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Ibrahim Khalil A, Mpunga T, Wei F, Baussano I, de Martel C, Bray F, Stelzle D, Dryden‐Peterson S, Jaquet A, Horner M, Awolude OA, Trejo MJ, Mudini W, Soliman AS, Sengayi‐Muchengeti M, Coghill AE, van Aardt MC, De Vuyst H, Hawes SE, Broutet N, Dalal S, Clifford GM. Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa. Int J Cancer 2022; 150:761-772. [PMID: 34626498 PMCID: PMC8732304 DOI: 10.1002/ijc.33841] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 01/28/2023]
Abstract
HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in sub-Saharan Africa (SSA). We estimated HIV- and age-stratified cervical cancer burden at a country, regional and global level in 2020. Proportions of cervical cancer (a) diagnosed in women living with HIV (WLHIV), and (b) attributable to HIV, were calculated using age-specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to age-specific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV-attributable fraction decreased from 86% in women ≤34 years to only 12% in women ≥55 years. The absolute burden of HIV-attributable cervical cancer (approximately 28 000 cases globally) also shifted toward younger women: in Southern Africa, 63% of 5341 HIV-attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non-HIV-attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV-targeted vs general population approaches to cervical screening, and impact of HIV prevention.
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Affiliation(s)
- Ahmadaye Ibrahim Khalil
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Tharcisse Mpunga
- Butaro Cancer Centre of Excellence, Ministry of HealthButaroRwanda
| | - Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Iacopo Baussano
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Catherine de Martel
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Dominik Stelzle
- Center for Global Health, Department of Neurology, Faculty of MedicineTechnical University of MunichMunichGermany,Chair of Epidemiology, Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - Scott Dryden‐Peterson
- Division of Infectious DiseasesBrigham and Women's HospitalBostonMassachusettsUSA,Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA,Botswana Harvard AIDS Institute PartnershipGaboroneBotswana
| | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR 1219BordeauxFrance
| | - Marie‐Josèphe Horner
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMarylandUSA
| | - Olutosin A. Awolude
- Department of Obstetrics and Gynaecology, College of MedicineUniversity of IbadanIbadanNigeria,Infectious Disease Institute, College of MedicineUniversity of IbadanIbadanNigeria
| | - Mario Jesus Trejo
- Department of Epidemiology and BiostatisticsUniversity of ArizonaTucsonArizonaUSA
| | - Washington Mudini
- Division of Anatomical Pathology, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Amr S. Soliman
- Community Health and Social Medicine Department, CUNY School of MedicineThe City College of New YorkNew York CityNew YorkUSA
| | - Mazvita Sengayi‐Muchengeti
- National Cancer Registry, National Health Laboratory ServiceJohannesburgSouth Africa,School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa,South African DSI‐NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA)Stellenbosch UniversityStellenboschSouth Africa
| | - Anna E. Coghill
- Cancer Epidemiology Program, Division of Population ScienceH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Matthys C. van Aardt
- Gynaecologic Oncology Unit, Department of Obstetrics and GynaecologyUniversity of PretoriaPretoriaSouth Africa
| | - Hugo De Vuyst
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
| | - Stephen E. Hawes
- Departments of Epidemiology, Health Services, and Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health OrganizationGenevaSwitzerland
| | - Shona Dalal
- Department of Global HIV, Hepatitis and STIs Programmes, World Health OrganizationGenevaSwitzerland
| | - Gary M. Clifford
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO)LyonFrance
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