‘Every South African is affected by this disease, we need to find solutions together and ensure that those facing this disease are afforded their constitutional- and human rights,’ says Lauren Pretorius from the cancer advocacy group Campaign for Cancer. ‘It is only by every person, organisation, and government, individually and together doing their part, that we will be able to reduce South Africa’s cancer burden.’
Cancer is a common health problem around the world and kills more people than Aids, tuberculosis and malaria combined. In South Africa one in six men will develop some type of cancer, while one in every eight women will be affected in her lifetime.
Cancer is not a death sentence and when it’s caught early and treated effectively, many patients go on to live long, healthy lives. However, not many people are aware of the risks and early symptoms of cancer, causing it to be diagnosed at a more progressed stage making it difficult to treat effectively.
‘Creating awareness about cancer symptoms and treatment options should take priority in cancer campaigns, because catching the disease early can make all the difference as far as survival goes,’ reads a Campaign for Cancer statement.
The disease is not the only problem cancer patients have to deal with and they also face challenges such as a lack of access to screening services, the social stigma attached to the disease, misconceptions about how cancer only affects certain communities, the ‘death sentence’ perception, and also the financial burden that cancer treatment can have for patients and their families.
Pretorius explained that for patients in the private health sector, cancer treatment can be financially devastating if a person’s medical scheme benefits don’t cover the necessary treatment. While in the public health sector, patients often wait long periods for treatment or have to travel vast distances to access healthcare services. And ‘time is deadly in the case of cancer,’ she warned.
To help South Africans understand their risk for developing cancer and to help them identify the early stages of the disease, Health-e has put together basic information on some of the most common cancers affecting men and women in South Africa. While skin cancer is common in both men and women, prostate-, lung- and oesophagus cancer affect many men South Africa, while breast-, cervical- and endometrial cancer is most common in women.
It is important to note that having the symptoms explained in this article does not mean a person has cancer, and may be attributed to a number of other conditions. It is, therefore, important to consult a medical professional for an accurate diagnosis.
Common cancer among men and women in South Africa
Skin cancer is very common among South African men and women. There are several types of skin cancer depending on where on the skin surface it occurs. Basil Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) are the most common types of skin cancers, while melanoma is less common, but more dangerous.
South Africa has the highest rate of skin cancer in the world after Australia, and is common in both men and women. Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems.
What are the risk factors?
Factors that may increase your risk of skin cancer include:
- Fair skin: Anyone of any skin colour can get skin cancer. However, having less pigment (melanin) in your skin provides less protection from damaging UV radiation. If you have blond or red hair and light-colored eyes, and you freckle or sunburn easily, you’re much more likely to develop skin cancer than is a person with darker skin.
- A history of sunburns: Every time you get sunburned, you damage your skin cells and increase your risk of developing skin cancer. Having multiple blistering sunburns as a child or teenager increases your risk of developing skin cancer as an adult. Sunburns in adulthood also are a risk factor.
- Excessive sun exposure: Anyone who spends considerable time in the sun may develop skin cancer, especially if the skin isn’t protected by sunscreen or clothing. Tanning, including exposure to tanning lamps and beds, also puts you at risk.
- Moles: People who have many moles or abnormal moles are at increased risk of skin cancer. These abnormal moles ‘ which look irregular and are generally larger than normal moles ‘ are more likely than others to become cancerous.
- A family history of skin cancer: If one of your parents or a sibling has had skin cancer, you may have an increased risk of the disease.
- A weakened immune system: People with weakened immune systems have a greater risk of developing skin cancer. This includes people living with HIV/Aids or leukemia and those taking immunosuppressant drugs after an organ transplant.
The warning signs of skin cancer
Warning signs for the various types of skin cancer differ:
- Basal cell carcinoma usually occurs in sun-exposed areas of your body, such as your face, ears or scalp. Basal cell carcinoma may appear as a pearly or waxy bump, or a flat, flesh-colored or brown scar-like lesion.
- Squamous cell carcinoma also occurs on sun-exposed areas of your body, and may appear as A firm, red nodule, or a flat lesion with a scaly, crusted surface.
- Melanoma can develop anywhere on the body, in otherwise normal skin or in an existing mole that becomes cancerous and can occur on skin that hasn’t been exposed to the sun. Melanoma signs include:
- A large brownish spot with darker speckles
- A mole that changes in color, size or feel or that bleeds
- A small lesion with an irregular border and portions that appear red, white, blue or blue-black
- Dark lesions on your palms, soles, fingertips or toes, or on mucous membranes lining your mouth, nose, vagina or anus.
Most common cancers among South African men
South African males have a one in six lifetime risk of getting cancer. The three most common cancers affecting men in the country are prostate cancer, affecting one in every 23 males, lung caner, one in 69 males, and cancer of the oesophagus, which occurs in one in every 82 men.
Prostate cancer is not only common among South African males, but is one of the leading cancers in men worldwide. It is most prevalent among white South African males, but recent statistics showed that it is also increasing among black males who often develop an aggressive type of the disease.
Prostate cancer is caused by changes in the DNA of a normal prostate cell.
What are the risk factors?
Soe of the main risk factors for prostate cancer are:
Age: Prostate cancer occurs more frequently in older men, and most men diagnosed are over 65 years of age. The disease is rare in men under 45.
Family history: There is often a history of a brother or father who had prostate cancer, and studies suggest the existence of a gene that raises one’s susceptibility to the disease.
Lifestyle: As with many cancers, diet and certain lifestyle factors have been linked to a higher risk of developing prostate cancer. Factors include a high fat intake, high red meat intake, low consumption of vegetables, obesity, lack of physical activity, and smoking. High alcohol intake (more than two alcoholic drinks per day) also raises a man’s risk for prostate cancer.
Race: Although prostate cancer occurs across all cultures, is more common among certain races. The lifetime risk of developing prostate cancer in the South African male population is as follows: Black males are least susceptible with a one in 49 chance; one in 45 Asian males will develop prostate cancer in their lifetime; the risk drastically increases for coloured males who have a one in 17 chance; and white males are at highest risk at one in 11.
A risk factor affects a person’s chance of getting a particular disease. Having a risk factor, or even several risk factors, does not mean that a person will get the disease, and nor does having no risk factors exclude a person from developing the disease.
Warning signs of prostate cancer
Warning signs of prostate cancer include:
- Difficulty or inability to pass urine
- A slow stream of urine, often with dribbling at the end
- Inability to start or stop the flow of urine
- Frequent need to pass urine, especially at night
- Swelling in legs
- Discomfort in pelvic area
- Lower back pain
- Blood in the urine or semen
- Painful ejaculation
- Erectile dysfunction
Lung cancer is the most common cancer worldwide, and the second most common cancer among South African men’although it kills more of its patients that the number one ranked prostate cancer.
What are the risk factors?
The main cause of lung cancer is tobacco smoke, and in South Africa it is estimated that about 60% of lung-cancer deaths are caused by smoking. Experts reckon that as many 8% of all deaths in South Africa can be ascribed to tobacco smoke.
Other known causes of lung cancer include breathing in second-hand tobacco smoke, and domestic and industrial pollution.
Warning signs of lung cancer
The warning signs of lung cancer include:
- Chronic cough
- Coughing up blood-stained sputum
- A dull ache or sharp pain when coughing or taking a deep breath
- Loss of appetite and weight loss
The oesophagus, also known as the gullet, is the long muscular tube that connects the throat and the stomach. In South Africa, men are twice as likely to develop cancer of the oesophagus than women. It is the third most common cancer among men in the country and one in 73 men will be diagnosed with it in their lifetime.
What are the risk factors?
Oesophageal cancer occurs mostly in older people, and although the exact causes are unknown, smoking, excessive drinking (and particularly a combination of the two), and a poor diet are important factors. The risk for developing oesophageal caner is also greater in people who eat maize meal contaminated with fungal toxins, and regular infection with Candida Albicans (a fungus that causes diseases in the digestive system).
Warning signs of oesophageal cancer
The warning signs of oesophageal cancer include:
- Progressive difficulty in swallowing (dysphagia)
- Persistent heartburn
- Indigestion or regurgitation
- Unexplained weight loss
- Physical tiredness and weakness
Most common cancers among South African women
South African women have a one in eight lifetime risk of getting cancer. The three most common cancers affecting women in the country are breast cancer, affecting one in every 29 women, cervical caner, one in 35 women, and endometrial cancer, which occurs in one in every 144 women.
Breast cancer is not only the most common cancer among South African women, but is widespread among women worldwide. Although rife, women with breast cancer have an excellent chance of recover if it is detected early’that’s why every woman should examine her breasts and underarms regularly to check for any changes.
What are the risk factors?
The causes of breast cancer are not yet fully known, although a number of risk factors have been identified. These include:
Age: A woman’s chance of developing breast cancer increases as she gets older, and most advanced breast cancers are found in women over the age of 50.
Family history: There is a higher risk for breast cancer if there is a history of a close relative who has had breast, endometrial, ovarian, or colon cancer. About 20% to 30% of women with breast cancer have a family history of the disease which indicates to a genetic predisposition to breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. Women with one of the defects have up to an 80% chance of getting breast cancer sometime during her life.
Menstrual cycle: Women who started menstruating before age 12, or who went through menopause late (after age 55) have an increased risk for breast cancer.
Alcohol use: Drinking more than one alcoholic drink per day increases a woman’s risk for breast cancer.
Childbirth: Women who have never given birth, or who only gave birth after the age of 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces the risk of breast cancer.
Hormone replacement therapy: There is a higher risk of breast cancer in women who have received hormone replacement therapy with oestrogen for several years.
Obesity: Obesity has been linked to breast cancer. It is believed that obese women produce more oestrogen, which can fuel the development of breast cancer.
Lack of exercise: Studies have shown that exercise reduces the risk for breast cancer, and it is suggests that women exercise 45 to 60 minutes, five days a week.
Dense breast tissue: Women with denser breast tissue have a higher risk of breast cancer as there is more gland tissue and less fatty tissue. Dense tissue can also make it harder for doctors to spot problems on mammograms.
Race: Caucasian (white) women are more likely to develop breast cancer than women from other races.
Warning signs of breast cance
Breast cancer may cause any of the following signs and symptoms:
- General pain in or on any part of the breast
- Irritated or itchy breasts
- Presence of a lump in or near the breast or in the under-arm area
- Thickening in or near the breast or in the under-arm area
- A change in the size or shape of the breast
- A dimple or puckering in the skin of the breast
- A nipple turned inward into the breast
- Fluid, other than breast milk, coming from the nipple, especially if it is bloody
- Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin that is around the nipple)
- A change in breast colour
- Changes in the appearance of one or both nipples
- Dimples in the breast that look like orange peel
- Skin changes, such as swelling, redness, or other visible differences in one or both breasts
CANCER OF THE CERVIX
The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a foetus grows). The cervix leads from the uterus to the vagina (birth canal). Worldwide, cervical cancer is the third most common type of cancer in women, but in South Africa it is the second most common and one in every 35 women in the country will develop it in her lifetime. The high burden of HIV/Aids in South Africa also aggravates the prevalence of cervical cancer as it lowers women’s resistance to the human papillomavirus (HPV) which causes most cervical cancer cases.
Cervical cancer tends to appear during midlife. Over half of the women diagnosed are between the ages of 35 and 55.
What are the risk factors?
Most cervical cancers are caused by certain strains of HPV’a common virus that is spread through sexual intercourse. Several risk factors have been linked to the development of cervical cancer, these include:
- Having sex at an early age
- Having many sexual partners
- Having first sexual intercourse at a young age
- Smoking tobacco
- Using oral contraceptives
- Having a weakened immune system
- Not being able to afford regular Pap smears or have limited access to screening services through which cervical cancer is diagnosed
- Sexual partners who have multiple partners or who participate in high-risk sexual activity
Warning signs of cervical cancer
The warning signs of cervical cancer may include:
- Abnormal vaginal bleeding between periods, after intercourse, or after menopause
- Any bleeding after menopause
- Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody or foul-smelling
- Periods becoming heavier and last longer than usual
Endometrial cancer, also known as uterine cancer, is the third most common cancer among women in South Africa and one in every 144 women will be diagnosed with it in her lifetime.
The exact cause of endometrial cancer is unknown, however, increased levels of the female hormone oestrogen appear to play a role. Oestrogen helps stimulate the build-up of the lining of the uterus. Studies have shown that high levels of oestrogen in animals result in excessive endometrial growth and cancer.
Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.
What are the risk factors for endometrial cancer?
The following increase your risk of endometrial cancer:
- Oestrogen replacement therapy without the use of progesterone
- History of endometrial polyps or other benign growths of the uterine lining
- Infertility (inability to become pregnant)
- Infrequent periods
- Tamoxifen, a drug for breast cancer treatment
- Never being pregnant
- Polycystic ovarian syndrome (PCOS)
- Starting menstruation at an early age (before age 12)
- Starting menopause after age 50
Warning signs of uterine cancer
The symptoms of uterine cancer include:
- Bleeding between normal periods before menopause
- Vaginal bleeding or spotting after menopause
- Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
- Lower abdominal pain or pelvic cramping
- Thin white or clear vaginal discharge after menopause
Sources: CANSA, American Cancer Association, 2000-2001 NCR Report, National Cancer Institute, Men’s Health 4-men, PubMed Health, Mayo Clinic, Cancer Treatment Centers of America MedlinePlus Medical Encyclopedia, CervicalCancer.org