Background
South Africa (SA) has the highest cancer incidence in sub-Saharan Africa. The top ten cancers contribute 54% of the total cancers reported from 2010–2019. Analysis of long-term cancer trends is useful to understand cancer patterns and identify causes of observed changes and effectively plan preventive measures. This study aims to provide a 10-year trend analysis of the top ten cancers in SA.

Methods
A cross-sectional study was conducted to determine the top ten cancer incidence trends from 2010–2019. The age-standardised incidence rate (ASR) was calculated using Segi-World Standard Population. The average annual per cent change (AAPC) was estimated for each cancer site by sex and population group using Joinpoint Regression statistical programme.

Results
Breast and prostate cancers remained the most common cancers among women and men respectively throughout the study period. Among women, the ASRs for breast (AAPC=4.4, p–value=0.152) and colorectal (AAPC=2.3, p–value=0.08) cancers increased, while Kaposi sarcoma (AAPC=-8.3, p–value˂0.001) declined. Among men, the ASRs for prostate (AAPC=3.6, p–value=0.006) and colorectal (AAPC=3.6, p–value=0.001) cancers increased while lung (AAPC=-7.1, p–value=0.071) cancer and Kaposi sarcoma (AAPC=-6.4, p–value=0.001) declined. When further stratified by population groups, the increase in breast cancer was significant among White women (AAPC=6.0, p–value<0.001). The increase in prostate cancer among White men (AAPC=3.3, p–value=0.001) and Black men (AAPC=7.2, p–value=<0.001) were statistically significant. Colorectal cancer increased among Black women (AAPC=4.3, P–value=0.001), Coloured women (AAPC=2.1, p–value<0.001) and Asian men (AAPC=8.8, p–value=0.009).

Conclusion
Breast and cervical cancers account for a third of all cancers in women, while prostate cancers remained the top cancer in men. The observed trends reflect changes in socioeconomic development, lifestyles, HIV epidemic and SA’s policy implementation. Strengthening the current cancer prevention and control measures is required, particularly for cancers such as colorectal cancer.