NATIONAL POPULATION BASED- CANCER REGISTRY- Dr. G.Z. Mutuma Principal Research Officer, Head, Non-Communicable Diseases Research Programme, Kenya Medical Research Institute, Nairobi, Kenya.

Pathology & Oncology Research Unit (PORU) Non-Communicable Diseases Research Programme. (NCD) 1. Registries Cancer registry - Since 2001 Other NCD registries -Not yet 2. NCD Research- Cancer research Cervix, Burkitt’s Lymphoma, Oesophagus, Liver, NSC, Breast. 3. DIAGNOSTIC- Histology, cytology and Immunohistochemistry.

Pathology & Oncology Research Unit (PORU) COLLABORATORS. 1. MOH 2. WHO 3. NCI- US 4. UICC 5. IARC and IACR 6. INCTR 7. OTHER ORGANIZATIONS-

Nairobi Cancer Registry – POPULATION. Population based Cancer registry: An important tool for cancer Research, control, prevention and treatment Nairobi Cancer Registry covers a population of 4 Million. Nairobi city and its Adjacent divisions.

NAIROBI CANCER REGISTRY- MAP.

Nairobi Cancer Registry - Background: Nairobi Cancer Registry is a population- based registry that was established in the year 2001 at the Kenya Medical Research Institute (KEMRI), Nairobi. The initial three years was funded by National Cancer Institute (NCI) of USA

Population-based cancer registry A population-based registry records all new cases in a defined population with emphasis on epidemiological research, and evaluation of health services for prevention, diagnosis and treatment of the disease. In Kenya: Nairobi Cancer Registry – KEMRI Eldoret Cancer Registry - MTRH

The goals of population-based registries. Research Cancer prevention Early detection Determination of cancer rates and trends Patterns of care and outcomes Evaluation of control efforts

Nairobi Cancer Registry. Roles. Provide data on: Statistics – Incidence rates Age Standardized Rates Mortality rates Treatment strategies Public health initiatives

Quality control To assure that every cancer patient has been reported To avoid over-counting and under-counting cases To monitor multiple primaries To document completeness of the registry

What to collect: Eligible cases Newly diagnosed returns Tissue and clinical diagnoses Treated and untreated Current status

Sources of Data. Hospitals – hospital-based cancer registries Cancer centers / Hospices Pathology labs. Imaging centers Physician offices - Private clinics (chemotherapy and radiotherapy Death certificates Public health sources – screening programmes

Hospital sources: In-patient records Out-patient records Histopathology labs Radiology units Hematology labs Private physicians attached to the hospital Surgery Autopsy reports

Pathology department Tissue – histology Biopsies, excisions Cells – cytology Pap smears, ascites, pleural fluid, sputum Bone marrow – hematology Autopsy

Medical records department Admission form/Patient registration form Discharge summaries Disease index cards – ICD books Reports Pathology Imaging Operations Consultation Treatments – Chemotherapy, Radiotherapy – patient appointment schedules

NCR relation with IACR & IARC IARC supported the registry trough training of registrars both locally and abroad. (4 cancer registrars have been trained in Lyon and South-Africa) One fellowship offered to the supervisor through IACR to train in Thames Cancer Registry, UK Registrars have benefited through Annual conferences by presenting abstracts on various topics.

Most Common Cancers as Registered by Nairobi Cancer Registry - KEMRI

In the Nairobi population the 16 most common cancer sites among males are prostate, oesophagus, stomach, liver, larynx, pancreas, trachea, bronchus and lung, rectum, mouth, colon, Non- Hodgkin lymphoma, Multiple Myeloma, Brain, nervous, nasopharynx, bladder and bone. They account for 69.1% of incident male cancer cases.

In the Nairobi population the 20 most common cancer sites among females are Breast, Cervix, Uteri, Stomach, Oesophagus, Colon, Ovary, Liver, Corpus Uteri, Bone, Trachea, Bronchus, Lung, Pancreas, Uterus unspecified, Multiple Myeloma, Rectum, Non-Hodgkin lymphoma, Mouth, Nasopharynx, Larynx, Brain, Nervous system and Bladder. They account for 78.1% of incident females cancer cases.

POINTS TO NOTE 1. Lung cancer becoming more common. 2. Stomach cancer the 3 rd common in adults

LUNG CANCER ? MORE COMMON Nairobi Cancer Registry – KEMRI- Lung Cancer is not among the top ten cancers in Kenya

Lung cancer in Europe Lung cancer is the most common cancer in Europe and other developed countries and Oesophagus is the least common yet the most frequent cancer in Kenya

Childhood cancers as reported to Nairobi Cancer Registry

Future Plans: Establishment of a National Cancer Registry; The government is interested in the National statistics to show burden of cancer in the whole country With some support Nairobi Cancer Registry is well place to set up a National Cancer Registry. i.e. we have trained personnel, equipment and established good relation with hospitals. Initial coordination funding from WHO 2007

ON-GOING REGIONAL REGISTRIES : 1. RIFT VALLEY- ALREADY GOING ON (MRTH) 2. WESTERN KENYA- KISUMU- Kisumu cancer registry has so far been set up and there is ongoing case abstraction and registration 3. CENTRAL REGION – NYERI COUNTY 4. COASTAL REGION- MOMBASA

Future Plans: 1. COASTAL REGION- MOMBASA COUNTY 2. EASTERN – EMBU COUNTY MACHAKOS COUNTY 3. RIFT VALLEY NAKURU – COUNTY BOMET COUNTY

Eradication of NCDs

Healthy living = Healthy eating

Cancer Registrars’ Training: August 2011, KEMRI

Thank you for your attention!