Gynaecological malignancies at a tertiary care centre in Mozambique

Objective: To determine the frequency of gynaecological cancers over an 18-year-period in Mozambique a country located in South Eastern sub-Saharan Africa, an area in which comprehensive statistics on cancer are limited. Materials and Methods: Retrospective review of the pathological records of gynaecological cancers at the Maputo Central Hospital from January 1991 to December 2008. Results: 3,726 gynaecological cancers were reported. Malignant neoplasms of the uterine cervix (64.0% of all tumours) were the most frequent cancers, followed by breast (23.2%), vulvar-vaginal (4.1%), ovarian cancers (3.8%), cancers of the uterine corpus (3.3%), and gestational choriocarcinoma (1.7%). Tumours of the uterine cervix, vulva/vagina, uterine corpus, and ovary increased in number three times, whereas breast cancers increased five times during the study period. Conclusions: Malignant tumours related to human papillomavirus (HPV) accounted for over two-thirds of all malignancies. Screening for cervical cancer and vaccination against HPV should be a health priority in sub-Saharan Africa.

Gynaecological cancer; Cervical cancer; Human papillomavirus; Sub-Saharan Africa

[1] Agarwal S., Malhotra K.P., Sinha S., Rajaram S.: “Profile of gynecological malignancies reported at a tertiary care center in India over the past decade: comparative evaluation with international data”. Indian J. Cancer, 2012, 49, 298.

[2] Bray F., Jemal A., Grey N., Ferlay J., Forman D.: “Global cancer transitions according to the Human Development Index (2008-2030): a population-based study”. Lancet Oncol., 2012, 13, 790.

[3] Ferlay J., Shin H.R., Bray F., Forman D.: “GLOBOCAN 2008: Cancer Incidence, mortality and prevalence worldwide in 2008”. Int. J. Cancer, 2010, 127, 2893.

[4] Jemal A., Bray F., Center M.M., Ferlay J., Ward E., Forman D.: “Global cancer statistics”. CA. Cancer J. Clin., 2011, 61, 69.

[5] Amegbor K., Alfa A.K., Darre T., Napo-Koura G.A., Akpadza K.: “Epidemiological and pathological aspects of the gynecological and mammary cancers in Togo]”. Med. Trop. (Mars.), 2011, 71, 451.

[6] Jemal A, Bray F, Forman D, O’Brien M, Ferlay J, Center M, et al. Cancer burden in Africa and opportunities for prevention. Cancer 2012, 118, 4372.

[7] Prates M.D., Torres F.O.: “A cancer survey in Lourenco Marques, Portuguese East Africa”. J. Natl. Cancer Inst., 1965, 35, 729.

[8] Ugwu E.O., Iferikigwe E.S., Okeke T.C., Ugwu A.O., Okezie O.A., Agu P.U.: “Pattern of gynaecological cancers in University of Nigeria Teaching Hospital, Enugu, south eastern Nigeria”. Niger. J. Med., 2011, 20, 266.

[9] Lorenzoni C., Vilajeliu A., Carrilho C., Ismail M.R., Castillo P., Augusto O., et al.: “Trends in Cancer Incidence in Maputo, Mozambique, 1991-2008”. PLoS One, 2015, 10, e0130469.

[10] Fritz A., Percy C., Jack A.: “International classification of diseases for oncology (3rd ed). Geneva: World Health Organization, 2000.

[11] Percy C., Van Holten V., Muir C.: “International classification of diseases for oncology”. (2nd ed). Geneva: World Health Organization, 1990.

[12] World Health Organization: “International statistical classification of diseases and related health problems”. (10th revision ed). Geneva: World Health Organization, 1992.

[13] de Sanjose S., Quint W.G., Alemany L., Geraets D.T., Klaustermeier J.E., Lloveras B., et al.: “Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study”. Lancet Oncol., 2010, 11, 1048.

[14] de Sanjose S., Alemany L., Ordi J., Tous S., Alejo M., Bigby S.M., et al.: “Worldwide human papillomavirus genotype attribution in over 2000 cases of intraepithelial and invasive lesions of the vulva”. Eur. J. Cancer, 2013, 49, 3450.

[15] del Pino M, Rodriguez-Carunchio L, Ordi J. Pathways of vulvar intraepithelial neoplasia and squamous cell carcinoma. Histopathology 2013; 62: 161-175.

[16] Kane MA, Serrano B, de Sanjose S, Wittet S. Implementation of human papillomavirus immunization in the developing world. Vaccine 2012; 30 Suppl 5:F192-200.

[17] Menendez C, Castellsague X, Renom M, Sacarlal J, Quintó L, Lloveras B, et al. Prevalence and risk factors of sexually transmitted infections and cervical neoplasia in women from a rural area of southern Mozambique. Infect Dis. Obstet. Gynecol. 2010; 2010. pii: 609315.

[18] Watson-Jones D., Baisley K., Brown J., Kavishe B., Andreasen A., Changalucha J., et al.: “High prevalence and incidence of human pa- pillomavirus in a cohort of healthy young African female subjects”. Sex. Transm. Infect., 2013, 89, 358.

[19] Parkin D.M., Sitas F., Chirenje M., Stein L., Abratt R., Wabinga H.: “Part I: Cancer in Indigenous Africans—burden, distribution, and trends”. Lancet Oncol., 2008, 9, 683.

[20] Parkin D.M., Nambooze S., Wabwire-Mangen F., Wabinga H.R.: “Changing cancer incidence in Kampala, Uganda, 1991-2006”. Int. J. Cancer, 2010, 126, 1187.

[21] Sitas F., Parkin D.M., Chirenje M., Stein L., Abratt R., Wabinga H.: “Part II: Cancer in Indigenous Africans—causes and control”. Lancet Oncol., 2008, 9, 786.

[22] Gonzalez R., Munguambe K., Aponte J., Bavo C., Nhalungo D., Macete E., et al.: “High HIV prevalence in a southern semirural area of Mozambique: a community-based survey”. HIV Med., 2012, 13, 581.

[23] Denny L.A., Franceschi S., de Sanjose S., Heard I., Moscicki A.B., Palefsky J.: “Human papillomavirus, human immunodeficiency virus and immunosuppression”. Vaccine, 2012, 30 , F168.

[24] Stein L., Urban M.I., O’Connell D., Yu X.Q., Beral V., Newton R., et al.: “The spectrum of human immunodeficiency virus-associated cancers in a South African black population: results from a case-control study, 1995-2004”. Int. J. Cancer, 2008, 122, 2260.

[25] Moodley M.: “Reduction in prevalence of invasive cervical cancer in KwaZulu-Natal, South Africa: impact of the human immunodeficiency virus epidemic”. Int. J. Gynecol. Cancer, 2006, 16, 1036.

[26] Lomalisa P., Smith T., Guidozzi F.: “Human immunodeficiency virus infection and invasive cervical cancer in South Africa”. Gynecol. Oncol., 2000, 77, 460.

[27] ter Meulen J., Eberhardt H.C., Luande J., Mgaya H.N., Chang-Claude J., Mtiro H., et al.: “Human papillomavirus (HPV) infection, HIV infection and cervical cancer in Tanzania, east Africa”. Int. J. Cancer, 1992, 51, 515.

[28] Mbulaiteye S.M., Bhatia K., Adebamowo C., Sasco A.J.: “HIV and cancer in Africa: mutual collaboration between HIV and cancer programs may provide timely research and public health data”. Infect. Agent. Cancer, 2011, 6, 16.

[29] De Vuyst H., Ndirangu G., Moodley M., Tenet V., Estambale B., Meijer C.J., et al.: “Prevalence of human papillomavirus in women with invasive cervical carcinoma by HIV status in Kenya and South Africa”. Int. J. Cancer, 2012, 131, 949.

[30] Moodley J.R., Hoffman M., Carrara H., Allan B.R., Cooper D.D., Rosenberg L., et al.: “HIV and pre-neoplastic and neoplastic lesions of the cervix in South Africa: a case-control study:. BMC Cancer, 2006, 6, 135.

[31] Vizcaino A.P., Moreno V., Bosch F.X., Muñoz N., Barros-Dios X.M., Parkin D.M.: “International trends in the incidence of cervical cancer: I. Adenocarcinoma and adenosquamous cell carcinomas”. Int. J. Cancer, 1998, 75, 536.

[32] Ward K.K., Shah N.R., Saenz C.C., McHale M.T., Alvarez E.A., Plaxe S.C.: “Changing demographics of cervical cancer in the United States (1973-2008)”. Gynecol. Oncol., 2012, 126, 330.

[33] Sankaranarayanan R., Nene B.M., Shastri S.S., Jayant K., Muwonge R., Budukh A.M., et al.: “HPV screening for cervical cancer in rural India”. N. Engl. J. Med., 2009, 360, 1385.

[34] Bray F., Ren J.S., Masuyer E., Ferlay J.: “Global estimates of cancer prevalence for 27 sites in the adult population in 2008”. Int. J. Cancer, 2013, 132, 1133.

[35] Youlden D.R., Cramb S.M., Dunn N.A., Muller J.M., Pyke C.M., Baade P.D.: “The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality”. Cancer Epidemiol., 2012, 36, 237.

[36] Seckl M.J., Sebire N.J., Berkowitz R.S.: “Gestational trophoblastic disease. Lancet, 2010, 376, 717.

[37] Goldstein D.P., Berkowitz R.S.: “Current management of gestational trophoblastic neoplasia”. Hematol. Oncol. Clin. North. Am., 2012, 26, 111.