Cervical cancer in women living in South Africa: a record linkage study of the National Health Laboratory Service and the National Cancer Registry

Abstract

Introduction:In countries with high HIV prevalence, it is important to understand the cervical cancer (CC) patterns by HIV status to ensure targeted prevention measures. We aimed to determine the factors associated with CC compared to non-infection related cancer in women living in South Africa.Methods: This was a cross-sectional study of women aged 15 years and older diagnosed with CC and non-infection related cancer in the South African public health sector from 2004 to 2014. The National Cancer Registry provided data on cancer, whilst HIV status was determined from routinely collected HIV related data from the National Health Laboratory Service. We explored the association of HIV infection, age, ethnicity and calendar period with CC compared to non-infection related cancer.Results: From 2004 to 2014, 49,599 women were diagnosed with CC, whilst 78,687 women had non-infection related cancer. About 40% (n = 20,063) of those with CC and 28% (n = 5,667) of those with non-infection related cancer had a known HIV status. The median age at CC diagnosis was 44 years (interquartile range (IQR): 37-52) and 54 years (IQR: 46-64) for HIV positive and negative women, respectively, and for non-infection related cancer, 45 years (IQR: 47-55) and 56 years (IQR: 47-66) for HIV negative and positive women, respectively. Diagnosis of CC was associated with HIV positivity, Black ethnicity, earlier calendar period (2004)(2005)(2006) and the ages 30-49 years. In comparison with Black women, the odds of CC were 44% less in Coloured women, 50% less in Asian women and 51% less in White women. Conclusions:HIV positive women presented a decade earlier with CC compared to HIV negative women. A large proportion of women with CC were unaware of their HIV status Short Communication

Cervical precancer and cancer incidence among insured women with and without HIV in South Africa

“…Interestingly, we did not find a substantial difference in peak ages of cervical precancer rates between WLWH and women without HIV. However, in South Africa, previous studies reported that cervical cancer diagnoses occurred 10 years earlier in WLWH than in women without HIV 13,14 . In our study, we found a 7‐year difference between the cervical cancer incidence rate peaks of WLWH and women without HIV (49 vs 56 years).…”

“…However, in South Africa, previous studies reported that cervical cancer diagnoses occurred 10 years earlier in WLWH than in women without HIV. 13,14 In our study, we found a 7-year difference between the cervical cancer incidence rate peaks of WLWH and women without HIV (49 vs 56 years). Therefore, HIV is a particularly relevant risk factor for cervical cancer among young and middle-aged women.…”

“…WLWH have a six times higher risk of developing cervical cancer than women without HIV 12 . Cervical cancer has been reported to occur around 10 years earlier in WLWH than in women without HIV 13,14 . In Southern Africa, more than 50% of women diagnosed with cervical cancer are WLWH 12 .…”

Age‐specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub‐Saharan Africa

“…Few data exist on age-specific cervical cancer incidence in WLHIV in SSA. However, some preliminary data have been recently reported by a large linkage study in South Africa41 describing, as expected, strongly increasing cervical cancer incidence in WLHIV by age: from 29 cases per 100 000 persons years for WLHIV aged 20 to 29 years up to 242 cases per 100 000 person years at 60 to 69 years 41. Similar measures are not easily calculable from our approach, due to difficulties in establishing person years by HIV status at a population level.The fact that there were no relevant empirical cervical cancer series against which to validate our HIV estimates outside SSA is a limitation of this analysis.…”

State of the science and future directions for research on HIV and cancer: Summary of a joint workshop sponsored by IARC and NCI

“…45,46 These risks can be partially reduced by ART. 47 It is therefore predicted that the high age-standardized cervical cancer incidence observed in largely unscreened women with HIV in SSA 48 should decline with wider and earlier access to ART. 49,50 Currently however, cervical cancer burden in women with HIV in SSA remains high, 9,51 perhaps partly due to sub-optimal ART use to date.…”