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Cervical Cancer Incidence in Nairobi Kenya

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					Cervical Cancer Incidence in
Nairobi Kenya


   Anne Rugutt Korir
   Nairobi Cancer Registry,
   Kenya Medical Research Institute- KEMRI
Background
 Cervical cancer is the 3rd most common cancer in
  women worldwide with approximately 529,000 new
  cases diagnosed in 2008 (http://globocan.iarc.fr/factsheets/cancers/cervix.asp)
 In less developed countries, this type of cancer is the
  second most common in women and accounts for up
  to 300,000 annual deaths. 80% of the cases occur in
  low-income or middle-income countries.
 The risk of cervical cancer is closely linked to sexually
  transmitted infections with certain types of human
  papilloma virus
Most Frequent Cancers Women
Cancer of the Cervix in Kenya

 Estimate of newly diagnosed cases in Kenya per
  million women per year – 800pmm
 Incidence Kampala Uganda - 40.8 / 100,000
 In Nairobi Kenya – 46% of mortality in gynecological
  ward.(Rogo et al 1990)
 Death in women in Harare Zimbabwe 67/100,000 ---
  Gynaecological Cancers(Chirenye, Cancer registry
  Harare)
Cervical Cancer in Nairobi
 Data from Nairobi cancer registry indicates that cervical
  cancer is the second most common cancer after breast in
  female cancers
 Breast and Cervix are the most common cancers in women
  accounting for over 40% of all female cancers
 475 cases of cervical cancer were registered in Nairobi, the
  capital city of Kenya with a population of 3 million people
  (2009 population census)
 Cervical cancer accounted for 19% of all female cancers
  registered.
 The crude incidence rate was 10.1 per 100,000 while the
  ASR(W) was 31.2 per 100,000 from 2003-2006
Most Frequent Female Cancers, Nairobi
2003 - 2006
                                          Most Frequent Female Cancers, Nairobi 2003 - 2006


                            Breast                                                                                        39.2

                       Cervix Uteri                                                                           31.2

                      Oesophagus                                   9.9

                            Ovary                              9.2

                          Stomach                              9

                             Colon                       7.3

                              Liver                    6.3
ICD-O site




                       Corpus Uteri              4.7

             Non-Hodgkin lymphoma           3.7

             Trachea,Bronchus,Lung          3.5

                         Pancreas          3.3

                             Mouth         3.1

                             Bone         2.7

                           Rectum         2.7

                           Thyroid        2.5

                                      0          5             10        15        20         25         30          35   40     45
                                                                              ASR (W) rate per 100,000
                                         Age Specific Incidence Rates for Cervical and Breast
                                                     Cancer, Nairobi 2003 - 2006

          250




          200
                                               Crude Rate:
Age Specific Incidence Rates




                                               Cervix 10.1
                                               Breast 11.7
          150

                                               ASR (World)
                                               Cervix 31.2
          100
                                               Breast 39.2




                           50




                               0
                                   0-4   5-9   10 - 14       20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74   75+

                                                                                       Cervix Uteri             Breast
Age Specific Incidence Rates
 The crude incidence rates for cervical cancer increase with
  increasing age, even though number of cases decreases with
  increasing age
 Greater proportion of population is between age 0-59 after
  which there is a sharp decline
 Crude incidence rates are skewed in older populations –
  higher rates in older populations are due to decreases in
  denominator in older age groups
Age Standardized Rates for Common Female Cancers

                                                  Age Standardized Rates for common female cancers

                                      60




                                      50
 Age Standardized Rates per 100,000




                                      40


                                                                                                            Breast
                                                                                                            Cervix
                                      30                                                                    Oesophagus
                                                                                                            Ovary
                                                                                                            Stomach

                                      20




                                      10




                                      0
                                           2003          2004                 2005                   2006
                                                                   Years
 Age Standardized Rates for Top 5 Female Cancers,
 per year. Nairobi 2003 - 2006

Site         2003   2004   2005   2006
                                          There is a steady increase
                                           from the year 2005 for three
Breast       38.6   40.6   42.1   51.6
                                           of the four common cancers
Cervix       28.9   30.5   30.4   47.6     (breast, cervical and ovarian)
Oesophagus    9.1    9.4   11     13.9    Even with age standardizing
Ovary         9.2   9.0    7.2    15.1     crude rates, there is a trend
                                           of increasing rates of
                                           cervical cancer over time
                                          Biggest increase in rates in
                                           2006 – perhaps reflection of
                                           improved case
                                           ascertainment?
Most Common Morphology Types for Cervical
Cancer
             3.1   1.9   1.0
       4.4                                                         Histology                                    No of Cases Perc.(%)
                                                                   Carcinoma, NOS                                       235       49.2
                                                                   Squamous cell carcinoma, NOS                         187       39.1
                                                                   Adenocarcinoma, NOS                                   21        4.4
                                                49.2
                                                                   Carcinoma, anaplastic, NOS                            15        3.1
39.1                                                               Squamous cell carc.large cell,nonkeratinizin           9        1.9
                                                                   Squamous cell carcinoma, microinvasive                 5        1.0
                                                                   Grand Total                                          478     100.0
                               Carcinoma, NOS
                               Squamous cell carcinoma, NOS
                               Adenocarcinoma, NOS
                               Carcinoma, anaplastic, NOS
                               Squamous cell carc.large cell,nonkeratinizin
                               Squamous cell carcinoma, microinvasive
Stage at Diagnosis for Cervical Cancer, 2003 - 2006

                      Stage At Diagnosis


                            1% 6%
                                                               Stage2        Total Perc. (%)
                                                               In Situ          3         0.6
                                              14%
                                                               Stage I         28         5.9
   38%                                                         Stage II        66       13.9
                                                               Stage III      119       25.1
                                                               Stage IV        76       16.0
                                               25%
                                                               Unknown        183       38.5
                                                               Grand Total    475      100.0
                      16%
  In Situ   Stage I    Stage II   Stage III   Stage IV   Unknown
Cervical cancer in Kenya: Challenges
 Human Resource capacity         Financial constraint
  limited                             o Patient
      o Oncologists                   o Health facilities
      o Support staff
 Equipment                       Accessibility
      o No. of equipments             o Distance
      o Maintenance                   o Accommodation
      o Cost of equipment
 Infrastructure                  Awareness
      o Limited space                o Ignorance
      o Dilapidated structures       o Beliefs
Cervical Cancer in Kenya: What should be done?
 In resource restricted areas of the world like Kenya, cancer of the cervix
  is the leading cause of death in women dying from cancers.
 Life style change, especially in the area of reproductive health can lead
  to some reduction of cancer of the cervix.
 The recently introduced vaccines are highly affective and can prevent
  up to 70 percent of cervical cancer in those women who are not infected
  with HPV.
 Vaccination for HPV should be introduced in Kenya as a part of routine
  vaccination schedules.
 Education aimed at changing life style including reproductive health
  education should be taken as priority.
 Pap screening of women should be expanded to complement
  vaccination when it is introduced.
 Screening for HPV virus can contribute to cervical cancer prevention
 Regional population based registries should be established and
  maintained to know burden of disease in the country
Challenges facing Nairobi Cancer Registry

   Case Ascertainment
     Estimated case ascertainment for Nairobi is 50-60%
     Data are still being collected for 2003-2006 and up to 2010
   Personnel:
     Cancer registrars
     Quality Assurance staff
     Statistician
   Equipment:
     Computers, copier, printers
   Materials and supplies: Regular supply of Abstract forms
   Funds
     Limited funds to pay staff for data abstraction
     Maintenance cost of registry
NCR Opportunities
 Good relations established with participating hospitals
 Collaboration with international organizations hence
  training enhanced and possible funding opportunities
 Availability and access to Death Certified Cases (DCOs)
  hence follow up studies e.g survival rates may be
  undertaken
 Improved pathological diagnosis e.g stage is now done for
  most biopsy specimen
Conclusion
 Despite many challenges faced by the registry, there is
  room for improvement. Goals:
   Increase case ascertainment in Nairobi to approach
     100%
   Improve quality control of data
   Inclusion in CI5 (Cancer Incidence in 5
     Continents)/IARC
   Publication of data in peer reviewed journals
Thank You.
 Special thanks to:
   Prof. Amr Soliman, University of Michigan for
    support of the registry through training.
   Dr. Farzana Walcott, UTMD – Co-author

				
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posted:11/19/2011
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