Stomach cancer, once largely associated with older adults, is increasingly being diagnosed in younger people in Rwanda, according to a leading oncologist, who has urged the public to seek early screening and medical attention when symptoms appear.

The disease was Rwanda's fourth most common cancer in 2022, with an estimated 651 new cases, according to Global Cancer Observatory (GLOBOCAN) estimates published by the International Agency for Research on Cancer (IARC) in February 2024.

Dr Eulade Rugengamanzi, a clinical oncologist and Director General of Butaro Level II Teaching Hospital, said he has observed a shift in the age profile of stomach cancer patients.

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"We are now seeing stomach cancer among younger people," he said.

Risk factors include Helicobacter pylori (H. pylori) infection, smoking, excessive alcohol consumption, chronic gastritis and a family history of the disease.

Screening depends on cancer type

Speaking to The New Times, Rugengamanzi said not all cancers can be detected through screening, but early diagnosis significantly improves treatment outcomes.

"Screening helps detect cancer early or identify precancerous changes before they become cancer," he said.

He cited cervical cancer as an example, noting that it develops through identifiable precancerous stages, allowing health workers to detect and treat abnormal cells before they become cancerous.

"When cancer is detected early, treatment is more effective, complications are fewer and survival rates improve."

He explained that screening recommendations vary depending on the type of cancer, age, sex and individual risk factors such as family history.

For breast cancer, people with a family history may need genetic testing and should begin screening earlier than the general population if they are found to have inherited a higher risk.

Women who have not received the human papillomavirus (HPV) vaccine are advised to begin cervical cancer screening around the age of 30.

Women living with HIV require closer follow-up because they face a higher risk of developing cervical cancer.

Screening intervals also differ depending on the method used. For example, women living with HIV may require annual screening when using visual inspection with acetic acid (VIA), while HPV testing may allow longer intervals.

Rugengamanzi also noted that colorectal cancer, once considered a disease affecting people in their 50s and older, is increasingly being diagnosed in younger adults.

"As a result, screening is now recommended from the age of 40," he said, adding that those with a family history may need to start even earlier.

For prostate cancer, he recommends screening from age 50, or from around 45 for men with a family history of the disease.

Do not ignore warning signs

Rugengamanzi urged people to seek medical attention promptly if they notice symptoms that could indicate cancer.

Women who detect breast lumps, nipple discharge, abnormal vaginal bleeding, bleeding after sexual intercourse or unusual vaginal discharge should be assessed by a health professional without delay, he said.

He noted that cervical cancer screening is available at health centres and district hospitals nationwide under the country's cervical cancer elimination programme, which aims to eliminate the disease by 2027.

The Rwanda Biomedical Centre (RBC) also conducts screening campaigns targeting people at higher risk based on factors such as age and HIV status. Cervical cancer screening is generally offered free during these campaigns, although consultation fees may apply in some settings.

Screening for breast, prostate and colorectal cancers is available at selected referral hospitals, including Butaro Level II Teaching Hospital, King Faisal Hospital, Rwanda Military Referral and Teaching Hospital, the University Teaching Hospital of Kigali (CHUK) and the University Teaching Hospital of Butare (CHUB).

Rugengamanzi said screening costs for these cancers can be covered under the Rwanda Social Security Board (RSSB) health insurance scheme when recommended by a doctor.

According to GLOBOCAN 2022 estimates, Rwanda recorded an estimated 7,122 new cancer cases and 4,887 cancer-related deaths in 2022. Prostate cancer accounted for the highest number of new cases, followed by cervical, breast, stomach and liver cancers.

Key risk factors for growing cases of stomach cancer among young people in Rwanda

Doctors are reporting more stomach cancer cases among younger people in Rwanda, highlighting the importance of understanding the factors that increase the risk of developing the disease.

According to Dr Eulade Rugengamanzi, a clinical oncologist and Director General of Butaro Level II Teaching Hospital, the main risk factors include:

Helicobacter pylori (H. pylori) infection: This common bacterial infection affects the stomach lining and is one of the leading risk factors for stomach cancer. If left untreated, it can cause long-term inflammation that may lead to cancer.

Smoking: Tobacco use increases the risk of stomach cancer by damaging the stomach lining and exposing the body to cancer-causing chemicals.

Heavy alcohol consumption: Excessive alcohol intake can irritate the stomach lining and, over time, increase the likelihood of developing stomach cancer.

Chronic gastritis: Persistent inflammation of the stomach lining can cause cellular changes that raise the risk of cancer if not properly managed.

Family history: People with close relatives who have had stomach cancer may have an inherited genetic predisposition, putting them at a higher risk than the general population.

While these factors do not mean someone will definitely develop stomach cancer, they significantly increase the risk. Health experts advise people experiencing persistent stomach pain, unexplained weight loss, difficulty swallowing, loss of appetite, blood in vomit or stool, or ongoing indigestion to seek medical evaluation promptly.

Doctors also encourage adopting healthy lifestyles, avoiding tobacco and excessive alcohol use, and seeking treatment for H. pylori infection where appropriate, as early diagnosis greatly improves treatment outcomes.