Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA.
Ocean Road Cancer Institute, Dar es Salaam, Tanzania.
Cancer Causes Control. 2021 Apr;32(4):401-407. doi: 10.1007/s10552-021-01397-2. Epub 2021 Feb 9.
Globally, the highest cervical cancer mortality rates are found in East Africa. Visual inspection with acetic acid (VIA)-based screening in resource-poor settings has been shown to decrease the proportion of women presenting with late-stage cervical cancer, a process known as clinical downstaging. The only cancer treatment center in Tanzania, Ocean Road Cancer Institute (ORCI) in Dar es Salaam, opened a VIA-based cervical cancer screening program in 2002. We reviewed 6,676 medical records of cervical cancer patients at the ORCI from 2002-2011 to 2014-2018 for stage at diagnosis and screening status, among other variables. We investigated whether clinical downstaging occurred in this period among women screened at the ORCI, when compared to unscreened women. Our results indicated that the proportion of women presenting with late-stage cervical cancer among women screened at the ORCI decreased by 27.7% over the 16-year period (χ = 16.99; p = 0.0002). Among unscreened women, a non-significant 13.2% decrease in late-stage disease was observed (χ = 1.74; p = 0.4179). Our results suggest clinical downstaging occurred among women screened at the ORCI over the 16-year period, and this difference may be attributed to the screening program as the same decrease in stage was not observed among unscreened women during the same time period. At present, less than one percent of Tanzanian women receive yearly cervical cancer screenings. Access to screening through expansion of the ORCI screening clinic and the creation of more clinics should be prioritized.
全球范围内，宫颈癌死亡率最高的地区在东非。在资源匮乏的地区，醋酸视觉检查（VIA）筛查已被证明可降低呈现晚期宫颈癌的女性比例，这一过程被称为临床降期。坦桑尼亚唯一的癌症治疗中心，位于达累斯萨拉姆的海洋路癌症研究所（ORCI），于 2002 年开设了一项基于 VIA 的宫颈癌筛查项目。我们对 2002 年至 2011 年和 2014 年至 2018 年期间在 ORCI 就诊的 6676 例宫颈癌患者的病历进行了回顾，以了解诊断时的分期和筛查情况等变量。我们调查了在该时期，ORCI 筛查的女性与未筛查的女性相比，是否发生了临床降期。我们的结果表明，在 16 年期间，在 ORCI 筛查的女性中，呈现晚期宫颈癌的女性比例下降了 27.7%（χ²=16.99；p=0.0002）。在未筛查的女性中，晚期疾病的比例下降了 13.2%，但无统计学意义（χ²=1.74；p=0.4179）。我们的结果表明，在 16 年期间，ORCI 筛查的女性发生了临床降期，这种差异可能归因于筛查项目，因为在同一时期，未筛查的女性中未观察到分期的相同下降。目前，不到 1%的坦桑尼亚女性接受每年的宫颈癌筛查。应该优先考虑通过扩大 ORCI 筛查诊所和创建更多诊所来增加筛查机会。
