The Gambia National Cancer Registry (GNCR) was established in 1986 to record data on the pattern of cancer occurrence in The Gambia. It is remarkable amongst cancer registries in Africa in achieving a broad coverage, including a substantial proportion of the rural population.
The registry was actually established to monitor the outcome of the Gambia Hepatitis Intervention Study, which has provided for its funding over the years.
The high coverage and quality of the data from the GNCR also permitted one of the rare studies of cancer survival in an African population, showing just how poor the outcomes were compared to high-resource countries.
Bojang Lamin (data manager)
Medical Research Council, The Gambia Unit
Atlantic Road, Fajara PO Box 273
National Cancer Registry
Office: +220 4495 442 dial extension 5004
The Registry Director provides overall supervision of the unit, but the work of registration is all carried out by tumour registration officer’s base at the hospitals. Data collected at various hospitals is sent to the head office for entry.
Left to right: Forster-Nyarko Mavis, Director Lamin M. Giana, Tumour Registration Officer (TRO) Mamina Bojang, Data Entry Clerk maritou Rahman, TRO Ebrima Bojang, Driver Shaihou Tijan Njie, TRO Yusupha Bah and Clinician Dr Gibril Ndow.(Registry Director)
The registry is one of the very few nationwide population cancer registries in Africa. According to the 2010 revision of the World Population Prospects the total population was 1 728 000 in 2010. The proportion of children below the age of 15 in 2010 was 44%, 53.8% was between 15 and 65 years of age, while 2.2% was 65 years or older.
Sources of information for the registry
The main source of the data is from four Government hospitals and ten private hospitals. Each hospital is equipped with a member of GNCR with AFP and HBsAg test materials.
Methods of registration
Case finding is entirely active, by medical students, as part of their course work (preparation of mini-theses). They visit the clinical services expected to generate cancer cases, and collect the information onto a Registration Form (Annex). None of the hospitals have central records departments. Medical records are kept in each service, although these may also have registers of admissions/discharges, with a simple diagnosis for each.
Data quality indices
The proportion of cases with histological confirmation of cancer diagnosis in this series is 25%, varying between 1% for liver cancer and 45% for non-Hodgkin lymphoma. The proportion of cases registered based on a death certificate only is negligible except for lung cancer
Outcome of follow-up
Follow-up has been carried out predominantly by active methods. Cancer mortality information obtained from accessible death certificates in registration office is matched with the registry database. The vital status of the unmatched incident cases is then ascertained by repeated scrutiny of hospital records and house visits.
The closing date of follow-up was 31st December 1999. The median follow-up varied from one month in stomach, liver and lung cancers to 6 months for cervix cancer. Complete follow-up at five years from the incidence date ranged between 81% in cancer of the lung and 98% for liver cancer. The bulk of the losses to follow-up generally occurred in the first year of follow-up.
All ages and both sexes together
The 5-year relative survival was the highest in cancer of the lung (32%) followed by non-Hodgkin lymphoma (25%) and cervix (24%). The lowest survival rate was encountered with liver (3%) cancer and preceded by stomach (5%) cancer in the series.
The 5-year age-standardized relative survival (ASRS) probability for all ages together is either less than or similar to the corresponding unadjusted one for all the cancers except lung. The 5-year ASRS (0–74 years of age) is observed to be greater than or similar to the corresponding ASRS (all ages) for most cancers.
The highest 5-year relative survival was observed in lung cancer (29%). None of the breast cancer cases survived for 5 years from incidence date. The 5-year relative survival was notably higher among males than females in cancer of the stomach.
The 5-year relative survival estimates for breast and cervix cancers were 11% and 24% respectively. None of the stomach cancer cases survived until 5 years from incidence date. Survival from non-Hodgkin lymphoma was noticeably higher among females than males.
The 5-year relative survival by age group was seen to fluctuate, with no definite pattern or trend emerging and no survivors in many age intervals.
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