Kyadondo County Research Articles

Trends in the incidence of cancer in Kampala, Uganda, 1991 to 2015.

Trends in the incidence of cancer in the population of Kyadondo County, Uganda-which comprises the city of Kampala and a peri-urban hinterland-are presented for a period of 25 years (1991-2015) based on data collected by the Kampala Cancer Registry. Incidence rates have risen overall-age-adjusted rates are some 25% higher in 2011 to 2015 compared with 1991 to 1995. The biggest absolute increases have been in cancers of the prostate, breast and cervix, with rates of some 100% (prostate), 70% (breast) and 45% (cervix) higher in 2010 to 2015 than in 1991 to 1995. There were also increases in the incidence of cancers of the esophagus and colon-rectum (statistically significant in men), while the incidence of liver cancer-the fifth most common in this population-increased until 2007, and subsequently declined. By far the most commonly registered cancer over the 25-year period was Kaposi sarcoma, but the incidence has declined, consistent with the decreasing population-prevalence of HIV. Non-Hodgkin lymphomas, also AIDS-related, increased in incidence until 2006/2007 and then declined-possibly as a result of availability of antiretroviral therapy. The trends reflect the changing lifestyles of this urban African population, as well as the consequences of the epidemic of HIV/AIDS and the availability of treatment with ARVs. At the same time, it highlights the fact that the decreases in cancer of the cervix observed in high and upper-middle income countries are not a consequence of changes in lifestyle, but demand active intervention through screening (and, in the longer term, vaccination).

Prognostic Factors for Overall Survival of Patients with Prostate Cancer in Kyadondo County, Uganda.

Background Prostate cancer is the second most common cancer among men globally. A few studies that have been done in Uganda on survival of patients with prostate cancer indicate that, the overall survival of patients with prostate cancer in Uganda is poor. The aim of this study was to determine the 3-year overall survival rate of a cohort of patients with prostate cancer residing in Kyadondo County who were diagnosed from 2012 to 2014. The secondary objective was to correlate the overall survival with the clinicopathological prognostic factors. Materials and Methods This was a retrospective cohort study which involved 136 patients who were diagnosed histologically with prostate cancer at the department of pathology between 2012 and 2014. The cases were registered at the Kampala cancer registry and followed up to 31st December 2017. Data analysis was done using STATA version 12.0. The Kaplan-Meir curves were used for analysis of the 3-year overall survival rate. Hazard ratio (HR) and Log-rank test at 95% confidence interval under Cox-regression model were used to evaluate the effect of the covariates on the 3-year overall survival rate. p < 0.05 was considered statistically significant. Results More than half of the cases, 55.9% (n = 76) had Gleason score >8. Most of the patients, 67.7% (n = 92) had advanced disease at diagnosis. The 3-year overall survival rate was 67.6% with median survival of 36.5 months and range of 0–65 months. Clinical stage of the patients (HR = 1.65, p = 0.039), Gleason score (HR = 1.88, p = 0.008), and lymphovascular invasion (HR = 0.37, p = 0.002) were the independent predictors of the 3-year overall survival rate in this study. Conclusion. The 3-year overall survival of prostate cancer patients in Uganda is poor. Most of the patients with are diagnosed with advanced clinical stages (stage III and IV). The Gleason score, clinical stage and lymphovascular invasion can powerfully predict independently the overall survival of patients with prostate cancer. This implies that the Gleason score, clinical stage and lymphovascular invasion may be used to predict the overall survival of patients with prostate cancer even prior prostatectomy.

Presentation and Outcomes of Childhood Cancer Patients at Uganda Cancer Institute.

Introduction. Limited data suggest that children with cancer in sub-Saharan Africa have poor survival. We aimed to describe the presentation, treatment outcomes, and factors associated with survival among children with cancer managed at Uganda Cancer Institute. Methods. We retrospectively evaluated patients with childhood cancer (age ≤19 years) from Kyadondo County treated at Uganda Cancer Institute from 2006 to 2009. Cox’s regression and Kaplan-Meier methods were used to study 1-year survival. Results. Among 310 patients studied, median age was 7 years (range = 0.25-19 years), 64% were boys, and 92% had histological confirmation of cancer diagnosis. The commonest diagnoses were Burkitt lymphoma (BL, N = 87), Kaposi sarcoma (KS, N = 68), non-BL non-Hodgkin lymphoma (NHL, N = 32), acute lymphoblastic leukemia (ALL, N = 28), Wilms (N = 28), and Hodgkin disease (HD, N = 20). Advanced disease at diagnosis was common for all cancers (ranging from 45% for KS to 83% for non-BL NHL). Overall, 33.2% abandoned treatment. One-year survival was 68% for HD (95% confidence interval [CI] = 11.3-40.6), 67% for KS (95% CI = 52.1-77.9), 55% for BL (95% CI = 42-66.9), 44% for Wilms (95% CI = 22.5-63), 43% for non-BL NHL (95% CI = 23.3-61.3), and 20% for ALL (95% CI = 6.4-38.7). In univariate and multivariate analysis, anemia and thrombocytopenia were associated with mortality for several cancers. Conclusion. Survival among children with cancer in Uganda is poor. Advanced stage disease and loss to follow-up likely contribute to poor outcomes. Anemia and thrombocytopenia may augment traditional staging methods to provide better prognostic factors in Uganda and warrant further evaluation.

Contrast Between Incidence of Childhood and Adolescent Cancers: Using a Population Based Cancer Registry, Kyadondo County, Uganda: 2009 to 2014

Background: Cancer is relatively rare in childhood compared with later in life. In high-income countries, hematologic malignancies are the most common, then brain tumors and solid tumors. World age-standardized incidence rates in Ireland averaged 142 cases per million children per year, higher than European average and lower than US average. In Africa, distribution of childhood cancers is quite similar, commonest being Kaposi sarcoma (KS), Burkitt's lymphoma, retinoblastoma, leukemia and Hodgkin lymphomas (HL). Among adolescent in Zimbabwe, leukemia has highest incidence rates then osteosarcoma, non-Hodgkin lymphoma (NHL) and KS. Aim: To describe the incidence of cancer among children and adolescents in Kyadondo County, Uganda from 2009 to 2014 which is necessary for planning of cancer control programs. Methods: Descriptive cross-sectional study which involved review of data from Kampala Cancer Registry that gathers information on cancers diagnosed within Kyadondo County (formed by Kampala and Wakiso districts) and analyzed using STATA 13. From 2014 Uganda population census, Kyadondo County had a population of 3,523,910 (32.2% children and 10% adolescents). Study population was children (0-14 years) and adolescents (15-19 years) diagnosed with cancer from January 2009 to December 2014. Results: The spectrum of cancers in adolescents reflects a transition. Carcinomas which are so prevalent in adults occur but at lower frequencies in adolescents. Study results are comparable to others studies indicating that nephroblastoma and retinoblastoma were common among children and not adolescents. Leukaemia and lymphomas cut across both children and adolescents. Conclusion: The spectrum of cancers in adolescents reflects a transition. Carcinomas which are so prevalent in adults occur but at lower frequencies in adolescents. Study results indicate that nephroblastoma and retinoblastoma were common among children and not adolescents. New prospective studies should be done on children and adolescent cancers covering a wide population size. Leukaemia and lymphomas cut across both children and adolescents. National cancer registries should be set up.

The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda

BackgroundBreast cancer, the third most frequent cancer of women is preventable through knowledge on breast self-examination. Of the 44% of women diagnosed with breast cancer at the Uganda Cancer Institute, only 22% go for check-up in less than three months. This study explored the effect of breast cancer knowledge on the uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda.MethodsA household survey of women in Kyadondo County was conducted during June, 2014 to August, 2015. This involved studying in-depth using a questionnaire the level of breast cancer knowledge of the respondents. Data was analyzed using logistic regression model. Chi-square test was used to establish relationships between knowledge base factors and the uptake of breast cancer prevention modalities.ResultsThis study has established an empirical relationship between uptake of breast cancer prevention modalities and source of information especially radio (OR 1.94 95% CI: 1.16–3.24), television (OR 1.82 95%CI: 1.14–2.93), awareness of breast cancer (OR 4.03 95%CI: 1.01–15.98), knowledge on how to reduce risk of breast cancer (OR 1.98 95% CI: 1.20–3.27), what reduces breast cancer acquisition (OR 2.75 95% CI: 1.42–5.35), how to check for signs of breast cancer especially through breast self-examination (OR 3.09 95% CI: 1.62–5.88), and other methods of breast cancer diagnosis in a health care set up.ConclusionThe women’s level of breast cancer awareness as a primary prevention strategy was found wanting, and requires a boost through community health education.

Knowledge, Attitudes, and Practices of Tomato Producers and Vendors in Uganda

Background: Uganda’s horticultural sub-sector is growing at a fast rate and tomato is one of the major horticultural crops with wide spread production in peri-urban and rural areas. However tomato is susceptible to different pests and diseases and this has resulted into use of synthetic pesticides as the main control strategy. There is wide spread pesticide misuse behavior amongst tomato farmers owing to different social, economical and regulatory factors. This misuse includes among others inadequate personal protection and failure to follow the recommended pre-harvest no spray interval. This puts the health of millions of tomato farmers and consumers at risk. In Uganda, information on such misuse, consumer safety, and residues in food is limited. Objectives: This article presents findings from a survey of knowledge, attitudes and practices of tomato farmers and vendors. The article also draws conclusions from the findings and recommends areas that could help to improve or avert the foregoing. Methodology: This study was carried out in Nangabo Sub-County, Kyadondo County, Wakiso District in the Central Region of Uganda. Quantitative and qualitative data was gathered using an interviewer administered structured questionnaire and Focus Group Discussion guides, respectively from 50 tomato farmers and 6 tomato vendors in June 2013. Quantitative data analysis was done using the Epi Info statistical package software, while the qualitative data were audio recorded, transcribed and analysed on the basis of the themes/objectives of the study, namely, pesticide use and handling knowledge, attitudes and practices by farmers and vendors. Results: 41.4 years was the average age of farmer respondents. 26% were females. 56% had completed secondary education. 92% spray with synthetic pesticides as their main control tactic against pests and diseases. 44% reported spraying three times in a week during the wet season. 24.5% were not aware of any health risks of spraying tomatoes close to harvest time. 45.8% reported spraying their tomatoes less than a week to harvest time while 29.2% of the respondents sprayed their tomatoes at/after harvest; with reason for this spraying being to extend the shelf-life ( according to 70% of respondents), to attract customers (50%) and to control pests and diseases (46%). Class II pesticide, especially organophosphates were the most used. Conclusion: Recommended pesticide usage is not followed. Inadequate personal protection and use of pesticides for wrong purposes are prevalent misuse behavior. Market demand, lack of knowledge, financial constraints and community beliefs influence pesticide use behavior. Shelf life and tomato appearance are the key drivers of nonobservance of the pre-harvest no spray period. Education influences farmers’ safe use but doesn’t guarantee producer concern towards the consumer. Money takes precedence compared to health, amongst these tomato farmers.

Knowledge, Attitudes, and Practices of Tomato Producers and Vendors in Uganda

Background: Uganda’s horticultural sub-sector is growing at a fast rate and tomato is one of the major horticultural crops with wide spread production in peri-urban and rural areas. However tomato is susceptible to different pests and diseases and this has resulted into use of synthetic pesticides as the main control strategy. There is wide spread pesticide misuse behavior amongst tomato farmers owing to different social, economical and regulatory factors. This misuse includes among others inadequate personal protection and failure to follow the recommended pre-harvest no spray interval. This puts the health of millions of tomato farmers and consumers at risk. In Uganda, information on such misuse, consumer safety, and residues in food is limited. Objectives: This article presents findings from a survey of knowledge, attitudes and practices of tomato farmers and vendors. The article also draws conclusions from the findings and recommends areas that could help to improve or avert the foregoing. Methodology: This study was carried out in Nangabo Sub-County, Kyadondo County, Wakiso District in the Central Region of Uganda. Quantitative and qualitative data was gathered using an interviewer administered structured questionnaire and Focus Group Discussion guides, respectively from 50 tomato farmers and 6 tomato vendors in June 2013. Quantitative data analysis was done using the Epi Info statistical package software, while the qualitative data were audio recorded, transcribed and analysed on the basis of the themes/objectives of the study, namely, pesticide use and handling knowledge, attitudes and practices by farmers and vendors. Results: 41.4 years was the average age of farmer respondents. 26% were females. 56% had completed secondary education. 92% spray with synthetic pesticides as their main control tactic against pests and diseases. 44% reported spraying three times in a week during the wet season. 24.5% were not aware of any health risks of spraying tomatoes close to harvest time. 45.8% reported spraying their tomatoes less than a week to harvest time while 29.2% of the respondents sprayed their tomatoes at/after harvest; with reason for this spraying being to extend the shelf-life ( according to 70% of respondents), to attract customers (50%) and to control pests and diseases (46%). Class II pesticide, especially organophosphates were the most used. Conclusion: Recommended pesticide usage is not followed. Inadequate personal protection and use of pesticides for wrong purposes are prevalent misuse behavior. Market demand, lack of knowledge, financial constraints and community beliefs influence pesticide use behavior. Shelf life and tomato appearance are the key drivers of nonobservance of the pre-harvest no spray period. Education influences farmers’ safe use but doesn’t guarantee producer concern towards the consumer. Money takes precedence compared to health, amongst these tomato farmers.

A Population-Level Evaluation of the Effect of Antiretroviral Therapy on Cancer Incidence in Kyadondo County, Uganda, 1999-2008.

The introduction of antiretroviral therapy (ART) in the United States and Europe has led to changes in the incidence of cancers among HIV-infected persons, including dramatic decreases in Kaposi sarcoma and non-Hodgkin lymphoma, and increases in Hodgkin lymphoma, liver, and anogenital malignancies. We sought to evaluate whether increasing availability of ART is associated with changing cancer incidence in Uganda. Incident cases of 10 malignancies were identified from Kampala Cancer Registry from 1999 to 2008. ART coverage rates for Uganda were abstracted from the Joint United Nations Program on HIV/AIDS reports. Negative binomial and Poisson regression modeled the association between ART coverage and age-adjusted cancer incidence. ART coverage in Uganda increased from 0% to 43% from 1999 to 2008. With each 10% increase in ART coverage, incidence of Kaposi sarcoma decreased by 5% [incidence rate ratio (IRR) = 0.95, 95% confidence interval: 0.91 to 0.99, P = 0.02] and stomach cancer decreased by 13% [IRR = 0.87 (95% CI: 0.80 to 0.95), P = 0.002]. Conversely, incidence of non-Hodgkin lymphoma increased by 6% [IRR = 1.06 (95% CI: 1 to 1.12), P = 0.05], liver cancer by 12% [IRR = 1.12 (95% CI: 1.04 to 1.21), P = 0.002], prostate cancer by 5% [IRR = 1.05 (95% CI: 1 to 1.10), P = 0.05], and breast cancer by 5% [IRR = 1.05 (95% CI: 1 to 1.11), P = 0.05]. ART coverage was not associated with incidence of invasive cervical cancer, lung, colon, and Hodgkin disease. These findings were similar when restricted to histologically confirmed cases. Our findings suggest that AIDS-defining malignancies and other malignancies are likely to remain significant public health burdens in sub-Saharan Africa even as ART availability increases.

Trends in the incidence of cancer in Kampala, Uganda 1991-2010

The Kampala cancer registry is the longest established in Africa. Trends in incidence rates for a 20-year period (1991-2010) for Kyadondo County (Kampala city and a rural hinterland) illustrate the effects of changing lifestyles in urban Africa, and the effects of the epidemic of HIV-AIDS. There has been an overall increase in the risk of cancer during the period in both sexes, with incidence rates of major cancers such as breast and prostate showing particularly marked increases (3.7% and 5.2% annually, respectively). In the 1960s cancer of the oesophagus was the most common cancer of men (and second in women), and incidence in the last 20 years has not declined. Cancer of the cervix, always the most frequent cancer of women, has shown an increase over the period (1.8% per year), although the rates appear to have declined in the last 4 years. HIV prevalence in adults in Uganda fell from a maximum in 1992 to a minimum (about 6%) in 2004, and has risen a little subsequently, while availability of antiretroviral drugs has risen sharply in recent years. Incidence of Kaposi sarcoma in men fell until about 2002, and has been relatively constant since then, while in women there has been a continuing decline since 2000. Other HIV related cancers-non-Hodgkin lymphoma of younger adults, and squamous cell carcinoma of conjunctiva-have shown major increases in incidence, although the former (NHL) has shown a small decline in incidence in the most recent 2 years.

Contribution of HIV infection to mortality among cancer patients in Uganda

HIV infection is associated with cancer risk. This relationship has resulted in a growing cancer burden, especially in resource-limited countries where HIV is highly prevalent. Little is known, however, about how HIV affects cancer survival in these settings. We therefore investigated the role of HIV in cancer survival in Uganda. Retrospective cohort (N = 802). Eligible cancer patients were residents of Kyadondo County, at least 18 years of age at cancer diagnosis, and diagnosed between 2003 and 2010 with one of the following: breast cancer, cervical cancer, non-Hodgkin's lymphoma, Hodgkin's lymphoma, or esophageal cancer. Patients were classified as HIV-infected at cancer diagnosis based on a documented positive HIV antibody test, medical history indicating HIV infection, or an HIV clinic referral letter. The primary outcome, vital status at 1 year following cancer diagnosis, was abstracted from the medical record or determined through linkage to the national hospice database. The risk of death during the year after cancer diagnosis was compared between cancer patients with and without evidence of HIV infection using Cox proportional hazards regression. HIV-infected cancer patients in Uganda experienced a more than two-fold increased risk of death during the year following cancer diagnosis compared to HIV-uninfected cancer patients [hazard ratio 2.28; 95% confidence interval (CI) 1.61-3.23]. This association between HIV and 1-year cancer survival was observed for both cancers with (hazard ratio 1.56; 95% CI 1.04-2.34) and without (hazard ratio 2.68; 95% CI 1.20-5.99) an infectious cause. This study demonstrates the role of HIV in cancer survival for both cancers with and without an infectious cause in a resource-limited, HIV-endemic setting.

Changing cancer incidence in Kampala, Uganda, 1991–2006

Incidence rates of different cancers have been calculated for the population of Kyadondo County (Kampala, Uganda) for a 16-year period (1991-2006). This period coincides with continuing social and lifestyle changes and the peak and subsequent wane of the epidemic of HIV-AIDS. There has been an overall increase in the risk of cancer during the period in both sexes, with the incidence rates of cancers of the breast and prostate showing particularly marked increases (4.5% annually). Prostate cancer is now the most common cancer in men. The incidence of cancer of the esophagus, formerly the most common cancer in men and second in frequency in women, has remained relatively constant, whereas the incidence of cancer of the cervix, the most common malignancy in women, continues to increase. Since the early 1990s the incidence of Kaposi sarcoma (KS) in men has declined, and while remaining relatively constant in women, it has been diagnosed at progressively later ages. The rates of pediatric KS have declined by about 1/3rd. The incidence of squamous cell cancers of the conjunctiva has also declined since the mid 1990s. Cancer control in Uganda, as elsewhere in sub-Saharan Africa, involves meeting the challenge of emerging cancers associated with westernization of lifestyles (large bowel, breast and prostate); although the incidence of cancers associated with poverty and infection (liver, cervix, esophagus) shows little decline, the residual burden of the AIDS-associated cancers remains a major burden.

Frequency of the basal‐like phenotype in African breast cancer

Basal-like breast carcinoma has been recognized as a subtype with specific prognostic implications. However, there is a lack of reports about this category of breast tumors in African women. The aim of this study was to explore the basal-like phenotype in breast cancer patients in an African population, and a registry-based series was included from the well-defined Kyadondo County in Uganda (1.7 millions). We studied a total of 65 archival paraffin blocks of invasive breast cancer using antibodies against cytokeratin 5/6 and P-cadherin, and these markers were expressed in 34% of all cases and in 52% of ER (estrogen receptor)-negative tumors. All basal-like tumors were ER negative (p<0.0005) and PR (progesterone receptor) negative (p=0.002). Basal-like breast carcinomas were of a higher histologic grade (p=0.001), had high mitotic counts (p=0.002), and marked nuclear pleomorphism (p=0.002). P-cadherin-positive tumors had a high Ki-67 proliferative rate (p=0.039). In conclusion, the basal-like phenotype is frequent in this African series of breast cancer and is strongly associated with poor prognostic factors. Our findings might be significant in relation to clinical management of these patients, including novel targeted therapy.

Oncoprotein over-expression in breast cancer and its relationship to histology and grade in a Ugandan population

To evaluate c-erbB-2 oncoprotein over expression in breast cancer patients of Kyadondo county and also relate this oncoprotein to histological type and grade of the tumour. Cross-sectional study. Pathology Department, Faculty of Medicine, Makerere University. Seventy two breast cancer patients who were among the 174 entered in survival study had their paraffin breast tissue blocks retrieved from archives of Pathology Department and had their c-erbB-2 determined by peroxidase-labeled streptavidin-biotin immunohistochemical method. c-erbB-2 oncoprotein was over expressed in 33.3% of the tumours and correlated positively with histological grade (p = 0.007). TH oncoprotein over expression was not restricted to any particular histological type and there was no association with age of patient. The over expression of c-erbB-2 oncoprotein observed in one third of breast cancer patients of this African population could partly explain the observed poor survival rate reported in this community.

Spectrum of cancers among HIV‐infected persons in Africa: The Uganda AIDS‐Cancer Registry Match Study

Although more than 25 million people in sub-Saharan Africa have human immunodeficiency virus (HIV) infection, little is known regarding their cancer risk. We investigated cancer risk among persons with HIV/AIDS in Uganda using record-linkage. We linked records of 12,607 HIV-infected persons attending The AIDS Support Organization (TASO) in Kyadondo County from October 1988 through December 2002 to the Kampala Cancer Registry. We calculated standardized incidence ratios (SIRs) to identify increased cancer risks in the early (4-27 months after TASO registration), late (28-60 months), or combined (4-60 months) incidence periods. We identified 378 cancers (181 prevalent, 197 incident) among TASO participants. Of incident cancers, 137 (70%) were AIDS-defining cancers. Risk was increased in the early-incident period, compared to the general population, for the AIDS-defining cancers: Kaposi sarcoma (SIR 6.4, 95%CI 4.8-8.4), non-Hodgkin lymphoma (6.7, 1.8-17), and cervical carcinoma (2.4, 1.1-4.4). These three cancers were also increased in the combined periods. Risks of five non-AIDS-defining cancers were increased in the combined periods: Hodgkin lymphoma (5.7, 1.2-17) and cancers of the conjunctiva (SIR 4.0; 1.5-8.7), kidney (16, 1.8-58), thyroid (5.7, 1.1-16), and uterus (5.5, 1.5-14). Cancers of the breast, nasopharynx, and lung were increased either in the early or late incident periods only. Among 407 children, seven cancers were observed, of which five were Kaposi sarcoma. The application of a record-linkage design in Africa broadens the repertoire of epidemiological tools for studying HIV-infected populations. We confirm the increased risks of AIDS-defining cancers and report increased risks of a few non-AIDS-defining cancers.

Pattern of cancer in Mbarara, Uganda.

To determine the pattern of cancer in Mbarara region. Retrospective descriptive study. Mbarara University of Science and Technology (MUST), Mbarara, southwestern Uganda. A total of 585 cancer patients diagnosed between 1995 and 1999 formed the basis of the analysis. The most frequent cancers observed among males in their descending order were Kaposis sarcoma (KS), stomach, Non Hodgkin Lymphoma (NHL), prostate and penis while in females cancer of cervix, breast, NHL, stomach and KS were found most frequent. This pattern was different from that of Kyadondo county, Uganda in which stomach and penila cancer were found to be rare whereas oesophageal cancer was one of the commonest cancer in Kyadondo but rare in Mbarara. These differences which are discussed in detail could be attributed to both environmental and genetic factors.

The uganda study on HPV variants and genital cancers.

Genital cancers in Uganda have been the most frequently diagnosed cancer in men as well as in women since the 1950s. Genetic studies have detected HPV-16 variants of Af1 class and identified a new sub-class designated Af1-u. The main goal of this study is to analyze the prevalence of HPV strains and HPV variants in anogenital lesions of Ugandan male and female subjects in order to possibly determine their role in the pathogenesis of such lesions and to develop an Ugandan preventive HPV vaccine program. The study is planning to enroll male and female subjects affected by genital lesions, in particular to collect 200 scrapes/biopsies from women with normal ectocervical epithelium as well as with all different degrees of ectocervical lesions (from CIN 1/LSIL to cervical carcinoma). All samples are analyzed by PCR amplification of the L1 conserved region (nt 6584-7035) and the E6/E7 genes (nt 34-880), nucleotide sequence analysis, homology and phylogenetic studies. Variant distribution studies will be followed by serological studies of prevalence and incidence in 1000 women. PRELIMINARY RESULTS AND CONCLUSIONS: Penile cancers from the Kyadondo County have been analyzed for the presence of HPV sequences. More recently 16 ectocervical scrapes and three biopsies have been received from women attending the Nsambya Hospital and analyzed for the presence and type of HPVs. Our results, obtained by PCR and sequencing analysis, allowed the identification of HPV-16 Af1 sequences in 100% of tumor tissue and in 6.25% of scrapes. HPV 45 was identified only in one tumor together with HPV 16 infection. HPV 33 and HPV 58 were present in 20% and 40%, respectively of HPV positive benign samples. The results are showing a narrowing of the HPV pattern in more advanced lesions, suggesting that mainly HPV-16 Af1 patients are progressing to cancer.

Trends in cancer incidence in Kyadondo County, Uganda, 1960-1997.

Incidence rates of different cancers have been calculated for the population of Kyadondo County (Kampala, Uganda) for four time periods (1960–1966; 1967–1971; 1991–1994; 1995–1997), spanning 38 years in total. The period coincides with marked social and lifestyle changes and with the emergence of the AIDS epidemic. Most cancers have increased in incidence over time, the only exceptions being cancers of the bladder and penis. Apart from these, the most common cancers in the early years were cervix, oesophagus and liver; all three have remained common, with the first two showing quite marked increases in incidence, as have cancers of the breast and prostate. These changes have been overshadowed by the dramatic effects of the AIDS epidemic, with Kaposi's sarcoma emerging as the most common cancer in both sexes in the 1990s, and a large increase in incidence of squamous cell cancers of the conjunctiva. In the most recent period, there also seems to have been an increase in the incidence of non-Hodgkin lymphomas. So far, lung cancer remains rare. Cancer control in Uganda, as elsewhere in sub-Saharan Africa, faces a threefold challenge. With little improvement in the incidence of cancers associated with infection and poverty (liver, cervix, oesophagus), it must face the burden of AIDS-associated cancers, while coping with the emergence of cancers associated with Westernization of lifestyles (large bowel, breast and prostate). © 2000 Cancer Research Campaign

AIDS-related cancers in Africa: maturation of the epidemic in Uganda.

The AIDS epidemic has passed its peak in Uganda, with possible consequences for the risk of cancers related to infectious agents. To compare the incidence of cancers possibly linked to infections with HIV, before the AIDS epidemic (the 1960s), at its high point (the early 1990s) when HIV-seroprevalence and AIDS notifications peaked, and after the onset of its decline in the later 1990s. Analysis of incidence rates of infection-associated cancers in the population of Kyadondo county, in 1960-1971, 1991-1994, and 1995-1997. Comparison with data on prevalence of HIV infection, and notifications of AIDS. The incidence of Kaposi's sarcoma has increased enormously since the 1960s, with a shift to earlier age at onset, and more generalized and nodal disease; there has been little change in the profile during the 1990s. There was a large increase in incidence of squamous cell carcinomas of the conjunctiva, which has continued through the 1990s. Non-Hodgkin's lymphomas showed little increase in incidence until the most recent period, in which the incidence has increased both in children (particularly Burkitt's lymphomas) and adults. Although the incidence of cervical cancer was higher in the 1990s than the 1960s, it seems doubtful that this is related to HIV infection. Certain other cancers which have been linked to AIDS in western populations (Hodgkin's disease, anal carcinoma, childhood leiomyosarcoma) show no changes in risk. The AIDS epidemic has dramatically changed the profile of cancer in Uganda. Trends in the AIDS-related cancers are consistent with current knowledge concerning the mechanisms behind the increased risk. The incidence of certain cancers with a viral aetiology (liver, cervix, penis, Hodgkin's disease) appears not to have been influenced by AIDS.

Cancer in Kampala, Uganda, in 1989–91: Changes in incidence in the era of aids

Re-establishment of the cancer registry in Kyadondo County, Uganda, has allowed estimation of incidence rates for the period September 1989 to December 1991. The results are compared with earlier data from the same area, and from other African cancer registries. The most striking feature is the emergence of Kaposi's sarcoma as the leading cancer in males (almost half of all registered cases) and the second most frequent (17.9%) in females. This parallels the evolution of the epidemic of AIDS. There were also marked increases in the incidence of both oesophageal and prostatic carcinoma, while the incidence of cancer of the penis and the urinary bladder declined, possibly as a result of improved standards of hygiene. In females, the incidence of cancer of the cervix has more than doubled since the 1950s, and is now among the highest recorded in the African continent.

Cancer in Kyadondo County, Uganda, 1968–70

Cancer in Kyadondo County, Uganda, 1968–70