Colorectal cancer incidence and survival trends in Uganda: a population-based registry analysis (2000-20)

The epidemiology of colorectal cancer (CRC) in Uganda is not sufficiently described, with the limited available data suggesting an increasing incidence. This study assessed CRC incidence and survival trends by using data from the two major population-based cancer registries in Uganda.

We extracted incident CRC cases (ICD C18-C20) from the Kampala Cancer Registry (KCR; 2000-19) and the Gulu Cancer Registry (GCR; 2015-20). Crude and age-standardized incidence rates (ASIRs) and 1-, 3-, and 5-year survival estimates were calculated by using SEER*Stat software. Kaplan-Meier methods were applied to generate survival curves, with subgroup differences assessed by using log-rank tests. Joinpoint regression was used to evaluate trends in the incidence rates.

A total of 1118 CRC cases were identified. The mean age at diagnosis was 54.3 years (16.2 SD), with 37.8% diagnosed before age 50 years. The incidence was higher in the KCR compared with the GCR (crude: 2.4 vs. 0.8; ASIR: 9.2 vs. 2.0 per 100 000). A significant rise in ASIRs occurred exclusively among males in the KCR, with a 2.1% annual increase over 20 years (P < .001). In a sensitivity analysis restricted to histologically confirmed cases, the 1-, 3-, and 5-year relative survival in the KCR was 52.7%, 14.5%, and 4.3%, respectively.

CRC incidence in Uganda remains low but is increasing among males. Four in 10 cases are diagnosed before age 50 years, suggesting a substantial burden of early-onset disease. Survival outcomes remain poor, stressing the need for strengthened prevention, early detection, and treatment services.