Cervix Cancer in Sub-Saharan Africa: An Assessment of Cervical Cancer Management

Abstract

PURPOSE Underdeveloped nations carry the burden of most cervical cancer, yet access to adequate treatment can be challenging. This report assesses the current management of cervical cancer in sub-Saharan Africa to better understand the needs of underdeveloped nations in managing cervical cancer. METHODS A pre- and postsurvey was sent to all centers participating in the Cervical Cancer Research Network's 4th annual symposium. The pre- and postsurvey evaluated human papillomavirus and HIV screening, resources available for workup and/or treatment, treatment logistics, outcomes, and enrollment on clinical trials. Descriptive analyses were performed on survey responses. RESULTS Twenty-nine centers from 12 sub-Saharan countries saw approximately 300 new cases of cervical cancer yearly. Of the countries surveyed, 55% of countries had a human papillomavirus vaccination program and 30% (range, 0%-65%) of women in each region were estimated to have participated in a cervical cancer screening program. In the workup of patients, 43% of centers had the ability to obtain a positron emission tomography and computed tomography scan and 79% had magnetic resonance imaging capabilities. When performing surgery, 88% of those centers had a surgeon with an expertise in performing oncological surgeries. Radiation therapy was available at 96% of the centers surveyed, and chemotherapy was available in 86% of centers. Clinical trials were open at 4% of centers. CONCLUSION There have been significant advancements being made in screening, workup, and management of patients with cervical cancer in sub-Saharan Africa; yet, improvement is still needed. Enrollment in clinical trials remains a struggle. Participants would like to enroll patients on clinical trials with Cervical Cancer Research Network's continuous support.

Feasibility and first results of a prospective cohort study to investigate cisplatin-associated ototoxicity amongst cancer patients in South Africa

“…In South Africa, it is the most common cancer amongst the black female population, with an agestandardized incidence rate of 28.25 per 100,000 and a lifetime risk of 1 in 33 [2]. Treatment of cervical cancer may include surgery, radiotherapy, chemotherapy, or a combination of modalities based on International Federation of Gynecology and Obstetrics (FIGO) stage [3]. Concurrent chemoradiotherapy using weekly cisplatin as the chemotherapeutic agent is the standard of care as an outpatient therapy for locally advanced cervical cancer (LACC), commonly diagnosed in our setting [4].…”

Incidence, Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries

“…For example, in sub-Saharan Africa ultrasound (78%), computed tomography (CT) (47%) and intravenous pyelogram (5%) were used to evaluate for hydronephrosis. Most centres used CT (73%), followed by ultrasound (52%), MRI (26%) and positron emission tomography-computed tomography (PET-CT) (16%) to assess for metastatic lymph [5]. CT scanning, which is a sufficiently accurate tool for assessing lymph node involvement and distant metastasis, is more commonly used in LMICs.…”

“…In the East African countries, it ranges between 25 and 40% of all cancers. Africa has the highest age-standardised cervical cancer incidence and mortality rates in the world [5]. Within the continent, there is significant variation in incidence and death from cervical cancer.…”

Significance of Magnetic Resonance Imaging Combining with Detection of Serum HE4, TSGF, and CD105 Levels in Diagnosis and Treatment of Moderate to Advanced Cervical Cancer

“…Overall, assessment of tumor sensitivity to radiotherapy is key to selecting treatment Gynecological examination less clinically useful than MRI because it is subjective and does not precisely assess the necrosis and residual status of the tumor. MRI has the advantages such as zero radiation and easy operation, which can objectively evaluate the progression and regression of lesions, and in particular, T 1 WI-enhanced scan can show the ischemic and necrotic areas within the tumor at an early stage, which is beneficial for predicting the effect of radiotherapy [19][20][21]. e study found that before treatment, MRI finding of cervical lesion was irregular soft tissue mass, T 2 WI appeared mixed signal intensity or hyperintensity, with necrotic tissue and fat suppression being hyperintensity; after treatment, lesions shrunk, originally abnormal signals in 5 patients disappeared, and after T 1 WI enhancement, mild enhancement could be seen in 41 patients and no enhancement in 4 patients, which demonstrated that MRI could provide more valuable information of efficacy assessment for the clinical physicians.…”