidence rates for prostate cancer in the world come from among African Americans and the islands of Trinidad and Tobago in the Caribbean, based on widespread use of the PSA test, it seems unlikely to The “New” Prostate Cancer InfoLink that the real incidence of prostate cancer in Africa (and most certainly in sub-Saharan Africa) is anything like as low as 22 per 100,000. What is much more likely is that this is an incidence rate for clinically evident prostate cancer among selected populations that have access to hospital care. But this is not in any way intended as a criticism of the paper by Adeloye et al., who seem to have done the very best they could with very limited data to give us an up to date assessment of the risk for prostate cancer across the whole of Africa.

On the other hand, if your sitemaster was a man of black African ethnicity living in somewhere like Lagos, Nigeria, or Johannesburg, South Africa — and he had the resources to do this — he would get a first PSA test at age 40 and then subsequent tests at least every 5 years (with frequency of those tests based on the baseline result at age 40). Your sitemaster suspects that the actual risk for prostate cancer among black African males who reach the age of 50 is a great deal higher than we yet understand. Whether all those cancers need treatment, of course, is a whole other question.

2 Responses

  1. There was an interesting hypothesis put forth that only African-Americans/Caribbeans but NOT Africans have higher prostate cancer incidence and virulence because of the unnatural selection that took place on the slave ships. I suppose a comparative genotyping of the cancers of the two populations could help decide the issue. Here’s the article.

  2. Comparative genotyping has been going on. I have seen no suggestion of anything like this by the people who have been specializing in this area of research.

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