Grade of malignancy of cervical cancer in regions of Uganda with varying malarial endemicity.
As in a prior study on malignant lymphomas, 3 and 6 areas of Uganda showing low and high malarial endemicity, respectively, were selected for analysis and the data retrieved from the Kampala Cancer Registry, which in the 1960s and 1970s collected cases of cancer through a widely used free biopsy service from the whole country. Overall incidence rates were derived from 924 cases from the 12-year period 1964-1975. For reasons of economy, grade of tumour was determined only in cases pertaining to the 6-year period 1968-1973. Of 457 cases, 304 could be reviewed histologically. Only the group of squamous cell carcinomas (84.9%, 258 cases) was large enough for subsequent geographic analysis. High incidence rates of CC were found in areas with high malarial endemicity, whereas low incidence rates occurred where malaria was either frequent or rare. A correlate to malarial infection was the proportion of high-grade carcinomas irrespective of the overall incidence of CC. With high prevalence of malaria and high CPRs of 35-74%, the relative share of high-grade cancer amounted to 50-67%. Where malaria was rare with low CPRs of 8-11%, these values were lower and varied only from 25-39% with a similar range of 14%. Geographic agreement between malarial endemicity and the PI of high-grade cancer was high in the 9 study areas and only slightly lower than for BL, for which the association with malaria is beyond doubt. Compared to areas with little malaria, the RR for the incidence of high-grade carcinomas in areas with severe malaria was increased. The value was 2.04 with a 95% confidence interval of 1.37-3.04. Attributable to secondary immunodeficiency, lifelong exposure to malaria may result in excess frequency of high-grade malignant tumours not only in the group of malignant lymphomas but also in CC.
Department of Pathology, Makerere University, Kampala, Uganda.
Michael
M
Odida
Rolf
R
Schmauz
Stephen K
SK
Lwanga
D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D012042:Registries; D014454:Uganda / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology*