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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
