Cancer in Kampala, Uganda, in 1989-91: changes in incidence in the era of AIDS

Abstract

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.

PIP: The Kampala Cancer Registry (KCR), in Kyadondo County, Uganda, was established in 1951. During 1972-87, KCR activity was reduced because of the Ugandan political situation. Reactivation of the KCR has provided data on incidence in Kyadondo County residents from September 1989 to December 1991. Kyadondo County had just over 1 million residents (living there at least 1 year) in 1991. Data sources were the records of the Department of Histopathology, which receives KCR registration information along with specimens, and hospital records verified by a cancer registrar from the 4 major county hospitals. (Death certificates are not available at present in Uganda). These data were compared with those reported in 1954-60 and 1968-70 to determine changes in cancer incidence in an era marked by changing lifestyles and the emerging AIDS epidemic. 558 males and 675 females were registered in the 28-month period. Data were tabulated separately for males and females, showing number of cases/site and average annual age-specific incidence rates. Age-standardized incidence rates were compared for 1989-91, 1954-68, 4 other African population-based series, and White and Black US population rates. The most frequent 1981-91 cancers for men were Kaposi's sarcoma, 48.6% esophagus, 6.9%; nonHodgkin's lymphoma (NHL), 6.2%; prostate, 5.5%; and liver, 4.9%. In women, the most frequent cancers were cervical, 32.1% in the highest record in Africa; Kaposi's sarcoma, 17.9%; and breast cancer, 11.4%. A comparison to earlier KCR data revealed that incidence of Kaposi's sarcoma has increased from 2.6 to 30.1/100,000 in men and from 0 to 11/100,000 in women. This finding is clearly related to the AIDS epidemic. However, the rate of NHL, which is an increased risk for US AIDS patients, has shown little change. However, the incidence of NHL (specifically Burkitt's) in KCR children 0-14 years old is relatively high (19/1/million in boys and 12.1/million in girls), and the AIDS epidemic may be responsible, although much remains to be discovered about AIDS-related NHL, particularly Burkitt's. Incidence increases were found in men for esophageal and prostate cancer, whereas cases of cancer of the penis and bladder declined. In women, the incidence of cervical cancer doubled since the 1950s. Breast cancer, while the third most common, shows the typical low, rate of a low-birth population, although the rate has doubled since 1954-60.