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Tan SX, Pumpalova Y, Rogers AM, Bhatt K, Herbst C, Ruff P, Neugut AI, Hur C. Cost-effectiveness of adjuvant chemotherapy for high-risk stage II and stage III colon cancer in South Africa. Cancer Med 2023; 12:15515-15529. [PMID: 37318753 PMCID: PMC10417185 DOI: 10.1002/cam4.6199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Colon cancer incidence is rising in low- and middle-income countries (LMICs), where resource limitations and cost often dictate treatment decisions. In this study, we evaluate the cost-effectiveness of adjuvant chemotherapy for high-risk stage II and stage III colon cancer treatment in South Africa (ZA) and illustrate how such analyses can inform cancer treatment recommendations in a LMIC. METHODS We created a decision-analytic Markov model to compare lifetime costs and outcomes for patients with high-risk stage II and stage III colon cancer treated with three adjuvant chemotherapy regimens in a public hospital in ZA: capecitabine and oxaliplatin (CAPOX) for 3 and 6 months, and capecitabine for 6 months, compared to no adjuvant treatment. The primary outcome was the incremental cost-effectiveness ratio (ICER) in international dollars (I$) per disability-adjusted life-year (DALY) averted, at a willingness-to-pay (WTP) threshold equal to the 2021 ZA gross domestic product per capita (I$13,764/DALY averted). RESULTS CAPOX for 3 months was cost-effective for both patients with high-risk stage II and patients with stage III colon cancer (ICER = I$250/DALY averted and I$1042/DALY averted, respectively), compared to no adjuvant chemotherapy. In subgroup analyses of patients by tumor stage and number of positive lymph nodes, for patients with high-risk stage II colon cancer and T4 tumors, and patients with stage III colon cancer with T4 or N2 disease. CAPOX for 6 months was cost-effective and the optimal strategy. The optimal strategy in other settings will vary by local WTP thresholds. Decision analytic tools can be used to identify cost-effective cancer treatment strategies in resource-constrained settings. CONCLUSION Colon cancer incidence is increasing in low- and middle-income countries, including South Africa, where resource constraints can impact treatment decisions. This cost-effectiveness study evaluates three systemic adjuvant chemotherapy options, compared to surgery alone, for patients in South African public hospitals after surgical resection for high-risk stage II and stage III colon cancer. Doublet adjuvant chemotherapy (capecitabine and oxaliplatin) for 3 months is the cost-effective strategy and should be recommended in South Africa.
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Affiliation(s)
- Sarah Xinhui Tan
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Yoanna Pumpalova
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Alexandra M. Rogers
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Kishan Bhatt
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Candice‐lee Herbst
- Department of Internal Medicine, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Paul Ruff
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) LtdJohannesburgSouth Africa
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Division of Medical Oncology, Department of Medicine, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Alfred I. Neugut
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Chin Hur
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
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2
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Anugwom C, Braimoh G, Sultan A, Johnson WM, Debes JD, Mohammed A. Epidemiology and genetics of early onset colorectal cancer—African overview with a focus on Ethiopia. Semin Oncol 2023:S0093-7754(23)00040-4. [PMID: 37032270 DOI: 10.1053/j.seminoncol.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Colorectal cancer (CRC) is a common cause of cancer-related death worldwide, with high rates of late diagnosis and increased mortality in sub-Saharan Africa. Furthermore, there is an alarming uptrend in the incidence of early onset colorectal cancer (EOCRC) across the globe, thus necessitating the need for early screening in general and special populations. There is, however, limited data available on the incidence and genetic characteristics of EOCRC from resource-poor countries, particularly Africa. Moreover, there is lack of clarity if recommendations and mechanisms proposed based on data from resource-rich countries applies to other regions of the world. In this review, we appraise the literature on EOCRC, its overall incidence, and genetic components as it pertains to sub-Saharan Africa. In addition, we highlight epidemiologic and epigenetic findings of our EOCRC cohort in Ethiopia.
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McCabe M, Penny C, Magangane P, Mirza S, Perner Y. Left-sided colorectal cancer distinct in indigenous African patients compared to other ethnic groups in South Africa. BMC Cancer 2022; 22:1089. [PMID: 36280820 PMCID: PMC9590207 DOI: 10.1186/s12885-022-10185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction A large proportion of indigenous African (IA) colorectal cancer (CRC) patients in South Africa are young (< 50 years), with no unique histopathological or molecular characteristics. Anatomical site as well as microsatellite instability (MSI) status have shown to be associated with different clinicopathological and molecular features. This study aimed to ascertain key histopathological features in microsatellite stable (MSS) and low-frequency MSI (MSI-L) patients, to provide insight into the mechanism of the disease. Methods A retrospective cohort (2011–2015) of MSS/MSI-L CRC patient samples diagnosed at Charlotte Maxeke Johannesburg Academic Hospital was analyzed. Samples were categorized by site [right colon cancer (RCC) versus left (LCC)], ethnicity [IA versus other ethnic groups (OEG)] and MSI status (MSI-L vs MSS). T-test, Fischer’s exact and Chi-square tests were conducted. Results IA patients with LCC demonstrated an increased prevalence in males, sigmoid colon, signet-ring-cell morphology, MSI-L with BAT25/26 marker instability and advanced disease association. Conclusion This study revealed distinct histopathological features for LCC, and suggests BAT25 and BAT26 as negative prognostic markers in African CRC patients. Larger confirmatory studies are recommended.
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Affiliation(s)
- Michelle McCabe
- Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, National Health Laboratory Services, Johannesburg, 2193 South Africa ,Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, National Health Laboratory Services, Braamfontein, Johannesburg, 2000 South Africa
| | - Clement Penny
- grid.11951.3d0000 0004 1937 1135Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, 2193 South Africa
| | - Pumza Magangane
- Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, National Health Laboratory Services, Johannesburg, 2193 South Africa
| | - Sheefa Mirza
- grid.11951.3d0000 0004 1937 1135Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, 2193 South Africa
| | - Yvonne Perner
- Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, National Health Laboratory Services, Johannesburg, 2193 South Africa
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Uwamariya D, Ruhangaza D, Rugwizangoga B. Pathological Characteristics, Prognostic Determinants and the Outcome of Patients Diagnosed with Colorectal Adenocarcinoma at the University Teaching Hospital of Kigali. Can J Gastroenterol Hepatol 2022; 2022:6608870. [PMID: 36247044 PMCID: PMC9553703 DOI: 10.1155/2022/6608870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Worldwide, colorectal cancer (CRC) is the second most diagnosed cancer in female and the third in men, arising from the epithelium of the colorectum. It is known that colorectal cancer is common in developed countries than in developing countries which may be due to inaccurate data on the existence of the disease in that region combined with embracing western lifestyle expressed by the current trend of changes in cultural, social, and lifestyle practices playing a major part in the etiology of CRC. The aim of this study was to document epidemiological, pathological characteristics, and prognostics determinants of patients diagnosed with CRC in Rwanda. The data from patients' files and reviewed glass slides for 101 cases all from Kigali University Teaching Hospital (CHUK) were statistically analyzed and patient characteristics were described as mean and frequency accordingly. Comparisons were performed using chi square tests, Fisher's exact test and odds ratio with 95% confidence interval (CI). Survival curves were plotted using the Kaplan-Meier method, and log-rank test was used to assess the statistical differences in the observed survival curves by each categorical variable. A P value < 0.05 was considered statistically significant. Statistical analyses were performed using Statistical Product and Service Solutions (SPSS), GraphPad Prism, and MedCalc, accordingly. Mean age of the participants was 54.26 years, the main symptom was rectal bleeding (46.5%), rectal adenocarcinoma NOS represented 40.6%, conventional adenocarcinoma was 60.4%, most tumors were of Grade II (54.5%), most common stage was pT3N0 (20.8%), resection margins were free at 71.3%, lympho-vascular invasion was 49.5% of cases, a high immune response was in 71.3% of cases and of 101cases, and 55.4% were still alive at the end of the data collection, with 29.3% of patients have overall survival of 5 years. Prognostic determinants also affect the outcome in this study and overall survival period was 3 years for CRC diagnosed in Rwanda.
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Affiliation(s)
- Delphine Uwamariya
- Department of Pathology, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | - Belson Rugwizangoga
- Department of Pathology, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
- Department of Pathology, University Teaching Hospital of Kigali, Kigali, Rwanda
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Alatise OI, Knapp GC, Bebington B, Ayodeji P, Dare A, Constable J, Olasehinde O, Kingham TP. Racial Differences in the Phenotype of Colorectal Cancer: A Prospective Comparison Between Nigeria and South Africa. World J Surg 2022; 46:47-53. [PMID: 34482410 PMCID: PMC8688240 DOI: 10.1007/s00268-021-06304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION There are significant differences in the phenotype of CRC by race in the U.S. A similar CRC phenotype-race relationship also appears to exist in South Africa (SA). However, there is a paucity of comparative data on the presentation and survival of CRC in sub-Saharan African by country of origin or race. This study compares clinicopathologic variables between CRC patients in Nigeria and SA. METHODS From a prospective CRC database, consecutive patients diagnosed between September, 2013 and October, 2018 from the African Research Group for Oncology in South West Nigeria were compared to consecutive patients diagnosed from January, 2016 to October, 2018 from the Colorectal Cancer in South Africa database. Patients with histologically confirmed adenocarcinoma were included. Patients were excluded if they had in-situ disease or no histological diagnosis. Clinical outcomes were calculated from the date of presentation. National census categories were used to define self-reported race in SA. RESULTS The mean age at presentation in Nigeria (n = 347) was 54.1 years (SD 15.5) compared to 56.8 (SD 13.7) in SA (n = 534). The median age among Black SA (BSA) patients was significantly lower than the median age among White SA (WSA) patients (55 vs. 63, p < 0.001). Right-sided colon cancer was more common in Nigerian (27.4%) and BSA (21.2%) patients compared to WSA patients (15.2%, p < 0.001). Nigerian (39.1%) and BSA (16.7%) patients were also more likely to present with mucinous histology than WSA patients (4.9%, p < 0.001). There was a significant difference in the stage-at-presentation between the cohorts, with a large burden of stage IV disease in the Nigerian cohort (52.6%). Adjusting for stage-at-presentation, there was a significant difference in the median overall survival between country and racial cohorts. CONCLUSION There are significant differences in the phenotype of CRC between Nigeria and SA. Nigerian and BSA patients, appear to share characteristics that are different than those of WSA patients. Larger series with tissue banking and next-generation sequencing are needed to better delineate these observed differences.
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Affiliation(s)
- Olusegun I. Alatise
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria
| | - Gregory C. Knapp
- Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brendan Bebington
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patrick Ayodeji
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria
| | - Anna Dare
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeremy Constable
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olalekan Olasehinde
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University Teaching Hospital Complex, PMB 5538, Ile-Ife, Osun State, Nigeria
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Pumpalova Y, Rogers AM, Tan SX, Herbst CL, Ruff P, Neugut AI, Hur C. Modeling the Cost-Effectiveness of Adjuvant Chemotherapy for Stage III Colon Cancer in South African Public Hospitals. JCO Glob Oncol 2021; 7:1730-1741. [PMID: 34936375 PMCID: PMC8710350 DOI: 10.1200/go.21.00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer incidence is rising in low- and middle-income countries, where resource constraints often complicate therapeutic decisions. Here, we perform a cost-effectiveness analysis to identify the optimal adjuvant chemotherapy strategy for patients with stage III colon cancer treated in South African (ZA) public hospitals. METHODS A decision-analytic Markov model was developed to compare lifetime costs and outcomes for patients with stage III colon cancer treated with six adjuvant chemotherapy regimens in ZA public hospitals: fluorouracil, leucovorin, and oxaliplatin for 3 and 6 months; capecitabine and oxaliplatin (CAPOX) for 3 and 6 months; capecitabine for 6 months; and fluorouracil/leucovorin for 6 months. Transition probabilities were derived from clinical trials to estimate risks of toxicity, disease recurrence, and survival. Societal costs and utilities were obtained from literature. The primary outcome was the incremental cost-effectiveness ratio in international dollars (I$) per disability-adjusted life-year (DALY) averted, compared with no therapy, at a willingness-to-pay (WTP) threshold of I$13,006.56. RESULTS CAPOX for 3 months was cost-effective (I$5,381.17 and 5.74 DALYs averted) compared with no adjuvant chemotherapy. Fluorouracil, leucovorin, and oxaliplatin for 6 months was on the efficiency frontier with 5.91 DALYs averted but, with an incremental cost-effectiveness ratio of I$99,021.36/DALY averted, exceeded the WTP threshold. CONCLUSION In ZA public hospitals, CAPOX for 3 months is the cost-effective adjuvant treatment for stage III colon cancer. The optimal strategy in other settings may change according to local WTP thresholds. Decision analytic tools can play a vital role in selecting cost-effective cancer therapeutics in resource-constrained settings.
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Affiliation(s)
- Yoanna Pumpalova
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Alexandra M Rogers
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Sarah Xinhui Tan
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Candice-Lee Herbst
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Ruff
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa.,SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alfred I Neugut
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Chin Hur
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Selemane C, Jamisse L, Arroz J, Túlsidas S, Morais AG, Carrilho C, Modcoicar P, Sidat M, Rodrigues J, Moreira-Gonçalves D, Ismail M, Santos LL. Demographic, clinical and pathological characterisation of patients with colorectal and anal cancer followed between 2013 and 2016 at Maputo Central Hospital, Mozambique. Ecancermedicalscience 2021; 15:1205. [PMID: 33912230 PMCID: PMC8057776 DOI: 10.3332/ecancer.2021.1205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study was to investigate colorectal cancer (CRC) data and anal cancer data from Maputo Central Hospital (MCH), the largest hospital and a reference for oncological diseases in Mozambique, with the aim of characterising the disease profile in view to define an appropriate control programme. Methods MCH records from the Pathology and Surgery Services and MCH Cancer Registry database were assessed to obtain retrospective clinical and pathologic data of patients with CRC or anal cancer admitted to and treated between 13 December 2013 and 23 March 2016. Results The female gender was more prevalent (54.8%), even when anal cancers were excluded. Median age was 54 years (20–99). Most patients (51.6%) lived in the city of Maputo. The most common presenting symptom was found to be rectal bleeding. Adenocarcinoma was the most frequent histological type, and the most prevalent anatomical site was the rectum. Most of the cases were diagnosed at MCH in advanced stages. Colostomy was the most frequent surgical procedure and performed in 38.7% of the patients. Most cases of anal cancer occurred in human immunodeficiency virus-infected patients. Most patients had a poor prognosis due to advanced stage at first diagnosis. Conclusion We observed an increase in cases of CRC and anal cancer in Mozambique and mostly diagnosed at advanced stages, which anticipates a dismal prognosis. Our data supports the urgent need of a comprehensive public health programme dedicated to solving this growing concern.
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Affiliation(s)
- Carlos Selemane
- Surgical Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Luisa Jamisse
- Pathology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Jorge Arroz
- Save the Children, P.O.Box 1854, Rua de Tchamba nº 398, Maputo, Mozambique
| | - Satish Túlsidas
- Medical Oncology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - António Gudo Morais
- Radiotherapy Service, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Carla Carrilho
- Pathology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Moçambique
| | - Prassad Modcoicar
- Gastroenterology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Moshin Sidat
- Department of Community Health, University of Eduardo Mondlane, 1653 Av Eduardo Mondlane, Maputo, Mozambique.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon,R. da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Jessica Rodrigues
- Epidemiology Service, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal
| | - Daniel Moreira-Gonçalves
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, R. Dr. Plácido da Costa 91, 4200-450, Porto, Portugal.,Experimental Pathology and Therapeutics Research Group, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal
| | - Mamudo Ismail
- Pathology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Moçambique
| | - Lúcio Lara Santos
- Experimental Pathology and Therapeutics Research Group, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal.,Surgical Oncology Department, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal.,ONCOCIR-Education and Care in Oncology, Lusophone , Africa, Rua de Quires 168-10J, Moreira da Maia , Portugal
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Motsuku L, Chen WC, Muchengeti MM, Naidoo M, Quene TM, Kellett P, Mohlala MI, Chu KM, Singh E. Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002-2014. BMC Cancer 2021; 21:129. [PMID: 33549058 PMCID: PMC7866437 DOI: 10.1186/s12885-021-07853-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND South Africa (SA) has experienced a rapid transition in the Human Development Index (HDI) over the past decade, which had an effect on the incidence and mortality rates of colorectal cancer (CRC). This study aims to provide CRC incidence and mortality trends by population group and sex in SA from 2002 to 2014. METHODS Incidence data were extracted from the South African National Cancer Registry and mortality data obtained from Statistics South Africa (STATS SA), for the period 2002 to 2014. Age-standardised incidence rates (ASIR) and age-standardised mortality rates (ASMR) were calculated using the STATS SA mid-year population as the denominator and the Segi world standard population data for standardisation. A Joinpoint regression analysis was computed for the CRC ASIR and ASMR by population group and sex. RESULTS A total of 33,232 incident CRC cases and 26,836 CRC deaths were reported during the study period. Of the CRC cases reported, 54% were males and 46% were females, and among deaths reported, 47% were males and 53% were females. Overall, there was a 2.5% annual average percentage change (AAPC) increase in ASIR from 2002 to 2014 (95% CI: 0.6-4.5, p-value < 0.001). For ASMR overall, there was 1.3% increase from 2002 to 2014 (95% CI: 0.1-2.6, p-value < 0.001). The ASIR and ASMR among population groups were stable, with the exception of the Black population group. The ASIR increased consistently at 4.3% for black males (95% CI: 1.9-6.7, p-value < 0.001) and 3.4% for black females (95% CI: 1.5-5.3, p-value < 0.001) from 2002 to 2014, respectively. Similarly, ASMR for black males and females increased by 4.2% (95% CI: 2.0-6.5, p-value < 0.001) and 3.4% (, 95%CI: 2.0-4.8, p-value < 0.01) from 2002 to 2014, respectively. CONCLUSIONS The disparities in the CRC incidence and mortality trends may reflect socioeconomic inequalities across different population groups in SA. The rapid increase in CRC trends among the Black population group is concerning and requires further investigation and increased efforts for cancer prevention, early screening and diagnosis, as well as better access to cancer treatment.
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Affiliation(s)
- Lactatia Motsuku
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
- Department of Global Health, South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
- Faculty of Health Sciences, Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Mazvita Molleen Muchengeti
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Naidoo
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Tamlyn Mac Quene
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Patricia Kellett
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
| | - Matshediso Ivy Mohlala
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa
| | - Kathryn M Chu
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, 1 Modderfontein road, Sandringham, Johannesburg, 2131, South Africa.
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
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9
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Hyperplastic polyp or sessile serrated lesion? The contribution of serial sections to reclassification. Diagn Pathol 2020; 15:140. [PMID: 33298116 PMCID: PMC7726909 DOI: 10.1186/s13000-020-01057-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/29/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The histological discrimination of hyperplastic polyps from sessile serrated lesions can be difficult. Sessile serrated lesions and hyperplastic polyps are types of serrated polyps which confer different malignancy risks, and surveillance intervals, and are sometimes difficult to discriminate. Our aim was to reclassify previously diagnosed hyperplastic polyps as sessile serrated lesions or confirmed hyperplastic polyps, using additional serial sections. METHODS Clinicopathological data for all colorectal hyperplastic polyps diagnosed in 2016 and 2017 was collected. The slides were reviewed and classified as hyperplastic polyps, sessile serrated lesion, or other, using current World Health Organization criteria. Eight additional serial sections were performed for the confirmed hyperplastic polyp group and reviewed. RESULTS Of an initial 147 hyperplastic polyps from 93 patients, 9 (6.1%) were classified as sessile serrated lesions, 103 as hyperplastic polyps, and 35 as other. Of the 103 confirmed hyperplastic polyps, 7 (6.8%) were proximal, and 8 (7.8%) had a largest fragment size of ≥5 mm and < 10 mm. After 8 additional serial sections, 11 (10.7%) were reclassified as sessile serrated lesions. They were all less than 5 mm and represented 14.3% of proximal polyps and 10.4% of distal polyps. An average of 3.6 serial sections were required for a change in diagnosis. CONCLUSION Histopathological distinction between hyperplastic polyps and sessile serrated lesions remains a challenge. This study has uncovered a potential role for the use of additional serial sections in the morphological reappraisal of small hyperplastic polyps, especially when proximally located.
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