Abstract
M.A. (Public Health)
Globally, Endometrial Cancer (EC) is the sixth most common female cancer. Traditionally, EC is more common in high-income countries on account of the predominance of risk factors such as obesity and low parity. However, the epidemiological and health transition in South Africa (SA) after the advent of multiracial democracy in 1994 may impact EC trends in the country. We therefore evaluated the trends in EC from 1997 – 2015. Temporal trend analyses of the incidence and mortality of EC was conducted using the South African National Cancer Registry and the Statistics South Africa (Stats SA) data. Average annual percent change (AAPC) of the age standardised incidence rate (ASIR) and age standardised mortality rate (ASMR) rates were calculated using the Join point regression modelling to evaluate the incidence and mortality trends. Spatial distribution of ASMR of EC at province level was mapped using ArcGIS software. An unmatched case control study of the risk factors of EC was conducted using the Stats SA cancer mortality data. Statistically significant level was set at 95% confidence level (P-value: < 0.05). There were 14,238 cases and 3,955 deaths of EC over the study period. Incidence and mortality rates increased at 3.5% (95% Confidence interval (CI): 1.7-5.4, P-value: <0.001) and 3.7% (95% CI: 2.7-4.7, P-value: <0.001) per annum respectively. All nine provinces had increased ASMR with KwaZulu-Natal experiencing the highest AAPC of 8.2% (95% CI: 5.4-11.1, P-value: <0.001). Among the population groups, Blacks experienced the highest increase in ASIR with AAPC of 4.1% (95% CI: 2.0-6.3; Pvalue: <0.001) while the increase in ASMR was highest among Whites16.3% (95% CI: 8.4-24.7; P-value: <0.001). There was higher odds of EC deaths among the postmenopausal age group (adjusted odds ratio {adjOR}: 3.98; 95% CI: 3.14-5.03; Pvalue: <0.001) and lower odds among divorcees (adjOR: 0.73; 95% CI: 0.59-0.89; Pvalue 0.002) and smokers (adjOR: 0.53; 95% CI: 0.43-0.65; P-value: <0.001). In conclusion, there was an upward trend in incidence and mortality of EC in South Africa from 1997 – 2015. This reflects clearly in 8 of the 9 provinces with KZN experiencing the highest mortality. Public health interventions are necessary to reduce the impact of EC in South Africa.