THE SEYCHELLES HOSPITAL, PO box 52, Victoria, Mahe Island
Responsible: Anne Finesse
Phone: +248 4388416
The Seychelles National Cancer Registry (SNCR) was established in 2008 under the Cancer and Mental Health Programme of the Ministry of Health within the Public Health department,to address the burden of cancer in the country. Registration is not mandatory by law. An advisory committee consisting of different medical and public health experts was formed upon establishment of the registry, but has not assembled for over a year.
The Seychelles National Cancer Registry is located within the hospital diagnostic centre in a new building donated by Sheikh Khalifa Bin Zayed Al Nahyan of the United Arab Emirates in 2011. In the same complex with the hospital are the Ministry of Health and the WHO Office. The registry consists of one office, which is equipped by one computer (donated by International Atomic Energy Agency) with installed CanReg4 software and two printers.
The registry registrar is the only full-time staff member. Ms Finesse is a Senior health information assistant, who received training in cancer registration at the cancer registration course of the International Agency for Research on Cancer Summer School in 2008, and at a visiting fellowship at the Vaud Cancer Registry. Five medical specialists (for general surgery, gyneacology, ear, nose, throat, urology and oral cavity cancers) from the Seychelles Hospital act as registry consultants by providing assistance in coding stage of disease on monthly or two-weeks basis. Also attached the registry (one part time) lab technologist responsible for notifying all new cancer cases recorded at the laboratory.
Republic of Seychelles consists of 116 islands, of which Mahe, Praslin, La Digue and Silhouette are permanently populated. Close to 90% of the population lives on Mahe island. Administratively, the Seychelles are divided in 26 districts. The population of Seychelles was 89,949 according to the 2013 estimate by the National Statistics Bureau. Population estimates are considered to be more reliable than the census data as they take migrations into account. The census overestimates the total population number, due to registration of temporary residents. The population is younger than in European countries, but older than African mainland, and has been increasing by 1% annually between 1994 to 2012. (National Statistics Bureau. Statistical Bulletin 2010). The main ethnic group is Creole (85-90% population) and the main religion is Roman Catholic.
SOURCE OF INFORMATION
There are five hospitals in the registration area, on Mahe, Praslin, La Digue, and Silhouette islands. However, apart from the Seychelles hospital in Victoria, the others serve mostly as emergency hospitals, and provide only basic diagnostics. There is also one hospice on Mahe island.
The Seychelles Hospital has 404 beds capacity and consists of female health, male health, surgery, internal medicine, pediatric, radiology, pathology and cytology, and psychiatric wards.
The pathology laboratory at the Seychelles Hospital is the only pathology laboratory in the country. It employs two pathologists, and three technicians. These two technicians also work as cytoscreeners for Pap-smear readings with two cytotechnologists. The pathology department keeps a database from the year 2005. However, the laboratory software is mainly used for registering and printing out the pathological findings, while the data reported to the cancer registry are saved in Excel files. There are over 1000 yearly biopsies and about 1000 Pap-smears. Haematology laboratory employs five laboratory technicians. Bone marrow examinations and immunodiagnostics are available.
The diagnostic unit disposes of X-ray, 1 digital mammography machine, CT and MRI scans, colonoscopy, and gastroscopy.
Cancer Register Books
All health centres, as well as all hospital wards notify the patients in ''Cancer register'' books – listings of patient data (name and surname, age, sex, address, file number, telephone number, diagnosis, basis of diagnosis, date, clinician/physician, date of next exam) that are filled in upon every visit or prescription of palliative treatment. The cancer registrar collects them every three months from the health centres in primary care and hospital wards, and brings them back as soon as the data are entered. On Praslin and La Digue islands, there are nurses appointed for registrations in the cancer register books.
METHODS OF REGISTRATION
Cancer Notification Forms
The case finding system is a combination of active and passive based on cancer notification forms (Appendix 1). Upon confirmation of diagnosis, the name and surname, date of birth, basis of diagnosis, date of diagnosis, primary site and morphology (both text and ICD-O-3 codes) are filled in at the pathology laboratory,where there are one lab technologist responsible for notifying all cases recorded. Therefore, every notification is checked at the registry, and corrected if neccessary. In case of corrections, the pathology laboratory is notified, so that their database can also be updated. After the patient has received treatment, the registrar collects his medical record from the ward. The availability and location of the medical records can be checked in the hospital documentation centre. The database at the documentation centre does not contain medical data, but personal identification data and the medical record number. Based on the data from the medical record, the registrar completes the rest of the cancer notification form. The personal ID number is always available, as based on it the right to free medical treatment is exercised. Non-Seychellois population temporarily living at the Seychelles can also be assigned the national ID number, which can be differentiated from those of Seychellois population. Stage is coded as extent of disease, summary stage according to the SEER summary staging manual and TNM stage. However, the medical record often does not contain stage of disease, which is a problem for registration. If a person is diagnosed and/or treated overseas, the hospital receives medical records from the hospital abroad and the notification is completed at the registry based on this record. Yearly number of notifications received is about 150.
The computer system used is CanReg4, which was planned at the start of the registry, and then customized at the International Agency for Research on Cancer. In the database there are 1074 (2005-2012) cancer cases, as some data was also entered retrospectively. So far there has been no need to add new variables to the existing dataset, however, there is a need to add additional data sources, which is not possible in the current system.
The cancer notification data are usually entered in batches of about 20 from the same ward at a time, to be able to check with the respective consultant. When the cancer register books are collected, every patient entered is cross-checked with the registry database. If the person is in the registry database, the data are cross-checked and updated with the date of last contact. If more specific topography or morphology information is available, this is also updated. If the person is not in the registry database, he is tracked through the hospital documentation centre, and when the medical record is identified, the cancer notification form is filled in and entered into the database. The information on date and cause of death is completed from the mortality data.
Every time a new notification is entered, the database is checked for duplicates. IACR/IARC multiple primary rules are incorporated into the software. After the end of each data year, all cancer cases for that year are checked for missing data, and completed if possible.
Data Analysis/Recent Results
The most common male and female cancers 2011-2012 period, and the age-standardised rates per World Standard Population (ASR(W)) are presented below. The distribution of most common cancer sites differs from estimates for East Africa from GLOBOCAN 2008 database, which also reflects different age-structure of the population. Overall male cancer incidence is high, the only other African countries with estimated incidence ASR of more than 200/100,000 according to the GLOBOCAN 2008 database are South African Republic and La Reunion. The prostate cancer incidence is higher than estimated for any other African country. It is however, hard to estimate to which extent is this due to PSA testing and possible registration of prevalent cases due to relatively recent start of the registry operation. The proportions, as well as ASRs of colorectal cancer for each sex are also higher than in other African countries. In women, breast cancer is the most common site, comprising 43% of new cases. However, breast cancer incidence rates compared to other African countries are intermediate. The distribution by summary stage for the period 2011-2012 was: 15% stage I, 20% stage II, 25% stage III, 30% stage IV and 10% unknown. Even though cervical cancer is the second most common female cancer site, both the contribution to incidence and the ASR are very low. This is also substantiated by very few registered cases of CIN III in spite of intense screening activity.
The Seychelles National Cancer Registry Triennial Report for 2009-2011 is available now.