The National Cancer Registry (NCR), which was first established in 1986, plays a vital role in maintaining and developing national and international awareness of the enormous and growing problem of cancer in the South African population. Cancer is one of the major killers throughout both the developed and developing world, including South Africa. Government bodies including the Departments of Health, Home Affairs and Finance need to know how many people develop and die from cancer, while this information is also critical to the financial planning of many private sector bodies including medical aids, life insurance companies, pharmaceutical companies, private hospital groups and financial institutions. Although the NCR is a pathology-based registry, resulting in under-reporting of many malignancies, some more than others, many critical decisions need to be made based on its data. A planned population-based registry will be even more vital, especially when decisions relating to screening, prevention, as well as cancer treatments are made.

Bronchogenic carcinoma

The latest 2000-2001 NCR Report shows that males have a lifetime risk of 1 in 6 of getting cancer, as opposed to 1 in 4 in the previous report, with cancers of the prostate (1 in 23), lung (1 in 69), oesophagus (1 in 82), colon/rectum (1 in 97) and bladder (1 in 108) predominating. Prostate cancer therefore remains the most common major cancer in men, with lung, oesophagus and colorectal cancer following closely behind. In women the lifetime risk of getting cancer is now 1 in 8, as opposed to 1 in 6 in the previous report, with cancer of the breast (1 in 29) and cancer of the uterine cervix (1 in 35) predominating. Uterine, colorectal and oesophageal cancer follow, as was the case in 1998-1999.

Lung cancer remains a growing health problem in both sexes. Although males far exceed females, the long term effects of smoking will result in an increasing incidence of lung cancer in females for many years to come. It will be decades before recent anti-smoking drives and legislation reduce these figures.

The reporting of many cancers is suboptimal due to a lack of tissue diagnoses. An important example is hepatocellular carcinoma which is grossly under-reported, as it is usually diagnosed clinically and by a blood test, without a tissue diagnosis, but this still remains in the top 15 cancers. Over 700,000 new cases per year are diagnosed throughout the world, especially in southern Africa and the Far East, which are endemic areas for the hepatitis B virus, the major causative agent of this disease. A future population-based registry as well as better cancer diagnoses, especially in rural areas, will give a more accurate picture of this usually fatal malignancy, as well as many other pathologically under-diagnosed cancers.

The NCR primarily relies on funding support from the National Health Laboratory Service and the Department of Health.