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Chen DW, Lang BHH, McLeod DSA, Newbold K, Haymart MR. Thyroid cancer. Lancet 2023; 401:1531-1544. [PMID: 37023783 DOI: 10.1016/s0140-6736(23)00020-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 04/08/2023]
Abstract
The past 5-10 years have brought in a new era in the care of patients with thyroid cancer, with the introduction of transformative diagnostic and management options. Several international ultrasound-based thyroid nodule risk stratification systems have been developed with the goal of reducing unnecessary biopsies. Less invasive alternatives to surgery for low-risk thyroid cancer, such as active surveillance and minimally invasive interventions, are being explored. New systemic therapies are now available for patients with advanced thyroid cancer. However, in the setting of these advances, disparities exist in the diagnosis and management of thyroid cancer. As new management options are becoming available for thyroid cancer, it is essential to support population-based studies and randomised clinical trials that will inform evidence-based clinical practice guidelines on the management of thyroid cancer, and to include diverse patient populations in research to better understand and subsequently address existing barriers to equitable thyroid cancer care.
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Affiliation(s)
- Debbie W Chen
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian H H Lang
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Donald S A McLeod
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kate Newbold
- Thyroid Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Okerosi S, Mokoh LW, Rubagumya F, Niyibizi BA, Nkya A, Van Loon K, Buckle G, Bent S, Ha P, Fagan JJ, Ng D, Aswani J, Xu MJ. Human Papillomavirus-Associated Head and Neck Malignancies in Sub-Saharan Africa: A Systematic Review. JCO Glob Oncol 2023; 9:e2200259. [PMID: 36730877 PMCID: PMC10166441 DOI: 10.1200/go.22.00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The proportion of head and neck cancers (HNCs) with human papillomavirus (HPV) positivity in sub-Saharan Africa (SSA) is poorly characterized. Characterizing this has implications in staging, prognosis, resource allocation, and vaccination policies. This study aims to determine the proportion of HPV-associated HNC in SSA. MATERIALS AND METHODS This systematic review included searches from PubMed, EMBASE, Web of Science, African Index Medicus, Google Scholar, and African Journals Online. All English publications reporting the proportion of HNC specimens from SSA patients who tested positive for HPV and/or p16 were included. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Case Series Studies. RESULTS In this systematic review of 31 studies and 3,850 patients, the overall p16 positivity was 13.6% (41 of 1,037 patients tested) with the highest proportion among oropharyngeal cancers (20.3%, 78 of 384 patients) and the overall HPV polymerase chain reaction positivity was 15.3% (542 of 3,548 samples tested) with the highest proportion among nasopharyngeal cancers (16.5%, 23 of 139 patients). Among the 369 HPV strains detected, the most common genotypes were HPV 16 (226 patients, 59.2%) and HPV 18 (78, 20.4%). CONCLUSION HPV was found to be associated with a significant proportion of HNC in SSA. The genotypes reported suggest that the nine-valent vaccine and gender-neutral vaccination policies should be considered. Given that these studies may not accurately capture prevalence nor causation of HPV in HNC subsites, additional research is needed to provide a more thorough epidemiologic understanding of HPV-associated HNC in SSA, including risk factors and clinical outcomes.
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Affiliation(s)
- Samuel Okerosi
- ENT, Kenyatta National Hospital, ENT Department, Nairobi, Kenya
| | | | - Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda.,Rwanda Cancer Relief, Kigali, Rwanda
| | | | - Aslam Nkya
- Department of Otorhinolaryngology, Muhimibili National Hospital, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Department of Medicine, University of California San Francisco, San Francisco, CA.,Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Geoffrey Buckle
- Department of Medicine, University of California San Francisco, San Francisco, CA.,Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Stephen Bent
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Patrick Ha
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA
| | - Johannes J Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Dianna Ng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joyce Aswani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | - Mary Jue Xu
- Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, CA.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA
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3
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Bukasa JK, Bayauli-Mwasa P, Mbunga BK, Bangolo A, Kavula W, Mukaya J, Bindingija J, M’Buyamba-Kabangu JR. The Spectrum of Thyroid Nodules at Kinshasa University Hospital, Democratic Republic of Congo: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16203. [PMID: 36498276 PMCID: PMC9737877 DOI: 10.3390/ijerph192316203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
We analyzed the spectrum of thyroid nodules in patients attending the endocrinology unit care of the Kinshasa University Hospital and assessed their associated factors. We conducted a cross-sectional study, performing descriptive statistics and logistic regression. From the 888 enrolled patients, thyroid nodules were detected in 658 patients (74.1%), as mononodules in 22.5% and multiple nodules in 77.5%. Thyroid function was normal in 71.3% cases, while hyperthyroidism and hypothyroidism were found in 26.1% and 2.6% of cases, respectively. Women were more affected than men (75.1% vs. 63.6%; p = 0.03). Patients with thyroid nodules were older (44 ± 12 vs. 38 ± 12 years; p < 0.001), with a family history of goiter (38.3% vs. 27.4%; p = 0.003) and residence in the iodine-deficient region (51.7% vs. 38.8%; p = 0.012); they had a higher proportion of longer delays to consultation (47% vs. 20%; p < 0.001), but a higher rate of normal thyroid function (85.5% vs. 3 1.3%; p < 0.001). Thyroid nodules were associated with the delay to consultation (for duration ≥ three years, OR: 6.560 [95% CI: 3.525−12.208)], multiparity (present vs. absent: 2.863 [1.475−5.557]) and family history of goiter (present vs. absent: 2.086 [95% CI:1.231−3.534]) in female patients alone. The high frequency of thyroid nodules observed requires measures aimed at early detection in the population, the training of doctors involved in the management and the strengthening of technical platforms in our hospitals.
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Affiliation(s)
- John Kakamba Bukasa
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Endocrinology, Liège University Hospital Center, 4000 Liège, Belgium
| | - Pascal Bayauli-Mwasa
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Branly Kilola Mbunga
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ayrton Bangolo
- Department of Internal Medicine, Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Wivine Kavula
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Mukaya
- Radiology and Medical Imaging Unit, Department of Internal Medicine, University Hospital of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph Bindingija
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-René M’Buyamba-Kabangu
- Cardiology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Dedhia PH, Stoeckl EM, McDow AD, Saruni S, Schneider DF, Long KL. Preoperative surgeon-performed ultrasound of massive thyroid goiter in rural Kenya. Am J Surg 2021; 221:925-926. [DOI: 10.1016/j.amjsurg.2020.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 02/03/2023]
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Chorath K, Prasad A, Luu N, Go B, Moreira A, Rajasekaran K. Critical review of clinical practice guidelines for evaluation of neck mass in adults. Braz J Otorhinolaryngol 2021; 88:625-632. [PMID: 33879419 PMCID: PMC9422615 DOI: 10.1016/j.bjorl.2021.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/07/2021] [Accepted: 03/15/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Several clinical practice guidelines have been produced and disseminated for the evaluation of a neck mass. However, to date, the quality and methodologic rigor of these clinical practice guidelines have not been appraised. Therefore, this study set out to identify and assess the methodologic quality of national and international guidelines for the evaluation and management of neck masses in adults. Methods We conducted a comprehensive search of EMBASE, MEDLINE/PubMed, SCOPUS and grey literature sources until September 2020. The quality of these guidelines was assessed by four reviewers using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II). Domain scores were considered acceptable quality if they scored >60%, and Intraclass Correlation Coefficients (ICC) were calculated to assess agreement among the appraisers. Results Seven guidelines were assessed for evaluation. Among these, only the American Academy of Otolaryngology (AAO), Cancer Care Manitoba (CCMB), and the American Society of Clinical Oncology (ASCO) achieved an overall rating of “high”. The remaining four guidelines achieved ratings of either “average” or “low”. The “Scope and Purpose” domain achieved the highest mean score (94.4% ± 5.0%), and lowest was “Applicability” (51.5% ± 29.2%). ICC analysis showed substantial to very good agreement across all domains (0.75–0.98). Conclusion These findings highlight the variability in methodologic quality of guidelines for the evaluation and management of adult neck mass. The results from this analysis highlight the need to improve guidelines development process for this topic and may guide the selection and use of these guidelines in clinical practice.
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Affiliation(s)
- Kevin Chorath
- University of Pennsylvania, Department of Otorhinolaryngology, Philadelphia, PA, USA
| | - Aman Prasad
- University of Pennsylvania, Department of Otorhinolaryngology, Philadelphia, PA, USA
| | - Neil Luu
- University of Pennsylvania, Department of Otorhinolaryngology, Philadelphia, PA, USA
| | - Beatrice Go
- University of Pennsylvania, Department of Otorhinolaryngology, Philadelphia, PA, USA
| | - Alvaro Moreira
- University of Texas Health-San Antonio, Department of Pediatrics, San Antonio, TX, USA
| | - Karthik Rajasekaran
- University of Pennsylvania, Department of Otorhinolaryngology, Philadelphia, PA, USA; University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA.
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Luginbuhl A, Kahue CN, Stewart M, Curry JM, Weed D, Zender C, Netterville J, Zafereo M. Head and neck surgery global outreach: Ethics, planning, and impact. Head Neck 2021; 43:1780-1787. [PMID: 33586258 PMCID: PMC8248027 DOI: 10.1002/hed.26643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 01/28/2023] Open
Abstract
Background Head and neck surgical oncology and reconstruction are uniquely suited to address burdens of disease in underserved areas. Since these efforts are not well known in our specialty, we sought to understand global outreach throughout our society of surgeons. Methods Survey distributed to members of the American Head and Neck Surgery involved in international humanitarian head and neck surgical outreach trips. Results Thirty surgeons reported an average of seven trips to over 70 destinations. Identification of candidates, finances, on‐site patient care, complications, long‐term post‐surgical care, ethics, and educational goals are reported. We report a success rate of 90% on 125 free flaps performed in these settings. Conclusions The effort to answer the call for alleviating the global burden of surgical disease is strong within our specialty. There is a shared focus on humanitarian effort and teaching. Ethics of high resource surgeries such as free flap reconstruction remains controversial.
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Affiliation(s)
- Adam Luginbuhl
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Charissa N Kahue
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Matthew Stewart
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Donald Weed
- Department of Otolaryngology - Head and Neck Surgery, University of Miami Health System, Florida, USA
| | - Chad Zender
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - James Netterville
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Todsen T, Bennedbaek FN, Kiss K, Hegedüs L. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Head Neck 2020; 43:1009-1013. [PMID: 33368812 DOI: 10.1002/hed.26598] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 01/21/2023] Open
Abstract
Fine needle aspiration biopsy (FNAB) remains crucial in the evaluation of thyroid nodules with suspicious clinical findings or ultrasound (US) features suggestive of malignancy. The use of US-guidance for FNAB allows real-time visualization of the needle, but is also highly operator-dependent. Physicians from many specialties (endocrinologists, otolaryngologists/endocrine surgeons, nuclear medicine physicians, radiologists, and pathologists) are involved in the diagnostic workup of thyroid nodules and a standardized and meticulous technique for US-FNAB is essential for lowering the yield of nondiagnostic specimens and false-negative results. This video, therefore, demonstrates a well-proved technique and technical tips to increase the diagnostic results from US-FNAB.
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Affiliation(s)
- Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Capital Region, Copenhagen, Denmark
| | | | - Katalin Kiss
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Tierney HT, Eldeiry LS, Garber JR, Haddad CA, Varvares MA, Iannuzzi RA, Randolph GW. In-Practice Endocrine Surgery Fellowship: A Novel Training Model. Otolaryngol Head Neck Surg 2020; 164:1166-1171. [PMID: 33048614 DOI: 10.1177/0194599820962791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Endocrine surgery is an expanding field within otolaryngology. We hypothesized that a novel endocrine surgery fellowship model for in-practice otolaryngologists could result in expert-level training. STUDY DESIGN Qualitative clinical study with chart review. SETTING Urban community practice and academic medical center. METHODS Two board-certified general otolaryngologists collaborated with a senior endocrine surgeon to increase their endocrine surgery expertise between March 2015 and December 2017. The senior surgeon provided intensive surgical training to both surgeons for all of their endocrine surgeries. Both parties collaborated with endocrinology to coordinate medical care and receive referrals. All patients undergoing endocrine surgery during this time frame were reviewed retrospectively. RESULTS A total of 235 endocrine surgeries were performed. Of these, 198 thyroid surgeries were performed, including 98 total thyroidectomies (48%), 90 lobectomies (45%), and 10 completion thyroidectomies (5%). Sixty cases demonstrated papillary thyroid carcinoma, 11 follicular thyroid carcinoma, and 4 medullary thyroid carcinoma. Neck dissections were performed in 14 of the cases. Thirty-seven parathyroid explorations were performed. There were no reports of permanent hypoparathyroidism. Thirteen patients (5.5%) developed temporary hypoparathyroidism. Six patients (2.5%) developed postoperative seroma. Three patients (1.3%) developed postoperative hematomas requiring reoperation. One patient (0.4%) developed permanent vocal fold paralysis, and 3 patients (1.3%) had temporary dysphonia. Thirty-five of 37 (94.5%) parathyroid explorations resulted in biochemical resolution of the patient's primary hyperparathyroidism. CONCLUSION This is the first description of a new fellowship paradigm where a senior surgeon provides fellowship training to attending surgeons already in practice.
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Affiliation(s)
- Hien T Tierney
- Department of Otolaryngology Head and Neck Surgery, Atrius Health, Boston, Massachusetts, USA.,Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Leslie S Eldeiry
- Department of Endocrinology, Atrius Health, Boston, Massachusetts, USA
| | - Jeffrey R Garber
- Department of Endocrinology, Atrius Health, Boston, Massachusetts, USA
| | - Chia A Haddad
- Department of Otolaryngology Head and Neck Surgery, Atrius Health, Boston, Massachusetts, USA.,Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ralph A Iannuzzi
- Department of Otolaryngology Head and Neck Surgery, Atrius Health, Boston, Massachusetts, USA.,Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Fagan JJ, Wetter J, Otiti J, Aswani J, Konney A, Diom E, Baidoo K, Onakoya P, Mugabo R, Noah P, Mashamba V, Kundiona I, Macharia C, Mainasara MG, Gebeyehu M, Bogale M, Twier K, Faniriko M, Melesse GB, Shrime MG. Is AJCC/UICC Staging Still Appropriate for Head and Neck Cancers in Developing Countries? OTO Open 2020; 4:2473974X20938313. [PMID: 32671318 PMCID: PMC7338737 DOI: 10.1177/2473974x20938313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/10/2020] [Indexed: 11/15/2022] Open
Abstract
By 2030, 70% of cancers will occur in developing countries. Head and neck cancers are
primarily a developing world disease. While anatomical location and the extent of cancers
are central to defining prognosis and staging, the American Joint Committee on Cancer
(AJCC)/International Union Against Cancer (UICC) have incorporated nonanatomic factors
that correlate with prognosis into staging (eg, p16 status of oropharyngeal cancers).
However, 16 of 17 head and neck surgeons from 13 African countries cannot routinely test
for p16 status and hence can no longer apply AJCC/UICC staging to oropharyngeal cancer.
While the AJCC/UICC should continue to refine staging that best reflects treatment
outcomes and prognosis by incorporating new nonanatomical factors, they should also retain
and refine anatomically based staging to serve the needs of clinicians and their patients
in resource-constrained settings. Not to do so would diminish their global relevance and
in so doing also disadvantage most of the world’s cancer patients.
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Affiliation(s)
- Johannes J Fagan
- Division of Otolaryngology, University of Cape Town, South Africa
| | - Julie Wetter
- Department Radiation Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Joyce Aswani
- Department of Surgery, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Anna Konney
- ENT Department, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Evelyne Diom
- Division of Otolaryngology, Hôpital de la Paix, Universite Assane Seck, Ziguinchor, Senegal
| | | | - Paul Onakoya
- University of Ibadan/University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | | | | | | | | | | | | | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School and Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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