Cervical cancer in Sub-Saharan Africa: a multinational population-based study on patterns of care

Purpose:

Cervical cancer (CC) has an incidence up to 42/100,000 per year in Sub-Saharan Africa (SSA). Lack of health services, late stages at presentation and poor overall survival (OS) are reported, but little is known about the patterns of care. Thus, we designed a retrospective, population-based study to collect data upon stage, therapy, and OS.

Methods:

Random sets of 60 cases from 2010 – 2016 were selected from nine population-based cancer registries in eight countries: Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. FIGO stage, HIV and ECOG status, and detailed treatment data was obtained from patient files and phone calls. Therapy was evaluated for adherence to NCCN Guideline 1.2010.

Findings:

Preliminary analysis of 410 traced patients: HIV status was positive in 20% (61% unknown). Late stages prevailed with FIGO III&IV found in 54% (12% unknown). Two-year OS was 50%. Guideline adherence in FIGO I-III patients was best in early stages; minor deviations were found in 30% and treatment without curative potential or none in 54%. FIGO stage>II, positive HIV status, and low guideline adherence were significantly (p < 0.05) associated with adverse OS in multivariate analysis.

Conclusions:

This is the first study to describe patterns and guideline adherence of CC care in eight SSA countries using a random set of cases from population-based registries. The data is limited by unprecise staging and poor documentation in this low-resource setting. Still, it could possibly quantify the impact of planned health service interventions.