Burden of Cancer in Kampala, Uganda: Common Types, Incidence and Trends
Authors: Leocadia Kwagonza1*, Daniel Kadobera1, Annet Nakaganda3, Mary Phoebe Amulen2, Joy Kusiima Bbaale1, Sarah Nambooze2, Henry Wabinga2; Affiliations: 1Public Health Fellowship Program 2 Kampala Cancer Registry 3Uganda Cancer Institute
Comprehensive data on the burden and trends of cancer to inform public health action is limited in most Eastern African countries. The Kampala Cancer Registry (KCR) was established to fill this gap in Uganda. We described the trends, incidences, and morphological verification of top five cancers in males and females using data from Kampala Cancer Registry. We extracted data from the KCR CANREG5 system into EPI Info V7.2 for analysis. From January 2009 to December 2013, 8,168 new cancer cases were registered. 55% (4522/8168) were female. Cancer of the Cervix in females and Prostate in males were leading cancers while Kaposi Sarcoma affected mostly young age groups equally. The Morphological Verification was 54.3%. This study demonstrated that cancer is an important Public Health problem with high incidences. Cervical, KS and Prostate cancer are the leading cancers. We recommend integration of cancer screening services in HIV programs.
Introduction: Cancer is one of the leading causes of death in the world. The World Health Organization’s GloboCan project, estimated 14.5 million new cancer cases of all types globally in 2012, with 55% (8 million cases) occurring in less developed countries [1]. According to the GloboCan report, 32.6 million people were living with cancers worldwide causing 5.3 million deaths [1]. The projected, cancer incidence and mortality will increase by 69% and 72% respectively by 2030.[2, 3]. Globally, cancers of the lung, breast, colorectum, stomach and prostate are the most common cancers [3], however in sub-Saharan Africa (SSA), infection related cancers such as
Kaposi Sarcoma and cervical cancer are the most prevalent. Prevalence of risk factors for cancers in SSA are high; HIV 10% or more, human papillomavirus 34%, tobacco smoking 25% and harmful use of alcohol 19% particularly in men, obesity in women 28% or more among others [4]. Comprehensive data on the burden and trends of cancer to inform policies, strategies and interventions are lacking in most countries in eastern and southern African region. We described the trends, incidence and Morphological Verification (MV) of top five cancers in Kampala District using the Kampala Cancer Registry (KCR) a population-base Cancer registry.
Methods: KCR covers Kyadondo County is comprised of Kampala district and surrounding Wakiso district. The population is mainly Baganda (50%); 30% are other ethnic groups from Uganda and 20% of immigrants from other countries. We used the UBoS 2010 census data and assumed that the population was stable over the study period. Total population was 2,100,305 (995,601 males and 1,104,704 females with the younger age groups being the majority. We extracted KCR records from 2009 to 2013. Data at KCR is extracted from health facilities, histopathology laboratories, and palliative centers such as Hospice Uganda.
Results: Between 1st January 2009 and 31st December 2013, 8168 new cases were registered. Of these, 55.4% (4522/8168) were females. 58% (4554/8168) of the new cases contributed to the top five cancers among males and females.
Top five cancers: Among females, Cervical cancer was most incident cancer at 20/100,000.followed by Breast, Kaposi Sarcoma, Esophagus and Ovarian cancer. Among males, Kaposi Sarcoma had the highest annual incidence of 18 per 100,000 Populations followed by Prostate, Esophagus, Leukemia and liver cancers.
Cumulative incidences of top five cancers: Among females, cervical cancer had the highest cumulative incidence of up to 6.4% followed by breast, Kaposi Sarcoma, Esophagus and Ovarian as shown in figure 2a. Among males, Prostate cancer had the highest cumulative incidence followed Esophagus, Kaposi sarcoma, Leukemia and Liver cancer.t
Trends in incidence of top five cancers: There were more incident cases of Cancer of the cervix registered in 2012 and 2013, compared to the incidence registered during the previous years. Kaposi Sar- coma (KS) was highest among cancers in Males as shown in Figure 1.0.
There was a gradual increase in the incidence of cancers with increase in age. Whereas majority of cancers affected the older age- groups, KS was more frequent among the younger age-
groups and then declined among adults as shown in the figures below.
Discussion: This study demonstrated that cancers are a important public health problem with high incidences in both men and women. Cancer of the cervix, prostate, breast and KS were the most incident cancers. Incidence of KS and cervical cancer is partly fueled by high HIV prevalence in Kampala and Wakiso Districts [5]. Several studies now clearly demonstrate an increased risk of preinvasive cervical lesions among HIV- infected women [6] and the incidence of Kaposi Sarcoma among HIV patients. KS remains the most common AIDS- associated neoplasm [7]. AIDS-associated KS occurs with in- creased frequency in all HIV transmission groups compared with the general population[7].
The increased incidence in the trends of cancer in 2012 was due to the enhanced screening programs for both breast cancers and cervical cancer within Kyadondo county and neighboring communities and the launching of Uganda Breast Cancer early detection project at Fred Hutch cancer institute in Mulago [8].
The fairly good MV of cancers in the registry shows that a good number of cases are being captured through clinical assessment. Kaposi Sarcoma had the highest percentage Morphological Verification of 70%.
Kaposi sarcoma, one of the commonest cancers is much easier to diagnose clinically compared to other cancers. Leukemia had the lowest % MV of 29% yet it is expected to be diagnosed cytologically. Ideally we would have expected the leukemia %MV to be over 70%. This means that nonspecific methods such as clinical assessments, death certificates, or blood cell count are the basis of diagnosis for leukemia. This has implications of either under reporting or over reporting of leukemia.
Conclusions and recommendation: Cervical cancer in females and Prostate cancer in males remain the leading cancers. Prostate cancer was most common among the elderly men while Kaposi Sarcoma affected the younger age groups in both males and females equally. The MV of cancer cases in the cancer registry was fair. We recommended integration of cancer screening into HIV programs to enhance early detection and treatment and enhanced advocacy for cancer screening programs .
References:
1. World Health Organisation, GloboCan: Estimated Cancer incidence, mortality and prevalence 2012. 2. World Health Organisation, WHO International Agency for Research on Cancer (IARC): Globocan 2008 Report IARC: Lyon; . 2008. 3. World Health Organisation, Cancer fact sheet no. 297. Geneva: 2011. 4. Msyamboza KP, N.B., Dzowela T et al., The Burden of Selected Chronic Non-Communicable Diseases and Their Risk Factors in Malawi: Nationwide STEPS Survey. PLoS One 2011, 6(5):e20316. 2011. 5. UBoS, Uganda AIDS Indicator survey. 2011. 6. Chirenje, Z.M., HIV and cancer of the cervix. Best Pract Res Clin Obstet Gynaecol, 2005. 19(2): p. 269-76. 7. Krown, S.E., Highly active antiretroviral therapy and incidence of cancer in human immunodeficiency virus-infected adults. . J Natl Cancer Inst, 2000. 92:1823-30. 8. https://www.fredhutch.org/en/news/center-news/2012/04/lehman-ge-uganda.html. Accessed on 15 August 2016.
