The Kampala cancer registry is the longest established in Africa. Trends in incidence rates for a 20-year period (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) for Kyadondo County (Kampala city and a rural hinterland) illustrate the effects of changing lifestyles in urban Africa, and the effects of the epidemic of HIV-AIDS. There has been an overall increase in the risk of cancer during the period in both sexes, with incidence rates of major cancers such as breast and prostate showing particularly marked increases (3.7% and 5.2% annually, respectively). In the 1960s cancer of the oesophagus was the most common cancer of men (and second in women), and incidence in the last 20 years has not declined. Cancer of the cervix, always the most frequent cancer of women, has shown an increase over the period (1.8% per year), although the rates appear to have declined in the last 4 years. HIV prevalence in adults in Uganda fell from a maximum in 1992 to a minimum (about 6%) in 2004, and has risen a little subsequently, while availability of antiretroviral drugs has risen sharply in recent years. Incidence of Kaposi sarcoma in men fell until about 2002, and has been relatively constant since then, while in women there has been a continuing decline since 2000. Other HIV related cancers-non-Hodgkin lymphoma of younger adults, and squamous cell carcinoma of conjunctiva-have shown major increases in incidence, although the former (NHL) has shown a small decline in incidence in the most recent 2 years. IntroductionKampala Cancer Registry (KCR) was established in 1954 with the aim of obtaining information on cancer occurrence in the population of Kyadondo County which includes Kampala city the capital of Uganda. 1 The registry is located in the Department of Pathology of the Makerere University College of Health Sciences, and achieved adequate coverage of the population in 1960. However, after 10 years, registration activity became confined to the recording of pathology diagnoses, during the period of dictatorship and civil war in the 1970s and 1980s. Full coverage of the Kyadondo population was achieved again in 1989 and has continued since then. 2The registry provides the longest time series of cancer incidence in Africa. This makes the data of special value of cancer surveillance and research, particularly in monitoring the epidemic of HIV/AIDS and as a baseline for analytical studies and intervention studies. Screening programmes are now in existence especially for cancer of the cervix, as a consequence of the very high incidence rates recorded by the registry in previous reports.In a previous paper 3 we presented cancer incidence data from KCR for a 16-year time period (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). Here we update this analysis, including more recent data, to identify the consistency or otherwise of the previously observed trends. Materials and MethodsSubmission to the registry is volun...

Incidence rates of different cancers have been calculated for the population of Kyadondo County (Kampala, Uganda) for a 16-year period (1991-2006). This period coincides with continuing social and lifestyle changes and the peak and subsequent wane of the epidemic of HIV-AIDS. There has been an overall increase in the risk of cancer during the period in both sexes, with the incidence rates of cancers of the breast and prostate showing particularly marked increases (4.5% annually). Prostate cancer is now the most common cancer in men. The incidence of cancer of the esophagus, formerly the most common cancer in men and second in frequency in women, has remained relatively constant, whereas the incidence of cancer of the cervix, the most common malignancy in women, continues to increase. Since the early 1990s the incidence of Kaposi sarcoma (KS) in men has declined, and while remaining relatively constant in women, it has been diagnosed at progressively later ages. The rates of pediatric KS have declined by about 1/3rd. The incidence of squamous cell cancers of the conjunctiva has also declined since the mid 1990s. Cancer control in Uganda, as elsewhere in sub-Saharan Africa, involves meeting the challenge of emerging cancers associated with westernization of lifestyles (large bowel, breast and prostate); although the incidence of cancers associated with poverty and infection (liver, cervix, esophagus) shows little decline, the residual burden of the AIDS-associated cancers remains a major burden.

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Incidence rates of different cancers have been calculated for the population of Kyadondo County (Kampala, Uganda) for four time periods (1960–1966; 1967–1971; 1991–1994; 1995–1997), spanning 38 years in total. The period coincides with marked social and lifestyle changes and with the emergence of the AIDS epidemic. Most cancers have increased in incidence over time, the only exceptions being cancers of the bladder and penis. Apart from these, the most common cancers in the early years were cervix, oesophagus and liver; all three have remained common, with the first two showing quite marked increases in incidence, as have cancers of the breast and prostate. These changes have been overshadowed by the dramatic effects of the AIDS epidemic, with Kaposi's sarcoma emerging as the most common cancer in both sexes in the 1990s, and a large increase in incidence of squamous cell cancers of the conjunctiva. In the most recent period, there also seems to have been an increase in the incidence of non-Hodgkin lymphomas. So far, lung cancer remains rare. Cancer control in Uganda, as elsewhere in sub-Saharan Africa, faces a threefold challenge. With little improvement in the incidence of cancers associated with infection and poverty (liver, cervix, oesophagus), it must face the burden of AIDS-associated cancers, while coping with the emergence of cancers associated with Westernization of lifestyles (large bowel, breast and prostate). © 2000 Cancer Research Campaign

The survival experience of 261 patients with cancer of the cervix registered by the Kampala population-based cancer registry, Uganda, in 1995-1997, is described. Vital status of the subjects was established by active methods including a search of hospital records and house visits. Of the 261 cases, 82 (31.4%) were dead and 105 (40.2%) were alive at the closing date of 31 December 1999; the remaining 74 cases (28.4%) were lost during the follow-up period. Overall observed and relative survival at 3 years was 52.4 and 59.9%, respectively. Of these cases, one-quarter (63) had been treated in the radiotherapy department. These cases had better survival (82.6%) than nontreated patients (78.5%) after 1 year of follow-up, but there was no difference at 3 years. HIV status was not significantly related to prognosis. Stage is an important determinant of survival: cases with distant metastasis had a risk of death some three times that of patients with localised disease. Early detection and prompt treatment should improve overall survival from cervix cancer, in the African context.