Cancer in the Sudan: An overview of the current status of knowledge on tumor patterns and risk factors Khalid Dafaallah Awadelkarim a , Renato Mariani-Costantini b , Nasr Eldin Elwali a, ⁎ a Department of Molecular Biology, National Cancer Institute (NCI-UG), University of Gezira, Wad Medani, Sudan b Department of Oncology and Experimental Medicine, “G. d'Annunzio” University, and Unit of Molecular Pathology and Genomics, Aging Research Center (CeSI), “G. d'Annunzio” University Foundation, Via Colle dell'Ara, 66013 Chieti, Italy abstract article info Article history: Received 2 December 2009 Received in revised form 6 September 2010 Accepted 7 September 2010 Available online 10 November 2010 Keywords: Sub-Saharan Africa Cancer Sudan Tumor type Frequency Case series Risk factors The Sudan, the largest and most diverse country in Africa, is experiencing a growing cancer problem, but little is presently known on tumor patterns, cancer epidemiology and ethnic or environmental cancer risk factors. We review here the current status of knowledge, summarizing data from local and international publications as well as primary information from the only two cancer hospitals of the country, both located in Central Sudan (Khartoum and Wad Medani). We provide frequencies reported for cancers detected in adults and children, and summarize studies on specific cancer types, as well as information on risk factors that most likely impact on tumor patterns. © 2010 Elsevier B.V. All rights reserved. 1. Introduction The Sudan, with an area of 2,505,810 km 2 (967,499 mi 2 ), is the largest country in Africa and the tenth largest in the world (Fig. 1) (Sudan Demographic and Health Survey, 1991; The Republic of Sudan, 2002). This Afro-Arab country is an ethnic mosaic of about 700 tribes, many of which reported to be traditionally endogamic (Tay and Saha, 1988; El Moghraby, 2003). The population tripled from 10.3 million in 1955/56 to about 32 millions in 2001, and reached about 38 millions in 2008, but population density is markedly uneven. The current average of 10.2 persons/km 2 would imply that the country is sparsely populated, but in fact there are densely populated areas and vast areas that are almost or completely uninhabited. In areas under cultivation the population density reaches 356 persons/km 2 (Sudan Demographic and Health Survey, 1991; The Republic of Sudan, 2002). The population structure is young, with 44% under 15 years of age (Sudan Demographic and Health Survey, 1991; The Republic of Sudan, 2002). There has been a relative but significant increase in life expectancy, from 36.3 and 39.1 years in 1955 for males and females respectively, to 55.6 years for males and 58.4 years for females in 1999. While infectious diseases are still the main concern of the health care system, the Sudan, as most sub-Saharan African countries, needs to face a predicted increment in cancer incidence because of the progressively rising life expectancy, the wide diffusion of cancer- related infections, and the mounting pollution due to urbanization and spread of intensive agriculture and industrialization (Parkin et al., 2008; Sitas et al., 2008). As in other sub-Saharan African countries, the cancer patterns would be predicted to reflect population demography, such as shorter life expectancy and young population structure, and exposures to a variety of risk factors, associated with both traditional and new lifestyles (Ikpatt et al., 2002; Morris, 2003; Parkin et al., 2003; Gondos et al., 2005; Hamad, 2006; Kerr and Kerr, 2006; Porter, 2008). However, very little is known about cancer in Sudan (Morris, 2003; Hamad, 2006; Kerr and Kerr, 2006; Awadelkarim et al., 2010). The Sudan has no national population-based cancer registry. The main sources of cancer data are the hospital-based case series at the only two oncological centers of the country, both located in the densely populated Central Sudan, i.e., the Radiation and Isotope Center in Khartoum (RICK), Khartoum State (Fig. 1), and the National Cancer Institute of the University of Gezira (NCI-UG) in Wad Medani, Gezira State (formerly “Institute of Nuclear Medicine Molecular Biology & Oncology”, INMO) (Fig. 1). In addition, from the early sixties (1960s) to the early eighties (1980s), there was the Sudan Cancer Registry (SCR), which was based on histopathologically- confirmed cases diagnosed mainly at the National Health Labora- tories in Khartoum, formerly known as Stack Medical Research Science of the Total Environment 423 (2012) 214–228 ⁎ Corresponding author. Present address: Department of Basic Sciences, College of Medicine, Al Imam Mohamed Bin Saud Islamic University, P.O. Box 5701, Riyadh 11432, Saudi Arabia. Tel.: +966 12581388; fax: +966 12590209. E-mail address: nasreldinelwali@yahoo.com (N.E. Elwali). 0048-9697/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.scitotenv.2010.09.010 Contents lists available at ScienceDirect Science of the Total Environment journal homepage: www.elsevier.com/locate/scitotenv