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

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 ce...

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Autores principales: Ginindza, Themba G., Sartorius, Benn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992849/
https://www.ncbi.nlm.nih.gov/pubmed/29879943
http://dx.doi.org/10.1186/s12885-018-4540-1
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author Ginindza, Themba G.
Sartorius, Benn
author_facet Ginindza, Themba G.
Sartorius, Benn
author_sort Ginindza, Themba G.
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12885-018-4540-1) contains supplementary material, which is available to authorized users.
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spelling pubmed-59928492018-07-05 Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates Ginindza, Themba G. Sartorius, Benn BMC Cancer Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12885-018-4540-1) contains supplementary material, which is available to authorized users. BioMed Central 2018-06-07 /pmc/articles/PMC5992849/ /pubmed/29879943 http://dx.doi.org/10.1186/s12885-018-4540-1 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ginindza, Themba G.
Sartorius, Benn
Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates
title Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates
title_full Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates
title_fullStr Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates
title_full_unstemmed Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates
title_short Projected cervical Cancer incidence in Swaziland using three methods and local survey estimates
title_sort projected cervical cancer incidence in swaziland using three methods and local survey estimates
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992849/
https://www.ncbi.nlm.nih.gov/pubmed/29879943
http://dx.doi.org/10.1186/s12885-018-4540-1
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