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Sharon BA, Nakaganda A, Fadhil G, June M, Anecho E, Aniku G, Jacinto A, Wao H, Orem J, Daniel O. Cancer patterns in Arua district, Uganda: a hospital-based retrospective study. Ecancermedicalscience 2024; 18:1688. [PMID: 38566768 PMCID: PMC10984836 DOI: 10.3332/ecancer.2024.1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Indexed: 04/04/2024] Open
Abstract
Introduction Cancer is the second leading cause of mortality with over 19 million cases and 10 million deaths worldwide. Available data on cancer patterns in Uganda are through modelling of data from two population-based cancer registries (PBCRs) representing only about 10% of the cancer situation in Uganda. This study sought to determine the common types of cancer among adults and children in Arua District over a 5-year period (2017-2021). Methods Retrospective cohort chart review and 'catchment population approach' were employed. All newly diagnosed cancer patients from Arua between 2017 and 2021 were included in this study. Data were collected using Redcap whereas management and analysis were conducted using Stata 17. Cancer patterns were computed as frequencies and percentages and the interest was in finding out the common cancers among adults (above 19 years) and children (0-19 years). Results Over the 5-year study period, a total of 1,118 new cancer cases were registered, with slightly more females (52.1%). The top five common cancers irrespective of sex and age were: liver cancer (13.7%), cervical (11.8%), breast (10.7%), oesophagus (10.5%) and Burkitt's lymphoma (BL) (6.4%). In this study, 15.3% (n = 171) of the study participants were children. The top five common childhood cancers included BL (42%), leukemia (10.5%), other lymphomas (9.4%), osteosarcoma (4.7%) and nephroblastoma (3%). Conclusion There is a high incidence of liver cancer in Arua district. The high levels of cervical, breast and oesophagus cancer were consistent with what is reported by the two PBCRs in Uganda. However, BL could be due to the presence of a BL treatment centre at Kuluva hospital in Arua. Cancer interventions in Arua should therefore be targeted towards liver, cervix, breast, and oesophagus cancer and furthering research on the reason for the high incidence of liver cancer.
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Affiliation(s)
- Bridget Angucia Sharon
- Uganda Cancer Institute, PO Box 3935, Upper Mulago Hill Road, Kampala, Uganda
- Jaramogi Oginga Odinga University of Science and Technology, PO Box 210 - 40601, Bondo, Kenya
| | - Annet Nakaganda
- Uganda Cancer Institute, PO Box 3935, Upper Mulago Hill Road, Kampala, Uganda
| | - Geriga Fadhil
- Uganda Cancer Institute, PO Box 3935, Upper Mulago Hill Road, Kampala, Uganda
| | - Micah June
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research, PO Box 1578 - 40100, Kisumu, Kenya
| | - Ezra Anecho
- Uganda Cancer Institute, PO Box 3935, Upper Mulago Hill Road, Kampala, Uganda
| | - Gilbert Aniku
- Arua Regional Referral Hospital, PO Box 3, Arua, Uganda
| | | | - Hesborn Wao
- African Population and Health Research Centre, PO Box 10787-00100, Kitisuru, Nairobi, Kenya
| | - Jackson Orem
- Uganda Cancer Institute, PO Box 3935, Upper Mulago Hill Road, Kampala, Uganda
| | - Onguru Daniel
- Jaramogi Oginga Odinga University of Science and Technology, PO Box 210 - 40601, Bondo, Kenya
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Mitala Y, Ssenkumba B, Nabulya R, Kitenda FN, Tumwesigye H, Birungi A, Dratu Chau R, Mushabe B, Baker N, Atwine R. Primary Breast Burkitt Lymphoma. A Case Report of a 16-Year-Old Female with a Rapidly Growing Unilateral Breast Mass. Cancer Manag Res 2023; 15:1047-1052. [PMID: 37790899 PMCID: PMC10543409 DOI: 10.2147/cmar.s426780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Primary breast Burkitt lymphoma is extremely rare. Commonly endemic Burkitt lymphoma presents with abdominal, jaw, periorbital, or genitourinary mass. Case Presentation We report a case of a 16-year-old girl with rapidly enlarging left breast swelling associated with evening fevers. This was later confirmed to be stage 1 primary breast Burkitt lymphoma involving the left breast. This represents the first described case of primary breast endemic Burkitt lymphoma in Uganda. She was started on chemotherapy and exhibited an impressive response to the drugs. Conclusion This case raises awareness of rare sites for endemic Burkitt lymphoma in Uganda. Accurately diagnosing this case was of great importance since it determined the treatment modality (mastectomy or not) which would have an everlasting impact on her life.
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Affiliation(s)
- Yekosani Mitala
- Department of Pathology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Brian Ssenkumba
- Department of Pathology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Rita Nabulya
- Department of Pathology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Francis Nsumba Kitenda
- Department of Pathology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Habert Tumwesigye
- Department of Pathology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Abraham Birungi
- Department of Pathology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Richard Dratu Chau
- Department of Pathology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Branchard Mushabe
- Department of Pediatrics, Mbarara Regional Referral Hospital, Mbarara City, Uganda
| | - Nichole Baker
- Department of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Raymond Atwine
- Department of Pathology, Mbarara University of Science and Technology, Mbarara City, Uganda
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3
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Kizub D, Manner CK, Graef K, Abubakar B, Orem J, Odedina F, Adeyeye MC, Nakigudde G, Ayalew K, Kalidas C, Lyerly HK, Norman T, Fashoyin-Aje L, Freedman J, Dent J, Cance B, Gralow J. Action for Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials—Is Africa the Answer? Report From a Satellite Session of the Accelerating Anti-Cancer Agent Development and Validation Workshop. JCO Glob Oncol 2022; 8:e2200117. [PMID: 35714309 PMCID: PMC9232363 DOI: 10.1200/go.22.00117] [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: 11/25/2022] Open
Abstract
Patients of African ancestry are not well-represented in cancer clinical trials despite bearing a disproportionate share of mortality both in United States and Africa. We describe key stakeholder perspectives and priorities related to bringing early-stage cancer clinical trials to Africa and outline essential action steps. Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials—Is Africa the Answer? satellite session was organized at 2021 Accelerating Anti-Cancer Agent Development and Validation Workshop. Panelists included representatives of African Organization for Research and Training in Cancer, Uganda Cancer Institute, Uganda Women's Cancer Support Organization, BIO Ventures for Global Health, Bill & Melinda Gates Foundation, the US Food and Drug Administration, Nigeria's National Agency for Food and Drug Administration and Control, Bayer, and Genentech, with moderators from ASCO and American Cancer Society. Key discussion themes and resulting action steps were agreed upon by all participants. Panelists agreed that increasing diversity in cancer clinical trials by including African patients is key to ensuring novel drugs are safe and effective across populations. They underscored the importance of equity in clinical trial access for patients in Africa. Panelists discussed their values related to access and barriers to opening clinical trials in Africa and described innovative solutions from their work aimed at overcoming these obstacles. Multisectoral collaboration efforts that allow leveraging of limited resources and result in sustainable capacity building and mutually beneficial long-term partnerships were discussed as key to outlined action steps. The panel discussion resulted in valuable insights about key stakeholder values and priorities related to bringing early-stage clinical trials to Africa, as well as specific actions for each stakeholder group.
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Affiliation(s)
- Darya Kizub
- University of Texas MD Anderson Research Center, Houston, TX
| | | | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA
| | - Bello Abubakar
- National Hospital, Abuja, Nigeria
- African Organization for Research and Training in Cancer (AORTIC), Rondebosch, South Africa
| | | | - Folakemi Odedina
- African Organization for Research and Training in Cancer (AORTIC), Rondebosch, South Africa
- Mayo Clinic, Rochester, MN
| | | | | | - Kassa Ayalew
- United States Food and Drug Administration, Silver Spring, MD
| | | | | | - Thea Norman
- Bill & Melinda Gates Foundation, Seattle, WA
| | | | | | | | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA
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4
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Muhealdeen DN, Shwan A, Yaqo RT, Hassan HA, Muhammed BO, Ali RM, Hughson MD. Epstein-Barr virus and Burkitt's lymphoma. Associations in Iraqi Kurdistan and twenty-two countries assessed in the International Incidence of Childhood Cancer. Infect Agent Cancer 2022; 17:39. [PMID: 35897021 PMCID: PMC9327396 DOI: 10.1186/s13027-022-00452-0] [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: 05/02/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Burkitt's lymphoma (BL) has worldwide variations in incidence that are related to the age of Epstein-Barr virus (EBV) infection. This study examined the age-specific incidence rate (ASIR) of BL and community EBV seropositivity in Iraqi Kurdistan and compared results with data from countries tabulated in the International Incidence of Childhood Cancer volume 3 (IICC-3). Methods The ASIR (95% confidence intervals) of BL in Sulaimani Governorate of Iraqi Kurdistan were calculated for the years 2010–2020. Specimens from 515 outpatients were tested for IgG and IgM antibodies to EBV viral capsid antigen.
Results In Sulaimani, 84% of BL occurred under 20 years of age, with an ASIR of 6.2 (4.7–7.7) per million children. This ASIR was not significantly different than that of Egypt, Morocco, Israel, Spain, or France. It was slightly higher than the ASIR of the United States, the United Kingdom, and Germany and markedly higher than for Asia and South Africa. In Africa and much of Asia, early childhood EBV exposure predominates, with nearly all children being infected by 5 years of age. In Sulaimani, just over 50% of children were EBV seropositive at 3 years old and 90% seropositivity was reached at 15 years of age. In Europe and North America, seropositivity is commonly delayed until adolescence or young adulthood and adult predominates over childhood BL. Conclusion In the Middle East, childhood BL is relatively common and adult BL is rare. In Sulaimani, EBV seropositivity increases progressively throughout childhood and reaches 92% at mid-adolescence. This may reflect the Mid East more widely. We suggest that the high childhood and low adult BL rates may be a regional effect of a pattern of EBV exposure intermediate between early childhood and adolescent and young adult infections.
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Affiliation(s)
- Dana N Muhealdeen
- Sulaimani University College of Medicine, Sulaymaniyah, Iraq.,Hiwa Cancer Hospital, Sulaymaniyah, Iraq
| | - Alan Shwan
- Hiwa Cancer Hospital, Sulaymaniyah, Iraq
| | - Rafil T Yaqo
- Dohuk University School of Medicine, Dohuk, Iraq
| | - Hemin A Hassan
- Sulaimani University College of Medicine, Sulaymaniyah, Iraq.,Hiwa Cancer Hospital, Sulaymaniyah, Iraq
| | | | - Rawa M Ali
- Sulaimani University College of Medicine, Sulaymaniyah, Iraq.,Hiwa Cancer Hospital, Sulaymaniyah, Iraq
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Lyimo EP, Rumisha SF, Mremi IR, Mangu CD, Kishamawe C, Chiduo MG, Matemba LE, Bwana VM, Massawe IS, Mboera LEG. Cancer Mortality Patterns in Tanzania: A Retrospective Hospital-Based Study, 2006-2015. JCO Glob Oncol 2021; 6:224-232. [PMID: 32073912 PMCID: PMC7051795 DOI: 10.1200/jgo.19.00270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This retrospective study sought to determine the type, burden, and pattern of cancer deaths in public hospitals in Tanzania from 2006 to 2015. METHODS This study analyzed data on cancer mortality in 39 hospitals in Tanzania. Data on the age and sex of the deceased and type of cancer were extracted from hospital death registers and report forms. Cancer types were grouped according to the 10th revision of the International Classification of Diseases. Age-standardized mortality rates and cancer mortality patterns were analyzed. A χ2 test was used to examine the association between common cancers and selected covariates. RESULTS A total of 12,621 cancer-related deaths occurred during the 10-year period, which translates to an age-standardized hospital-based mortality rate of 47.8 per 100,000 population. Overall, the number of deaths was notably higher (56.5%) among individuals in the 15- to 59-year-old age category and disproportionately higher among females than males (P = .0017). Cancers of the cervix, esophagus, and liver were the 3 major causes of death across all study hospitals in Tanzania. Cancers of the cervix, esophagus, and liver were the largest contributors to mortality burden among females. Among males, cancers of the esophagus, liver, and prostate were the leading cause of mortality. CONCLUSION There is an increasing trend in cancer mortality over recent years in Tanzania, which differs with respect to age, sex, and geographic zones. These findings provide a basis for additional studies to ascertain incidence rates and survival probabilities, and highlight the need to strengthen awareness campaigns for early detection, access to care, and improved diagnostic capabilities.
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Affiliation(s)
- Emanuel P Lyimo
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Irene R Mremi
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Chacha D Mangu
- National Institute for Medical Research, Mbeya Research Centre, Mbeya, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Mercy G Chiduo
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Lucas E Matemba
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Malaria Atlas Project, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Veneranda M Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Isolide S Massawe
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Leonard E G Mboera
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
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6
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Apiyo M, Bongomin F, Balagadde J, Mupere E, Ndeezi G. Predictors of laboratory spontaneous tumour lysis syndrome in children with high-grade tumours in Uganda. Trop Doct 2021; 51:501-507. [PMID: 34233540 DOI: 10.1177/00494755211029782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High-grade malignancy is endemic in sub-Saharan Africa and is prone to the spontaneous tumour lysis syndrome. However, data on spontaneous tumour lysis syndrome remain scanty in our setting. We sought to determine the prevalence and factors associated with laboratory spontaneous tumour lysis syndrome in children in Uganda. We conducted a cross-sectional study among children <18 years old with histologically confirmed high-grade malignancy between October 2013 and April 2014. Laboratory spontaneous tumour lysis syndrome was defined as the presence of ≥2 of each of hyperkalaemia, hypocalcaemia, hyperuricaemia and hyperphosphatemia prior to administration of chemotherapy when alternative diagnoses had been excluded. A p < 0.05 was considered statistically significant. Of 108 children, of median age 7.7 years, where boys outnumbered girls 2:1, high-grade, malignancy included Burkitt's lymphoma, acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, acute myeloid leukaemia and Burkitt's leukaemia, with 14 suffering with laboratory spontaneous tumour lysis syndrome. Hypocalcaemia was its most common electrolyte imbalance; and four children died prior to commencement of chemotherapy. Bulky disease, lactate dehydrogenase levels ≥500 iu/l and serum creatinine levels >1.2 mg/dl were associated with laboratory spontaneous tumour lysis syndrome. However, only bulky disease was significantly predictive of laboratory spontaneous tumour lysis syndrome. Such children would benefit from routine screening.
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Affiliation(s)
- Mirriam Apiyo
- Paediatrician, Department of Paediatrics and Child Health, Case Hospital, Kampala, Uganda
| | - Felix Bongomin
- Lecturer, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Lecturer, Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Joyce Balagadde
- Paediatrician, Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ezekiel Mupere
- Senior Lecturer/Paediatrician, Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Ndeezi
- Professor/Paediatrician, Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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7
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Goitom Sereke S, Bongomin F, Muyinda Z. Primary Intradural Extramedullary Spinal Burkitt's Lymphoma: A Case Report. Int Med Case Rep J 2021; 13:701-705. [PMID: 33408533 PMCID: PMC7781032 DOI: 10.2147/imcrj.s291729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 12/22/2022] Open
Abstract
Background Non-Hodgkin's lymphoma (NHL) rarely involves the spine primarily, and if it does, is almost always associated with advanced disease. Case Presentation An 8-year-old male presented with a one month history of nuchal pain followed by stiffness and rapidly progressive upper and lower limb weakness. He was seronegative for HIV and EBV. Computed tomography myelogram and magnetic resonance imaging of the cervical and thoracic spine showed a long segment (C2 to T1) complete absence of cerebrospinal fluid signal and mildly enhancing intradural extramedullary lesion with an extradural and right paravertebral muscle extension, respectively. Post-excision biopsy histopathology and immunohistochemistry confirmed the diagnosis of a CD 10+, CD20+, CD45+, Bcl-2+, Ki67+, and EBER in situ hybridization for EBV negative, Burkitt's lymphoma (BL). Cytogenetic analysis showed chromosomal translocations of 8q24. CHOP plus intrathecal cytarabine, methotrexate was given as chemotherapy regimen. 1.8 grays (Gy) per fraction to the local area for an average total dose of 36 Gy was given with a resultant significant clinical improvement. Conclusion Though considered uncommon spinal canal tumors, BL should be in the differential diagnosis, if multilevel involvement is demonstrated on imaging.
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Affiliation(s)
- Senai Goitom Sereke
- Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Bongomin
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Zeridah Muyinda
- Department of Radiology, Mulago National Referral Hospital, Kampala, Uganda
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8
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McGoldrick SM, Mutyaba I, Adams SV, Larsen A, Krantz EM, Namirembe C, Mooka P, Nabakooza S, Ndagire M, Mubiru K, Nabwana M, Nankinga R, Gerdts S, Gordon-Maclean C, Geriga F, Omoding A, Sessle E, Kambugu J, Uldrick TS, Orem J, Casper C. Survival of children with endemic Burkitt lymphoma in a prospective clinical care project in Uganda. Pediatr Blood Cancer 2019; 66:e27813. [PMID: 31157502 DOI: 10.1002/pbc.27813] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/10/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE "Endemic" Burkitt lymphoma (BL) is a common childhood cancer in Africa. Social and treatment factors may contribute to poor survival. With the aim of improving BL outcomes in Uganda, we undertook a comprehensive project (BL Project) that provided diagnostic support, access to standard chemotherapy, nutritional evaluations, and case management. We evaluated survival of children with BL in the context of the project. PATIENTS AND METHODS Patients followed by the BL Project who consented to research were enrolled in this study. Children with a pathology diagnosis consistent with BL were eligible. Data were collected prospectively. First-line chemotherapy generally consisted of six cycles of cyclophosphamide, vincristine, low-dose methotrexate (COM). We used Kaplan-Meier and Cox regression analyses to evaluate factors associated with overall survival (OS). RESULTS Between July 2012 and June 2017, 341 patients with suspected BL presented to the BL Project. One hundred eighty patients with a pathology-based diagnosis were included in this study. The median age was seven years (interquartile range, 5-9), 74% lived ≥100 km from the Uganda Cancer Institute, 61% had late-stage disease, 84% had ECOG performance status < 3, 63% reported B-symptoms, and 22% showed neurologic symptoms. Fewer than 10% abandoned therapy. The four-year OS rate was 44% (95% CI, 36%-53%). In a multivariate model, ECOG status was significantly associated with mortality. CONCLUSION The BL Project reduced effects of lacking supportive care and oncology resources, and allowed patients from Uganda to receive curative intent therapy with minimal loss to follow-up. Nonetheless, OS remains unacceptably low. Improved therapeutic approaches to endemic BL are urgently needed in Africa.
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Affiliation(s)
| | | | - Scott V Adams
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anna Larsen
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Peter Mooka
- Hutchinson Centre Research Institute, Kampala, Uganda
| | | | | | - Kelvin Mubiru
- Hutchinson Centre Research Institute, Kampala, Uganda
| | | | - Rose Nankinga
- Hutchinson Centre Research Institute, Kampala, Uganda
| | - Sarah Gerdts
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | | | | | - Corey Casper
- Departments of Medicine and Global Health, Infectious Disease Research Institute and the University of Washington, Seattle, Washington
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Swanson M, Ueda S, Chen LM, Huchko MJ, Nakisige C, Namugga J. Evidence-based improvisation: Facing the challenges of cervical cancer care in Uganda. Gynecol Oncol Rep 2018; 24:30-35. [PMID: 29892691 PMCID: PMC5993527 DOI: 10.1016/j.gore.2017.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/04/2017] [Accepted: 12/28/2017] [Indexed: 12/15/2022] Open
Abstract
There is significant disparity in the prevalence of cervical cancer globally, with low- and middle-income countries (LMICs) shouldering a disproportionate share of disease incidence and an even greater proportion of morbidity and mortality. Available resources for diagnosis, treatment and palliation of cervical cancer are inversely related to per capita income. While prevention and screening remain public health priorities, given the large number of women affected by cervical cancer, expanding treatment capacity should be included in any evidence-based intervention plan. Uganda, a country with a high incidence of cervical cancer, serves as a representative case study in terms of the challenges of diagnosis and access to treatment in sub-Saharan Africa. Providers and patients in Uganda are challenged by late presentation to care, limited training opportunities, cost-prohibitive diagnostic studies, insufficient access to gold-standard treatment, and under-utilized palliative care services. This review highlights the ways in which Uganda's experience is typical of the continent at large, as well as areas where Uganda is unique. We describe the ways in which a small but dedicated group of gynecologists carefully use limited evidence and available resources creatively to provide the best possible care for their patients. We show that improvisation, albeit evidence-based, is central to the nature and success of oncology care in Africa (Livingston, 2012). We argue that a "recalibrated global response" (Farmer et al., 2010), particularly stressing the expansion of radiotherapy capabilities, could dramatically improve cancer care and outcomes for women in Uganda as well as in LMICs globally.
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Affiliation(s)
- Megan Swanson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States
| | - Stefanie Ueda
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States
| | - Lee-may Chen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States
| | - Megan J. Huchko
- Department of Obstetrics and Gynecology, Duke Global Health Institute, United States
| | - Carol Nakisige
- Division of Gynaecologic Oncology, Uganda Cancer Institute, Makerere University College for Health Sciences School of Medicine, United States
| | - Jane Namugga
- Division of Gynaecologic Oncology, Mulago National Referral Hospital, Makerere University College for Health Sciences School of Medicine, Uganda
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Ruiz-Mori E, Ayala-Bustamantea L, Ruiz-Morib H, Burgos-Bustamante J, Pérez-Samitier C, Zaharia-Bassan M. Masa tumoral cardiaca en un paciente con linfoma de Burkitt. Caso clínico. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:187-189. [DOI: 10.1016/j.acmx.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022] Open
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12
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Primary Breast Burkitt's Lymphoma in an HIV-Infected Woman. Case Rep Med 2015; 2015:792041. [PMID: 26089910 PMCID: PMC4454747 DOI: 10.1155/2015/792041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 11/18/2022] Open
Abstract
A 30-year-old HIV positive woman presented with a multifocal mass tumour associated with axillary and lateral-cervical lymphadenopathy in the right breast. Laboratory examination of the biopsy confirmed a case of mammary Burkitt's lymphoma with a nodular infiltration of the breast. Antiretroviral treatment and chemotherapy were effective to control the tumour. Although Burkitt's lymphoma rarely involves the breasts, it should be considered during routine breast examination of African woman.
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13
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Saeed IE, Weng HY, Mohamed KH, Mohammed SI. Cancer incidence in Khartoum, Sudan: first results from the Cancer Registry, 2009-2010. Cancer Med 2014; 3:1075-84. [PMID: 24821265 PMCID: PMC4303176 DOI: 10.1002/cam4.254] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 12/16/2022] Open
Abstract
In 2009, the first National Population-based Cancer Registry (NCR) was established in Sudan. We report in this study, the first data from the NCR for Khartoum State for the period 2009–2010. The NCR staff used passive and active approaches to collect data on cancer diagnosed by all means in Khartoum State. Rates were age standardized to the 2010 Sudan Standard Population and 1966 and 2000 World Standard Population and expressed per 100,000 populations. During 2009–2010, 6771 new cancer cases were registered. Of those, 3646 (53.8%) cases were in women and 3125 (46.2%) were in men. The most commonly diagnosed cancer among women was breast followed by leukemia, cervix, and ovary, and among men it was prostate cancer followed by leukemia, lymphoma, oral, colorectal, and liver. In children less than 15 years of age, leukemia was the most common cancer followed lymphoma, and cancer of the eye, bone, kidney, and the brain. The overall age-standardized rate (ASR) per 100,000 population was higher in women (124.3) than in men (90.8) using 2010 Sudan Standard Population. Similarly, it was higher in women (188.6 and 206.3 per 100,000 population) than in men (145.4 and 160.0 per 100,000 population) using 1966 and 2000 World Standard Population, respectively. The data from NCR indicated that prostate and breast as the most commonly diagnosed cancer sites in men and women in Khartoum, while cancer of the cervix trailed behind portraying a cancer picture similar to that of the developed world. Despite the study limitations, the NCR data gave a fair representation of cancer profile of Khartoum State and underscored the need for high-quality cancer registries in Sudan.
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Affiliation(s)
- Intisar E Saeed
- Cancer Registry Center, Federal Ministry of Health, Khartoum, Sudan
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14
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Petrara MR, Penazzato M, Massavon W, Nabachwa S, Nannyonga M, Mazza A, Gianesin K, Del Bianco P, Lundin R, Sumpter C, Zanchetta M, Giaquinto C, De Rossi A. Epstein-Barr Virus Load in Children Infected With Human Immunodeficiency Virus Type 1 in Uganda. J Infect Dis 2014; 210:392-9. [DOI: 10.1093/infdis/jiu099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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15
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Adesina A, Chumba D, Nelson AM, Orem J, Roberts DJ, Wabinga H, Wilson M, Rebbeck TR. Improvement of pathology in sub-Saharan Africa. Lancet Oncol 2013; 14:e152-7. [PMID: 23561746 DOI: 10.1016/s1470-2045(12)70598-3] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the coming decades, cancer will be a major clinical and public health issue in sub-Saharan Africa. However, clinical and public health infrastructure and services in many countries are not positioned to deal with the growing cancer burden. Pathology is a core service required to serve many needs related to cancer in sub-Saharan Africa. Cancer diagnosis, treatment, and research all depend on adequate pathology. Pathology is also necessary for cancer registration, which is needed to accurately estimate cancer incidence and mortality. Cancer registry data directly guide policy-makers' decisions for cancer control and the allocation of clinical and public health services. Despite the centrality of pathology in many components of cancer care and control, countries in sub-Saharan Africa have at best a tenth of the pathology coverage of that in high-income countries. Equipment, processes, and services are lacking, and there is a need for quality assurance for the definition and implementation of high-quality, accurate diagnosis. Training and advocacy for pathology are also needed. We propose approaches to improve the status of pathology in sub-Saharan Africa to address the needs of patients with cancer and other diseases.
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Affiliation(s)
- Adekunle Adesina
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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