Trop Doct 2008;38:208-210
doi:10.1258/td.2008.070408
© 2008 Royal Society of Medicine Press
Childhood cancer in Sudan: 1999–2007
Dafalla O Abuidris MBBS FC RAD ONC *
Mohamed E Ahmed MBBS MD 
Elgaili M Elgaili MBBS MD 
Ramandeep S Arora DCH MRCPCH 
* Department of Radiation Oncology, Institute of Nuclear Medicine, Molecular Biology and Oncology, University of Gezira, Wad Madani;
Department of Paediatrics;
Department of Pathology, Faculty of Medicine, University of Gezira, Wad Madani M27 4HA, Sudan;
Department of Paediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
Correspondence to: Dr Dafalla O Abuidris, Department of Radiation Oncology, Institute of Nuclear Medicine, Molecular Biology and Oncology, University of Gezira, PO Box 20, Wad Madani M27 4HA, Sudan Email: abuidris{at}yahoo.com
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SUMMARY
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There is paucity of information on childhood cancer from Sudan
with the last studies published more than 20 years ago. This
study aims to provide a current picture of childhood cancer
in Sudan. Data was obtained from the hospital registry for the
period May 1999 to June 2007 on all paediatric patients presenting
to the Institute of Nuclear Medicine and Oncology, University
of Gezira, Wad Madani, Sudan. There were 322 children with cancer
during this time period with a male:female ratio of 1.6:1. Lymphomas
(111, 35%), leukaemia (83, 26%) and Wilms' tumour (43, 13%)
were the three most common groups of tumours. Thirty percent
of all lymphomas were Burkitt's lymphoma; 3.4% of all childhood
cancer cases were nasopharyngeal carcinomas.
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Introduction
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Sudan is the largest country in Africa, in terms of geographical
area, with a population of over 36 million and an average life
expectancy of 57 years for men and 62 years for women.
1 Over
80% of the population live in rural settings or are nomadic,
which presents a great challenge to any disease control.
2 As
there are no population-based tumour registries in Sudan, the
magnitude of cancer as a health problem is not well defined
but an estimate of the age standardized rate for cancer is 84.2/100,000
for females and 101.8/100,000 for males.
3 There is also a paucity
of information on childhood cancer with the last published studies
more than 20 to 30 years old.
4,5
Data from Institute of Nuclear Medicine and Oncology (INMO), University of Gezira, Wad Madani, Sudan, was collected and analysed to provide a current picture of childhood cancer in Sudan. With this information we plan to look at individual cancers in the future, focusing in more detail on their treatment and outcomes.
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Patients and methods
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Data was obtained from the hospital registry for the period
May 1999 to June 2007 on all paediatric patients aged <15
years presenting to INMO. Established in 1999, INMO is the second
largest cancer hospital in Sudan. INMO patients came mainly
from the central and eastern states of Sudan, e.g. Al-Gezira,
Sennar, Al Gadarif, Kassala and Blue Nile. The data collected
was then analysed with the help of Microsoft Excel.
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Results
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From a total of 4145 cancer patients presenting to INMO during
the period May 1999 to June 2007, 322 (7.8%) were less than
15 years of age with a male:female ratio of 1.6:1 (Table
1).
Lymphomas (111, 35%), leukaemias (83, 26%) and Wilms' tumour
(43, 13%) were the three most common groups of tumours found
in this age range. Within lymphomas, 79% were non-Hodgkin's
lymphoma (one-third Burkitt's) and 21% were Hodgkin's lymphoma.
It is also noteworthy that nasopharyngeal tumours accounted
for 3.4% of the total and there were no cases of Kaposi's sarcoma.
Tumours presenting mainly in the 0–4-year age group included
Wilms' tumour, neuroblastoma and retinoblastoma. Hodgkin's disease,
osteosarcoma and nasopharyngeal cancers were more common in
the 10–14-year age group. Lymphoma, leukaemia, rhabdomyosarcoma
and retinoblastoma had a strong male preponderance while gonadal
tumours, neuroblastoma and Hepatic tumours were more common
in females.
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Table 1 Age and sex distribution of childhood cancer in Sudan across main pathological groups and selected subgroups
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Discussion
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There is no true population-based cancer registry in Sudan.
Registration activities in the past have been confined to hospital-based
registries, based on records of patients attending the Radiation
and Isotope Centre Khartoum – the largest cancer hospital
in the Sudan – and the Sudan Cancer Registry based on
histopathologically confirmed cases diagnosed at the National
Health Laboratories in Khartoum.
This data is also based on a hospital registry and is a reflection of the current childhood cancer burden in central and eastern Sudan. Almost 8% of patients presenting to our institute are children. This is in contrast to the USA where childhood cancers are 0.8% of the total.6 Two possible reasons for this difference could be that our data is from hospitals and so is not a true representation of the cancer burden. Moreover, children form a larger part of the population in a developing country where the life expectancy is lower than in the developed world. We found that the three most common cancer groups in our series were lymphomas (111, 35%), leukaemias (83, 26%) and Wilms' tumours (43, 13%). This is similar to that reported from other North African countries such as Morocco.7 However, it is in contrast to the data from the developed world, for example, in the USA6 the three most frequent major childhood cancers diagnosed were leukaemias (30.2%), central nervous system cancers (21.7%) and lymphomas (10.9%; 4.4% specified as Hodgkin's disease and 6.2% as non-Hodgkin's lymphoma).
Some of these findings are also similar to the few studies previously published from Sudan.4,8 The common occurrence of nasopharyngeal cancers has been reported before, as has the rarity of Ewing's sarcoma, neuroblastoma and brain tumours. Nasopharyngeal cancer in the North African population has been shown to have a bimodal distribution with the first peak at 10–20 years and the second at 55–65 years,9 unlike the Chinese where there is a sharp rise from 30 years to a high plateau at 40–45 years and then a decline.10
The median age of our children with nasopharyngeal carcinoma was 12 years. Besides Epstein-Barr virus, exposure to local preserved food products such as harissa, qaddid and touklia has been shown to be statistically significant.11 The presence of carcinogenic nitrosamines/precursors and genotoxic and Epstein-Barr virus-activating substances in these products is implicated.12,13 However, we did not find a high proportion of retinoblastoma or chronic myeloid leukaemia.
In previous studies Burkitt's lymphoma has been reported to be around 18–20% of total lymphomas.8,14 In this study we found Burkitt's lymphoma to constitute 30% of the overall lymphomas. This may be because most of the children came from areas south of latitude 15°N where malaria is more endemic: Sudan extends from 4°N to 22°N.
Our study has identified the main cancers in childhood in a region of Sudan. The aim now is to look at the outcome of these cancers individually as there is little published data on this subject. This will help organize the resources in order to improve the outcome of common cancers like non-Hodgkin lymphoma (including Burkitt's lymphomas), Hodgkin disease and Wilms' tumours which can have a good outcome if adequately treated.
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Acknowledgements
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We are grateful to Professor Tim Eden for his review of the
original report.
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References
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- WHO. World Health Statistics 2007, Geneva: WHO. See http://www.who.int/countries/sdn/en/ (last accessed 31 July 2007)
- Hamad HM. Cancer initiatives in Sudan. Ann Oncol 2006;17:viii32–6[Abstract/Free Full Text]
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- Ho JHC. Nasopharyngeal carcinoma in Hong Kong. In Cancer of the Nasopharynx. UICC Monograph Series, Munksgaard, Copenhagen, 1967:58–63
- Jeannel D, Hubert A, de Vathaire F, et al. Diet, living conditions and nasopharyngeal carcinoma in Tunisia–a case-control study. Int J Cancer 1990;46:421–5[Medline]
- Shao YM, Poirier S, Ohshima H, et al. Epstein–Barr virus activation in Raji cells by extracts of preserved food from high risk areas for nasopharyngeal carcinoma. Carcinogenesis 1988;9:1455–7[Abstract/Free Full Text]
- Poirier S, Bouvier G, Malaveille C, et al. Volatile nitrosamine levels and genotoxicity of food samples from high-risk areas for nasopharyngeal carcinoma before and after nitrosation. Int J Cancer 1989;44:1088–94[Medline]
- Veress B, Malik MO, Satir AA, El Hassan AM. Burkitt's lymphoma in the Sudan. Afr J Med Med Sci 1976;5:115–9[Medline]
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SUMMARY
Introduction
