Ovarian cancer survival in sub-Saharan Africa by human development index and histological subtypes: A population-based registry study

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.

Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study

Background

Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined.

Methods

This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach.

Discussion

This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research.

Trial registration

This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-09124-5.

Cervical Cancer Incidence and Trends in Uasin Gishu County, Kenya (2010 to 2014)

Background: Globally, cervical cancer is the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases (GLOBOCAN 2012). Cervical cancer is currently the most common cancer among women of Uasin Gishu County. Eldoret Cancer Registry (ECR) is a population based registry that collects cases diagnosed in Uasin Gishu County whose population is 894,179; 50% male and 50% female (2009 National Census). Aim: The aim of this study is to determine the incidence and trends of cervical cancer in Uasin Gishu for a 5 year period based on ECR data. Methods: Cancer registrars undertook case finding and abstraction in health facilities in Uasin Gishu. Confirmed malignant tumors were abstracted on to the Case Registration Form. Coding was done using ICD-O-3. CanReg5 was used for data entry, quality checks and data management. Data analyzed was for all women between the ages of 15-80 years. Results: A total of 2539 cancer cases were registered for the period 2010-2014 comprising of 1144 male and 1395 female. Cancer of the cervix was the most common cancer in female with 265 cases; 19.3% of all female cancers. ASR was 24.8 per 100,000. The most affected age group was 30-54 years. Stage I cases were 9%, stage II had 10%, stage III had 21%, stage IV 5% and unknown stage was 54%. There was high incidence observed in 2011 as compare with other years. 242 cases were histologic diagnosis, 10 cytology, 10 clinical investigation, death certificate only were 3 cases. Conclusion: Cervical cancer incidence was very high among women of Uasin Gishu County. Notably, most of the cases have unknown stage which may be associated with the fact that most patients are diagnosed within the county and may go for treatment elsewhere, or some go for traditional treatment in the villages after diagnosis and others may not come back for treatment after diagnosis due to cultural beliefs.

Incidences and Trends of Lung Cancer in Western Kenya for the Period Between 2012-2016

Background: Lung cancer diagnosis has been a challenge in western Kenya due to the technicalities related to screening and diagnostic procedures. The burden in the adult population is largely unknown, as most patients are managed for Pulmonary Tuberculosis, since both have similar clinical manifestations. The Eldoret Cancer Registry (ECR) provides statistics and epidemiologic profile across western region of Kenya. Aim: The aim of this study is to establish lung cancer incidences in relation to year of diagnosis, age, gender and stage at diagnosis across western Kenya region. Methods: A retrospective review of all cases of lung cancer disease diagnosed at Moi Teaching and Referral Hospital from 2012 to 2016 were identified from the ECR. Data on year of incidence, age, gender, stage at diagnosis and county of origin was analyzed Results: Out of the 60 patients diagnosed with lung cancer, the findings were as follows: In 2012 there were 11 cases representing 18.3%, 2013 10 cases (16.7%), 2014, 12 cases (20%), 2015 12 cases (20%) and 2016, 15 cases (25%). Incidences by age were in the following cohorts; 0-27 years 1 case representing 1.7%, 30-39 years (4) 6.7%, 40-49 years (8) 13.3%, 50-59 years (17) 28.3%, 60-69 years (12) 20%, 70-79 years (15) 25%, above 80 years (3) 5%. Incidences by gender: male had 38 cases at 63.3% and female had 22 cases at 36.7%. Incidence by stage at diagnosis; stage iv (6) 10%, unknown stage (54) 90%. Conclusion: 2016 had the highest incidence and may be associated with the increased awareness on screening services at MTRH. Most cases were between 50-79 years and could be attributed to the slow disease progression and delays in early diagnosis. Higher incidences were in males and may be related to susceptibilities to risks factors such as smoking and industrial fumes respectively. There's need for early diagnosis and disease staging as most cases were at stage 4 and unknown.

Development of a National Cancer Registry in a Low Resourced Country: The Case of Kenya National Cancer Registry Programme

Background: Population-based cancer registration represents the gold standard for the provision of information on cancer incidence in a defined population (Bray F, et. al, IARC Technical Report No. 43). In Kenya, the incidence and prevalence of cancer has not been well documented. The existing population-based cancer registries (PBCRs) cover less than 10% of Kenya's population. Kenya is made up of 47 administrative counties and has a population of over 45 million people. Aim: To establish a National Cancer Registry Program that will compile national data on incidence, mortality and trends of cancer in Kenya over time. Methods: Three functional PBCRs have been in existence covering 3 counties: Nairobi, Eldoret and Kisumu. Needs assessment was conducted in the 3 registries. Additional support and resources were provided. New registries were set up in different geographical regions of Kenya. A centralized office to host the national registry was established and equipped at the Centre for Clinical Research, Kenya Medical Research Institute. Sensitization and awareness activities targeting the leaders in the selected counties were undertaken. Similarly trainings and technical support of the regional registries were conducted. Data were collected on to case registration forms, coded using the International Classification of Diseases for Oncology (ICD-O); data entry, validation and analysis done using IARC software CanReg5. Results: Variations in cancer occurrence in the different counties were noted. However the leading cancers were somewhat similar in the 8 counties with prostate and esophageal cancers being the leading in men while breast and cervical cancer being top among women. These variations could provide understanding on causation of certain types of cancers. Data highlights the need to develop and expand intervention programs like HPV vaccination, screenings, early detection and early treatment. Governments' allocation of resources to cancer registries and surveillance programs is important as well as building partnerships. Conclusion: In countries with limited resources it is expensive to develop a national cancer registry covering the entire country. Our program demonstrates that a national cancer registry program can be established by setting up regional population-based cancer registries that covers a reasonable population of the entire country and aggregating the data in a centralized system. Population-based cancer registries are critical in generating data on burden of cancer in specified populations. These data should be used to inform effective cancer control programs and research.