Cervical cancer survival in sub‐Saharan Africa by age, stage at diagnosis and Human Development Index: A population‐based registry study

• Published in: International journal of cancer Vol. 147; no. 11; pp. 3037 - 3048
• Main Authors: Sengayi‐Muchengeti, Mazvita, Joko‐Fru, Walburga Yvonne, Miranda‐Filho, Adalberto, Egue, Marcel, Akele‐Akpo, Marie‐Therese, N'da, Guy, Mathewos, Assefa, Buziba, Nathan, Korir, Anne, Manraj, Shyam, Lorenzoni, Cesaltina, Carrilho, Carla, Hansen, Rolf, Finesse, Anne, Somdyala, Nontuthuzelo I. M., Wabinga, Henry, Chingonzoh, Tatenda, Borok, Margaret, Chokunonga, Eric, Liu, Biying, Singh, Elvira, Kantelhardt, Eva Johanna, Parkin, Donald Maxwell
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.12.2020; Wiley Subscription Services, Inc
• Subjects: Adult; Africa; Africa South of the Sahara - epidemiology; Age; Aged; Cancer; Cervical cancer; Diagnosis; Educational Status; Female; Human Development; Human Development Index; Humans; Medical research; Middle Aged; Mortality; Neoplasm Staging; Population studies; Population-based studies; Registries; Regression analysis; stage; Survival; Survival Analysis; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - pathology; Africa South of the Sahara; stage; cervical cancer; Africa; Human Development Index; survival
• ISSN: 0020-7136; 1097-0215; 1097-0215
• DOI: 10.1002/ijc.33120

Cervical cancer is the leading cause of cancer death in African women. We sought to estimate population‐based survival and evaluate excess hazards for mortality in African women with cervical cancer, examining the effects of country‐level Human Development Index (HDI), age and stage at diagnosis. We selected a random sample of 2760 incident cervical cancer cases, diagnosed in 2005 to 2015 from 13 population‐based cancer registries in 11 countries (Benin, Cote d'Ivoire, Ethiopia, Kenya, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Uganda and Zimbabwe) through the African Cancer Registry Network. Of these, 2735 were included for survival analyses. The 1‐, 3‐ and 5‐year observed and relative survival were estimated by registry, stage and country‐level HDI. We used flexible Poisson regression models to estimate the excess hazards for death adjusting for age, stage and HDI. Among patients with known stage, 65.8% were diagnosed with Stage III‐IV disease. The 5‐year relative survival for Stage I‐II cervical cancer in high HDI registry areas was 67.5% (42.1‐83.6) while it was much lower (42.2% [30.6‐53.2]) for low HDI registry areas. Independent predictors of mortality were Stage III‐IV disease, medium to low country‐level HDI and age >65 years at cervical cancer diagnosis. The average relative survival from cervix cancer in the 11 countries was 69.8%, 44.5% and 33.1% at 1, 3 and 5 years, respectively. Factors contributing to the HDI (such as education and a country's financial resources) are critical for cervical cancer control in SSA and there is need to strengthen health systems with timely and appropriate prevention and treatment programmes. What's new? Cervical cancer is the leading cause of cancer deaths among women in Africa. Some parts of Africa are more highly developed than others, where “development” is measured by life expectancy, per capita income, and education levels. Here, the authors compare cervical cancer survival rates across 13 population‐based cancer registries in 11 African countries, taking development into account. Overall, 3 year survival rates were 44.5%, compared to 73.7% in the United States. In countries with a medium or low development index, patients were 4 times more likely to die than those in countries with a high development index.