Changes in cervical cancer stage at diagnosis in Zambia over 15 years
Zambia implemented a national cervical cancer screening program in 2006, and in 2016 launched the country's first National Cancer Control & Prevention Plan. This study explored the hypothesis that the proportion of cervical cancer patients diagnosed at a late stage decreased from 2008 to 2022, with these policies. This study included data of 5775 cervical cancer patients seen at the Cancer Diseases Hospital (CDH) in Lusaka, Zambia, between 2008 and 2022. We evaluated the stage at diagnosis over three time periods (2008-2012, 2013-2017, 2018-2022). Regression analysis identified the predictors of late-stage presentation. The proportion of late-stage diagnosis (Stages III and IV) decreased during 2013-2017 compared to the late stages during 2008-2012 (OR: 0.60, 95% CI: 0.49-0.73). Subsequently, the proportion of late-stage diagnoses increased from 2018-2022 compared to 2013-2017 (OR: 1.25, 95% CI: 1.04-1.49), which contradicted our initial hypothesis. Women who were divorced or widowed, unemployed, and lived in provinces distant from Lusaka were more likely to present with late-stage diagnoses, irrespective of the time period. Although there was an initial decrease in late-stage diagnoses from 2008-2012 compared to 2013-2017, the trend reversed from 2018 to 2022. The increase in the proportion of late-stage presentations from 2018 to 2022 is likely due to low screening uptake and poor sensitivity of screening. Increasing the accessibility and availability of cervical cancer treatment, and educating the vulnerable groups about the importance of screening, may lead to early detection and downstaging in Zambia and other low-income countries.