Review Cervical Cancer in Africa Lynette Denny 1 and Rose Anorlu 2 Abstract Cervical cancer is a relatively rare disease in countries that have instituted and maintained national screening programs, with call and recall of women at various intervals and built-in quality control with appropriate monitoring and evaluation. Unfortunately, this process has failed in most areas of the world where more than 80% of new cases of cervical cancer are diagnosed. Cervical cancer affects women in the prime of their lives causing premature and needless suffering and death in a critically important segment of the world’s population, despite being one of the few cancers that can be prevented with simple testing. In the past 15 years innovative approaches to both primary and secondary prevention of cervical cancer have been subjected to a number of large scale, scientifically valid and applicable studies that have opened the way for new approaches. Treatment of cervical cancer in Africa is hampered by the lack of diagnostic and treatment facilities, lack of healthcare infrastructure and poor pathology services. Further, there is a significant brain drain of trained healthcare workers in Africa that exacerbates the problem. Cancer is becoming an increasingly important public health problem as more people live longer. It is time to develop programs for the prevention, early detection, treatment, and palliation of cancer sufferers in Africa. Cancer Epidemiol Biomarkers Prev; 21(9); 1434–8. Ó2012 AACR. Cervical Cancer In a recent analysis based on the 2008 world wide estimates of cancer compiled by the International Agency for Research on Cancer (IARC, Lyon, France; Globocan 2008; ref. 1), it was estimated that 529,512 women were diagnosed with cervical cancer corresponding to an annu- al Age Standardized Incidence Rate (ASIR) of 15.4/ 100,000. An estimated 274,967 women died of the disease, with an annual Age Standardized Mortality Rate (ASMR) of 7.8/100,000 (2). The majority of cases (n ¼ 453,032; 85.5%) and deaths (n ¼ 241,818; 85.5%) were found in developing countries. Globally, cervical cancer was the third most common cancer ranking after breast (1.3 million cases) and colorectal cancer (0.57 million cases) and the fourth most common cause of cancer death ranking below breast, lung, and colorectal cancer. Figures 1 and 2 illustrate the distribution of cervical cancer inci- dence and deaths in the different regions of the world (1). In Africa, which has a population of 267.9 million women aged 15 years and older at risk of developing cervical cancer, approximately 80,000 women are diag- nosed with cervical cancer per year, and just more than 60,000 women die from the disease (1). However, cervical cancer incidence in Africa also varies considerably by region. The highest rates in Africa (ASIR > 40/100,000) are found in Eastern and Southern Africa (Fig. 3; ref. 1). In addition, there are marked variations within regions themselves as illustrated in Fig. 4 for Southern Africa (1), where the highest incidence is found in Lesotho and Swaziland, 2 countries that have neither screening pro- grams nor any anticancer treatment facilities and who have 1 and 2 doctors per 10,000 population, respectively (compared with 8/10,000 in South Africa and 27/10,000 in the United States; ref. 3). Most women in developing countries present with advanced disease, often untreatable or suitable only for palliation. For instance, in Sudan where 197 women were diagnosed with cervical cancer in 2007, 141 (71%) had advanced stage disease (4). The Kampala population- based registry, estimated 5-year survival rates between 1993 and 1997 for various cancers and compared these to African-American cancer patients diagnosed during the same time period and registered in the Surveillance, Epidemiology, and End Results program of the Nation- al Cancer Institute of USA. The Kampala registry included a total population of 1.2 million people. The absolute and relative 5-year survival of women in Kampala was 15.9% and 18.2%, respectively, compared with approximately 60% in African-American women in the United States (5). Gondos and colleagues reported on the 5-year absolute and relative survival estimates for black Zimbabweans diagnosed with cancer in Har- are, Zimbabwe between 1993 and 1997. The 5-year absolute and relative 5-year survival was 26.5% and 30.5%, respectively, compared with around 60% for African-American women during the same time period. These very low rates of survival were attributed to late presentation of disease (6). Authors' Affiliations: 1 Department of Obstetrics and Gynaecology, Uni- versity of Cape Town/Groote Schuur Hospital, Cape Town, South Africa; and 2 Oncology and Pathological Studies Unit, Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria Corresponding Author: Lynette Denny, Department of Obstetrics and Gynaecology, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa. Phone: 27-21-404-4485; Fax: 27-21-448-6921; E-mail: lynette.denny@uct.ac.za doi: 10.1158/1055-9965.EPI-12-0334 Ó2012 American Association for Cancer Research. CEBP FOCUS Cancer Epidemiol Biomarkers Prev; 21(9) September 2012 1434 on January 25, 2022. © 2012 American Association for Cancer Research. cebp.aacrjournals.org Downloaded from Published OnlineFirst July 17, 2012; DOI: 10.1158/1055-9965.EPI-12-0334