Chapter 30: Cancer survival in Kampala, Uganda, 1993-1997
Wabinga H, Parkin DM, Nambooze S and Amero J
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The registry contributed data on survival from 15 cancer sites or types in this volume of the IARC publication on Cancer Survival in Africa, Asia, the Caribbean and Central America. For Kaposi sarcoma, only a random sample of the total incident cases (431 out of 1376 cases; 31%) was available for this survival study[3].
The closing date of follow-up was 31st December 1999. The median follow-up varied from 4 months in stomach cancer to 26 months for prostate cancer. Complete follow-up at five years from the incidence date ranged from 47% in cancer of the eye to 87% for liver and lung cancers. The bulk of the losses to follow-up have generally occurred in the first year of follow-up.
The 5-year age-standardized relative survival (ASRS) probability for all ages together is either less than or similar to the corresponding unadjusted one for a majority of cancers. The 5-year ASRS (0–74 years of age) is observed to be either higher than or similar to the corresponding ASRS (all ages) for all cancers.
Abstract
The Kampala cancer registry, was established in 1954 as a population-based cancer registry and registration of cases is done by active methods. The registry contributed data on survival for 15 cancer sites or types registered in 1993–1997. For Kaposi sarcoma, only a random sample of the total incident cases was provided for survival study. Follow-up has been carried out predominantly by active methods, with median follow-up ranging from 4–26 months. The proportion with histologically verified diagnosis for various cancers ranged between 36–83%; death certificate only cases (DCOs) were negligible; 58–92% of total registered cases were included for survival analysis. Complete follow-up at five years ranged between 47–87% for different cancers. Five-year age-standardized relative survival rates for selected cancers were Kaposi sarcoma (22%), cervix (19%), oesophagus (5%), non-Hodgkin lymphoma (26%), breast (36%) and prostate (46%). None survived beyond 5 years for cancers of the stomach and lung. Five-year relative survival by age group was fluctuating with no definite pattern or trend emerging and no survivors in many age intervals.Kampala cancer registry
The Kampala cancer registry was established in 1954 as a population-based cancer registry at the department of pathology, Makerere University Medical School, to obtain information on cancer occurrence in Kyadondo county[1]. It contributed data to the quinquennial IARC publication Cancer Incidence in Five Continents in volumes I, VII and VIII[2]. Cancer is not a notifiable disease, and registration of cases is done by active methods. The principal sources of data are medical records in the hospitals in the government and non-government sectors, pathology laboratories and hospice. The registry caters to a population of about 1.1 million in 1995 with a sex ratio of 1029 females to 1000 males. The average annual age-standardized incidence rate is 162 per 100 000 among males and 171 per 100 000 among females in 1993–1997. The top-ranking cancers among males are Kaposi sarcoma, cancer of the prostate and non-Hodgkin lymphoma. Among females, the order is Kaposi sarcoma, cervix and breast.| Map. Map showing location of Kampala, Uganda Click here to open map (PDF format) |
Data quality indices
The proportion of cases with histological confirmation of cancer diagnosis in this series is 66%, varying between 83% for cancer of the thyroid and 36% for liver. The proportion of cases registered based on a death certificate only was negligible. The exclusion of cases without any follow-up information is 21%, ranging from 5% in lung cancer to 39% in cancer of the eye. Thus, 58–92% of the total cases in different cancers registered are included in the estimation of the survival probability. | Table 1. Data quality indices - Proportion (%) of histologically verified and death certificate only cases, number and proportion of included and excluded cases by site, Kampala, Uganda, 1993–1997 cases followed-up until 1999 Click here to open table (PDF format) Click here to open comparative statistics by registry |
Outcome of follow-up
Follow-up has been carried out predominantly by active methods. Cancer mortality information obtained from accessible death certificates in health units of the county are matched with the registry database. The vital status of the unmatched incident cases are then ascertained by repeated scrutiny of hospital records, postal enquiries and house visits.The closing date of follow-up was 31st December 1999. The median follow-up varied from 4 months in stomach cancer to 26 months for prostate cancer. Complete follow-up at five years from the incidence date ranged from 47% in cancer of the eye to 87% for liver and lung cancers. The bulk of the losses to follow-up have generally occurred in the first year of follow-up.
 | Table 2. Number and proportion of cases with complete / incomplete follow-up and median follow-up (in months) by site, Kampala, Uganda, 1993–1997 cases followed-up until 1999 Click here to open table (PDF format) Click here to open comparative statistics by registry |
Survival statistics
All ages and both sexes together
The 5-year relative survival is the highest in cancer of the prostate (48%) followed by breast (44%) and non-Hodgkin lymphoma (34%) in the series. None survived for 5 years from incidence date among cancers of the stomach and lung.The 5-year age-standardized relative survival (ASRS) probability for all ages together is either less than or similar to the corresponding unadjusted one for a majority of cancers. The 5-year ASRS (0–74 years of age) is observed to be either higher than or similar to the corresponding ASRS (all ages) for all cancers.
 | Table 3. Comparison of 1-, 3- and 5-year absolute and relative survival and 5-year age-standardized relative survival (ASRS) by site, Kampala, Uganda, 1993–1997 cases followed-up until 1999 Click here to open table (PDF format) Click here to open comparative statistics by registry |
 | Figure 1a. Top ten cancers (ranked by survival), Kampala, Uganda, 1993–1997 Click here to open figure (PDF format) Click here to open graph for all the cancer sites |
Sex
 | Table 4a. Site-wise number of cases, 5-year absolute and relative survival by sex, Kampala, Uganda, 1993–1997 cases followed-up until 1999 Click here to open table (PDF format) Click here to open comparative statistics by registry |
Male
The 5-year relative survival was the highest for cancer of the breast (n=5, 111%) followed in order by prostate (48%), eye (42%), thyroid and non-Hodgkin lymphoma (39%). None survived for 5 years from incidence date in cancers of the nasopharynx, stomach and lung. The 5-year relative survival was notably higher among males than females in cancers of the eye, thyroid and non-Hodgkin lymphoma. | Figure 1b. Top five cancers (ranked by survival), Male, Kampala, Uganda, 1993–1997 Click here to open figure (PDF format) Click here to open graph for all the cancer sites |
Female
The top-ranking cancers in terms of 5-year relative survival were breast (42%), non-Hodgkin lymphoma (26%) and Kaposi sarcoma (21%). Survival from cervix and ovarian cancers were 20% and 16%, respectively. None survived until 5 years from incidence date in cancers of the nasopharynx, stomach and thyroid. | Figure 1c. Top five cancers (ranked by survival), Female, Kampala, Uganda, 1993–1997 Click here to open figure (PDF format) Click here to open graph for all the cancer sites |
Age group
The 5-year relative survival by age group is seen to fluctuate, with no definite pattern or trend emerging and no survivors in many age intervals. | Table 4b. Site-wise number of cases, 5-year absolute and relative survival by age group, Kampala, Uganda, 1993–1997 cases followed-up until 1999 Click here to open table (PDF format) Click here to open comparative statistics by registry |
References
- Wabinga HR, Parkin DM, Wabwire-Mangen F and Nambooze S. Trends in cancer incidence in Kyadondo County, Uganda, 1960–1997. Br J Cancer. 2000; 82(9): 1585–1592.
(link to pubmed) - Parkin DM, Whelan SL, Ferlay J and Storm H. Cancer Incidence in Five Continents, Vol I to VIII: IARC Cancerbase No. 7. IARCPressLyon, 2005.
(link to CI5) - Gondos A, Brenner H, Wabinga H, Parkin DM. Cancer survival in Kampala, Uganda. Br J Cancer. 2005 May 9;92(9):1808–12.
(link to pubmed)