Trends in the incidence of primary liver cancer in Central Uganda, 1960-1980 and 1991-2005.

Primary liver cancer (PLC) incidence trends from Africa are unknown. Using Kampala Cancer Registry data from 1960 to 1980 and 1991 to 2005, we identified 771 PLCs. Although rates were stable among men, PLC incidence among women increased >50%. Investigations of viral hepatitis, aflatoxin, obesity, and human immunodeficiency virus (HIV) may help to explain the increasing incidence of hepatocellular carcinomas (HCCs).

AIDS-related cancers in Africa: maturation of the epidemic in Uganda.

BACKGROUND: The AIDS epidemic has passed its peak in Uganda, with possible consequences for the risk of cancers related to infectious agents. OBJECTIVE: To compare the incidence of cancers possibly linked to infections with HIV, before the AIDS epidemic (the 1960s), at its high point (the early 1990s) when HIV-seroprevalence and AIDS notifications peaked, and after the onset of its decline in the later 1990s. METHODS: Analysis of incidence rates of infection-associated cancers in the population of Kyadondo county, in 1960-1971, 1991-1994, and 1995-1997. Comparison with data on prevalence of HIV infection, and notifications of AIDS. RESULTS: The incidence of Kaposi's sarcoma has increased enormously since the 1960s, with a shift to earlier age at onset, and more generalized and nodal disease; there has been little change in the profile during the 1990s. There was a large increase in incidence of squamous cell carcinomas of the conjunctiva, which has continued through the 1990s. Non-Hodgkin's lymphomas showed little increase in incidence until the most recent period, in which the incidence has increased both in children (particularly Burkitt's lymphomas) and adults. Although the incidence of cervical cancer was higher in the 1990s than the 1960s, it seems doubtful that this is related to HIV infection. Certain other cancers which have been linked to AIDS in western populations (Hodgkin's disease, anal carcinoma, childhood leiomyosarcoma) show no changes in risk. CONCLUSION: The AIDS epidemic has dramatically changed the profile of cancer in Uganda. Trends in the AIDS-related cancers are consistent with current knowledge concerning the mechanisms behind the increased risk. The incidence of certain cancers with a viral aetiology (liver, cervix, penis, Hodgkin's disease) appears not to have been influenced by AIDS.

Cancer survival in Kampala, Uganda, 1993-1997.

The Kampala cancer registry was established in 1954 as a population-based cancer registry, and registration of cases is done by active methods. The registry contributed data on survival for 15 cancer sites or types registered in 1993-1997. For Kaposi sarcoma, only a random sample of the total incident cases was provided for survival study. Follow-up has been carried out predominantly by active methods, with median follow-up ranging from 4-26 months. The proportion with histologically verified diagnosis for various cancers ranged between 36-83%; death certificate only (DCO) cases were negligible; 58-92% of total registered cases were included for survival analysis. Complete follow-up at five years ranged between 47-87% for different cancers. Five-year age-standardized relative survival rates for selected cancers were Kaposi sarcoma (22%), cervix (19%), oesophagus (5%), non-Hodgkin lymphoma (26%), breast (36%) and prostate (46%). None survived beyond 5 years for cancers of the stomach and lung. Five-year relative survival by age group was fluctuating with no definite pattern or trend emerging and no survivors in many age intervals.

Completeness in an African cancer registry.

OBJECTIVE: A high level of completeness of case-finding is essential if data from cancer registries are to be useful for comparative studies. A large case series, collected independently of the cancer registry case-finding mechanisms, as part of a study of the influence of HIV infection on cancer risk, was used to evaluate the completeness of the registry in Kampala, Uganda, for the years 1994-1996. RESULTS: For adults aged 15 or more, the completeness of registration of diagnosed cancer cases was 89.6% (95% CI 87.0-91.7) overall. It varied with age (better ascertainment of younger cases, aged under 30) and cancer site (with Kaposi sarcoma cases significantly better identified), and cases with a histology report were more likely to be registered than those without (though the difference was not significant). Completeness declined with time, as in most registries, which continue to identify "late" cases some time after the initial diagnosis. CONCLUSION: This is the first objective measurement of completeness of cancer registration in Africa, and it gives reassurance that published incidence rates are reasonablyaccurate (provided that there is not an insistence on the very latest results).

Survival of cervix cancer patients in Kampala, Uganda: 1995-1997.

The survival experience of 261 patients with cancer of the cervix registered by the Kampala population-based cancer registry, Uganda, in 1995-1997, is described. Vital status of the subjects was established by active methods including a search of hospital records and house visits. Of the 261 cases, 82 (31.4%) were dead and 105 (40.2%) were alive at the closing date of 31 December 1999; the remaining 74 cases (28.4%) were lost during the follow-up period. Overall observed and relative survival at 3 years was 52.4 and 59.9%, respectively. Of these cases, one-quarter (63) had been treated in the radiotherapy department. These cases had better survival (82.6%) than nontreated patients (78.5%) after 1 year of follow-up, but there was no difference at 3 years. HIV status was not significantly related to prognosis. Stage is an important determinant of survival: cases with distant metastasis had a risk of death some three times that of patients with localised disease. Early detection and prompt treatment should improve overall survival from cervix cancer, in the African context.

Trends in cancer incidence in Kyadondo County, Uganda, 1960-1997.

Incidence rates of different cancers have been calculated for the population of Kyadondo County (Kampala, Uganda) for four time periods (1960-1966; 1967-1971; 1991-1994; 1995-1997), spanning 38 years in total. The period coincides with marked social and lifestyle changes and with the emergence of the AIDS epidemic. Most cancers have increased in incidence over time, the only exceptions being cancers of the bladder and penis. Apart from these, the most common cancers in the early years were cervix, oesophagus and liver; all three have remained common, with the first two showing quite marked increases in incidence, as have cancers of the breast and prostate. These changes have been overshadowed by the dramatic effects of the AIDS epidemic, with Kaposi's sarcoma emerging as the most common cancer in both sexes in the 1990s, and a large increase in incidence of squamous cell cancers of the conjunctiva. In the most recent period, there also seems to have been an increase in the incidence of non-Hodgkin lymphomas. So far, lung cancer remains rare. Cancer control in Uganda, as elsewhere in sub-Saharan Africa, faces a threefold challenge. With little improvement in the incidence of cancers associated with infection and poverty (liver, cervix, oesophagus), it must face the burden of AIDS-associated cancers, while coping with the emergence of cancers associated with Westernization of lifestyles (large bowel, breast and prostate).