Estimating the under reporting of cervical cancer in Zambia 2009-2011

Background:
Invasive cervical cancer (ICC) is a leading cause of cancer-related mortality and morbidity among women in the developing world. Zambia has the world’s second highest annual cervical cancer incidence and mortality rates at 52.8 per 100,000 and 38.6 per 100,000 respectively. Amongst the fore driving factors to the cancer being very common in Zambian women is a lack of availability of diagnostic and screening services and timely treatment, limited awareness of early signs of symptoms, stigma associated with the disease, poverty, cultural behavioral influence, a high infection rate of HPV types 16 & 18 (21.6% apiece), and unavailability of the HPV vaccine in the country. Most of the cervical cancer cases seen in Zambia are at advanced stage needing radiotherapy or chemotherapy treatment. Despite cervical cancer being the most common cancer and most common cause of cancer-related death in Zambian women; not many studies have been published to ascertain the actual incidence. The National Cancer Registry has been poorly resourced and is estimated to capture approximately 10-15% of cancer cases countrywide. Due to the non-availability of incidence and mortality data, the World Health Organization International Agency for Research on Cancer (IARC), gives rate estimates for Zambia as the simple mean of the rates from East Africa estimated rates. This study therefore, seeks to capture actual observed cases; estimate incidence rates based on the observed cases, and compare that with approximate expected cases based on IARC GLOBOCAN estimates.

Objectives and Aims:
The aims of this study are to 1) calculate the age-specific incidence rate of cervical cancer in Lusaka Province of Zambia. 2) Assuming uniform population risk, use Lusaka Province rate to estimate rates in two other Provinces of Zambia, Western and Southern Provinces ─ considering the HIV prevalence in these two Provinces, HPV information if available, and demographic population statistics. 3) Obtain the observed cervical cancer cases in Western and Southern Provinces, and compare that with the expected rate based on the Lusaka Province calculated estimate; and also overall compare observed and expected rate with IARC GLOBOCAN estimate incidence rate information.

Design:
This is a retrospective observational study of observed cases at multiple sites in Zambia from 2009 to 2011. The data sources will include the Cancer Diseases Hospital – which is the only advanced cancer treatment facility in the country; the University Teaching Hospital Pathology laboratory – which is the largest and highest referral pathology laboratory in the country; Lewanika General Hospital – which is the largest and highest referral hospital in the Western province; Livingstone General Hospital – which is the largest and highest referral hospital in the Southern Province; Lancet-Nkanza  Laboratories – which is the largest private laboratory service in Zambia and has its head office in Lusaka; Prospect Hill Specialist Clinic – which is a private laboratory in Lusaka processing specimen mainly from the Center for Infectious Diseases Research in Zambia (CIDRZ) cervical cancer screening project and some from the University Teaching Hospital (UTH) admission wards; National Cancer Registry; and Zambian Ministry of Health aggregate data.

Mulele Kalima
Adrian Sifuniso Picture

Mulele graduated from the University of Zambia in 2006 with a Bachelor of Science in Mathematics. He started his early career working in the Insurance and Banking industry before going into Public Health with first serving as Data Manager and Statistician for two hospital based projects ─ one researching the KS-HHV-8 infection in Africa and the other offering Pediatric HIV/AIDS care and treatment. He is currently a Master of Public Health - Biostatistics Concentration graduate student at the University of Nebraska Medical Center. He will be graduating in December, 2013.

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