HPV vaccination in Africa in the COVID-19 era: a cross-sectional survey of healthcare providers' knowledge, training, and recommendation practices.

Introduction: Although the burden of cervical cancer in Africa is highest, HPV vaccination coverage remains alarmingly low in this region. Providers' knowledge and recommendation are key drivers of HPV vaccination uptake. Yet, evidence about providers' knowledge and recommendation practices about the HPV vaccine against a backdrop of emerging vaccine hesitancy fueled by the COVID-19 pandemic is lacking in Africa. Methods: A cross-sectional study was conducted in 2021-2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior training, the availability of the HPV vaccine in their practice, whether they recommended the HPV vaccine, and, if not, the reasons for not recommending it. Their knowledge about the HPV vaccine was assessed through self-reporting (perceived knowledge) and with three pre-tested knowledge questions (measured knowledge). Results: Of the 153 providers from 23 African countries who responded to the survey (mean age: 38.5 years, SD: 10.1), 75 (54.0%) were female and 97 (63.4%) were based In countries with national HPV immunization programs. Overall, 57 (43.8%) reported having received prior training on HPV vaccine education/counseling, and 40 (37.4%) indicated that the HPV vaccine was available at the facility where they work. Most respondents (109, 83.2%) reported recommending the HPV vaccine in their practice. Vaccine unavailability (57.1%), lack of effective communication tools and informational material (28.6%), and need for adequate training (28.6%) were the most commonly reported reasons for not recommending the HPV vaccine. While 63 providers (52.9%) reported that their knowledge about HPV vaccination was adequate for their practice, only 9.9% responded correctly to the 3 knowledge questions. Conclusion: To increase HPV vaccination coverage and counter misinformation about this vaccine in Africa, adequate training of providers and culturally appropriate educational materials are needed to improve their knowledge of the HPV vaccine and to facilitate effective communication with their patients and the community.

Issues in the surgical management of skin squamous cell cancers in albinos-experience of two surgical oncology units in Burkina Faso.

BACKGROUND AND OBJECTIVES: Skin cancers in albinos are frequent in sunny countries. The surgeon plays a crucial role in their treatment. The objective was to describe the challenges of surgical management of skin cancer in albinos. METHODS: Retrospective, descriptive, and multicenter study on skin cancer surgery in albinos performed over the past 14 years in Ouagadougou. We were interested in surgery indications, techniques, and results. Survival was assessed using the Kaplan-Meier method. Comparisons of proportions were made by Student's t-test. RESULTS: The cancers were multiple synchronous in 41.3%. We identified 46 albinos with 71 skin cancers. Surgery was performed in 93%. Lesions were located on the back, upper limbs, and head and face in 40.9%, 30.3%, and 16.7%, respectively. Precancerous lesions were treated concomitantly in 23.6%. The surgery consisted of a lumpectomy. Direct suturing and mobilization of flaps allowed skin coverage in 17.9% and 34.3%, respectively. Lymph node dissection was associated with the limbs in 73.1% of localizations. The average number of lymph nodes removed was 11, with extremes of 7 and 14. Node invasion was noted in 16 out of 19 cases. The resection margins were invaded in 7.5% and required surgical revision. Recurrences were noted in 8.9% of cases. Overall 2-year survival rate was 55.8%. CONCLUSIONS: Surgery must meet the triple challenge of treating single or multiple synchronous cancers, precancerous lesions, and allowing good healing. Early diagnosis would reduce the rate of secondary healing and improve survival. The absence of extemporaneous histology and the large size of the tumors associated with the delay in diagnosis meant that surgery, whenever possible, was limited to wide and deep resection, to ensure healthy margins.

Surgery for primary malignant tumors of the abdominal wall: experiences of three African surgical oncology units and review of the literature.

BACKGROUND AND OBJECTIVES: Tumors of the abdominal wall are uncommon but diverse. The surgical challenge is double. The tumor must be completely removed and the abdominal wall repaired. Our aim was to describe the indications, techniques, and results of surgery on these tumors in an African context. METHODS: Retrospective, multicentric and descriptive study conducted in three West African surgical oncology units. We included all abdominal wall tumors followed up between January 2010 and October 2022. Histological type, size, surgical procedure, and method of abdominal wall repair were considered. Survival was calculated using the Kaplan-Meier method and comparisons of proportions were made using the Student t test. RESULTS: We registered 62 tumors of the abdominal wall and we operated on 41 (66.1%). The mean size of the tumors was 14.3 ± 26 cm. Dermatofibrosarcoma and desmoid tumor were present in 33 and 3 cases respectively. In 31.7% of cases in addition to the tumour, the resections carried away the muscular aponeurotic plane. Parietal resections required the use of a two-sided prosthesis in 6 cases. In 13 cases, we used skin flaps. The resections margins were invaded in 5 cases and revision surgery was performed in all of them. Incisional hernia was noticed in 2 cases. The tumor recurrence rate was 12.2% with an average time of 13 months until occurrence. Overall survival at 3 years was 80%. CONCLUSIONS: Surgery is the mainstay of treatment for abdominal wall tumors. It must combine tumor resections and parietal repair. Cancer surgeons need to be trained in abdominal wall repair.

Enhancing information on stage at diagnosis of cancer in Africa.

BACKGROUND/PURPOSE: Stage at diagnosis is an important metric in treatment and prognosis of cancer, and also in planning and evaluation of cancer control. For the latter purposes, the data source is the population-based cancer registry (PBCR), but, although stage is usually among the variables collected by cancer registries, it is often missing, especially in low-income settings. Essential TNM has been introduced to facilitate abstraction of stage data by cancer registry personnel, but the accuracy with which they can do so is unknown. METHODS: 51 cancer registrars from 20 countries of sub-Saharan Africa (13 anglophone, 7 francophone) were tasked with abstracting stage at diagnosis, using Essential TNM, from scanned extracts of case. The panel comprised 28 records of each of 8 common cancer types, and the participants chose how many to attempt (between 48 and 128). Stage group (I-IV), derived from the eTNM elements that they assigned to each cancer, was compared with a gold standard, as decided by two expert clinicians. RESULTS: The registrars assigned the correct stage (I-IV) in between 60 and 80% of cases, with the lowest values for ovary, and the highest for oesophagus. The weighted kappa statistic suggested a moderate level of agreement between participant and expert (0.41-0.60) for 5 cancers, and substantial agreement (0.61-0.80) for three, with the best for cervix, large bowel, oesophagus and ovary, and the worst (weighted kappa 0.46) for non-Hodgkin lymphoma (NHL). For all except NHL, early stage (I/II) and late stage (III/IV) was correctly identified in 80% or more of the cases. CONCLUSIONS: A single training in staging using Essential TNM resulted in an accuracy that was not much inferior to what has been observed in clinical situations in high income settings. Nevertheless, some lessons were learned on how to improve both the guidelines for staging, and the training course.

Dermatofibrosarcoma protuberans surgery: Experiences of four African surgical oncology units and literature review.

BACKGROUND AND OBJECTIVES: Dermatofibrosarcoma is a locally malignant tumor. This gives surgery a place of choice. The advent of imatinib has improved outcomes. Our aim is to describe the indications, techniques and results of surgery. METHODS: A retrospective, multicenter, descriptive study conducted in four West African surgical oncology units. It covers dermatofibrosarcoma surgery performed between January 1, 1988 and December 31, 2020. We took into account the surgical procedure, the mode of skin coverage, adjuvant treatments and survival. Comparisons were possible using Student's t-test and Pearson's χ2 . RESULTS: We recorded 81 cases of dermatofibrosarcoma. Surgery was effective in 90.1% of cases. Wide resection was the principle with a mean resection margin of 3.8 ± 1.9 cm. healing by primary intention, flaps and healing by secondary intention were the methods of skin coverage in 30.1%, 24.7% and 41.1% respectively. The type of skin coverage was related to the topography and size of the tumor (p < 0.0001). The healing time is associated with the type of skin cover. The recurrence rate was not related to the type of skin coverage (p = 0.8). CONCLUSIONS: Wide and deep resection in the absence of Mohs micrographic surgery ensures healthy margins. Oncoplasty reduces the healing time without increasing the risk of recurrence.

Impact of surgery associated with radiotherapy on the prognosis of breast cancer - Guinea Breast Cancer Cohort Study.

BACKGROUND: In a country where radiotherapy (RT) is not available, advocacy based on the relevance of surgery + adjuvant RT in locoregional control and survival is needed. AIM: To evaluate the impact of surgery with RT on local control and survival compared to surgery alone in breast cancer (BC). METHODS AND RESULTS: Between 2007 and 2016, 210 patients with BC were retrospectively reviewed, of which 90 patients underwent surgery with RT (group 1) and 120 patients' surgery (group 2). There were several treatment combinations, including surgery combined with neoadjuvant chemotherapy [ACT], RT, and ACT. The results showed 88 (41.9%) cases of relapse, including 31 (34.4%) (group 1) and 57 (47.5%) (group 2) (p = .046). Recurrence occurred after a mean time of 1.5 years in group 1 versus 0.66 years in group 2 (p = .006). The 5-year overall and BC-specific survivals were 49.5% and 62.5%, respectively. The 5-year survival was 60.0% (group 1) and 40.0% (group 2) (p < .05). In a multivariate analysis by Cox model, we found that the risk of death was 1.90 81 (95% CI [1.17 09-3.0701]) higher in group 2 (p = .009022), 1.69 85 (95% CI 1.00087-23.86157) in obese patients and decreased by 0.21 (95% CI [0.129-0.368]) in patients who did not relapse (p < .001). CONCLUSION: In this study with several combination therapies, we cannot confirm that RT improves mainly locally advanced BC prognosis regardless of systemic treatment. However, we found that the risk of death correlated with the absence of RT, overweight, and risk of recurrence. Consideration of combinations of locoregional and systemic therapies, clinicopathological and biological data could improve the relevance of these results with a large sample size.

What Is the Impact of the Ebola Virus Disease Outbreak on Cancer Management in Guinea?

PURPOSE: To assess the impact of the Ebola virus disease outbreak (EVDO) on cancer management at the surgical oncology unit of Donka National Hospital. METHODS: This was a retrospective and comparative analysis of cancer consultation and care data before (2012-2013), during (2014-2015), and after (2016-2017) the EVDO. The number of cancer occurrences, referral mode, origin, main activities (consultations, surgery, chemotherapy), and access of radiotherapy were analyzed. The Mann-Whitney U test with independent samples used was considered as significant if P was ≤ .05. RESULTS: From 2012 to 2017, 4,977 patients were admitted, including 2,254 with cancer. The variations observed were a decrease in consultations by 2.3% during the EVDO versus an increase by 46.9% after the outbreak (P < .001). We found decreases of 0.7% and 12.5% during and increases of 253.8% and 15.4% after the EVDO from level 1 and 2 and from level 3 health facilities, respectively (P < .001). A total of 251 surgeries were performed, and 1,463 received chemotherapy. There was 5.2% more chemotherapy use during and 33.7% more after the EVDO (P < .001). The number of surgeries increased by 35.8% and decreased by 40.0% during and after the EVDO, respectively (P < .001). We evacuated 36 patients for radiotherapy, which reflected a decrease of 42.1% and 45.5% during and after the EVDO (P < .001). CONCLUSION: Cancer management slowed down during the EVDO. This change requires organization of the fight against cancer through the institutionalization and decentralization of its management.

Molecular profile of breast cancers in Guinean oncological settings.

Breast cancer is a complex disease characterized by the accumulation of multiple molecular alterations giving each tumor phenotype and an own evolutionary potential. This study aimed to describe the distribution of the profile and molecular subtypes of breast cancers followed at Surgical Oncology Unit of Donka National Hospital. This was retrospective and descriptive study on cases of breast cancer in which the hormone receptor status and expression of the Her2 oncogene have been performed from 2007 to 2016. We recorded 58 cases including 56 (96.6%) women and 2 (3.4%) men. The average age was 48.2 ± 10.9. Invasive ductal carcinoma accounted for 50 (86.2%) cases. The SBR grade was II in 31(53.4%) cases, III in 21 (36.2%) cases and I in 6 (10.3%) cases. The tumor was classified as T4 in 36 (62.1%) cases; it was metastatic in 11(19.0%) cases. Estrogen receptors were positive in 29 (50.0%) cases, progesterone receptors positive in 25 (43.1%) cases, the Her2 oncogene was positive in 22 (39.3%) cases. The distribution of molecular sub-types was: 20 (34.5%) luminal A, 15 (25.9%) triple negative, 13 (22.4%) Her2 overexpressed, 8 (13.8%) luminal B and 2 (3.2%) undetermined. This preliminary study showed the poor accessibility of immunohistochemistry for the molecular diagnosis of breast cancer in our country. Luminal A subtypes and triple negatives were more common. The determination of molecular subtypes is a rational basis for hormone therapy and targeted therapy, thus personalizing the treatment of breast cancer.

An Exceptional Adenocarcinoma in a Girl.

Anal adenocarcinoma is very rare and usually occurs in the elderly. We present a case of a 12-year-old girl with an anal margin painful tumor infiltrating the lower rectum, with perineal and vulvar permeation nodules and bilateral fixed inguinal and iliac lymph nodes. Histology showed anal adenocarcinoma with mucosecreting component and independent cells. She had no extra pelvic metastasis on CT scan. She underwent a colostomy and palliative care. This exceptional case challenges us on the diversity of forms of anal cancers that require a multidisciplinary approach. The precarious social context and the age of onset make it difficult to manage this rare cancer.

An exceptional case of bilateral gestational gigantomastia with multiple breast lumps.

Bilateral gigantomastia is a rare condition, often associated with pregnancy that is characterized by a diffuse enlargement of both breasts. Here we present a case of a late 20s woman in her seven months pregnancy with a bilateral gestational gigantomastia associated with multiple breast lumps. Histological analysis revealed a fibroadenoma. Her prolactin level after caesarean delivery was found particularly high. A significant decrease in breast size was achieved with bromocriptine treatment in conjunction with a bilateral lumpectomy. This case report highlights the diversity of gigantomastia and emphasizes the importance of a tailored, multidisciplinary approach to the diagnosis and treatment of this condition.

Primary Breast Burkitt's Lymphoma in an HIV-Infected Woman.

A 30-year-old HIV positive woman presented with a multifocal mass tumour associated with axillary and lateral-cervical lymphadenopathy in the right breast. Laboratory examination of the biopsy confirmed a case of mammary Burkitt's lymphoma with a nodular infiltration of the breast. Antiretroviral treatment and chemotherapy were effective to control the tumour. Although Burkitt's lymphoma rarely involves the breasts, it should be considered during routine breast examination of African woman.

The Prevalence of HIV in Cancer Patients at the Surgical Oncology Unit of Donka University Hospital of Conakry (Guinea).

Aim. To determine the prevalence of HIV infection among patients seen at the surgical oncology unit of Donka (Conakry, Guinea). Method. We conducted a retrospective and descriptive study of HIV infection in cancer patients from May 2007 to December 2012. Social characteristics (age, gender, marital status, and education) and immune status (HIV type, CD4 count) were reviewed. Results. Out of 2598 cancer patients, 54 (2.1%) tested positive for HIV. There were 11 (20.4%) defining AIDS and 43 (79.6%) nondefining AIDS cancers. The most frequent cancers were breast (14) (26.0%), non-Hodgkin lymphoma (6) (11.1%), liver (6) (11.1%), eye and annexes (6) (11.1%), and cervical cancer (5) (9.3%). These patients were female in 34 (63.0%) and had a median age of 39 years and body mass index was 20,3 Kg/m(2). They were unschooled in 40 (74.1%) and married in 35 (64.8%). CD4 count showed a median of 317 cells/mL. Antiretroviral treatment was performed in 40 (74.1%). Conclusion. HIV prevalence is higher in patients in our unit of surgical oncology. Breast cancer was the most common in this association. A national survey of a large sample is needed to determine the true prevalence and impact of HIV on cancer prognosis.