Presentation patterns of invasive cancer of the cervix : a Zimbabwean study

Abstract

The focus of this study is on the presentation patterns of invasive cancer of the cervix (CaCx) in Zimbabwe. The study was undertaken at a large referral cancer treatment centre in Harare the capital city of Zimbabwe. The main study question addressed was: Are there any changes in the presentation patterns of invasive CaCx in Zimbabwe? This was subdivided into three sub questions: 1) What are the presentation patterns of invasive CaCx among the Zimbabwean women presenting to the major referral centre in terms of histology, stage of the disease, ages of patients, Human immunodeficiency virus (HIV) status and socioeconomic status? 2) What is the trend in the presentation patterns of invasive CaCx in terms of the study variables during the period of study? 3) Are there any correlations that exist among the study variables? This study was conducted because of the sharp contrast that exists in invasive CaCx presentation patterns and incidence between the developed and developing countries. The incidence is now very low in developed countries while it is continuing to rise in developing countries resulting in death among women at a time when they are supposed to be more effective in their families and the nation at large. A retrospective documentary study of patients' files using an observation check list was done from 1998 to 2010. A systematic sample of four years was selected with 1998 as the base year (1998, 2002, 2006 and 2010). To strengthen the sample all the available patients' files for the selected years were considered. On average the majority of the patients (91.75%) presented with squamous cell carcinoma (SCC), 5.5% presented with adenocarcinoma and 2.75% with other types of histology. It was found that (89%) of women presented with late stage disease (stage liB and above). The ages of patients at presentation were between 40 to 60 years. Very few patients had recorded HIV status in 1998 and 2002 but a significant increase in proportion of patients with known HIV status was noted in 2006 (48%) and 2010 (73%). The average percentage for HIV positive patients for 2006 and 2010 was 57% and the average percentage for HIV negative patients was 43%. The majority (58.25%) of the patients were of low socioeconomic status. No significant change in trend was noted for variables except for HIV status where there was a downward trend in the percentage of HIV positive patients and an upward trend in the percentage of HIV negative patients. When correlation analysis was done among the variables no significant association was noted among the variables except that a low degree of association was recorded for the ages of patients and HIV status. The association indicated that young invasive CaCx patients are associated with HIV infection at presentation. The recommendations are that the government should mobilize resources towards prevention and control of invasive cancer of the cervix and awareness campaigns on early presentation should increase. Furthermore the cancer registry should expand its services to cover all health institutions nationwide. It is also recommended that further studies should be done on the presentation patterns of invasive CaCx and of HIV status. Longitudinal studies are recommended in order to monitor changes in presentation patterns.