Epidemiology of ocular surface squamous neoplasia in Africa

Abstract

ObjectivesTo describe the epidemiology and an aetiological model of ocular surface squamous neoplasia (OSSN) in Africa.MethodsSystematic and non-systematic review methods were used. Incidence was obtained from the International Agency for Research on Cancer. We searched PubMed, EMBASE, Web of Science and the reference lists of articles retrieved. Meta-analyses were conducted using a fixed-effects model for HIV and cigarette smoking and random effects for human papilloma virus (HPV).ResultsThe incidence of OSSN is highest in the Southern Hemisphere (16° South), with the highest age-standardised rate (ASR) reported from Zimbabwe (3.4 and 3.0 cases/year/100 000 population for males and females, respectively). The mean ASR worldwide is 0.18 and 0.08 cases/year/100 000 among males and females, respectively. The risk increases with exposure to direct daylight (2–4 h, OR = 1.7, 95% CI: 1.2–2.4 and ≥5 h OR = 1.8, 95% CI: 1.1–3.1) and outdoor occupations (OR = 1.7, 95% CI: 1.1–2.6). Meta-analysis also shows a strong association with HIV (6 studies: OR = 6.17, 95% CI: 4.83–7.89) and HPV (7 studies: OR = 2.64, 95% CI: 1.27–5.49) but not cigarette smoking (2 studies: OR = 1.40, 95% CI: 0.94–2.09). The effect of atopy, xeroderma pigmentosa and vitamin A deficiency is unclear.ConclusionsAfrica has the highest incidence of OSSN in the world, where males and females are equally affected, unlike other continents where male disease predominates. African women probably have increased risk due to their higher prevalence of HIV and HPV infections. As the survival of HIV-infected people increases, and given no evidence that anti-retroviral therapy (ART) reduces the risk of OSSN, the incidence of OSSN may increase in coming years.

Ocular Surface Squamous Neoplasia in 200 Patients

“…However, the linear association between CD4 counts and OSSN has not been confirmed. 5,31 In a study from Africa, low CD4 counts (<200 cells/ml) was noted in approximately 85% of HIV-positive OSSN cases with median CD4 count of 71 cells/ml. 5 However, there was no significant association between CD4 count and grade of malignancy.…”

“…5 However, there was no significant association between CD4 count and grade of malignancy. 5,31 The effect of highly active antiretroviral drug therapy on OSSN also is not known. 32 In our study, we did not have sufficient data on CD4 counts to study its association with OSSN.…”

Screening for Ocular Surface Squamous Neoplasia (OSSN) by Slit-lamp Assisted Visual Inspection (SAVI) following a short course of mild topical steroid-test qualities

“…OSSN lesions tend to present as irritating or painful conjunctival growths which are well circumscribed, gelatin-like, sessile, papillomatous with leukoplakia of varying extent and located on the interpalpebral region adjacent to the limbus 5,13 . Lesions on the nasal limbus are easily mistaken for pterygia or inflamed pingueculae.…”

Szemfelszíni laphám-neoplasia

“…Az ezredfordulón a regionális és nemi különbségek a korábbi közlemények eredményeihez képest növeke-dést mutattak. A női-férfi incidenciát ekkor Európában 0,01-0,05/100 000-re, Észak-Amerikában 0,00-0,08/ 100 000-re, míg Dél-és Közép-Amerikában 0,28-0,41/ 100 000-re, Afrikában pedig 1,18-1,38/100 000-re becsülték [8]. A fiatalabb korban megjelenő OSSN több-nyire xeroderma pigmentosumos pácienseknél jelenik meg [9].…”