Reducing colorectal cancer mortality in South Africa: experiences and progress from the South African National Cancer Prevention Services

Abstract

Aim The incidence rates of colorectal cancer are rapidly increasing in South Africa. Previous studies have shown that the prevalence of inherited colorectal cancer in South Africa is 3-5 times higher than in high-income countries. Targeted screening and surveillance programmes for individuals with known colorectal cancer-causing mutations have resulted in increased life expectancy. The South African National Cancer Prevention Services (SANCaPS), was established to implement national systems for identifying individuals with inherited cancers, improving their clinical management, and reducing the overall disease burden. Methods Using colorectal cancer as an example, SANCaPS aimed to extend surveillance and management practices from the Western Cape to a national level. The goals included improving the quality of pathology reporting, establishing counselling systems for at-risk individuals, developing cost-effective mutation detection protocols, identifying and counselling at-risk family members, providing mutation testing, organising endoscopic surveillance programmes for high-risk individuals, setting ethical frameworks for research, and extrapolating learnings from the inherited colorectal cancers surveillance programme to other cancers with known hereditary predispositions. Results SANCaPS initiated the standardisation of national pathology reporting for colorectal cancers. Currently, a minimum core pathology dataset collection is being piloted in the National Health Laboratory Service’s TrakCare system. Subsequently, SANCaPS aims for broader adoption through stakeholder engagements. This will help to identify patients with mismatch repair-deficient colorectal cancers, facilitate research, and improve reporting. Conclusions To improve patient outcomes, this consultative process and framework will be replicated to introduce standardised management workflows for other common cancers, including breast, prostate, uterine, and others.