Colorectal Cancer in Cape Verde: What Do We Know?

Abstract

Introduction: In 2022, Cape Verde established its population-based cancer registry (Registo Oncológico de Cabo Verde, ROCV). Until then, information on colorectal cancer (CRC) in the country relied largely on hospital-based series and modelled international estimates. Three consecutive years of population-based registration (2022-2024) are now available. We aimed to describe the incidence of colon and rectal cancer in Cape Verde using the ROCV case-level database for 2022-2024, and to characterize the demographic, clinicopathological, staging, treatment, and vital-status profile of an institutional cohort of patients with CRC managed at the Hospital Universitario Agostinho Neto (HUAN).

Methods: Descriptive study with two components. The population-based component analysed the ROCV case-level database, restricted to malignant tumours diagnosed between 2022 and 2024 at colon and rectal sites (ICD-10 C18-C20); anal tumours (C21) were excluded. The institutional component included 255 patients diagnosed with CRC recorded at HUAN between 2017 and 2026; for each variable, only patients with available information were analysed, the number of missing values is reported, and no imputation was performed.

Results: Between 2022 and 2024, 1424 malignant tumours were registered (excluding non-melanoma skin cancer). Colon and rectal cancer accounted for 113 cases (7.9%), the fourth most frequent site nationally and the third in each sex, with 58 cases in men and 55 in women. The age-standardized incidence rate (world population) was 8.9 per 100 000 in men and 6.7 in women, and the cumulative risk between birth and 74 years was 1.23% and 0.75%, respectively. The colon accounted for 59.3% of cases and the rectum and rectosigmoid junction for 40.7%. Median age at diagnosis was 62 years (range 24-90) and 21.2% of patients were younger than 50 years. Adenocarcinoma not otherwise specified accounted for 76.1% of cases, morphological verification reached 98.2%, and no case was registered from a death certificate only.

Conclusion: Colon and rectal cancer is the fourth most frequent malignancy in Cape Verde, affects men and women in similar proportions, although the age-standardized incidence rate is higher in men than in women (8.9 vs 6.7 per 100 000, with a cumulative risk to age 74 of 1.23% vs 0.75%), shows a high proportion of morphologically verified cases, and occurs before the age of 50 in about one fifth of patients. This high proportion of patients under 50 years mandates a dedicated early-diagnosis programme for symptomatic patients in this age group. In the institutional cohort, diagnosis at an advanced stage predominated, with limited use of radiotherapy and substantial gaps in vital-status ascertainment. Consolidation of the ROCV and its linkage to civil and mortality registries are essential to characterize the incidence, staging, and survival of CRC in the country.