The South African National Cancer Registry: an update

We would like to take this opportunity to correct the misconception created by the News piece published in The Lancet Oncology regarding the "demise" of the South African National Cancer Registry (NCR).

The NCR, a division of the National Health Laboratory Service, is the primary cancer surveillance system and largest repository of cancer data in South Africa. It was established in 1986 as a voluntary, pathology-based cancer surveillance system, and continues to operate; its database contains over 1·2 million cancer records with about 80 000 new cases added each year.

The misconception about the NCR referred to above might have come about because the NCR has had difficulties in the past due to changes in leadership, high staff turnover, and a lack of political and financial prioritisation of cancer surveillance caused by competing national health priorities at the peak of the HIV epidemic.

As a result of severe resource constraints, the NCR continued to obtain data but was unable to regularly produce reports. Additionally, between 2004 and 2010, some private laboratories withheld data because of concerns about voluntarily submitting confidential patient information to the registry without the protection of government legislation.

However, in 2011, Regulation 380 of the National Health Act (Act 61 of 2003)2 formally established the NCR as South Africa's main cancer surveillance agency; the legislation makes reporting all confirmed cancer diagnoses to the registry obligatory. Additionally, the Regulation mandated the NCR to implement population-based cancer registration in South Africa.
With renewed political support, NCR has been revitalised. To expedite data processing, the registry has moved to electronic reporting of pathology data from laboratories.

Cancer incidence reports for 2000—07 have been published online3 with further reports in progress. After great effort from NCR staff, we aim to soon report cancers within timeframes similar to those of leading international cancer registries. The NCR has developed a 10-year business plan for the implementation of both new population-based and existing pathology-based registration for the country.

Fundraising activities have started, and a pilot population-based registry is operational in one district of the country (Ekurhuleni District, Gauteng), with more to follow. In view of the concern among stakeholders about the decline in reporting from private laboratories in the past, our researchers did a thorough investigation to quantify the effect of withheld reports on national cancer surveillance. We found a marginal effect on overall reporting; NCR will submit these findings for peer-reviewed publication soon.

The NCR remains the main source of cancer data for South Africa, with laboratory-based reporting yielding high specificity. With the imminent implementation of national health insurance,4 it is vital for the country to be able to quantify the burden of cancer for national resource planning. Increased investment in the NCR will assist the organisation to improve South African cancer surveillance.

MS has received grants from IeDEA Southern Africa (grant number U01AI069924) from the National Institutes of Health for work unrelated to this submission. All other authors declare no competing interests.


  1. Furlow B. Mining pollution: a legacy of contamination. Lancet Oncol 2014; 15: 558. Full Text | PDF(779KB) | PubMed
  2. National Department of Health. National Health Act (Act No 61 of 2003): regulations relating to cancer registration. No R 380. Republic of South Africa, 2011.
  3. National Health Laboratory Service. National Cancer Registry: cancer in South Africa, full reports: 2000—2007. (accessed June 17, 2013).
  4. Health Systems Trust. Green paper: National Health Insurance in South Africa, National Department of Health, Republic of South Africa. (accessed April 25, 2014).