Frequent HIV and Young Age Among Individuals With Diverse Cancers at a National Teaching Hospital in Malawi

Abstract

Purpose Cancer surveillance provides a critical evidence base to guide cancer control efforts, yet population-based coverage in Africa is sparse. Hospital-based registries may help fill this need by providing local epidemiologic data to guide policy and forecast local health care needs. We report the epidemiology of patients with cancer recorded by a de novo hospital-based cancer registry at Kamuzu Central Hospital, Malawi, the sole provider of comprehensive oncology services for half the country and location of a high-volume pathology laboratory. Methods We conducted active case finding across all hospital departments and the pathology laboratory from June 2014 to March 2016. Patient demographics, tumor characteristics, treatment, and HIV status were collected. We describe epidemiology of the cancer caseload, registry design, and costs associated with registry operations. Results Among 1,446 registered patients, Kaposi sarcoma and cervical cancer were the most common cancers among men and women, respectively. Burkitt lymphoma was most common cancer among children. The current rate of pathology confirmation is 65%, a vast improvement in the diagnostic capacity for cancer through the hospital's pathology laboratory. Among leading cancer types, an alarming proportion occurred at young ages; 50% of Kaposi sarcoma and 25% of esophageal, breast, and cervical cancers were diagnosed among those younger than 40 years of age. A systematic, cross-sectional assessment of HIV status reveals a prevalence of 58% among adults and 18% among children. Conclusion We report a high caseload among typically young patients and a significant burden of HIV infection among patients with cancer. In low- and middle-income countries with intermittent, sparse, or nonexistent cancer surveillance, hospital-based cancer registries can provide important local epidemiologic data while efforts to expand population-based registration continue.

Fig 1

Distribution of patients with cancer and HIV status among men and women: (A) female and (B) male. Other sites include (A and B) anus; bones and joints; larynx; other digestive sites; skin, including melanoma; soft tissue; unspecified primary site; and (B) male breast.

Fig 2

Median age at cancer diagnosis among adults ≥ 20 years of age by primary tumor site (median, interquartile range).

Fig 3

Mode of cancer diagnosis among (A) adults and (B) children and adolescents. Direct visualization without pathology confirmation includes endoscopy or visual inspection with acetic acid. Other includes exploratory surgery/autopsy and radiologic studies. ICCC, International Classification of Childhood Cancer.

Fig 4

Distribution of patients with cancer and HIV status among children and adolescents: (A) female and (B) male. Non-Hodgkin lymphoma excludes Burkitt lymphoma. Leukemia includes lymphoid leukemias and other specified leukemias. Soft tissue and extraosseous sarcomas include rhabdomyosarcomas, fibrosarcomas, peripheral nerve sheath tumors, and other and unspecified soft tissue sarcomas, excluding Kaposi sarcoma. Other malignant tumors include other malignant epithelial neoplasms, malignant melanomas, and carcinomas. Not classified by International Classification of Childhood Cancer (ICCC) because of insufficient or absent histology information.