{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:37:18Z","timestamp":1780472238049,"version":"3.54.1"},"reference-count":38,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2018,2,24]]},"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:p>Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. The increasing burden of cancer calls for urgent policy attention to develop cancer prevention and control programmes. Cancer surveillance is an essential prerequisite. Only one in five low-income and middle-income countries have the necessary data to drive policy and reduce the cancer burden. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income and middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. Like many low-income and middle-income countries, Mozambique faces the dual challenge of a still high morbidity and mortality due to infectious diseases in rural areas and increased incidence of cancers associated with westernisation of lifestyles in urban areas, as well as a rise of cancers related to the HIV epidemic. An increase in cancer burden and changes in the cancer profile should be expected in coming years. The Mozambican healthcare and health-information systems, like in many other low-income and middle-income countries, are not prepared to face this epidemiological transition, which deserves increasing policy attention.<\/jats:p>","DOI":"10.1136\/bmjgh-2017-000654","type":"journal-article","created":{"date-parts":[[2018,3,26]],"date-time":"2018-03-26T01:55:09Z","timestamp":1522029309000},"page":"e000654","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Weak surveillance and policy attention to cancer in global health: the example of Mozambique"],"prefix":"10.1136","volume":"3","author":[{"given":"Cesaltina","family":"Lorenzoni","sequence":"first","affiliation":[{"name":"Department of Pathology, Maputo Central Hospital, Maputo, Mozambique"},{"name":"Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Oliveras","sequence":"additional","affiliation":[{"name":"ISGlobal, Hospital Cl\u00ednic-Universitat de Barcelona, Barcelona, Spain"},{"name":"Department of Preventive Medicine and Epidemiology, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Vilajeliu","sequence":"additional","affiliation":[{"name":"ISGlobal, Hospital Cl\u00ednic-Universitat de Barcelona, Barcelona, Spain"},{"name":"Department of Preventive Medicine and Epidemiology, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Carrilho","sequence":"additional","affiliation":[{"name":"Department of Pathology, Maputo Central Hospital, Maputo, Mozambique"},{"name":"Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamudo R","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Pathology, Maputo Central Hospital, Maputo, Mozambique"},{"name":"Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Castillo","sequence":"additional","affiliation":[{"name":"ISGlobal, Hospital Cl\u00ednic-Universitat de Barcelona, Barcelona, Spain"},{"name":"Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orvalho","family":"Augusto","sequence":"additional","affiliation":[{"name":"Community Health Department, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsin","family":"Sidat","sequence":"additional","affiliation":[{"name":"Community Health Department, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Men\u00e9ndez","sequence":"additional","affiliation":[{"name":"ISGlobal, Hospital Cl\u00ednic-Universitat de Barcelona, Barcelona, Spain"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a (CISM), Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto L","family":"Garcia-Basteiro","sequence":"additional","affiliation":[{"name":"ISGlobal, Hospital Cl\u00ednic-Universitat de Barcelona, Barcelona, Spain"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a (CISM), Maputo, Mozambique"},{"name":"Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaume","family":"Ordi","sequence":"additional","affiliation":[{"name":"ISGlobal, Hospital Cl\u00ednic-Universitat de Barcelona, Barcelona, Spain"},{"name":"Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,3,25]]},"reference":[{"key":"2025073015121530000_3.2.e000654.1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27410"},{"key":"2025073015121530000_3.2.e000654.2","unstructured":"International Agency for Research on Cancer (IARC). Cancer incidence and mortality worldwide. GLOBOCAN 2012 v1.0: IARC CancerBase."},{"key":"2025073015121530000_3.2.e000654.3","first-page":"512","article-title":"World cancer report 2008","volume":"199","author":"International Agency for Research on Cancer","year":"2008","journal-title":"Cancer Control"},{"key":"2025073015121530000_3.2.e000654.4","unstructured":"Stewart BW , Wild CP . World cancer report 2014. 2014;630 http:\/\/www.iarc.fr\/"},{"key":"2025073015121530000_3.2.e000654.5","unstructured":"Global Initiative for Cancer Registry Development (GICR). International Agency for Research on Cancer. World Health Organization [Internet]. (cited Jan 3 2018)."},{"key":"2025073015121530000_3.2.e000654.6","first-page":"729","article-title":"A cancer survey in Louren\u00e7o Marques, Portuguese East Africa","volume":"35","author":"Prates","year":"1965","journal-title":"J Natl Cancer Inst"},{"key":"2025073015121530000_3.2.e000654.7","doi-asserted-by":"crossref","first-page":"e0130469","DOI":"10.1371\/journal.pone.0130469","article-title":"Trends in cancer incidence in Maputo, Mozambique, 1991\u20132008","volume":"10","author":"Lorenzoni","year":"2015","journal-title":"PLoS One"},{"key":"2025073015121530000_3.2.e000654.8","doi-asserted-by":"crossref","unstructured":"Dudwick N , Hull K , Katayama R , et al . From farm to firm. Rural\u2013urban transition in developing countries. \u00a0Washington DC: The International Bank for Reconstruction and Development\/The World Bank, 2011:79\u2013106.","DOI":"10.1596\/9780821386231_CH04"},{"key":"2025073015121530000_3.2.e000654.9","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1016\/S0140-6736(15)61013-3","article-title":"An anthropology of aid in Africa","volume":"385","author":"Pfeiffer","year":"2015","journal-title":"Lancet"},{"key":"2025073015121530000_3.2.e000654.10","unstructured":"FAO. Nutrition Country Profile. Republic of Mozambique 2011 [Internet, 2006. Available from:. ftp:\/\/ftp.fao.org\/ag\/agn\/nutrition\/ncp\/kwt.pdf"},{"key":"2025073015121530000_3.2.e000654.11","unstructured":"Forum for Food Security in Southern Africa. Mozambique food security issues paper security. 2003."},{"key":"2025073015121530000_3.2.e000654.12","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01683-2016"},{"key":"2025073015121530000_3.2.e000654.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2012.01018.x"},{"key":"2025073015121530000_3.2.e000654.14","unstructured":"United Nations Development Programme (UNDP). Human development report 2015 work for human development, 2015."},{"key":"2025073015121530000_3.2.e000654.15","unstructured":"Mario M , Nandja D . Alfabetizaci\u00f3n en Mozambique: Desaf\u00edos de la Educaci\u00f3n Para Todos. Educ Adultos y Desarro 2006;67."},{"key":"2025073015121530000_3.2.e000654.16","unstructured":"The World Bank. Life expectancy at birth in Mozambique [Internet]. https:\/\/data.worldbank.org\/indicator\/SP.DYN.LE00.IN?locations=MZ (cited Jan 3 2018)."},{"key":"2025073015121530000_3.2.e000654.17","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1177\/0020731416637062","article-title":"Mozambique\u2019s debt and the International monetary fund\u2019s influence on poverty, education, and health","volume":"46","author":"Beste","year":"2016","journal-title":"Int J Heal Serv"},{"key":"2025073015121530000_3.2.e000654.18","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1985.107"},{"key":"2025073015121530000_3.2.e000654.19","doi-asserted-by":"crossref","first-page":"9352","DOI":"10.1021\/jf302003n","article-title":"Quantitation of mycotoxins in food and feed from Burkina Faso and Mozambique using a modern LC-MS\/MS multitoxin method","volume":"60","author":"Warth","year":"2012","journal-title":"J Agric Food Chem"},{"key":"2025073015121530000_3.2.e000654.20","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1017\/S0029665115000051","article-title":"Evidence of nutrition transition in Southern Africa","volume":"74","author":"Nnyepi","year":"2015","journal-title":"Proc Nutr Soc"},{"key":"2025073015121530000_3.2.e000654.21","first-page":"877","article-title":"Circumstances associated with the contamination of food by aflatoxin in a high primary liver cancer area","volume":"49","author":"Van Rensburg","year":"1975","journal-title":"S Afr Med J"},{"key":"2025073015121530000_3.2.e000654.22","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70198-0"},{"key":"2025073015121530000_3.2.e000654.23","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-2388(199709\/10)13:5<291::AID-SSU2>3.0.CO;2-8"},{"key":"2025073015121530000_3.2.e000654.24","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2009.08-0344"},{"key":"2025073015121530000_3.2.e000654.25","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/ijc.2910080116","article-title":"Kaposi\u2019s sarcoma in Uganda: a clinico-pathological study","volume":"8","author":"Taylor","year":"1971","journal-title":"Int J Cancer"},{"key":"2025073015121530000_3.2.e000654.26","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1002\/ijc.27714","article-title":"A contribution for a more accurate estimation of the incidence of Kaposi sarcoma in Mozambique","volume":"132","author":"Carrilho","year":"2013","journal-title":"Int J Cancer"},{"key":"2025073015121530000_3.2.e000654.27","doi-asserted-by":"publisher","DOI":"10.1054\/bjoc.1999.1071"},{"key":"2025073015121530000_3.2.e000654.28","doi-asserted-by":"publisher","DOI":"10.1007\/s00439-009-0712-z"},{"key":"2025073015121530000_3.2.e000654.29","unstructured":"GLOBOCAN. International Agency for Research on Cancer (IARC). World Health Organization [Internet]. http:\/\/globocan.iarc.fr\/Default.aspx (cited 2018 Jan 3)."},{"key":"2025073015121530000_3.2.e000654.30","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70211-5"},{"key":"2025073015121530000_3.2.e000654.31","doi-asserted-by":"crossref","unstructured":"Pi\u00f1eros M , Znaor A , Mery L , et al . A global cancer surveillance framework within noncommunicable disease surveillance: making the case for population-based cancer registries. 2017;39:161\u20139.","DOI":"10.1093\/epirev\/mxx003"},{"key":"2025073015121530000_3.2.e000654.32","unstructured":"Brunborg H . Vital statistics. Report from a mission to the National Statistical Institute of Mozambique, 2011."},{"key":"2025073015121530000_3.2.e000654.33","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyt148"},{"key":"2025073015121530000_3.2.e000654.34","unstructured":"World Health Organization. Mozambique\u2019s health system."},{"key":"2025073015121530000_3.2.e000654.35","unstructured":"WHO Country cooperation strategy 2009\u20132013. Mozambique. 2009."},{"key":"2025073015121530000_3.2.e000654.36","unstructured":"World Health Organization. World health report: working toghether for health, 2006."},{"key":"2025073015121530000_3.2.e000654.37","unstructured":"Increasing clinical and research capacity for cancer in Mozambique. A multi-center collaboration between the U.S, Brazil and Mozambique [Internet]. http:\/\/thegomap.org\/projects\/increasing-clinical-and-research-capacity-for-cancer-in-mozambique-a-multi-center-collaboration-between-the-u-s-brazil-and-mozambique (cited Jan 3\u00a0\u00a02018)."},{"key":"2025073015121530000_3.2.e000654.38","doi-asserted-by":"crossref","first-page":"23286","DOI":"10.3402\/gha.v7.23286","article-title":"The INDEPTH standard population for low- and middle-income countries, 2013","volume":"7","author":"Sankoh","year":"2014","journal-title":"Glob Health Action"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2017-000654","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T22:12:25Z","timestamp":1753913545000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2017-000654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,3,25]]},"published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1136\/bmjgh-2017-000654"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2017-000654","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}