Historical Evolution of the Malawi National Cancer Registry: A Collaborative Effort to Develop and Sustain an Impactful Cancer Control Resource in a Low-Income Country

Abstract

Abstract 26 Background: Population-based cancer registration is essential to inform cancer control, yet high-quality cancer registration is absent in much of Africa. We undertook this work to initiate and sustain the Malawi National Cancer Registry (MNCR) to: collect high-quality, population-based cancer data to describe the national burden; inform national cancer control programs and policies; provide a rich national resource for epidemiologic cancer research; and develop collaborations with other partners to increase MNCR impact. Methods: MNCR began in 1989 as a hospital-based pathology registry in Blantyre, Malawi. A population-based component was introduced in 1993 that initially covered the Blantyre district with active case finding. By using this platform, regular national surveys were initiated in 2005 and are carried out every 5 years. Building on this surveillance program, MNCR has pursued collaborations with the Malawi HIV unit to conduct a national HIV-Cancer Match Study to assess the evolving cancer burden in the antiretroviral scale-up era. MNCR has also collaborated with other regional registries through the African Cancer Registry Network. Results: MNCR has published descriptions of the cancer burden in Malawi and is one of few African data sources to contribute to the WHO’s Cancer Incidence in Five Continents. Kaposi sarcoma and cervical cancer are the most common cancers in men and women, respectively. Approximately 93,000 records from MNCR and the two largest HIV cohorts in Malawi have been linked, with preliminary data demonstrating 3,499 cancers among 15,920 antiretroviral initiators in Lilongwe. MNCR has also contributed to regional studies that have described the high incidence and young age for esophageal cancer in Africa. Conclusion: We must continue to improve the quality and coverage of population-based cancer registration throughout Malawi, update the HIV-cancer record linkage at regular intervals, and pursue further opportunities for collaboration. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.