High Incidence of Esophageal Cancer in Women in Eritrea and Its Potential Link to Low Age at Menopause: Evidence from a 10-Year Retrospective Data Analysis.

Background: Detecting a group of esophageal cancer (EC) cases in endemic regions is essential in identifying high-risk populations and executing appropriate interventions. The main aim of this study was to determine the epidemiology of EC in Eritrea. Methods: A retrospective (period: 2011 - 2021) study was carried out by abstracting data on EC patients from the logbook kept at the National Health Laboratory (ENHL). Information on socio-demographic, clinical history, and biopsy analysis findings was collected. For the statistical assessment of data, the End Results (SEER) Joinpoint Regression Program (V.4.5.0.1) was used to calculate crude incidence rate (CIR), age-adjusted incidence rate (ASR), and estimated annual percentage change (EAPC) by sex, age, and histotype. Results: A total of 189 patient's samples (134 (70.9%) females vs. 55 (29.1%) males, ratio 2.43 : 1) were evaluated. Of the 155 patients with EC, 44 (28.4%) and 111 (71.6%) were diagnosed with esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), respectively (AC/ESCC ratio, 0.4). The median age (IQR) of patients with EC was 60 years (46.0 - 70 years) - (males 62 (IQR: 49.0 - 77 years) vs. females 60 (IQR: 46 -67 years), p-value =0.43. Within age bands, the F: M ratios in patients with ESCC were as follows: >20 -29 years =2: 1; 30-39 years =8 : 1; 40 - 49 years =10.5 : 1; 50-59 years =6.67 : 1; 60-69 years =3.25.1; 70-79 years =1.5 : 1 and>80 years =2 : 1. The all-age CIR and ASR for EC were 0.468 per 100 000 and 2.281 per 100 000 persons, respectively. Similarly, the all-age ASR for both males and females was 2.88 per 100 000 and 1.61 per 100 000. Over the study period, the EAPC for all cases was -3.0% (95% CI, -11.3 to 6.1, p-value =0.455). Conclusion: In large part, EC is a women's disease in Eritrea. The unusually high incidence of ESCC and the high female-to-male ratio point at sex-dependent exposures as a major driver of the EAC epidemic in the country. Therefore, research on the risk factors of EC in Eritrea is urgently needed.

Incidence of prostate cancer in Eritrea: Data from the National Health Laboratory, Orotta Referral Hospital and Sembel Hospital 2011-2018.

INTRODUCTION: Up-to-date statistics on prostate cancer incidence and causative risk factors are essential for the primary prevention of this disease. However, the incidence of Prostate cancer (ICD-10 code C61) (PCa), or cancers in general, are poorly documented in Eritrea. This study analyses the data available to produce an estimate of the incidence of PCa in Eritrea. METHODS: We conducted a retrospective study by identifying all incident cases of PCa captured between 2011-2018 in the National Health Laboratory pathology database (Polytech 8.37.C); Urology departments of Orotta Referral Hospital and Sembel Hospital. Crude incidence rates (CIRs), age-adjusted rates per 100,000 person years and associated trends were subsequently calculated. Joinpoint Regression Program, V.4.5.0.1 was employed in these analyses. RESULTS: A total of 1721 cases were reported, of which 1593 (92.5%) were benign prostatic hypertrophy cases and 128 (7.5%) were PCa cases. The mean (±SD) age of the patients with PCa was 73.49 (± 8.9), confidence interval (CI) (54-98) and the minimum and maximum ages were 54 and 98, respectively. The median age interquartile ranges (IQR) was 73 (13) years. The highest and lowest PCa incidence rates were in 2017 (4.51 per 100 000) and 2014 (2.69 per 100 000), respectively. The age standardised rates (ASIR) (World) over the study period (2011-2018) was 30.26 per 100 000. The annualized ASIR values over the study period was 3.78 per 100 000. The associated average annual percentage change (APC) (CI) over the study period was 5.4 (-1.4-12.7), P-value = 0.100, showing a static trend over the study period. CONCLUSION: This study suggests that previous reports have under-estimated the incidence of PCa in Eritrea. The study provides ample evidence on the need for research targeted at uncovering the true burden of PCa in Eritrea. Potential solutions will require the establishment of high-quality population-based cancer registries (PBCRs) and long-term commitment to improvements in research, training, screening, diagnosis, and the overall management of PCa in the country.

Incidence of colorectal cancer in Eritrea: Data from the National Health Laboratory, 2011-2017.

INTRODUCTION: Recent studies have reported a significant increase in the prevalence of colorectal cancer (CRC) in Sub-Saharan Africa (SSA). Further, several studies employing disparate modelling algorithms have projected a significant rise in the frequency of CRC cases in the region. However, lack of good quality data on multiple themes related to CRC including incidence, among others, continues to be a problem in the region. Therefore, this study was designed to collect data on the incidence of CRC in Eritrea. METHODS: We conducted a retrospective analysis using data captured between 2011 and 2017 at the National Health Laboratory (NHL) in Asmara, Eritrea. RESULTS: 241 colorectal cases were identified in the Eritrean National Health Laboratory (NHL) database between 2011 and 2017. In the final analysis we included 94 patients confirmed cases giving an average of 18.8 patients per annum. The average age ± Standard deviation (SD) was 57.62 ± 17.14 with a male: female ratio of 58/36 (1: 1.61). The minimum and maximum age of the patients was 19 and 90 years, respectively. The rectum to colon ratio was 47/47 (1:1). The proportion of patients < 50 years in this cohort was significant. The age-standardized incidence rate (ASIR) in the study period was between 0.97 per 100 000 to 2.21 per 100 000. Similarly, the cumulative ASIR was 9.97 per 100 000. Analysis of trends did not reveal shifts over the study period (P<0.05). However, a strong correlation between incidence and age was established. CONCLUSION: This study suggests that the incidence of CRC in Eritrea is relatively low. A significant number of patients were less than 50 years of age. Even then it's our opinion that this study may underestimate the incidence of CRC.