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Observed and Expected Incidence of Cervical Cancer in Lusaka and the Southern and Western Provinces of Zambia, 2007 to 2012
  1. Mulele Kalima, BSc, MPH*,,
  2. Kennedy Lishimpi, BSc, MBChB, MMed, FC Rad Onc (SA),,
  3. Jane L. Meza, PhD*,
  4. Shinobu Watanabe-Galloway, PhD§,
  5. Susan C. Msadabwe, MBChB, MMed, FC Rad Onc (SA),
  6. Catherine K. Mwaba, MD, FC Rad Onc (SA),
  7. Aaron L. Shibemba, MBChB, MMed,
  8. Lewis Banda, MBChB, MMed, FC Rad Onc (SA),
  9. Charles Wood, PhD,
  10. Robert M. Chamberlain, PhD§, and
  11. Amr S. Soliman, MD, PhD§
  1. *Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE;
  2. Cancer Diseases Hospital, Lusaka, Zambia;
  3. Faculty of Medical Radiation Sciences, Lusaka Apex Medical University, Lusaka, Zambia;
  4. §Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha;
  5. Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE; and
  6. Department of Epidemiology, MD Anderson Cancer Center, University of Texas, Houston, TX.
  1. Address correspondence and reprint requests to Amr S. Soliman, MD, PhD, Department of Epidemiology, College of Public Health, 984395 University of Nebraska Medical Center, Omaha, NE 68198. E-mail: amr.soliman{at}unmc.edu.

Abstract

Objectives Cervical cancer is increasing but underestimated in developing countries. We calculated the observed and expected incidence of cervical cancer in Lusaka and Southern and Western provinces of Zambia.

Methods/Materials Data for 2007 to 2012 were obtained for the 3 provinces. Data included age, residence, year of diagnosis, marital status, occupation, human immunodeficiency virus (HIV), stage, radiotherapy, and chemotherapy. Expected incidence in Southern and Western provinces was calculated based on observed incidence for Lusaka province, adjusting for HIV.

Results Crude and age-standardized incidence rates (ASRs) in Lusaka were 2 to 4 times higher than incidence in the other 2 provinces. Lusaka had a rate of 54.1 per 105 and ASR of 82.1 per 105 in the age group of 15 to 49 years. The Southern province had a rate of 17.1 per 105 and ASR of 25.5 per 105; the Western province had a rate of 12.3 per 105 and ASR rate of 17.2 per 105. The observed cervical cancer incidence rates in the Southern and Western provinces were lower than the rate in Lusaka, possibly because of the uncertainty of underreporting/underdiagnosis or actual lower risk for reasons yet unclear. The HIV seroprevalence rates in patients from the 3 provinces were 46% to 93% higher than seroprevalence in the respective general populations.

Conclusions Cervical cancer is significantly underestimated in Zambia, and HIV has a significant role in pathogenesis. Future studies should establish methods for case ascertainment and better utilization of hospital- and population-based registries in Zambia and other similar developing countries.

  • Zambia
  • Cervical cancer
  • Incidence
  • Developing countries

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Footnotes

  • Supported in part by the Cancer Epidemiology Education in Special Populations Program of the University of Nebraska Medical Center through the funding from the National Cancer Institute (R25CA112383). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.

  • Mulele Kalima was funded by the Fogarty International Training and Research Program (grant D43 TW001429). His research utilized resources available through the Cancer Epidemiology Education in Special Populations Program of the University of Nebraska (grant R25 CA112383).

  • The authors declare no conflicts of interest.

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