Tessa S Stewart1, Jennifer Moodley2, Fiona M Walter3. 1. The University of Cambridge School of Clinical Medicine, Addenbrookes Hospital, Hills Road, Cambridge CB2 0SP, United Kingdom. Electronic address: tss32@cam.ac.uk. 2. Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa; Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa; SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Electronic address: Jennifer.Moodley@uct.ac.za. 3. The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, United Kingdom. Electronic address: fmw22@medschl.cam.ac.uk.
Abstract
BACKGROUND: Cervical cancer is the most prevalent malignancy in sub-Saharan Africa (SSA) with many women only seeking professional help when they are experiencing symptoms, implying late-stage malignancy and higher mortality rates. This ecological study assesses population-level exposures of SSA women to the numerous risk factors for HPV infection and cervical cancer, against late-stage presentation of cervical cancer. MATERIALS AND METHOD: A literature review revealed the relevant risk factors in SSA. Open-access databases were mined for variables closely representing each risk factor. A proxy for late-stage presentation was used (ratio of incidence-to-mortality, IMR), and gathered from IARC's GLOBOCAN 2012 database. Variables showing significant correlation to the IMR were used in stepwise multiple regression to quantify their effect on the IMR. RESULTS: Countries with high cervical cancer mortality rates relative to their incidence have an IMR nearer one, suggesting a larger proportion of late-stage presentation. Western Africa had the lowest median IMR (1.463), followed by Eastern Africa (IMR = 1.595) and Central Africa (IMR = 1.675), whereas Southern Africa had the highest median IMR (1.761). Variables selected for the final model explain 65.2% of changes seen in the IMR. Significant predictors of IMR were GDP (coefficient = 2.189 × 10-6, p = 0.064), HIV infection (-1.936 × 10-3, p = 0.095), not using a condom (-1.347 × 10-3, p = 0.013), high parity (-1.744 × 10-2, p = 0.008), and no formal education (-1.311 × 10-3, p < 0.001). CONCLUSION: Using an IMR enables identification of factors predicting late-stage cervical cancer in SSA including: GDP, HIV infection, not using a condom, high parity and no formal education.
BACKGROUND:Cervical cancer is the most prevalent malignancy in sub-Saharan Africa (SSA) with many women only seeking professional help when they are experiencing symptoms, implying late-stage malignancy and higher mortality rates. This ecological study assesses population-level exposures of SSA women to the numerous risk factors for HPV infection and cervical cancer, against late-stage presentation of cervical cancer. MATERIALS AND METHOD: A literature review revealed the relevant risk factors in SSA. Open-access databases were mined for variables closely representing each risk factor. A proxy for late-stage presentation was used (ratio of incidence-to-mortality, IMR), and gathered from IARC's GLOBOCAN 2012 database. Variables showing significant correlation to the IMR were used in stepwise multiple regression to quantify their effect on the IMR. RESULTS: Countries with high cervical cancer mortality rates relative to their incidence have an IMR nearer one, suggesting a larger proportion of late-stage presentation. Western Africa had the lowest median IMR (1.463), followed by Eastern Africa (IMR = 1.595) and Central Africa (IMR = 1.675), whereas Southern Africa had the highest median IMR (1.761). Variables selected for the final model explain 65.2% of changes seen in the IMR. Significant predictors of IMR were GDP (coefficient = 2.189 × 10-6, p = 0.064), HIV infection (-1.936 × 10-3, p = 0.095), not using a condom (-1.347 × 10-3, p = 0.013), high parity (-1.744 × 10-2, p = 0.008), and no formal education (-1.311 × 10-3, p < 0.001). CONCLUSION: Using an IMR enables identification of factors predicting late-stage cervical cancer in SSA including: GDP, HIV infection, not using a condom, high parity and no formal education.
Keywords:
Africa south of the Sahara; Condoms; HIV infections; Incidence; Prevalence; Risk factors; Rural population; Socioeconomic factors; Uterine cervical neoplasms
Authors: Gaudence Niyonsenga; Darius Gishoma; Ruth Sego; Marie Goretti Uwayezu; Bellancille Nikuze; Margaret Fitch; Pierre Céléstin Igiraneza Journal: Can Oncol Nurs J Date: 2021-07-01
Authors: Gaudence Niyonsenga; Darius Gishoma; Ruth Sego; Marie Goretti Uwayezu; Bellancille Nikuze; Margaret Fitch; Pierre Céléstin Igiraneza Journal: Can Oncol Nurs J Date: 2021-07-01
Authors: Biniyam Tefera Deressa; Mathewos Assefa; Ephrem Tafesse; Eva Johanna Kantelhardt; Ivan Soldatovic; Nikola Cihoric; Daniel Rauch; Ahmedin Jemal Journal: BMC Cancer Date: 2021-10-13 Impact factor: 4.430