Cancer in Kampala, Uganda, in 1989–91: Changes in incidence in the era of aids

Abstract

Re-establishment of the cancer registry in Kyadondo County, Uganda, has allowed estimation of incidence rates for the period September 1989 to December 1991. The results are compared with earlier data from the same area, and from other African cancer registries. The most striking feature is the emergence of Kaposi's sarcoma as the leading cancer in males (almost half of all registered cases) and the second most frequent (17.9%) in females. This parallels the evolution of the epidemic of AIDS. There were also marked increases in the incidence of both oesophageal and prostatic carcinoma, while the incidence of cancer of the penis and the urinary bladder declined, possibly as a result of improved standards of hygiene. In females, the incidence of cancer of the cervix has more than doubled since the 1950s, and is now among the highest recorded in the African continent.

Association between human immunodeficiency virus type 1 infection and cancer in the black population of Johannesburg and Soweto, South Africa

“…Acquisition of EBV in childhood (a common infection in Africa; Zur-Hausen, 1991) may impart immunity to subsequent EBV infection or may lead to less complicated pathology if the virus is reactivated because of immune suppression. Evidence of increases in the incidence of NHL in sub-Saharan Africa is not clear, but in Uganda (Wabinga et al, 1993) no increase in incidence of NHL was observed between 1995 and 1992. Given the discrepancies in the odds ratio for HIV-associated NHL between developed countries and Africa, it is unclear whether these findings are applicable to South Africa's white population, which has a lifestyle closer to populations from developed country settings.…”

“…British Journal of Cancer (1997) 75 (11), 1 704-1 707 the commonest cancer in African men in Kampala (48% of all cancers) and in Harare (23.3%) and is a common cancer in women in Kampala (17.6%; Wabinga et al, 1993) and in Harare (9.9%; Bassett et al, 1995). In Western countries, young single men, for example in San Francisco, have shown a 5000-fold increase in the incidence of KS since the advent of HIV (Rabkin et al, 1991).…”

“…No increases in incidence or relative frequency of cancer of the cervix have been observed in South Africa (Sitas et al, 1996) or in Zambia (Patil et al, 1995). In Kampala (Wabinga et al, 1993), the incidence of cancer of the cervix doubled over a 20-year period, but this increase began before the advent of HIV. No increases in mortality because of cancer of the cervix in women aged 15-44 years residing in states with a high risk of HIV (Buehler et al, 1992) have been documented in the USA between 1979 and 1988.…”

“…In South Africa about a third of the female and a sixth of the male cancers are thought to be infective in origin (Sitas et al, 1996). HIV-induced immune suppression in populations with a high prevalence of HIV has led to an increased incidence of a number of these infection-associated cancers, notably Kaposi's sarcoma (KS) and non-Hodgkin lymphoma (NHL) (and perhaps other cancers) in, for example, San Francisco single men (Rabkin et al, 1994) and sub-Saharan Africa (Bourdeaux et al, 1988;Wabinga et al, 1993;Bassett et al, 1995). In South Africa, the first notifications of HIV were in 1981, but by 1994 the HIV seroprevalence in female antenatal clinic attenders in Johannesburg and Soweto had increased to 7.9% in blacks and 0.6% in whites (Department of Health, 1995).…”

Review of the distribution of Kaposi's sarcoma-associated herpesvirus (KSHV) in Africa in relation to the incidence of Kaposi's sarcoma

“…In the last 10 -15 years, the incidence of Kaposi's sarcoma has increased about 20-fold in Uganda and Zimbabwe, such that it is now the most common cancer in men and the second most common in women (Wabinga et al, 1993(Wabinga et al, , 2000Bassett et al, 1995). As a result of the HIV epidemic, the incidence of Kaposi's sarcoma has also increased in countries where it was previously relatively rare, but where KSHV was prevalent.…”