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Gizaw M, Parkin DM, Stöter O, Bukirwa P, Seife E, Chesumbai G, Korir A, Liu B, Manraj SS, Nda G, Somdyala NIM, Kantelhardt EJ. Ovarian cancer survival in sub-Saharan Africa by human development index and histological subtypes: A population-based registry study. Int J Cancer 2024; 154:1911-1919. [PMID: 38339849 DOI: 10.1002/ijc.34877] [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: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 02/12/2024]
Abstract
Ovarian cancer (OC) is the fourth most common cancer of women in sub-Saharan Africa (SSA), although few data have been published on population-level survival. We estimate ovarian cancer survival in SSA by human development index and histological subtype, using data from seven population-based cancer registries in six countries: Kenya (Nairobi and Eldoret), Mauritius, Uganda (Kampala), Cote d'Ivoire (Abidjan), Ethiopia (Addis Ababa) and South Africa (Eastern Cape). A total of 644 cases diagnosed during 2008-2014 were included, with 77% being of epithelial subtypes (range 47% [Abidjan]-80% [Mauritius]). The overall observed survival in the study cohort was 73.4% (95% CI: 69.8, 77.0) at 1 year, 54.4% (95% CI: 50.4, 58.7) at 3 years and 45.0% (95% CI: 41.0, 49.4) at 5 years. Relative survival at Year 1 ranged from 44.4% in Kampala to 86.3% in Mauritius, with a mean for the seven series of 67.4%. Relative survival was highest in Mauritius at 72.2% and lowest in Kampala, Uganda at 19.5%, with a mean of 47.8%. There was no difference in survival by age at diagnosis. Patients from high and medium HDI countries had significantly better survival than those from low HDI countries. Women with cancers of epithelial cell origin had much lower survival compared to women with other histological subtypes (p = .02). Adjusted for the young age of the African patients with ovarian cancer (44% aged <50) survival is much lower than in USA or Europe, and underlines the need for improvements in the access to diagnosis and treatment of OC in SSA.
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Affiliation(s)
- Muluken Gizaw
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- NCD Working Group, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Donald Maxwell Parkin
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
- African Cancer Registry Network (AFCRN), Oxford, UK
| | - Ole Stöter
- Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- Department of Gynaecology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Phiona Bukirwa
- Kampala Cancer Registry and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edom Seife
- Addis Ababa Cancer Registry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gladys Chesumbai
- Eldoret Cancer Registry, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Anne Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Biying Liu
- African Cancer Registry Network (AFCRN), Oxford, UK
| | | | - Guy Nda
- Abidjan Cancer Registry, Abidjan, Ivory Coast
| | - Nontuthuzelo I M Somdyala
- South African Medical Research Council, Eastern Cape Cancer Registry, Burden of Disease Research Unit, Cape Town, South Africa
| | - Eva Johanna Kantelhardt
- Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- Department of Gynaecology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
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Joko-Fru WY, Bardot A, Bukirwa P, Amidou S, N'da G, Woldetsadik E, Chesumbai G, Korir A, Kamaté B, Koon M, Hansen R, Finesse A, Somdyala N, Chokunonga E, Chigonzoh T, Liu B, Kantelhardt EJ, Parkin DM, Soerjomataram I. Cancer survival in sub-Saharan Africa (SURVCAN-3): a population-based study. Lancet Glob Health 2024; 12:e947-e959. [PMID: 38762297 PMCID: PMC11126368 DOI: 10.1016/s2214-109x(24)00130-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/22/2024] [Accepted: 03/14/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The Cancer Survival in Africa, Asia, and South America project (SURVCAN-3) of the International Agency for Research on Cancer aims to fill gaps in the availability of population-level cancer survival estimates from countries in these regions. Here, we analysed survival for 18 cancers using data from member registries of the African Cancer Registry Network across 11 countries in sub-Saharan Africa. METHODS We included data on patients diagnosed with 18 cancer types between Jan 1, 2005, and Dec 31, 2014, from 13 population-based cancer registries in Cotonou (Benin), Abidjan (CÔte d'Ivoire), Addis Ababa (Ethiopia), Eldoret and Nairobi (Kenya), Bamako (Mali), Mauritius, Namibia, Seychelles, Eastern Cape (South Africa), Kampala (Uganda), and Bulawayo and Harare (Zimbabwe). Patients were followed up until Dec 31, 2018. Patient-level data including cancer topography and morphology, age and date at diagnosis, vital status, and date of death (if applicable) were collected. The follow-up (survival) time was measured from the date of incidence until the date of last contact, the date of death, or until the end of the study, whichever occurred first. We estimated the 1-year, 3-year, and 5-year survival (observed, net, and age-standardised net survival) by sex, cancer type, registry, country, and human development index (HDI). 1-year and 3-year survival data were available for all registries and all cancer sites, whereas availability of 5-year survival data was slightly more variable; thus to provide medium-term survival prospects, we have focused on 3-year survival in the Results section. FINDINGS 10 500 individuals from 13 population-based cancer registries in 11 countries were included in the survival analyses. 9177 (87·4%) of 10 500 cases were morphologically verified. Survival from cancers with a high burden and amenable to prevention was poor: the 3-year age-standardised net survival was 52·3% (95% CI 49·4-55·0) for cervical cancer, 18·1% (11·5-25·9) for liver cancer, and 32·4% (27·5-37·3) for lung cancer. Less than half of the included patients were alive 3 years after a cancer diagnosis for eight cancer types (oral cavity, oesophagus, stomach, larynx, lung, liver, non-Hodgkin lymphoma, and leukaemia). There were differences in survival for some cancers by sex: survival was longer for females with stomach or lung cancer than males with stomach or lung cancer, and longer for males with non-Hodgkin lymphomas than females with non-Hodgkin lymphomas. Survival did not differ by country-level HDI for cancers of the oral cavity, oesophagus, liver, thyroid, and for Hodgkin lymphoma. INTERPRETATION For cancers for which population-level prevention strategies exist, and with relatively poor prognosis, these estimates highlight the urgent need to upscale population-level prevention activities in sub-Saharan Africa. These data are vital for providing the knowledge base for advocacy to improve access to prevention, diagnosis, and care for patients with cancers in sub-Saharan Africa. FUNDING Vital Strategies, the Martin-Luther-University Halle-Wittenberg, and the International Agency for Research on Cancer. TRANSLATIONS For the French and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- W Yvonne Joko-Fru
- The African Cancer Registry Network, Oxford, UK; Department of Medical Genetics, University of Cambridge, Cambridge, UK; Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Aude Bardot
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Phiona Bukirwa
- Kampala Cancer Registry, Makerere University School of Medicine, Kampala, Uganda
| | | | - Guy N'da
- Registre des cancers d'Abidjan, Abidjan, Côte d'Ivoire
| | | | - Gladys Chesumbai
- Eldoret Cancer Registry, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | | | - Marvin Koon
- National Cancer Registry of Mauritius, Quatre Bornes, Mauritius
| | | | - Anne Finesse
- National Cancer Registry of Seychelles, Victoria, Seychelles
| | | | - Eric Chokunonga
- Zimbabwe National Cancer Registry, Parirenyatwa Hospital, Harare, Zimbabwe
| | | | - Biying Liu
- The African Cancer Registry Network, Oxford, UK
| | - Eva Johanna Kantelhardt
- Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Halle, Germany; Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Donald Maxwell Parkin
- The African Cancer Registry Network, Oxford, UK; Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France; Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Evans SM, Ivanova K, Rome R, Cossio D, Pilgrim C, Zalcberg J, Antill Y, Blake L, Du Guesclin A, Garrett A, Giffard D, Golobic N, Moir D, Parikh S, Parisi A, Sanday K, Shadbolt C, Smith M, Te Marvelde L, Williams K. Registry-derived stage (RD-Stage) for capturing cancer stage at diagnosis for endometrial cancer. BMC Cancer 2023; 23:1222. [PMID: 38087227 PMCID: PMC10714535 DOI: 10.1186/s12885-023-11615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Capture of cancer stage at diagnosis is important yet poorly reported by health services to population-based cancer registries. In this paper we describe current completeness of stage information for endometrial cancer available in Australian cancer registries; and develop and validate a set of rules to enable cancer registry medical coders to calculate stage using data available to them (registry-derived stage or 'RD-Stage'). METHODOLOGY Rules for deriving RD-stage (Endometrial carcinoma) were developed using the American Joint Commission on Cancer (AJCC) TNM (tumour, nodes, metastasis) Staging System (8th Edition). An expert working group comprising cancer specialists responsible for delivering cancer care, epidemiologists and medical coders reviewed and endorsed the rules. Baseline completeness of data fields required to calculate RD-Stage, and calculation of the proportion of cases for whom an RD stage could be assigned, was assessed across each Australian jurisdiction. RD-Stage (Endometrial cancer) was calculated by Victorian Cancer Registry (VCR) medical coders and compared with clinical stage recorded by the patient's treating clinician and captured in the National Gynae-Oncology Registry (NGOR). RESULTS The necessary data completeness level for calculating RD-Stage (Endometrial carcinoma) across various Australian jurisdictions varied from 0 to 89%. Three jurisdictions captured degree of spread of cancer, rendering RD-Stage unable to be calculated. RD-Stage (Endometrial carcinoma) could not be derived for 64/485 (13%) cases and was not captured for 44/485 (9%) cases in NGOR. At stage category level (I, II, III, IV), there was concordance between RD-Stage and NGOR captured stage in 393/410 (96%) of cases (95.8%, Kendall's coefficient = 0.95). CONCLUSION A lack of consistency in data captured by, and data sources reporting to, population-based cancer registries meant that it was not possible to provide national endometrial carcinoma stage data at diagnosis. In a sample of Victorian cases, where surgical pathology was available, there was very good concordance between RD-Stage (Endometrial carcinoma) and clinician-recorded stage data available from NGOR. RD-Stage offers promise in capturing endometrial cancer stage at diagnosis for population epidemiological purposes when it is not provided by health services, but requires more extensive validation.
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Affiliation(s)
- S M Evans
- Cancer Council Victoria, Melbourne, Australia.
| | - K Ivanova
- Cancer Council Victoria, Melbourne, Australia
| | - R Rome
- Epworth Health Care, Melbourne, Australia
| | - D Cossio
- Cancer Alliance Queensland, Woolloongabba, Australia
| | - Chc Pilgrim
- Central Clinical School, Department of Surgery, The Alfred, Monash University, Melbourne, Australia
| | - J Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Y Antill
- Monash University, Melbourne, Australia
| | - L Blake
- Cancer Council Victoria, Melbourne, Australia
| | - A Du Guesclin
- Department of Anatomical Pathology, The Alfred, Melbourne, Australia
| | - A Garrett
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - D Giffard
- Cancer Alliance Queensland, Woolloongabba, Australia
| | - N Golobic
- Cancer Alliance Queensland, Woolloongabba, Australia
| | - D Moir
- Department of Anatomical Pathology, The Alfred, Melbourne, Australia
| | - S Parikh
- Cancer Council Victoria, Melbourne, Australia
| | - A Parisi
- ACT Cancer Registry Australian Capital Territory Health, Deakin, Australia
| | - K Sanday
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - C Shadbolt
- Royal Women's Hospital, Melbourne, Australia
| | - M Smith
- ACT Cancer Registry Australian Capital Territory Health, Deakin, Australia
| | | | - K Williams
- Cancer Council Victoria, Melbourne, Australia
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