Increasing Cervical Cancer Incidence in Rural Eastern Cape Province of South Africa, 1998-2012 - A Population-Based Cancer Registry Study

Abstract

Background: South Africa introduced free cytology-based screening for cervical cancer in 1999. A high cervical cancer incidence has been observed in rural Eastern Cape Province, an area with a high prevalence of Human Immunodeficiency Virus and extensive provision of highly active anti-retroviral therapy. Cervical cancer incidence trends from the population-based Eastern Cape Cancer Registry are further examined by distinct geographic areas; northern and southern. Methods: Cases (topography C53.0-C53.9) for the period 1998-2012 were extracted from a cancer registry database from which basic descriptive statistics and frequencies were analysed for all variables using CanReg4.Trends over time were estimated using a direct standardization method and world standard population as a reference. Screening coverage annualized figures for women 30 years and older by sub-health district were extracted from the District Health Information System. Findings: In the northern area, annual age-standardized incidence rates per 100 000 women increased from 24.0 (95% CI: 21.1-27.0) in 1998-2002 to 39.0 (95% CI: 35.6-42.5) in 2008-2012, with a screening coverage rate of 15% by 2012. In contrast, no increase was observed in incidence in the southern area, with rates of 20.0 (95% CI: 18.5-21.4) in 1998-2002 and 18.8 (95% CI: 16.2-21.4) in 2008-2012, and a higher screening coverage of 41% in 2012. Overall, the percentage distribution of stage at diagnosis showed that 28.5% of cases were diagnosed at disease stages I and II, 35% III and IV, and 36% with missing stage information (2003-2012). In 77% of cases, a histologically verified diagnosis was made, compared with only 12.3% by cytology. Interpretation: The significant increase in the incidence in the northern area does not appear to be directly related to the screening programme but may portend increases associated with the widespread provision of highly active ante-retroviral therapy. Funding Statement: South African Medical Research Council. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This study was approved by the South African Medical Research Council.