A prospective ascertainment of cancer incidence in sub-Saharan Africa: The case of Kaposi sarcoma.
A prospective ascertainment of cancer incidence in sub-Saharan Africa: The case of Kaposi sarcoma.
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DOI：
10.1002/cam4.618
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发表时间：
2016-05
期刊：
影响因子：
4
通讯作者：
Martin J
中科院分区：
文献类型：
--
作者：
Semeere A;Wenger M;Busakhala N;Buziba N;Bwana M;Muyindike W;Amerson E;Maurer T;McCalmont T;LeBoit P;Musick B;Yiannoutsos C;Lukande R;Castelnuovo B;Laker-Oketta M;Kambugu A;Glidden D;Wools-Kaloustian K;Martin J
在资源有限的地区，如撒哈拉以南非洲地区，准确的癌症病例确定和高危人群计数问题使得难以估计癌症发病率。我们利用一个大型的医疗保健系统来估计卡波西肉瘤（KS）的发病率，这是一种在艾滋病毒时代变得突出的癌症，其发病率可能会随着抗逆转录病毒治疗（ART）的推出而发生变化。为了实现这一目标，我们评估了2007年至2012年期间在肯尼亚和乌干达的三个医疗中心接受治疗的艾滋病毒感染成年人，这些医疗中心参加了东非国际流行病学数据库评估艾滋病（IeDEA）联盟。通过IeDEA，临床医生接受了KS识别和活检设备的培训。我们发现，在102，945名HIV感染的成年人中，KS的总体患病率为1.4%;在最大的研究中心，随着时间的推移，KS患病率下降。在随访319，632人年的140，552例患者中，年龄标准化发病率为334/100，000人年（95% CI：314-354/100，000人年）。发病率随着时间的推移而下降，女性、接受抗逆转录病毒治疗的人和CD 4计数较高的人发病率较低。接受抗逆转录病毒治疗且CD 4计数>350个细胞/mm 3的患者的发病率为32/100，000人年（95% CI：14-70/100，000人年）。尽管随着时间的推移，随着ART的扩大，KS在东非艾滋病毒感染成年人中的发病率下降，但在资源丰富的环境中，KS的发病率等于或超过了最常见的癌症。在资源有限的环境中，改善癌症诊断的战略努力与已经充分列举的风险因素相结合，可以使医疗保健系统成为估计癌症发病率的有吸引力的平台。
In resource‐limited areas, such as sub‐Saharan Africa, problems in accurate cancer case ascertainment and enumeration of the at‐risk population make it difficult to estimate cancer incidence. We took advantage of a large well‐enumerated healthcare system to estimate the incidence of Kaposi sarcoma (KS), a cancer which has become prominent in the HIV era and whose incidence may be changing with the rollout of antiretroviral therapy (ART). To achieve this, we evaluated HIV‐infected adults receiving care between 2007 and 2012 at any of three medical centers in Kenya and Uganda that participate in the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium. Through IeDEA, clinicians received training in KS recognition and biopsy equipment. We found that the overall prevalence of KS among 102,945 HIV‐infected adults upon clinic enrollment was 1.4%; it declined over time at the largest site. Among 140,552 patients followed for 319,632 person‐years, the age‐standardized incidence rate was 334/100,000 person‐years (95% CI: 314–354/100,000 person‐years). Incidence decreased over time and was lower in women, persons on ART, and those with higher CD4 counts. The incidence rate among patients on ART with a CD4 count >350 cells/mm3 was 32/100,000 person‐years (95% CI: 14–70/100,000 person‐years). Despite reductions over time coincident with the expansion of ART, KS incidence among HIV‐infected adults in East Africa equals or exceeds the most common cancers in resource‐replete settings. In resource‐limited settings, strategic efforts to improve cancer diagnosis in combination with already well‐enumerated at‐risk denominators can make healthcare systems attractive platforms for estimating cancer incidence.