

National Health Insurance Cancer in South Africa Download full PDF Document The purpose of this series of policy briefs on National Health Insurance (NHI) and the related IMSA web-site is to put in the public domain material and evidence that will progress the technical work of developing a National Health Insurance system in South Africa. This includes tools for costing NHI and evidence on where savings could be achieved in moving to a future mandatory system with universal coverage. Policy Brief 3 dealt with the impact on a future NHI of the 25 chronic diseases that make up the Chronic Disease List in medical schemes, including asthma, diabetes mellitus, hypertension and hyperlipidaemia. Policy Brief 4 dealt with the how to determine the impact of HIV/AIDS and related diseases like tuberculosis. This Policy Brief discusses what is known about cancer in South Africa and how estimates of the future burden of cancer might be made. Resources that could be adapted for planning a comprehensive cancer service for the National Health Insurance system are described. Cancer in South Africa The Cancer Association of South Africa (CANSA) says: “One in six South African men and one in seven South African women will get cancer during their lives. Cancer is a great equalizer. It knows no boundaries of class, race and gender, sex or age. It can strike anyone at any time”. The graph below shows the expected incidence of cancers in 2009. Figure 1: Expected Incidence of Cancers in South Africa in 2009 The Cancer Association continues: “And yet, if one takes a look at South African statistics, age, race, gender and socio-economic status play an important part in determining the prevalence of particular cancers”. For example, in order of prevalence in each case: Cancers affecting all South African women: breast cancer, cervical cancer, colorectal cancer, lung cancer and oesophageal cancer; Cancers more prevalent amongst black South African women: cervical cancer, • breast cancer, oesophageal cancer, uterine cancer and lung cancer. Cancers affecting all South African men: prostate cancer, lung cancer, oesophageal cancer, bladder cancer and colorectal cancer. Cancers more prevalent amongst black South African men: oesophageal cancer, lung cancer, liver cancer and cancer of the larynx. The Cancers most prevalent amongst South African children follow a worldwide trend: leukaemia (24%), brain tumours (21%), lymphomas (16%), cancer of the kidney (Wilm’s tumour) (10%) and neuroblastoma. In the South African Health Review 2008, Day and Gray provide some evidence of the different experiences of the provinces by comparing deaths from cancer by cause, as reproduced in the table derived from StatsSA data below. Table 1: Percentage of Cancer Deaths by type of cancer as underlying cause of death, by leading cause, by province 2005 In a chapter on lifestyle-induced cancer in South Africa, the authors found that “population group estimates of the revised SA NBD study indicate that the highest age-standardised cancer death rates are found in the coloured population (212.5/100 000), followed by the white (198.9), African (126.0) and Asian (121.4) groups”. “The Western Cape had the highest cancer death rates followed by Gauteng, the Northern Cape and the Eastern Cape provinces. The lowest rates were found in KwaZulu-Natal (KZN), Limpopo and Mpumalanga. The profile of the type of cancer also differed enormously across the provinces. ... The variations between the provinces may be related to levels of wealth and development, population group differences and demographic features of the province, geographical differences and environmental exposures, as well as access to health services or other basic services.” The prevalence of cancer in South Africa is additionally burdened by “the huge load of AIDS-related Kaposi’s sarcoma” (KS). “Before the onset of HIV/AIDS, KS was endemic in parts of sub-Saharan Africa, such as Uganda and the Democratic Republic of Congo, comprising about 9% of cancers in males. KS occurred to a lesser extent in South Africa and was very rare in other parts of the world. With the HIV/AIDS epidemic, KS has become the leading cancer in African countries with high HIV prevalence. Endemic KS affects predominantly the skin of the lower limbs and is primarily a disease of the elderly. In the epidemic form of KS, the lesions are usually multiple and may affect any area of the skin as well as internal organs, with incidence peaks also in the younger, sexually active age groups.” The differences in HIV prevalence and the staging of HIV infection by province were dealt with in an earlier policy brief5. << Back to NHI Project List	Contact Details: Innovative Medicines SA Val Beaumont P.O. Box 2008 Houghton, 2041 Tel: +27 11 880-4644 Fax: +27 11 880-5987 Contact Us! IMSA: Published Profile of Member Companies and Position Statements Deloitte Final Report: Feb 2010

National Health Insurance
Cancer in South Africa

The purpose of this series of policy briefs on National Health Insurance (NHI) and the related IMSA web-site is to put in the public domain material and evidence that will progress the technical work of developing a National Health Insurance system in South Africa. This includes tools for costing NHI and evidence on where savings could be achieved in moving to a future mandatory system with universal coverage.

Policy Brief 3 dealt with the impact on a future NHI of the 25 chronic diseases that make up the Chronic Disease List in medical schemes, including asthma, diabetes mellitus, hypertension and hyperlipidaemia. Policy Brief 4 dealt with the how to determine the impact of HIV/AIDS and related diseases like tuberculosis. This Policy Brief discusses what is known about cancer in South Africa and how estimates of the future burden of cancer might be made. Resources that could be adapted for planning a comprehensive cancer service for the National Health Insurance system are described.

Cancer in South Africa

The Cancer Association of South Africa (CANSA) says: “One in six South African men and one in seven South African women will get cancer during their lives. Cancer is a great equalizer. It knows no boundaries of class, race and gender, sex or age. It can strike anyone at any time”. The graph below shows the expected incidence of cancers in 2009.

Figure 1: Expected Incidence of Cancers in South Africa in 2009

The Cancer Association continues: “And yet, if one takes a look at South African statistics, age, race, gender and socio-economic status play an important part in determining the prevalence of particular cancers”. For example, in order of prevalence in each case:

Cancers affecting all South African women: breast cancer, cervical cancer, colorectal cancer, lung cancer and oesophageal cancer;
Cancers more prevalent amongst black South African women: cervical cancer, • breast cancer, oesophageal cancer, uterine cancer and lung cancer.
Cancers affecting all South African men: prostate cancer, lung cancer, oesophageal cancer, bladder cancer and colorectal cancer.
Cancers more prevalent amongst black South African men: oesophageal cancer, lung cancer, liver cancer and cancer of the larynx.
The Cancers most prevalent amongst South African children follow a worldwide trend: leukaemia (24%), brain tumours (21%), lymphomas (16%), cancer of the kidney (Wilm’s tumour) (10%) and neuroblastoma.

In the South African Health Review 2008, Day and Gray provide some evidence of the different experiences of the provinces by comparing deaths from cancer by cause, as reproduced in the table derived from StatsSA data below.

Table 1: Percentage of deaths by types of cancer Table 1: Percentage of Cancer Deaths by type of cancer as underlying cause of death, by leading cause, by province 2005

In a chapter on lifestyle-induced cancer in South Africa, the authors found that “population group estimates of the revised SA NBD study indicate that the highest age-standardised cancer death rates are found in the coloured population (212.5/100 000), followed by the white (198.9), African (126.0) and Asian (121.4) groups”.

“The Western Cape had the highest cancer death rates followed by Gauteng, the Northern Cape and the Eastern Cape provinces. The lowest rates were found in KwaZulu-Natal (KZN), Limpopo and Mpumalanga. The profile of the type of cancer also differed enormously across the provinces. ... The variations between the provinces may be related to levels of wealth and development, population group differences and demographic features of the province, geographical differences and environmental exposures, as well as access to health services or other basic services.”

The prevalence of cancer in South Africa is additionally burdened by “the huge load of AIDS-related Kaposi’s sarcoma” (KS). “Before the onset of HIV/AIDS, KS was endemic in parts of sub-Saharan Africa, such as Uganda and the Democratic Republic of Congo, comprising about 9% of cancers in males. KS occurred to a lesser extent in South Africa and was very rare in other parts of the world. With the HIV/AIDS epidemic, KS has become the leading cancer in African countries with high HIV prevalence. Endemic KS affects predominantly the skin of the lower limbs and is primarily a disease of the elderly. In the epidemic form of KS, the lesions are usually multiple and may affect any area of the skin as well as internal organs, with incidence peaks also in the younger, sexually active age groups.” The differences in HIV prevalence and the staging of HIV infection by province were dealt with in an earlier policy brief5.

<< Back to NHI Project List

Contact Details:

Innovative Medicines SA
Val Beaumont

P.O. Box 2008
Houghton, 2041

Tel: +27 11 880-4644

Fax: +27 11 880-5987

IMSA: Published Profile of Member Companies and Position Statements

Deloitte Final Report: Feb 2010

National Health InsuranceCancer in South Africa

Contact Details:

National Health Insurance
Cancer in South Africa