Abstract Cancer incidence and mortality rates in Africa are increasing, with sub-Saharan Africa reporting 2.7-fold higher fatality than global averages. The incidence of cancer in Africa in 2020 was about 1.1 million new cases, with 711,000 deaths, indicating a mortality-to-incidence ratio (MIR) of 0.64. These cancer challenges in Africa necessitate a concerted approach towards effective cancer control and management. Here, we present an extensive report of emerging epidemiological cancer trends among West African adults seen between 1972-2022 in Zaria, Nigeria. We used the Zaria cancer registry of the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria to obtain information on histologically diagnosed cancers from January 1st, 1972 to December 31, 2022. Records in the Zaria registry are indexed into a register paper-based and 2008 and transferred by CanReg4 software on the computer. We used WHO classification of tumors (WHO Blue Book) 5th edition to classify all the abstracted cancers for the purpose of this study. Time-trend analyses were performed by utilizing linear regression models. In the analysis of the Zaria cancer registry, 12,114 adults (42.2% male, 57.8% female) were diagnosed with histologically confirmed cancer between 1972 - 2022. The most common diagnosis among male cancer patients was prostate cancer, comprising a quarter of all cases. The median age of diagnosis for prostate cancer was 65 years, with an interquartile range (IQR) of 60 and 70. Among female cancer patients, the most common diagnoses were cervical cancer and breast cancer, together comprising 68.2% of all cases. Median age at diagnosis were 45 (IQR, 40-56) and 42 (IQR, 35-50), respectively. In time-trend analyses, the total number of new cancer cases diagnosed at ABUTH from 1972 to 2022 increased over time (p<0.001). In the analyses of individual cancers, those in which the number of new cases increased over time were neoplasms of the bones and joints, breast, cervix, prostate, colorectum and stomach, head and neck (p<0.001); esophagus (p=0.006); eye and orbit and soft tissue (p=0.002); and ovary (p=0.005). Cancers in which the number of new cases decreased over time were Hodgkin lymphoma, Non-Hodgkin lymphoma, melanoma of the skin, and non-melanoma cancer of the skin (p<0.001). The number of new adult cancer diagnoses recorded in the Zaria cancer registry have increased over time from 1972 to 2022. Prostate cancer accounted for a quarter of all cancer cases among males, whereas cervical cancer and breast cancer accounted for nearly 70% of all cases among females. Westernization with associated change in dietary habits, physical inactivity, obesity and reproductive behaviors and changes in the population size and life expectancy may be attributable factors to change in cancer in Zaria. Better understanding of these factors will inform cancer prevention and control strategies. Citation Format: Faruk Mohammed, David J. Lee, Katy Graef, Abdulmumini Hassan Rafindadi, Sani Ibrahim, Sirajo Mohammed Aminu, Ahmed Adamu, Adamu Abdullahi, Aishatu Maude Suleiman, Abdullahi Mohammed, John Idoko, Abdulkadir Lawal Rafindadi, Danladi Amodu Ameh, Bello Ahmad Kumo, Ahmad Bello, Abdullahi Jubril Randawa, Oguntayo Olanrewaju Adekunle, Usman Mohammed Aminu, Muhammad Manko, Olasinde Tajudeen Tajudeen, Lazarus M. Yusufu, Mohammed Dauda Maigatari, Lawal Khalid, Dahiru Ismail, Aliyu Ahmed Babadoko, Ahmed Tijjani Lawal, Abdullahi Alfa Mohammed, Yahaya Ukwenya, Ahmed Mai, Maitama Yusuf Hussaini, Anisah Yahaya, Caitlin Bishop, Jennifer Dent, Timothy R. Rebbeck, Yawale Iliyasu. Emerging epidemiological cancer trends among West African adults in Zaria, Nigeria (1972 to 2022) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2158.