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. 2018 Jun 7;18(1):639.
doi: 10.1186/s12885-018-4540-1.

Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates

Themba G Ginindza  1 , Benn Sartorius  2
Affiliations

Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates

Themba G Ginindza et al. BMC Cancer. .

Abstract

Background: The scarcity of country data (e.g. a cancer registry) for the burden of cervical cancer (CC) in low-income countries (LCIs) such as Swaziland remains a huge challenge. Such data are critical to inform local decision-making regarding resource allocation [1]. We aimed to estimate likely cervical cancer incidence in Swaziland using three different methodologies (triangulation), to help better inform local policy guidance regarding likely higher "true" burden and increased resource allocation required for treatment, cervical cancer screening and HPV vaccine implementation.

Methods: Three methods were applied to estimate CC incidence, namely: 1) application of age-specific CC incidence rates for Southern African region from GLOBOCAN 2012 extrapolated to the 2014 Swaziland female population; 2) a linear regression based model with transformed age-standardised CC incidence against hr-HPV (with and without HIV as a covariate) prevalence among women with normal cervical cytology; and 3) a mathematical model, using a natural history approach based on parameter estimates from various available literature and local survey estimates. We then triangulated estimates and uncertainty from the three models to estimate the most likely CC incidence rate for Swaziland in 2015.

Results: The projected incidence estimates for models 1-3 were 69.4 (95% CI: 66.7-72.1), 62.6 per 100,000 (95%CI: 53.7-71.8) and 44.6 per 100,000 (41.5 to 52.1) respectively. Model 2 with HIV prevalence as covariate estimated a higher CC incidence rate estimate of 101.1 per 100,000 (95%CI: 90.3-112.2). The triangulated ('averaged') age-standardized CC incidence based across the 3 models for 2015 was estimated at 69.4 per 100,000 (95% CI: 63.0-77.1) in Swaziland.

Conclusion: It is widely accepted that cancer incidence (and in this case CC) is underestimated in settings with poor and lacking registry data. Our findings suggest that the projected burden of CC is higher than that suggested from other sources. Local health policy decisions and decision-makers need to re-assess resource allocation to prevent and treat CC effectively, which is likely to persist given the very high burden of hr-HPV within the country.

Keywords: Cervical cancer incidence; High risk human papillomavirus prevalence modelling; Swaziland.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Swaziland Scientific Ethics Committee (MH599C/FW00015267/IRB0009688) and the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (BE 242/14). Ethics committees approved written informed consent, which was obtained from all the participants prior participating to the study. All sexually active women aged between 15 and 49 years attending various reproductive health clinics and other units from all the study sites, were eligible for the study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Age-specific cervical cancer incidence rate for the Southern African region
Fig. 2
Fig. 2
Showing the association between HPV prevalence among women with normal cytology from African countries and standardized CC incidence in women ages 15–75+. HPV only. HPV and HIV
See this image and copyright information in PMC

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