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. 2023 Oct 9;115(10):1213-1219.
doi: 10.1093/jnci/djad119.

Decreasing incidence of conjunctival squamous cell carcinoma in people with HIV in South Africa

Carole Metekoua  1   2 , Yann Ruffieux  3 , Victor Olago  1 , Tafadzwa Dhokotera  1   3   4   5   6 , Matthias Egger  3   7   8 , Julia Bohlius  3   4   5 , Eliane Rohner  3 , Mazvita Muchengeti  1   9   10
Affiliations

Decreasing incidence of conjunctival squamous cell carcinoma in people with HIV in South Africa

Carole Metekoua et al. J Natl Cancer Inst. .

Abstract

Background: The main risk factors for squamous cell carcinoma of the conjunctiva (SCCC) are immunodeficiency and exposure to ultraviolet radiation. Little is known about SCCC epidemiology among people with HIV (PWH) in South Africa.

Methods: We used data from the South African HIV Cancer Match study, a nation-wide cohort of PWH in South Africa, created through a privacy-preserving probabilistic record linkage of HIV-related laboratory records from the National Health Laboratory Service and cancer records from the National Cancer Registry from 2004 to 2014. We calculated crude incidence rates, analyzed trends using joinpoint models, and estimated hazard ratios for different risk factors using Royston-Parmar flexible parametric survival models.

Results: Among 5 247 968 PWH, 1059 cases of incident SCCC were diagnosed, for a crude overall SCCC incidence rate of 6.8 per 100 000 person-years. The SCCC incidence rate decreased between 2004 and 2014, with an annual percentage change of ‒10.9% (95% confidence interval: ‒13.3 to ‒8.3). PWH residing within latitudes 30°S to 34°S had a 49% lower SCCC risk than those residing at less than 25°S latitude (adjusted hazard ratio = 0.67; 95% confidence interval: 0.55 to 0.82). Other risk factors for SCCC were lower CD4 counts and middle age. There was no evidence for an association of sex or settlement type with SCCC risk.

Conclusions: An increased risk of developing SCCC was associated with lower CD4 counts and residence closer to the equator, indicative of higher ultraviolet radiation exposure. Clinicians and PWH should be educated on known SCCC preventive measures, such as maintaining high CD4 counts and protection from ultraviolet radiation through sunglasses and sunhats when outdoors.

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Conflict of interest statement

The authors state that they have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Yearly incidence rates of squamous cell carcinoma of the conjunctiva, by sex. The estimates are based on a model that included sex only (ie, the model was not adjusted for any confounders).
Figure 2.
Figure 2.
Age-specific incidence rates of squamous cell carcinoma of the conjunctiva, by sex (A) and calendar period (B).
Figure 3.
Figure 3.
Incidence rates of squamous cell carcinoma of the conjunctiva in South Africa, by district.
See this image and copyright information in PMC

Comment in

References

    1. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Biological agents. IARC Monogr Eval Carcinog Risks Hum. 2012;100(Pt B):1-441. https://publications.iarc.fr/119. - PMC - PubMed
    1. Walsh-Conway N, Conway RM.. Plaque brachytherapy for the management of ocular surface malignancies with corneoscleral invasion. Clin Exp Ophthalmol. 2009;37(6):577-583. doi:10.1111/J.1442-9071.2009.02092.X. - DOI - PubMed
    1. Newton R, Ziegler J, Ateenyi-Agaba C, et al.; Uganda Kaposi’s Sarcoma Study Group. The epidemiology of conjunctival squamous cell carcinoma in Uganda. Br J Cancer. 2002;87(3):301-308. doi:10.1038/SJ.BJC.6600451. - DOI - PMC - PubMed
    1. Gichuhi S, Sagoo MS, Weiss HA, Burton MJ.. Epidemiology of ocular surface squamous neoplasia in Africa. Trop Med Int Health. 2013;18(12):1424-1443. doi:10.1111/TMI.12203. - DOI - PMC - PubMed
    1. Hämmerl L, Ferlay J, Borok M, Carrilho C, Parkin DM.. The burden of squamous cell carcinoma of the conjunctiva in Africa. Cancer Epidemiol. 2019;61:150-153. doi:10.1016/j.canep.2019.06.007. - DOI - PubMed

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