Ten year cancer trend as diagnosed at the Department of Pathology Mulago National Referral Hospital

Abstract

Introduction globally, cancer is the biggest non communicable disease; estimated to have accounted for about 13% of all deaths in 2007. The burden of NCDs for low income and middle income countries is expected to rise by over 60% by 2020 compared to a rise of 10% in high income countries. This study established the cancer trend (1999 to 2008) from the pathology department of Mulago National Referral Hospital. The study also described the demographic distribution of the cancers diagnosed and established institutional capacity for response in Uganda.

Methods This was a descriptive retrospective study, which employed quantitative and qualitative methods. Records were reviewed to establish cancer trends. Key informant interviews were held with leaders at various departments that offer cancer related services to establish institutional capacity. Quantitative data was analyzed using STATA Version 10 and qualitative data analyzed using thematic manifest techniques.

Results Diagnosis of previously uncommon cancers such as breast and prostate in Uganda is on the upward trend, and females contribute to 58% of all the cancers diagnosed at the pathology department of Mulago national referral hospital. The most commonly diagnosed cancers between 1999 and 2008 were; Kaposi’s sarcoma, cervical cancer and cancers of the eye, breast, ovary and prostate. In 1999, Kaposi’s sarcoma and cervical cancer contributed the two largest proportions amongst the top 10 cancers diagnosed (24% and 21% respectively). In 2008, while Kaposi’s sarcoma and cervical cancer were still contributing the larger portion (16% and 12% respectively), the cases of breast cancer (10%) were growing markedly. The mean age at time of diagnosis of a cancer was 39.5 years (SD 20.5). HIV related cancers are still prevalent but declining, Kaposi’s sarcoma for instance declined from a rate of 1.9 per 100,000 populations in 1999 to less than 0.7 in 2008. Critical institutional service gaps identified by key informants were: the lack of a central national cancer registry, inadequate access to diagnostic and treatment services and shortage of human resources.

Conclusion There is a steady increase of previously uncommon cancers in Uganda with females being most affected. In spite of the increasing trend of such cancers, the cancer-related services available lack adequate human resources, and much of the population in the country has inadequate access to cancer-related services. There is, therefore, an urgent need for government and partners to increase human resources and accessibility to diagnostic and treatment services for cancer in order to improve cancer outcomes. The decline in HIV related cancers that are observed in this study may partially be due to the increased accessibility to ARVs. On the other hand, more cancers are becoming less likely to be centrally diagnosed and registered at the pathology department of Mulago national referral hospital, as was the case in the past, making it gradually more difficult to draw precise conclusions related to cancer trends.