Article Text
Abstract
Introduction Cervical cancer is the most common cause of cancer-related mortality in Botswana. Since September 2022, it has become feasible in Botswana to get cross-sectional imaging for all patients with cancer. This study describes stage changes after incorporation of radiographic staging.
Methods Patients with pathologically confirmed cervical cancer in Gaborone, Botswana were retrospectively reviewed between September 2022 and December 2023. Initial clinical staging included chest x-ray, abdominal/pelvic ultrasound, and physical exam. Radiographic staging was completed with CT or MR imaging. Only curative patients were referred for imaging. Data was analyzed with descriptive statistics.
Results Overall, 180 patients were reviewed. Median age was 49 (IQR: 43-59) years and 121 (67.2%) women were living with HIV. By clinical staging, 42 were stage I, 60 stage II, 72 stage III, and 6 stage IV. After radiographic staging, 27 were stage I, 39 were stage II, 61 were stage III, and 53 were stage IV (table 1). Overall, 108 (60.0%) patients were upstaged, 7 (3.9%) were downstaged, and 65 (36.1%) did not change stage (figure 1). Among those upstaged, 61 (56.5%) had a change in treatment plan, including 11 (10.2%) patients prescribed chemoradiation rather than surgery and 50 (46.3%) patients upstaged to IVA or IVB warranting induction chemotherapy or palliative radiation rather than upfront concurrent chemoradiation.
Conclusion/Implications Implementation of cross-sectional imaging resulted in stage changes for over half of patients, resulting in treatment changes for approximately one-third of all patients. Public insurance coverage of imaging for staging could significantly improve treatment outcomes for cervical cancer patients in Botswana.