Bladder cancer cases in Africa projected to surge 133% by 2050, GLOBOCAN study finds

Bladder cancer is set to become a far heavier burden across Africa in the coming decades, according to a new analysis of GLOBOCAN 2024 estimates published in the African Journal of Urology. The study, led by Reinhard Kipkoech, Roy Olunga and Hildah Chepkoech, estimates that 33,477 new bladder cancer cases and 18,626 deaths occurred across the continent in 2024. Using the Cancer Tomorrow projection platform of the Global Cancer Observatory, the authors calculate that by 2050 annual incidence will climb to 77,989 cases, an increase of 133.0 percent, while annual deaths will reach 44,335, an increase of 138.0 percent. Crucially, the authors attribute this rise predominantly to population growth and ageing rather than to any assumed change in underlying cancer risk, because the projection applies demographic projections to the 2022 baseline estimates under a constant-risk scenario.

The geographic distribution of the current burden is strikingly uneven. Northern Africa carried the highest burden in 2024, accounting for 54.4 percent of cases and 54.7 percent of deaths. The subregion recorded the highest age-standardized incidence rate of 7.9 per 100,000 population and the highest mortality rate of 4.5 per 100,000, roughly three to four times the rates seen in Eastern, Middle and Western Africa. Egypt stands out as the epicenter, with the highest national age-standardized incidence rate of 11.4 per 100,000 and the highest mortality rate of 6.4 per 100,000. Egypt also recorded the largest absolute numbers on the continent, with 10,579 incident cases and 5,866 deaths, followed by Algeria with 3,534 cases and 2,016 deaths. Tunisia, Libya and Algeria followed Egypt in the rate rankings, with incidence age-standardized rates of 8.6, 8.2 and 7.8 per 100,000 respectively, and mortality rates of 4.8, 4.7 and 4.5 per 100,000.

The study’s authors link this North African concentration to the historically high prevalence of urinary schistosomiasis in the Nile Valley and the Maghreb region. Chronic infection with the parasitic worm Schistosoma haematobium is strongly associated with the development of bladder cancer, and this exposure has shaped regional patterns of the disease in historically endemic areas such as Egypt. The discussion notes that male-dominated agricultural and other occupational risks involving prolonged contact with infested freshwater in North Africa increase male exposure to cercariae, the infective stage of the parasite, producing male-to-female ratios of approximately 3 to 5 to 1 for schistosomiasis-associated bladder cancer in Egypt. At the continental scale, however, the disease is far from dominant: the estimated 33,477 new African cases represent only 5.3 percent of the global incidence of 635,624 new cases and 227,626 deaths estimated by GLOBOCAN 2024, with Asia, Europe and the Americas accounting for the highest shares of global incidence.

Sex disparities in the disease are pronounced and vary by subregion. In every UN subregion, incidence and mortality rates were significantly higher in males than females, with the gap most evident in Northern Africa, where male incidence and mortality age-standardized rates were more than four times those of females, with a male-to-female incidence ratio of 4.5 to 1. Southern Africa showed incidence rates of 4.9 in males versus 1.2 in females and mortality rates of 2.4 versus 0.81. Eastern Africa recorded incidence rates of 3.1 versus 1.8 and mortality rates of 1.8 versus 1.1. Western Africa showed incidence rates of 2.7 versus 1.6 and mortality rates of 1.6 versus 1.0, while Middle Africa had incidence rates of 2.5 versus 1.5 and mortality rates of 1.5 versus 0.89. The narrower disparity in Eastern, Western and Middle Africa, the authors note, agrees with reports that squamous cell carcinoma of the bladder is more evenly distributed by sex in sub-Saharan countries where occupational water exposure is less differentiated by gender.

Beyond the schistosomiasis belt, the analysis identifies countries where other risk factors likely dominate. Malawi and Burkina Faso, despite low schistosomiasis burden, had the fifth- and sixth-highest incidence rates on the continent, suggesting a role for tobacco smoking, which the authors describe as the single largest risk factor for urothelial bladder cancer globally and a source of elevated risk in both men and women. Occupational exposure to aromatic amines and other industrial carcinogens, together with chronic bladder inflammation from other causes, may further contribute to the residual burden observed outside the historically endemic belt, although country-specific data on the prevalence of these exposures across Africa remain limited. The study also highlights the interplay between population size and rates: Nigeria, with 1,249 cases and 654 deaths, and South Africa, with 1,625 cases and 886 deaths, rank among the countries with the highest case counts despite low age-standardized rates of 0.97 and 2.6 per 100,000 respectively, a pattern the authors attribute largely to their large populations.

The projection to 2050 reveals a shifting geography of relative growth. Eastern Africa is predicted to see the largest relative increases in both incidence, up 159.3 percent, and mortality, up 168.5 percent, a finding the authors link to the region’s young and rapidly growing population, projected to rise from 500.7 million to 855.5 million by 2050. Middle Africa follows with projected incidence increases of 145.2 percent and mortality increases of 147.9 percent. Southern Africa, with the lowest relative population growth of 25.3 percent, is projected to experience the lowest incidence increase of 108.7 percent and mortality increase of 107.5 percent. Despite these relative differences, the absolute burden in 2050 is estimated to remain highest in Northern Africa, with 41,220 incident cases and 23,515 deaths, representing over half of the projected continental total.

At the national level, the most pronounced proportional increases in incidence are projected for Zambia, up 250.0 percent, Cape Verde, up 228.6 percent, Uganda, up 220.7 percent, and Burundi, up 182.7 percent. In contrast, the smallest proportional increases are projected for France, La Réunion, up 66.7 percent, Mauritius, up 67.1 percent, Tunisia, up 95.0 percent, and Morocco, up 101.1 percent, patterns consistent with more advanced stages of the demographic transition in these settings. In absolute terms, Egypt is projected to carry the largest national burden by 2050, with 24,149 projected cases and 13,681 projected deaths, followed by Nigeria with 2,643 cases and 1,416 deaths, and the Democratic Republic of the Congo with 2,125 cases and 1,226 deaths.

The health-system implications are significant. The authors note that countries such as Zambia, Uganda and Burundi currently have some of the least developed urological and oncological infrastructure on the continent. A two- to threefold increase in caseload over the next 25 years, coupled with already low capacity for diagnosis and treatment, could exacerbate inequalities in stage at diagnosis and survival unless addressed through proactive investment in cystoscopy services, pathology capacity and trained urological oncology staff. The authors frame these projections as a signal for early investment in increased capacity to diagnose, treat and control cancer, alongside strengthening infrastructure for schistosomiasis control, tobacco-control interventions and cancer-registry creation across the region.

The study’s methodology underpins both its strengths and its caveats. The authors conducted a descriptive epidemiological study of bladder cancer, defined by the ICD-10 code C67, across all 54 African Union member states recognized as UN member states, grouped into the five UN subregions of Northern, Western, Middle, Eastern and Southern Africa. Data were retrieved from the Global Cancer Observatory through the Cancer Today platform, with projected 2050 figures drawn from the Cancer Tomorrow platform. Two investigators independently extracted case counts, deaths, age-standardized rates per 100,000 person-years using the world standard population, crude rates, and cumulative risk of diagnosis or death from birth to age 84 years. The data source classification for each country, whether registry-based, modelled or extrapolated, was documented to represent estimate quality, and countries with no reported figures were left blank rather than recorded as zero to avoid conflating genuine absence of cases with absence of data.

Several limitations temper the precision of these estimates. Fewer than a third of countries in sub-Saharan Africa have a population-based cancer registry with adequate national coverage, and most registries rely on cases ascertained from hospitals and laboratories, which are likely to carry a high urban bias and lack coverage for peri-urban and rural populations with limited access to cancer diagnostic services. The authors therefore caution that the reported estimates should be interpreted as indicative of broad regional patterns rather than as precise national counts. The 2050 projection additionally assumes that risk remains constant over time and does not incorporate future changes in risk exposure, screening uptake, or diagnostic and therapeutic advances. Within those constraints, the authors conclude that bladder cancer in Africa is both geographically localized and rapidly expanding, with the absolute burden most pronounced in Northern Africa and the relative burden rising most strongly in Eastern and Middle Africa, and they identify enhanced schistosomiasis control in endemic areas, expanded tobacco-control coverage continentally, and development of cancer-registry infrastructure as complementary priorities for national cancer-control planning.

Subject of Research: Bladder cancer incidence and mortality across Africa in 2024 and projections to 2050 based on GLOBOCAN estimates

Article Title: The burden of bladder cancer in Africa: a 2024 GLOBOCAN-based study with projections to 2050

Article References: Kipkoech, R., Olunga, R., & Chepkoech, H. (2026). The burden of bladder cancer in Africa: a 2024 GLOBOCAN-based study with projections to 2050. African Journal of Urology, 32(1), Article 72. https://doi.org/10.1186/s12301-026-00621-2

Image Credits: AI Generated

DOI: 10.1186/s12301-026-00621-2

Keywords: bladder cancer, Africa, GLOBOCAN 2024, cancer projections, schistosomiasis, Northern Africa, Eastern Africa, population ageing, cancer registries, tobacco control, Egypt, health-system planning