Incidence patterns and temporal trends of breast, prostate, oesophageal and cervical cancer in rural Eastern Cape Province, South Africa 1998–2021

BACKGROUND: In South Africa, prostate, breast, and cervical cancers are prioritised under the National Cancer Strategic Framework (2017-2022), while oesophageal cancer remains a major public health concern in the Eastern Cape Province. This study describes the incidence patterns and temporal trends of breast, cervical, prostate, and oesophageal cancers in the Eastern Cape from 1998 to 2021. METHODS: Cancer incidence data were obtained from the Eastern Cape Population-Based Cancer Registry for 1998-2021. Population denominators were derived from the 2001 and 2011 national censuses, with intercensal and postcensal estimates used to generate annual age- and sex-specific populations. Age-standardised incidence rates were calculated using direct standardisation to the World Standard Population. Temporal trends were analysed using Joinpoint regression models. RESULTS: A total of 10 240 cancer cases were recorded, with a median age at diagnosis of 61.6 years (IQR: 50.7-71.0). Of the 10 240, oesophageal cancer accounted for 40.1% (4 108), followed by cervical cancer 36.4% (3 732), breast cancer 13.0% (1 327), and prostate cancer 10.5% (1 073). Incidence rates increased significantly for prostate cancer 9.6% (95% CI: 6.9%-12.4%), breast cancer 4.1% (95% CI: 2.4%-5.4%), and cervical cancer 3.8% (95% CI: 1.7%-5.8%). In contrast, oesophageal cancer incidence declined significantly in both sexes -3.0% (95% CI: -4.4% to -3.1%). CONCLUSIONS: Prostate, breast, and cervical cancer incidence has increased substantially in the Eastern Cape over the past two decades, while oesophageal cancer incidence decreased significantly. Strengthened cancer surveillance and targeted control strategies are needed in this predominantly rural setting.