Open AccessA prospective ascertainment of cancer incidence in sub‐Saharan Africa: The case of Kaposi sarcoma
Author(s) -
Semeere Aggrey,
Wenger Megan,
Busakhala Naftali,
Buziba Nathan,
Bwana Mwebesa,
Muyindike Winnie,
Amerson Erin,
Maurer Toby,
McCalmont Timothy,
LeBoit Philip,
Musick Beverly,
Yiannoutsos Constantin,
Lukande Robert,
Castelnuovo Barbara,
LakerOketta Miriam,
Kambugu Andrew,
Glidden David,
WoolsKaloustian Kara,
Martin Jeffrey
Publication year - 2016
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.618
Subject(s) - incidence (geometry) , medicine , cancer , population , sarcoma , demography , health care , human immunodeficiency virus (hiv) , kaposi's sarcoma , pediatrics , environmental health , family medicine , pathology , physics , sociology , optics , economics , economic growth , human herpesvirus
In resource‐limited areas, such as sub‐Saharan Africa, problems in accurate cancer case ascertainment and enumeration of the at‐risk population make it difficult to estimate cancer incidence. We took advantage of a large well‐enumerated healthcare system to estimate the incidence of Kaposi sarcoma ( KS ), a cancer which has become prominent in the HIV era and whose incidence may be changing with the rollout of antiretroviral therapy ( ART ). To achieve this, we evaluated HIV ‐infected adults receiving care between 2007 and 2012 at any of three medical centers in Kenya and Uganda that participate in the East Africa International Epidemiologic Databases to Evaluate AIDS (Ie DEA ) Consortium. Through Ie DEA , clinicians received training in KS recognition and biopsy equipment. We found that the overall prevalence of KS among 102,945 HIV ‐infected adults upon clinic enrollment was 1.4%; it declined over time at the largest site. Among 140,552 patients followed for 319,632 person‐years, the age‐standardized incidence rate was 334/100,000 person‐years (95% CI : 314–354/100,000 person‐years). Incidence decreased over time and was lower in women, persons on ART , and those with higher CD 4 counts. The incidence rate among patients on ART with a CD 4 count >350 cells/mm 3 was 32/100,000 person‐years (95% CI : 14–70/100,000 person‐years). Despite reductions over time coincident with the expansion of ART , KS incidence among HIV ‐infected adults in East Africa equals or exceeds the most common cancers in resource‐replete settings. In resource‐limited settings, strategic efforts to improve cancer diagnosis in combination with already well‐enumerated at‐risk denominators can make healthcare systems attractive platforms for estimating cancer incidence.