Muluken Gizaw

Ovarian cancer survival in sub‐Saharan Africa by human development index and histological subtypes: A population‐based registry study

AbstractOvarian cancer (OC) is the fourth most common cancer of women in sub‐Saharan Africa (SSA), although few data have been published on population‐level survival. We estimate ovarian cancer survival in SSA by human development index and histological subtype, using data from seven population‐based cancer registries in six countries: Kenya (Nairobi and Eldoret), Mauritius, Uganda (Kampala), Cote d'Ivoire (Abidjan), Ethiopia (Addis Ababa) and South Africa (Eastern Cape). A total of 644 cases diagnosed during 2008–2014 were included, with 77% being of epithelial subtypes (range 47% [Abidjan]—80% [Mauritius]). The overall observed survival in the study cohort was 73.4% (95% CI: 69.8, 77.0) at 1 year, 54.4% (95% CI: 50.4, 58.7) at 3 years and 45.0% (95% CI: 41.0, 49.4) at 5 years. Relative survival at Year 1 ranged from 44.4% in Kampala to 86.3% in Mauritius, with a mean for the seven series of 67.4%. Relative survival was highest in Mauritius at 72.2% and lowest in Kampala, Uganda at 19.5%, with a mean of 47.8%. There was no difference in survival by age at diagnosis. Patients from high and medium HDI countries had significantly better survival than those from low HDI countries. Women with cancers of epithelial cell origin had much lower survival compared to women with other histological subtypes (p = .02). Adjusted for the young age of the African patients with ovarian cancer (44% aged <50) survival is much lower than in USA or Europe, and underlines the need for improvements in the access to diagnosis and treatment of OC in SSA.

Prevalence and associated factors of persistent precancerous lesions among women treated for cervical lesions in Addis Ababa, Ethiopia

Abstract Background Cervical cancer is one of the leading causes of cancer-related deaths among Ethiopian women, despite being largely preventable. Women treated for precancerous cervical lesions remain at elevated risk of developing invasive cancer, yet little is known about the burden and predictors of persistent lesions following treatment in resource-limited settings. Materials and Methods We conducted a cross-sectional study among 242 women who underwent ablative or excisional therapy for precancerous cervical lesions at 3 clinics in Addis Ababa between November 2022 and December 2023. Data were collected using structured questionnaires and clinical records. Logistic regression analysis was used to identify factors associated with persistent lesions, reported as adjusted odds ratios (AORs) with 95% CIs. Results Of the 242 women treated, 104 (43.0%; 95% CI, 37.2-49.6%) experienced persistent lesions within 1 year. Persistent lesion rates were highest among women initially screened with a Pap smear (97.4%) compared to visual inspection with acetic acid (VIA) (21.9%) and HPV DNA testing (14.7%). Independent predictors of persistent lesions included an age of ≥50 years (AOR = 5.4; 95% CI, 1.56-18.93), being married (AOR = 2.5; 95% CI, 1.15-5.44), an HIV-positive status (AOR = 5.0; 95% CI, 1.41-20.3), and Pap smear as the initial screening modality (AOR = 4.9; 95% CI, 1.04-23.15). Conclusion Nearly half of the women treated for precancerous cervical lesions experienced persistent disease within 1 year, particularly those who were older, married, HIV-positive, or initially screened by Pap smear. These findings raise concerns about the effectiveness of current treatment and screening strategies.

Predictors of advanced-stage presentation among patients with a diagnosis of breast and cervical cancer in Ethiopia

Abstract Background Breast and cervical cancers are the most common causes of cancer incidence and mortality in women in Africa. Women with breast and cervical cancers in Sub-Saharan Africa are frequently diagnosed with their disease at advanced stages. Delays in seeking health, diagnosis, and treatment are contributing factors to high mortality in Ethiopia. This study aimed to assess predictors of advanced stage presentation among patients with breast and cervical cancer attending public hospitals in Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted with a total of 418 patients at Tikur Anbessa specialized hospital and Saint Pauls’ Hospital Millennium Medical College from October to November 2021. Stages III and IV were considered advanced stages. Data were collected by reviewing medical records and face-to-face interviews with a structured questionnaire. Bivariate and multivariable analyses were performed to examine the association between independent and outcome variables. Results A total of 269 patients with breast cancer and 149 patients with cervical cancer were included in the study, and the mean age was 44 years (SD = 10.9 years) and 50 years (SD = 11.2) years, respectively. About 66.9% of breast cancers and 71.1% of cervical cancers were diagnosed at an advanced disease stage. Rural residence (adjusted odds ratio [AOR] = 2.041, 95% CI, 1.108-3.758), indirect referral (AOR = 3.8, 95% CI, 1.485-9.946), financial difficulty (AOR = 10, 95% CI,1.859-56.495), and cancer screening recommended during their visit (AOR = 4.029 95% CI, 1.658-10.102) were independent predictors of advanced-stage presentation. Conclusions This study revealed a high prevalence of advanced-stage breast and cervical cancer diagnosis in Ethiopia, like data collected 10 years ago, despite the introduction of a cancer control plan in 2015. For better implementation, interventions should aim to improve referral pathways, adapt screening and early detection services, and increase cancer awareness at the community level in a culturally accepted way.

Trends in the incidence of ovarian cancer in sub‐Saharan Africa

AbstractOvarian cancer (OC) is one of the commonest cancers of women in sub‐Saharan Africa (SSA), although to date no data have been available on time trends in incidence to better understand the disease pattern in the region. We estimate time trends by histological subtype from 12 population‐based cancer registries in 11 countries: Kenya (Nairobi), Mauritius, Seychelles, Uganda (Kampala), Congo (Brazzaville), Zimbabwe (Bulawayo and Harare), Cote d'Ivoire (Abidjan), The Gambia, Mali (Bamako), Nigeria (Ibadan) and South Africa (Eastern Cape). The selected registries were those that could provide consistent estimates of the incidence of ovarian cancer and with quality assessment for periods of 10 or more years. A total of 5423 cases of OC were included. Incidence rates have been increasing in all registries except Brazzaville, Congo, where a nonsignificant decline of 1% per year was seen. Statistically significant average annual increases were seen in Mauritius (2.5%), Bamako (5.3%), Ibadan (3.9%) and Eastern Cape (8%). Epithelial ovarian cancer was responsible for the increases observed in all registries. Statistically significant average annual percentage changes (AAPC) for epithelial OC were present in Bamako (AAPC = 5.9%), Ibadan (AAPC = 4.7%) and Eastern Cape (AAPC = 11.0%). Creating awareness among professionals of the growing importance of the disease is surely an important step to improving availability of, and access to, diagnosis and treatment of OC in SSA. Support must be given to the cancer registries to improve the availability of good‐quality data on this important cancer.

Reasons for Not Attending Cervical Cancer Screening and Associated Factors in Rural Ethiopia

Abstract Social, economic, and cultural factors have been associated with the level of participation in cervical cancer screening programs. This study identified factors associated with nonparticipation in cervical cancer screening, as well as reasons for not attending, in the context of a population-based, cluster-randomized trial in Ethiopia. A total of 2,356 women aged 30 to 49 years in 22 clusters were invited to receive one of two screening approaches, namely human papillomavirus (HPV) self-sampling or visual inspection with acetic acid (VIA). Participants and nonparticipants were analyzed according to their sociodemographic and economic characteristics. Reasons were determined for the refusal of women to participate in either screening method. More women in the VIA arm compared to the HPV arm declined participation in the screening [adjusted OR (AOR) 3.5; 95% confidence interval (CI), 2.6–4.8]. Women who declined attending screening were more often living in rural areas (AOR = 2.0; 95% CI, 1.1–3.5) and were engaged in informal occupations (AOR = 1.6; 95% CI, 1.1–2.4). The majority of nonattendants perceived themselves to be at no risk of cervical cancer (83.1%). The main reasons given for not attending screening for both screening approaches were lack of time to attend screening, self-assertion of being healthy, and fear of screening. We found that perceived time constraints and the perception of being at no risk of getting the disease were the most important barriers to screening. Living in rural settings and informal occupation were also associated with lower participation. Offering a swift and convenient screening service could increase the participation of women in cervical cancer screening at the community level.