Cancer Burden in Rwanda: 5 Years Diagnostic Experience at University of Teaching Hospital of Butare, Rwanda

PURPOSE Cancer is recognized as a global problem. Recent reports indicate that 1 in 5 men and 1 in 6 women worldwide will develop cancer in their lifetime. In 2018, 18.1 million new cases were reported worldwide, with many of them occurring in low- and middle-income countries. Approximately 1 million new cases are diagnosed annually in Africa. The University Teaching Hospital of Butare (CHUB) diagnoses many cancer cases annually at Anatomical Pathology Laboratory, but there is no consensus or study as to which types of cancers predominate and how patient care can be enhanced in future. In this study, we studied the status of cancer burden based on types at CHUB, Rwanda. We reviewed the different types of diagnosis made and the associated demographics. METHODS This retrospective study included all anatomical pathology reports seen between 2018-2022 at CHUB. Anatomical pathology reports were examined, and cases were classified based on age, sex, district/location, and diagnosis of malignancy. Cancer types were grouped according to the 10th revision of the International Classification of Diseases. RESULTS A total of 8085 specimens reports were examined. Of the 8085 specimens, 1709 (21%) had diagnosis of malignancy and 6376 specimens had a benign diagnosis. Of the 1709 specimens, 990 were female patients and 717 were male patients. Diagnosis of Carcinoma (1365), sarcoma (109), lymphoma (99), melanoma (59), and non-differentiated (45) was made. In patients less than 15 years old, lymphoma had the highest rate of diagnosis, followed by sarcoma. Of all diagnosed cancers, cervix was most prevalent followed by stomach, prostate, breast, and skin. Cervical carcinoma was most prevalent in females and prostate in males. CONCLUSION Cancer cases and the number of diagnosed specimens increased in 2020. The number of histologically diagnosed cancers is still low considering 4 million people who can access care at CHUB. Gastric cancer is a major concern as it comes second behind cervix by only 5 cases in the last 5 years. Major challenges of further classifications of sarcomas, lymphomas and non-differentiated cancers are due to lack of immunohistochemistry, as well as population sensitization for screening and early diagnosis.