South African National Cancer Registry Research Articles

Breast cancer in women by HIV status: A report from the South African National Cancer Registry.

Breast cancer (BC) is the leading cause of cancer-related morbidity and mortality in women living in South Africa, a country with a high HIV burden. However, characteristics of the double burden of HIV and BC in South Africa have not been properly investigated. We described characteristics of BC cases by HIV status in South Africa. In this nationwide South African study, we obtained BC records for women aged ≥15 years diagnosed in the public health sector between January 2004 and December 2014. We included records from the National Cancer Registry that had been linked to HIV-related laboratory records from the National Health Laboratory Service. We assessed the odds of being HIV positive versus HIV negative in relation to patient-, cancer-, and municipality-related characteristics. From 2004-2014, 40 520 BC cases were diagnosed in women aged ≥15 years. Of these, 73.5% had unknown HIV status, 18.7% were HIV negative, and 7.7% were HIV positive. The median age at BC diagnosis was 43 years (interquartile range [IQR]: 37-52) in HIV positive and 57 years (IQR: 46-68) in HIV negative women, respectively. The odds of being HIV positive was higher for women who were aged 30-34 years compared to women aged 35-39 years at cancer diagnosis (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.10-1.71), Black versus non-Black (OR 6.41, 95% CI 5.68-7.23), diagnosed with cancer in rural versus urban areas (OR 1.59, 95% CI 1.40-1.82) and diagnosed in municipalities with low and middle (OR 3.46, 95% CI 2.48-4.82) versus high socioeconomic position (OR 2.69, 95% CI 2.11-3.42). HIV status was unknown for the majority of BC patients. Among those with known HIV status, being HIV positive was associated with a younger age at cancer diagnosis, being Black and receiving care in municipalities of poor socioeconomic position. Future studies should examine opportunities to integrate HIV and BC control programs.

Incidence and epidemiology of conjunctival squamous cell carcinoma in relation to the HIV epidemic in South Africa: a 25-year analysis of the National Cancer Registry (1994–2018)

AimsTo describe the incidence and epidemiology of conjunctival squamous cell carcinoma (CSCC) in South Africa over a 25-year period (1994–2018), with particular reference to the HIV epidemic.MethodsIncident cases of histologically...

The Incidence of Retinoblastoma in South Africa: Findings from the South African National Cancer Registry (2004–2018)

ABSTRACT Purpose To determine the frequency and incidence rate of retinoblastoma in children in South Africa from 2004 to 2018. Methods Incident cases of histologically diagnosed retinoblastoma were identified from the South African National Cancer Registry. Crude incidence rates were calculated using national population data on children <15 years and live births. Incidence rates were stratified and compared by age, sex and population group. Direct age-standardised incidence rates and comparative incidence ratios were calculated. Results The overall age-standardised incidence rate for children <15 years was 3.3 per million or 1 per 21 641 live births. Age-specific rates for children aged 0–4, 5–9 and 10–14 years were 7.7, 0.8 and 0.2 per million, respectively. There was no difference in incidence rates by sex. White children had a significantly higher incidence rate compared to other population groups, but this finding may be due to systemic biases introduced by access to healthcare in South Africa or study methodology. Conclusion This is the largest study to provide population-based, histologically confirmed national estimates of retinoblastoma incidence from an African nation to date and affirms the need for high-quality cancer registries across the African continent.

Reporting Incidences of Neuroblastoma in Various Resource Settings.

PURPOSEThe incidences of neuroblastoma (NB) differ significantly between various resource settings because of varying quality of cancer registries and underdiagnoses. This study aimed to evaluate current regional variations as reported by international cancer registries and the theoretical and reported differences in international NB incidences and to evaluate South Africa (SA) as a case for variable reporting.METHODSA comprehensive literature review on registries reporting on NB was performed to construct incidence tables. The SEER Program incidence of 10.5/million children was used to calculate the expected number of NB cases for each country. Registry data of NB cases between 2000 and 2016 were requested from The South African National Cancer registry (SA-NCR) and the South African Children's Tumour Registry (SACTR) for comparison and to perform a probabilistic linkage study.RESULTSInternationally, incidences varied between –97.1% and +80% compared with the SEER program. SA under-reported NB cases by an estimated 74.2%. Between 2000 and 2016, the SA-NCR reported between 23 and 51 cases/year, whereas the SACTR reported between 18 and 57 cases/year for the same period. The incidence reported by the SA-NCR varied between 1.5 and 2.8/million children under 15-year per year, whereas the SACTR reported 1.74-2.6 cases/million children. Both registries reported incidences less than high-income country. A probabilistic record linkage of the two registries resulted in a combined incidence of 2.9 cases/million children.CONCLUSIONAs with most low- and middle-income countries, SA has either a lower incidence or underdiagnoses of NB cases. The reasons for under-reporting are not clear, but can be due to undiagnosed NB cases with spontaneous regression, missed possible cases because of lack of autopsies, and diagnosed cases not recorded in registries.

Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002\u20132014

BackgroundSouth Africa (SA) has experienced a rapid transition in the Human Development Index (HDI) over the past decade, which had an effect on the incidence and mortality rates of colorectal cancer (CRC). This study aims to provide CRC incidence and mortality trends by population group and sex in SA from 2002 to 2014.MethodsIncidence data were extracted from the South African National Cancer Registry and mortality data obtained from Statistics South Africa (STATS SA), for the period 2002 to 2014. Age-standardised incidence rates (ASIR) and age-standardised mortality rates (ASMR) were calculated using the STATS SA mid-year population as the denominator and the Segi world standard population data for standardisation. A Joinpoint regression analysis was computed for the CRC ASIR and ASMR by population group and sex.ResultsA total of 33,232 incident CRC cases and 26,836 CRC deaths were reported during the study period. Of the CRC cases reported, 54% were males and 46% were females, and among deaths reported, 47% were males and 53% were females. Overall, there was a 2.5% annual average percentage change (AAPC) increase in ASIR from 2002 to 2014 (95% CI: 0.6–4.5, p-value < 0.001). For ASMR overall, there was 1.3% increase from 2002 to 2014 (95% CI: 0.1–2.6, p-value < 0.001). The ASIR and ASMR among population groups were stable, with the exception of the Black population group. The ASIR increased consistently at 4.3% for black males (95% CI: 1.9–6.7, p-value < 0.001) and 3.4% for black females (95% CI: 1.5–5.3, p-value < 0.001) from 2002 to 2014, respectively. Similarly, ASMR for black males and females increased by 4.2% (95% CI: 2.0–6.5, p-value < 0.001) and 3.4% (, 95%CI: 2.0–4.8, p-value < 0.01) from 2002 to 2014, respectively.ConclusionsThe disparities in the CRC incidence and mortality trends may reflect socioeconomic inequalities across different population groups in SA. The rapid increase in CRC trends among the Black population group is concerning and requires further investigation and increased efforts for cancer prevention, early screening and diagnosis, as well as better access to cancer treatment.

The Use of Density-Based Spatial Clustering of Application With Noise (DBSCAN) for Record Linkage in An Observational HIV Cohort

IntroductionThe South African HIV Cancer Match (SAM) study is a probabilistic record linkage study involving creation of an HIV cohort from laboratory records from the National Health Laboratory Service (NHLS). This cohort was linked to the pathology based South African National Cancer Registry to establish cancer incidences among HIV positive population in South Africa. As the number of HIV records increases, there is need for more efficient ways of de-duplicating this big-data. In this work, we used clustering to perform big-data deduplication.&#x0D; Objectives and ApproachOur objective was to use DBSCAN as clustering algorithm together with bi-gram word analyser to perform big-data deduplication in resource-limited settings. We used HIV related laboratory records from entire South Africa collated in the NHLS Corporate Data Warehouse for period 2004-2014. This involved data pre-processing, deterministic deduplication, ngrams generation, features generation using Term Frequency Inverse Document Frequency vectorizer, clustering using DBSCAN and assigning cluster labels for records that potentially belonged to the same person. We used records with national identification numbers to assess quality of deduplication by calculating precision, recall and f-measure.&#x0D; ResultsWe had 51,563,127 HIV related laboratory records. Deterministic deduplication resulted in 20,387,819 patient record deduplicates. With DBSCAN clustering we further reduced this to 14,849,524 patient record clusters. In this final dataset, 3,355,544 (22.60%) patients had negative HIV test, 11,316,937 (76.21%) had evidence for HIV infection, and for 177,043 (1.19%) the HIV status could not be determined. The precision, recall and f-measure based on 1,865,445 records with national identification numbers were 0.96, 0.94 and 0.95, respectively.&#x0D; Conclusion / ImplicationsOur study demonstrated that DBSCAN clustering is an effective way of deduplicating big datasets in resource-limited settings. This enabled refining of an HIV observational database by accurately linking test records that potentially belonged to the same person. The methodology creates opportunities for easy data profiling to inform public health decision making.

The impact of the South African antiretroviral treatment programme on the age-standardised incidence rate of Kaposi sarcoma, 1999–2016: An interrupted time series analysis

ObjectiveThe objective of this study was to quantify the impact of the South African antiretroviral treatment programme on the age-standardised incidence rate of Kaposi sarcoma among black South African residents of all ages. MethodsWe performed an interrupted time series analysis using routinely collected, histologically confirmed surveillance data from the South African National Cancer Registry for the years 1999 to 2016. The analysis was performed using R statistical software. The total number of cases was 29,623 (12,475 females and 17,166 males). The background antiretroviral treatment coverage was less than 1% at the time that the antiretroviral programme was introduced and increased to over 50% in 2016. ResultsIn 1999, the age-standardised rates were 1.48 and 2.82 cases per 100,000 per year for black females and males, respectively. These rates increased to 5.52 and 7.46 in 2008 before declining. The antiretroviral treatment programme was started in 2004. Five years after 2008 (nine years after the antiretroviral programme was introduced), the predicted standardised rates were 58.3% and 50.3% lower for females and males, respectively, than what they would have been without the treatment programme. ConclusionIntroduction of the antiretroviral treatment programme was associated with a decrease of over 50% in the predicted age-standardised incidence rates of Kaposi sarcoma.

Strengthening African Population-Based Cancer Registration Through Regional Mentorship: UICC Fellowship Experience at Zimbabwe National Cancer Registry

Background: South Africa (SA) recently established an urban population-based cancer registry in Ekurhuleni metropolitan district in Gauteng Province. The Ekurhuleni Population-Based Cancer Registry (EPBCR) aims to inform cancer policy and comprehensive cancer control programs. The registry covers 3.5 million residents including public/private, rural/urban patients and a mix of the multiethnic SA population. The first complete year's data will be published in April 2018. It is crucial that high-quality data collected by newly established registries are comparable regionally and globally. The Union for International Cancer Control (UICC) fellowship provides a practical opportunity for South African National Cancer Registry staff to learn from the Zimbabwe National Cancer Registry (ZNCR), a well-established population-based registry in the region. Aim: To enhance the SA EPBCR through observation and application of methods for population-based cancer registration used at the ZNCR. Methods: A desktop review of published and unpublished articles/reports of the ZNCR was conducted. Semi-structured informal interviews were conducted with registry staff to understand data processes from case finding to reporting. Representative data sources were visited to understand case-finding processes. Results: The ZNCR was established in 1985 through a collaborative research agreement between the Ministry of Health (MoH) and International Agency for Research on Cancer (IARC). Its activities are overseen by a 17-member constituted multidisciplinary advisory committee. The registry staff comprise one registrar, one executive assistant (EA) and four health information assistants (HIA). The process of ensuring quality data are guided by the African Cancer Registry Network and the International Association of Cancer Registries standards for population-based cancer registries. The ZNCR uses a combination of active and passive case-finding methods where HIAs have unrestricted access to patient information in private and public sectors such as hospitals, pathology laboratories, radiotherapy centers and death registries. HIAs conduct patient interviews for accurate demographics and to complete missing information. Cases are coded according to International Classification of Diseases for Oncology-V3 and Canreg software is used for data entry, quality control and analysis. The hard copies are stored in locked cabinets in offices with restricted access. The data are then used for reporting and research. Conclusion: The support of government, commitment of advisory committee volunteers, highly trained and experienced staff are key elements behind the success of ZNCR. Strict adherence to international practices for population-based cancer registration has enabled ZNCR to produce high-quality data for research and cancer programs. The processes used by ZNCR will be customised and implemented at EPBCR.

Temporal trends in the epidemiology of cervical cancer in South Africa (1994-2012).

Cervical cancer (CC) is the leading cause of cancer death among female South Africans (SA). Improved access to reproductive health services following multi-ethnic democracy in 1994, HIV epidemic, and the initiation of CC population-based screening in early 2000s have influenced the epidemiology of CC in SA. We therefore evaluated the trends in CC age-standardised incidence (ASIR) (1994-2009) and mortality rates (ASMR) (2004-2012) using data from the South African National Cancer Registry and the Statistics South Africa, respectively. Five-year relative survival rates and average per cent change (AAPC) stratified by ethnicity and age-groups was determined. The average annual CC cases and mortalities were 4,694 (75,099 cases/16 years) and 2,789 (25,101 deaths/9 years), respectively. The ASIR was 22.1/100,000 in 1994 and 23.3/100,000 in 2009, with an average annual decline in incidence of 0.9% per annum (AAPC = -0.9%, p-value < 0.001). The ASMR decreased slightly by 0.6% per annum from 13.9/100,000 in 2004 to 13.1/100,000 in 2012 (AAPC = -0.6%, p-value < 0.001). In 2012, ASMR was 5.8-fold higher in Blacks than in Whites. The 5-year survival rates were higher in Whites and Indians/Asians (60-80%) than in Blacks and Coloureds (40-50%). The incidence rate increased (AAPC range: 1.1-3.1%, p-value < 0.001) among young women (25-34 years) from 2000 to 2009. Despite interventions, there were minimal changes in overall epidemiology of CC in SA but there were increased CC rates among young women and ethnic disparities in CC burden. A review of the CC national policy and directed CC prevention and treatment are required to positively impact the burden of CC in SA.

Record linkage augments cancer ascertainment in HIV cohorts in South Africa

ABSTRACT&#x0D; BackgroundSub-Saharan Africa is the region most heavily affected by the HIV/AIDS epidemic. HIV increases the risk of developing cancer but the ascertainment of cancers in patients attending antiretroviral therapy (ART) treatment programs might be incomplete. To estimate the under-ascertainment of cancer we compared incidence rates of AIDS-defining cancers in South African HIV cohorts with and without cancer case ascertainment through record linkage with the National Cancer Registry.&#x0D; MethodsWe used the data of adult (≥16 years) HIV-positive persons receiving care between 2004 and 2011 at one of four ART programs in South Africa. These programs collaborate with the International Epidemiologic Databases to Evaluate AIDS Southern Africa (www.iedea-sa.org) and collected data for AIDS-defining cancers but not for other cancers. To improve cancer ascertainment we probabilistically linked patient records (using first name, surname, age, and gender) from two HIV cohorts with the cancer records of the South African National Cancer Registry. We calculated incidence rates per 100,000 person-years after starting ART for the AIDS-defining cancers, i.e. Kaposi sarcoma (KS), invasive cervical cancer (ICC) and non-Hodgkin lymphoma (NHL). We compared incidence rates before and after inclusion of record linkage identified cancer cases using the attributable fraction of cancers identified with 95% confidence intervals (CI).&#x0D; ResultsA total of 49,207 adults starting ART in South Africa were included. 65% of patients were female, median age at starting ART was 35 years (interquartile range 30-41 years). We identified a total of 471 incident cancer cases. With record linkage the incidence increased from 81 to 292 for KS, from 1 to 119 for NHL and 12 to 497 for ICC per 100,000 person-years. The attributable fraction of cancers identified was 72% (95% CI 63-79%) for KS, 98% (95% CI 94-99%) for NHL and 98% (95% CI 95-99%) for ICC.&#x0D; ConclusionAscertainment of cancer in HIV program data in African settings is incomplete. This case study has shown that probabilistic record linkage to cancer registries is both feasible and essential for cancer ascertainment in HIV cohorts in South Africa.

The burden of oral cancer in sub-Saharan Africa

Objectives: To describe incidence and mortality rates of oral and of oropharyngeal cancers in sub-Saharan Africa using available sources and to discuss shortcomings. Methods: Incidence and mortality rates were obtained from GLOBOCAN online (IARC 2012) and the pathology-based South African National Cancer Registry (SA-NCR). Descriptions of oral and of oropharynx cancers for the four main geographical regions were derived from the literature. For South Africa, the incidence by ethnic group of lip and intra-oral cancer over the period 1988–2012 could be calculated from SA-NCR. The age distributions for intraoral and for oropharynx cancer in both genders in South Africa were compared for the period 1996–2002. Results: Age standardized incidence rates and mortality rates of lip and of oral cancer in sub-Saharan Africa varied substantially, depending on the regions, the mix of carcinogenic substances consumed in each country and the quality of the cancer registry data. African islands in the Indian Ocean and the Southern and Eastern African countries report the highest rates; these are generally reported to be much lower in West African countries. Available data are now old: not beyond 2010. Up until that time, in the Republic of South Africa, there appears to have been a slight decline in oral cancer rates, except in Black females, but a rise this millennium in cancer of the oropharynx, especially in Coloureds (mixed-race). At least until 2002, the Human Immunodeficiency Virus infection (HIV) pandemic had little or no stimulating influence on the incidence rates of oral squamous carcinoma in South Africa, although Kaposi’s sarcoma has been a major burden in the past. Asian and mixed-race South African females had the highest levels of oral squamous cell carcinomas in the &lt;45 year age group. Conclusion: The quality of cancer registry data in sub-Saharan Africa is variable, unreliable and out of date, suggesting gross under-ascertainment. Records of all causes of death are poor, which can result in both under- and over-attribution of cancer mortality. Improvements of the necessary resources for cancer registration and death certification deserve a high priority.

Breast cancer trends differ by ethnicity: a report from the South African National Cancer Registry (1994-2009).

To describe breast cancer (BC) incidence and mortality by ethnicity in South Africa (SA). Sources of data included the South African National Cancer Registry (NCR) pathology-based reports (1994–2009) and Statistics South Africa (SSA) mortality data (1997–2009). Numbers of cases, age-standardised incidence rates (ASIR) and lifetime risk (LR) were extracted from the NCR database for 1994–2009. Age-specific incidence rates were calculated for five-year age categories. The direct method of standardisation was employed to calculate age-standardised mortality rates (ASMR) using mortality data. Between 1994 and 2009, there were 85 561 female BC. For the Black, Coloured and Asian groups, increases in ASIR and LR were observed between 1994 and 2009. In 2009, the ASIR for the total population, Blacks, Whites, Coloureds and Asians were 26.9, 18.7, 50.2, 40.9 and 51.2 per 100 000, respectively. For Asians, an increase in proportion of BC as a percentage of all female cancers was observed between 1994 and 2002 (11.1%) and continued to increase to 2009 (a further 4.5%). Whites and Asians presented higher incidences of BC at earlier ages compared with Blacks and Coloureds in 2009. In 1998, there were 1618 BC deaths in SA compared with 2784 deaths in 2009. ASMR between 1997 and 2004 increased but stabilised thereafter. This paper demonstrated that SA BC incidence rates are similar to other countries in the region, but lower than other countries with similar health systems. Ethnic differences in BC trends were observed. However, the reasons for observed ethnic differences are unclear.

Investigation of breast cancer sub-populations in black and white women in South Africa.

Bimodal age distributions at diagnosis have been widely observed among US and European female breast cancer populations. To determine whether bimodal breast cancer distributions are also present in a sub-Saharan African population, we investigated female breast cancer in South Africa. Using the South African National Cancer Registry data, we examined age-at-diagnosis frequency distributions (density plots) for breast cancer overall and by their receptor (oestrogen, progesterone and HER2) determinants among black and white women diagnosed during 2009-2011 in the public healthcare sector. For comparison, we also analysed corresponding 2010-2011 US SEER data. We investigated density plots using flexible mixture models, allowing early/late-onset membership to depend on receptor status. We included 8857 women from South Africa, 7176 (81%) with known oestrogen receptor status, and 95064 US women. Bimodality was present in all races, with an early-onset mode between ages 40-50years and a late-onset mode among ages 60-70years. The early-onset mode was younger in South African black women (age 38), compared to other groups (45-54years). Consistent patterns of bimodality and of its receptor determinants were present across breast cancer patient populations in South Africa and the US. Although the clinical spectrum of breast cancer is well acknowledged as heterogeneous, universal early- and late-onset age distributions at diagnosis suggest that breast cancer etiology consists of a mixture two main types.

South African National Cancer Registry: Effect of withheld data from private health systems on cancer incidence estimates.

The National Cancer Registry (NCR) was established as a pathology-based cancer reporting system. From 2005 to 2007, private health laboratories withheld cancer reports owing to concerns regarding voluntary sharing of patient data. To estimate the impact of under-reported cancer data from private health laboratories. A linear regression analysis was conducted to project expected cancer cases for 2005-2007. Differences between actual and projected figures were calculated to estimate percentage under-reporting. The projected NCR case total varied from 53,407 (3.8% net increase from actual cases reported) in 2005 to 54,823 (3.7% net increase) in 2007. The projected number of reported cases from private laboratories in 2005 was 26,359 (19.7% net increase from actual cases reported), 27,012 (18.8% net increase) in 2006 and 27,666 (28.4% net increase) in 2007. While private healthcare reporting decreased by 28% from 2005 to 2007, this represented a minimal impact on overall cancer reporting (net decrease of <4%).

Repeatability of manual coding of cancer reports in the South African National Cancer Registry, 2010

Data validity is a very important aspect of cancer registries in ensuring data quality for research and interventions. This study focused on evaluating the repeatability of manual coding of cancer reports in the South African National Cancer Registry (NCR). This cross-sectional study used the Delphi technique to classify 48 generic tumour sites into sites that would be most likely (“difficult”) and least likely (“not difficult”) to give rise to discordant results among coders. Reports received from the Charlotte Maxeke Academic Hospital were manually recoded by five coders (2 301 reports, e.g. approximately 400 reports each) for intracoder agreement; and by four coders (400 reports) for inter-coder agreement. Unweighted kappa statistics were calculated and interpreted using Byrts’ criteria. After four rounds of the Delphi technique, consensus was reached on the classification of 91.7% (44/48) of the sites. The remaining four sites were classified according to modal expert opinion. The overall kappa was higher for intra-coder agreement (0.92) than for inter-coder agreement (0.89). “Not difficult” tumour sites reflected better agreement than “difficult” tumour sites. Ten sites (skin other, basal cell carcinoma of the skin, connective tissue, other specified, lung, colorectal, prostate, oesophagus, naso-oropharynx and primary site unknown) were among the top 80% misclassified sites. The repeatability of manual coding at the NCR was rated as “good” according to Byrts’ criteria. Misclassified sites should be prioritised for coder training and the strengthening of the quality assurance system.

Cervical cancer and the human immunodeficiency virus: A review

Globally cervical cancer is one of the commonest cancers in women. It comprises approximately 12% of all cancers and is the commonest cancer in women in developing countries. The most recent compilation of global data indicates that an estimated 490 000 new cases of cervical cancer occur annually worldwide and nearly 80% of these are in developing countries, where screening programmes are not well established and are poorly organised. Cervical cancer is the leading cause of cancer death among women. It is estimated that 270 000 women die annually from cervical cancer, 85% of them in low-resource nations.1-3 In Africa, cervical cancer comprises 23.3% of all cancers in women.4 According to the South African National Cancer Registry (NCR) data, the lifetime risk for the development of cervical cancer in 1998 was 1 in 26 for South African women and 1 in 21 for black South African women.5 These are believed to be minimal rates, as the registry publishes only data collected from the pathology laboratories and is not a population-based cancer registry. HIV/ AIDS poses a severe threat to global health. In addition, the HIV epidemic has hit hardest in regions of high prevalence of cervical dysplasia and cancer. The HIV epidemic in South Africa is one of the worst in the world. The prevalence of HIV among South African women attending antenatal clinics in 2006 was 29.1%.6 With improved access to antiretroviral therapy, women are expected to live longer as the risk of death from opportunistic infections decreases. It is assumed that the incidence of cervical cancer and the prevalence of precursor lesions will increase, especially in countries that lack well-organised cervical screening. However, this remains to be seen.

The spectrum of HIV-associated cancers in a South African black population: results from a case-control study, 1995–2004

Accumulating evidence confirms different patterns of HIV-associated cancers in developed and developing countries. We report results of risk for specific cancers associated with HIV-1 infection from an on-going case control study started in government hospitals in Johannesburg in 1995. Cases consisted of cancers known or suspected to be associated with HIV infection: Kaposi sarcoma (n = 333), Non-Hodgkin lymphoma (n = 223), cancer of the uterine cervix (n = 1586), Hodgkin lymphoma (n = 154), cancers of anogenital organs other than cervix (n = 157), squamous cell skin cancer (n = 70), oral cavity and pharyngeal cancers (n = 319), liver cancer (n = 83), stomach cancer (n = 142), leukaemias (n = 323), myelomas (n = 189), melanoma (n = 53), lung cancer (n = 363) and sarcomas other than Kaposi (n = 93). The comparison group comprised 3,717 patients with all other cancer types and 682 patients with cardiovascular diseases. Odds Ratios (OR) were adjusted for age, sex, year of diagnosis, education level and number of sexual partners. Significantly increased risks associated with HIV-1 infection were found for Kaposi sarcoma (OR = 47.1, 95% CI = 31.9 – 69.8), Non-Hodgkin lymphoma (OR = 5.9, 95% CI = 4.3 – 8.1), cancer of the cervix (OR = 1.6, 95% CI = 1.3 – 2.0), Hodgkin lymphoma (OR = 1.6, 95% CI = 1.0 – 2.7), cancers of anogenital organs other than cervix (OR = 2.2, 95% CI = 1.4 – 3.3) and squamous cell skin cancers (OR = 2.6, 95% CI = 1.4 – 4.9). Our study results are supported by data from the pathology-based South African National Cancer Registry. In 2001 Kaposi sarcoma was recorded as the leading cancer in black males age 20 to 44 and in black females aged 20 to 29. From age 30, cervical cancers was the most common cancer diagnosed in black women. The above figures reflect HIV-related cancers prior to the public health sector roll-out of ART (anti-retroviral therapy), which began in 2005.