Perspectives Associated with an Increase in the Incidence of Colorectal Adenocarcinoma in Uganda: An Advanced Study

This paper is a current review of work done on colorectal adenocarcinoma in Uganda highlighting the perspectives associated with the increased rate of cases observed in our hospitals. Differences in tumor location compared to the Western world and the challenges encountered in obtaining an early diagnosis of CRC in Ugandan patients are also highlighted in this work. A steady increase of CRC in other Sub-Saharan African countries is also currently being documented however this is associated with a higher CRC-associated morbidity and mortality. Reasons behind this increase may be the nutrition transition in Sub-Saharan Africa characterized by decreased consumption of dietary fibre, starch and plant proteins to a Western diet associated with consumption of fatty foods and red meat. The emergence of noncommunicable diseases such as diabetes and obesity coupled with increased alcohol consumption and smoking confers a higher risk to CRC. A shift in the demographics is observed in Uganda compared to high income countries with 22.8% of our CRC cases being diagnosed at <40years of age compared to 3-7% in high income countries. A challenge experienced with this early age onset is that it is associated with an aggressive biological behavior with a poor prognosis. The high proportion of left sided colon and rectal adenocarcinoma in Uganda makes our population more amenable to screening. However challenges experienced in Uganda and other Sub-Saharan African countries include the availability of endoscopic training and equipment, costs, availability of pathologic services and patient acceptance. The increased diagnosis of CRC cases that will result from screening will eventually require a parallel increase in surgical and oncological infrastructure to manage CRC patients. An improvement in diagnosing, screening and treating CRC by increasing surgical and endoscopic capacity with the aid of international medical and surgical societies should be a public health priority in Uganda given the observed epidemiological shifts. Future implementation of National screening programmes to detect CRC at an early stage is also necessary to reduce the mortality in the Ugandan population.