Cancer Burden and Epidemiological Trends in Somalia and Djibouti: A Comparative Analysis Using Publicly Available Global Cancer Data

Abstract

Cancer is increasingly recognized as a major public health challenge in low- and middle-income countries, including countries in the Horn of Africa such as Somalia and Djibouti. Despite limited national cancer registries and constrained healthcare systems, publicly available datasets from the Global Cancer Observatory (GLOBOCAN), the World Health Organization (WHO), and other international agencies provide valuable insights into the cancer burden in these countries. This review aimed to analyze the epidemiological characteristics, incidence, mortality patterns, and healthcare challenges associated with cancer in Somalia and Djibouti using publicly available secondary data. Breast and cervical cancers were identified as the leading cancers among women in both countries, while prostate and colorectal cancers predominated among men. Somalia reported approximately 10,681 new cancer cases and 8,038 cancer-related deaths in 2022, whereas Djibouti reported approximately 805 new cases and 572 deaths. High mortality-to-incidence ratios in both countries indicate late diagnosis, limited screening programs, and inadequate treatment infrastructure. The absence of robust cancer registries, pathology services, radiotherapy centers, and oncology workforce capacity significantly contributes to poor outcomes. Public health interventions focusing on early detection, HPV vaccination, awareness campaigns, tobacco control, and strengthening oncology infrastructure are urgently needed. This article highlights the growing cancer burden in Somalia and Djibouti and emphasizes the importance of regional and international collaboration to improve cancer control strategies in resource-limited settings.

Keywords: Somalia, Djibouti, cancer epidemiology, GLOBOCAN, WHO, Cancer awareness

Introduction

Cancer is one of the leading causes of morbidity and mortality worldwide, accounting for nearly 20 million new cases and approximately 10 million deaths globally in 2022. The burden of cancer is increasingly shifting toward low- and middle-income countries (LMICs), where healthcare systems often lack adequate infrastructure for prevention, screening, diagnosis, and treatment [1]. Countries in the Horn of Africa, particularly Somalia and Djibouti, face unique healthcare challenges resulting from fragile healthcare systems, prolonged political instability, limited health financing, and insufficient cancer surveillance programs [2]. While communicable diseases historically dominated the health agenda in these nations, non-communicable diseases (NCDs), including cancer, are becoming increasingly important contributors to mortality and disability. Reliable national cancer registries remain limited or absent in Somalia and Djibouti. Consequently, global databases such as the International Agency for Research on Cancer (IARC) Global Cancer Observatory (GLOBOCAN) and WHO country profiles provide essential epidemiological estimates for policymakers and researchers. GLOBOCAN 2022 estimates demonstrate a rising burden of breast, cervical, colorectal, prostate, and hematological malignancies in both countries [3]. 

Cancer care services in Somalia and Djibouti remain severely underdeveloped. Many patients present with advanced-stage disease due to delayed diagnosis, poor awareness, limited pathology services, and inadequate access to specialized oncology treatment. In addition, socioeconomic factors, geographic barriers, and cultural beliefs contribute to delayed healthcare-seeking behaviour.This article aims to provide a comparative overview of cancer epidemiology in Somalia and Djibouti using publicly available data from WHO, GLOBOCAN, and related international sources. The study discusses cancer incidence, mortality trends, common cancer types, healthcare system limitations, and future opportunities for cancer control in the region [5].

Methods

Study Design and Data Sources

This study was conducted as a descriptive epidemiological review using publicly available secondary cancer data obtained from international databases and published literature. Data were collected from the Global Cancer Observatory (GLOBOCAN) 2020 and 2022 databases developed by the International Agency for Research on Cancer (IARC), World Health Organization (WHO) cancer country profiles, WHO Eastern Mediterranean Regional reports, and peer-reviewed articles indexed in PubMed and Google Scholar. Additional demographic and health system information was obtained from WHO and World Bank reports related to Somalia and Djibouti. The study focused on evaluating cancer incidence, mortality patterns, prevalence, and temporal epidemiological trends in Somalia and Djibouti between 2020 and projected estimates through 2026.

Literature Search Strategy

A comprehensive literature search was performed using PubMed, Google Scholar, and WHO databases for studies published between January 2020 and March 2026. Search terms included combinations of the following keywords: “Somalia cancer epidemiology,” “Djibouti cancer burden,” “GLOBOCAN Somalia,” “GLOBOCAN Djibouti,” “breast cancer East Africa,” “cancer mortality Horn of Africa,” “oncology infrastructure Africa,” and “WHO cancer profiles.” Only English-language articles, reports, and publicly accessible epidemiological datasets were included. Studies focusing on cancer incidence, mortality, healthcare infrastructure, screening, and oncology services in Somalia, Djibouti, or the Eastern Mediterranean and sub-Saharan African regions were reviewed.

Data Collection and Variables

Data were extracted from publicly accessible international cancer databases and health reports, primarily from GLOBOCAN 2020 and 2022, WHO cancer country profiles, and published literature indexed in PubMed and Google Scholar. The collected data included the estimated number of new cancer cases, cancer-related deaths, five-year prevalence, age-standardized incidence rates (ASIR), and age-standardized mortality rates (ASMR) for Somalia and Djibouti. Particular attention was given to the most prevalent cancers in both countries, including breast, cervical, prostate, colorectal, liver, stomach, ovarian, and hematological malignancies. Demographic and healthcare system indicators relevant to cancer burden and oncology infrastructure were also reviewed. To evaluate temporal patterns, epidemiological estimates from 2020 to 2022 were analysed, while projected trends for 2023–2026 were interpreted using available WHO regional projections and previously reported GLOBOCAN trends.

Inclusion and Exclusion Criteria

Relevant articles, reports, and datasets were included if they provided epidemiological information related to cancer incidence, mortality, prevalence, screening, healthcare infrastructure, or oncology services in Somalia or Djibouti. Priority was given to studies published by recognized international organizations such as WHO, IARC, and peer-reviewed journals indexed in PubMed. Only studies published in English between 2020 and 2026 were considered for inclusion. Reports lacking sufficient epidemiological relevance, duplicate publications, editorials without primary data, and studies unrelated to cancer burden in the target countries were excluded from the review.

Statistical Analysis

Descriptive statistical methods were used to summarize cancer incidence and mortality patterns. Comparative analyses between Somalia and Djibouti were performed using available age-standardized incidence and mortality estimates. Due to the absence of comprehensive national cancer registries in both countries, formal meta-analysis and inferential statistical testing were not performed. Data were presented narratively using tables and figures to illustrate temporal cancer trends, regional comparisons, and distribution of major cancer types.

Ethical Considerations

This study utilized publicly available secondary data and did not involve human participants, patient identifiers, or confidential clinical information. Therefore, institutional ethical approval and informed consent were not required according to international guidelines for secondary data analysis.

Epidemiological Overview of Cancer in Somalia (2020–2026)

GLOBOCAN 2020 estimated approximately 9,800–10,000 new cancer cases annually in Somalia, with nearly 7,000 cancer-related deaths. By 2022, the estimated number of new cases had increased to approximately 10,681, while deaths rose to approximately 8,038 [6]. This increase likely reflects population growth, aging demographics, urbanization, lifestyle changes, improved diagnostic recognition, and ongoing epidemiological transition from communicable to non-communicable diseases. The age-standardized incidence rate (ASIR) for all cancers in Somalia increased modestly between 2020 and 2022, while mortality rates remained disproportionately high. The mortality-to-incidence ratio (MIR) remains among the highest globally, suggesting substantial deficiencies in cancer screening, early diagnosis, and treatment access. Females accounted for the majority of cancer cases, largely due to the high burden of breast and cervical cancers [7]. Breast cancer represented approximately 27.1% of all female cancers, followed by cervical cancer at 17.5%. Among males, prostate cancer was the leading malignancy, followed by colorectal cancer and leukemia. The high mortality burden reflects inadequate diagnostic and treatment capacity, with many patients presenting at advanced stages. [8]. 

Cancer epidemiology in Somalia has shown a gradual but concerning increase between 2020 and 2026, reflecting broader global trends in low- and middle-income countries (LMICs). Although Somalia lacks a comprehensive population-based national cancer registry,[10] estimates from the International Agency for Research on Cancer (IARC), Global Cancer Observatory (GLOBOCAN), World Health Organization (WHO), and regional public health reports indicate a rising burden of malignancies, particularly breast, cervical, colorectal, prostate, and haematological cancers. (Figure1) 

Figure 1. Cancer Epidemiology Trends in Somalia (2020–2026)

Major Cancer Types in Somalia

Breast cancer remained the leading malignancy among Somali women throughout the study period [11]. In 2020, breast cancer accounted for nearly one-quarter of female cancers, increasing further by 2022. Delayed presentation, low awareness, absence of mammographic screening programs, and limited pathology services contribute significantly to poor survival outcomes [12].  Cervical cancer represented the second most common female malignancy in Somalia from 2020 onward. Persistent infection with high-risk human papillomavirus (HPV), low HPV vaccination coverage, limited Pap smear screening, and inadequate gynaecologic oncology services remain major contributing factors [14]. Among Somali men, prostate cancer became increasingly recognized between 2020 and 2026 as the leading male cancer [15]. Population aging and improved clinical recognition may partially explain this increase. However, diagnosis often occurs at advanced stages due to lack of PSA screening and limited urologic services [16]. Colorectal cancer incidence also increased gradually during this period, likely associated with urban dietary changes, obesity, sedentary lifestyle, and tobacco exposure. Similar trends have been observed globally in LMICs undergoing epidemiological transition. (Table1) 

Table 1. Estimated Cancer Trends in Somalia (2020–2026)

Projected estimates based on GLOBOCAN trends and WHO regional projections.

Epidemiological Overview of Cancer in Djibouti (2020–2026)

Cancer has emerged as an increasingly important public health concern in Djibouti over recent years, reflecting the broader epidemiological transition occurring across low- and middle-income countries [17]. Historically, infectious diseases represented the dominant health burden in Djibouti; however, non-communicable diseases, particularly cancer, are now contributing substantially to morbidity and mortality. Between 2020 and 2026, available estimates from the International Agency for Research on Cancer (IARC), Global Cancer Observatory (GLOBOCAN), and the World Health Organization (WHO) indicate a gradual rise in cancer incidence and mortality in the country [18]. 

According to GLOBOCAN 2022 estimates, Djibouti recorded approximately 805 new cancer cases and 572 cancer-related deaths in 2022 among a population of nearly 1.02 million people. The age-standardized incidence rate (ASIR) was estimated at 90.7 per 100,000 population, while the age-standardized mortality rate (ASMR) reached 66.7 per 100,000 population [19]. Females accounted for most newly diagnosed cases, primarily due to the high burden of breast and cervical cancers [20].

Figure 2. Epidemiological Trends of Cancer in Djibouti 

Breast cancer remained the most common malignancy among women throughout the study period [21]. In 2022, breast cancer accounted for approximately 22.4% of all cancer cases in Djibouti, followed by cervical cancer and colorectal cancer. Among men, prostate cancer represented the leading malignancy, followed by colorectal cancer and non-Hodgkin lymphoma. Similar patterns have been observed across several countries in the Eastern Mediterranean and sub-Saharan African regions [22]. 

The increasing cancer burden in Djibouti is likely multifactorial. Rapid urbanization, population growth, aging demographics, dietary transition, tobacco exposure, reduced physical activity, and increasing prevalence of obesity may all contribute to rising cancer incidence. Additionally, chronic infections such as human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Helicobacter pylori continue to contribute to infection-related cancers, particularly cervical and liver cancers [23]. 

Despite relatively lower incidence rates compared with many high-income countries, Djibouti continues to experience disproportionately high cancer mortality. The mortality-to-incidence ratio remains elevated, indicating substantial deficiencies in early diagnosis, screening programs, pathology services, and treatment accessibility. Most patients are diagnosed at advanced stages, which significantly reduces survival outcomes. Limited public awareness regarding cancer symptoms and screening further contributes to delayed healthcare-seeking behaviour [24].

Table 2. Estimated Cancer Trends in Djibouti (2020–2026)

Projected estimates based on GLOBOCAN 2020–2022 trends and WHO regional projections.

Cancer care infrastructure in Djibouti remains limited despite gradual improvements in healthcare services over recent years. The country continues to face shortages of oncologists, pathologists, radiologists, oncology nurses, and radiotherapy facilities. Access to advanced diagnostic tools such as immunohistochemistry, computed tomography (CT), magnetic resonance imaging (MRI), and molecular testing remains restricted. Consequently, many patients seek specialized oncology care abroad, particularly in neighboring countries and the Middle East. Cervical cancer remains a major public health concern in Djibouti due to limited HPV vaccination coverage and inadequate cervical screening programs [25]. WHO has identified HPV vaccination and early detection as critical interventions for reducing cervical cancer mortality in low-resource settings. Similarly, breast cancer awareness campaigns and expansion of mammography services are urgently needed to improve early diagnosis. Future projections suggest that cancer incidence in Djibouti will continue increasing through 2026 and beyond if preventive interventions are not strengthened. Population aging, ongoing epidemiological transition, and lifestyle-related risk factors are expected to contribute to the continued rise in cancer burden. Strengthening national cancer control programs, improving cancer registries, expanding pathology infrastructure, and increasing access to screening and treatment services are essential priorities for reducing future cancer mortality in Djibouti [26].

Cancer Care Challenges in Somalia and Djibouti

Despite gradual improvements in healthcare services across the Horn of Africa, both Somalia and Djibouti continue to face substantial challenges in cancer prevention, diagnosis, and treatment. The oncology healthcare systems in both countries remain underdeveloped, limiting the ability to provide timely and effective cancer care. One of the major challenges is the absence or limited availability of population-based cancer registries, resulting in incomplete epidemiological data and underestimation of the true cancer burden. Reliable cancer surveillance remains essential for planning national cancer control strategies and allocating healthcare resources effectively [27].

Diagnostic capacity also remains limited in both countries. Access to pathology laboratories, immunohistochemistry, advanced imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), and molecular diagnostic testing is restricted, particularly outside major urban centers. As a result, many patients experience delayed diagnosis and are frequently diagnosed at advanced stages of disease, significantly reducing treatment success and survival outcomes.

Another major challenge is the severe shortage of trained oncology professionals, including oncologists, oncology nurses, radiologists, pathologists, and radiation therapists. Cancer treatment services such as chemotherapy and radiotherapy remain limited or unavailable in several regions. Somalia continues to face major constraints related to chemotherapy availability and widespread radiotherapy access, while Djibouti remains heavily dependent on foreign referral centers for specialized oncology care. Consequently, many patients are required to travel abroad for treatment, creating substantial financial and logistical burdens for patients and their families.

Financial toxicity represents another important barrier to cancer care in both countries. Out-of-pocket healthcare expenditure remains high, and many patients are unable to afford diagnostic investigations, medications, surgery, or overseas referrals. In Somalia, prolonged political instability, fragile healthcare infrastructure, and limited public health financing further exacerbate difficulties in accessing cancer services. Similarly, Djibouti continues to face resource limitations that affect the expansion of comprehensive oncology care programs.

Collectively, these healthcare system limitations contribute to delayed presentation, poor access to treatment, and high cancer mortality rates in both Somalia and Djibouti. Strengthening cancer registries, expanding diagnostic infrastructure, improving workforce training, and increasing investment in oncology services are essential steps toward improving cancer outcomes in the region [28].

Future Outlook for Cancer Burden in Somalia and Djibouti 

Current projections suggest that the cancer burden in both Somalia and Djibouti will continue increasing through 2026 and beyond. Rapid population growth, improving life expectancy, urbanization, lifestyle modifications, tobacco exposure, dietary transition, and declining mortality from communicable diseases are expected to contribute substantially to the rising incidence of cancer in both countries. Similar epidemiological transitions have been observed across several low- and middle-income countries undergoing demographic and socioeconomic changes. Breast, cervical, colorectal, and prostate cancers are expected to remain the dominant malignancies in Somalia and Djibouti over the coming years. In addition, increasing prevalence of obesity, physical inactivity, smoking, and chronic viral infections such as human papillomavirus (HPV), hepatitis B virus (HBV), and hepatitis C virus (HCV) may further contribute to the growing cancer burden. The aging population is also likely to increase the incidence of age-related cancers, particularly prostate and colorectal cancers.

Despite these projected increases, both countries continue to face major healthcare system limitations that may negatively affect cancer outcomes. Without substantial investment in prevention programs, early detection strategies, pathology infrastructure, screening services, and oncology workforce development, cancer mortality rates are likely to remain disproportionately high. Limited access to radiotherapy, chemotherapy, and specialized oncology care may continue contributing to delayed diagnosis and poor survival outcomes. The World Health Organization (WHO) and International Agency for Research on Cancer (IARC) have projected that countries with low Human Development Index (HDI) levels, including Somalia and Djibouti, may experience some of the largest proportional increases in global cancer incidence and mortality over the coming decades. Strengthening national cancer control plans, expanding HPV vaccination programs, improving breast and cervical cancer screening, and enhancing regional oncology collaborations will be essential to reducing the future cancer burden in both countries [29].

Comparative Analysis Between Somalia and Djibouti

Somalia and Djibouti show very similar cancer patterns, with breast and cervical cancers being the most common among women in both countries (Figure3). These cancers make up a large share of the overall cancer burden, largely due to low levels of screening, late diagnosis, and limited public awareness about early symptoms and prevention. At the same time, both countries are seeing a gradual increase in colorectal cancer, which may reflect changing diets, urbanization, and shifting lifestyles over recent years. Despite these emerging trends, both Somalia and Djibouti continue to face very high mortality compared to incidence rates, which points to significant delays in diagnosis and limited access to timely treatment. Health systems in both settings also struggle with weak screening programs and insufficient diagnostic and oncology services. In addition, (Table 3) the lack of well-established national cancer registries in both countries makes it difficult to accurately monitor cancer trends or design effective long-term control strategies [30].

                                       Table 3. Comparative Cancer Indicators

The mortality-to-incidence ratio is particularly concerning in both countries. This reflects late-stage presentation and limited access to effective oncology services.

Figure 3. Comparative Cancer Patterns in Somalia and Djibouti

Challenges in Cancer Care Infrastructure and Public Health Implications

Both Somalia and Djibouti face substantial challenges in developing effective cancer care systems, largely due to long-standing structural and resource limitations. A major gap is the absence of comprehensive, population-based cancer registries in both countries, which leads to underreporting and weak epidemiological surveillance. In addition, there is a critical shortage of trained oncology professionals, including oncologists, pathologists, oncology nurses, radiologists, and radiation therapists, which severely limits the capacity to diagnose and manage cancer patients effectively.

Diagnostic and treatment infrastructure is also highly constrained. Access to essential services such as pathology laboratories, immunohistochemistry, advanced imaging (CT and MRI), and molecular diagnostics remains limited, delaying accurate diagnosis and appropriate treatment planning. Radiotherapy services are either extremely scarce or unavailable in many regions, forcing patients to seek care abroad at great financial and logistical burden. This is further compounded by significant financial toxicity, as most cancer care expenses are paid out-of-pocket, placing many families under catastrophic economic strain. Given these challenges, the growing cancer burden in Somalia and Djibouti calls for urgent and coordinated public health action. Priority interventions should include the development of national cancer control plans, establishment of functional cancer registries, and implementation of preventive strategies such as HPV vaccination and tobacco control policies. Strengthening public awareness, expanding pathology and imaging services, and investing in oncology workforce training are also essential. Finally, building regional referral networks and fostering international partnerships and donor support will be crucial to improving cancer care capacity and outcomes in both countries.

Limitations

This study has several limitations that should be acknowledged. First, the lack of comprehensive, population-based cancer registries in both Somalia and Djibouti limits the accuracy and completeness of available epidemiological data. As a result, much of the existing information is based on hospital records or fragmented reporting systems, which may not fully reflect the true cancer burden in the population. In addition, the scarcity of published studies and reliable national datasets restricts the depth of comparative analysis between the two countries. Differences in healthcare infrastructure, reporting practices, and diagnostic capacity may also introduce bias and reduce the generalizability of findings. Furthermore, limited access to molecular and survival data makes it difficult to fully assess cancer outcomes and long-term trends in both settings.

Future Directions

Future research in Somalia and Djibouti should prioritize building stronger population-based cancer registries to ensure more accurate and reliable data on cancer incidence and outcomes. There is also a need for molecular epidemiology studies to better understand the biological and genetic patterns of cancers in these populations. In addition, more attention should be given to cancer survival analyses, healthcare access disparities, and the cost-effectiveness of screening programs to guide evidence-based policy decisions. Other important areas of focus include investigating environmental and occupational risk factors that may contribute to cancer development in the region. At the same time, emerging solutions such as digital health technologies and tele-oncology offer promising opportunities to improve access to specialist care, particularly for patients in remote or underserved areas where oncology services are limited.

Conclusion

Cancer is becoming an increasingly important public health challenge in both Somalia and Djibouti. The most affected sites include breast, cervical, prostate, and colorectal cancers, which together account for a large proportion of the overall cancer burden. Unfortunately, high mortality rates are still common, largely due to late-stage diagnosis and limited access to timely and effective treatment. These poor outcomes are closely linked to weak health system infrastructure, including the lack of comprehensive cancer registries, inadequate screening programs, and shortages in trained oncology personnel and essential treatment services. Addressing this growing burden will require urgent investment in public health systems, stronger regional cooperation, and sustained international support. Strengthening surveillance systems, expanding HPV vaccination coverage, improving community awareness, and developing the oncology workforce are essential steps toward reducing cancer-related illness and deaths in Somalia and Djibouti.

Conflict of Interest

The Authors has no conflict of Interest

Funding

None

Author Contribution 

SMH: conceived of the presented idea, wrote the manuscript verified the analytical methods. SMH, FKK, HS, proofread the manuscript. all authors read and approve the Last Version of this Manuscript

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