title: Observed and expected incidence of cervical cancer in lusaka and the southern and Western provinces of Zambia, 2007 to 2012.
abstract: OBJECTIVE
  Cervical cancer is increasing but underestimated in developing countries. We calculated the observed and expected incidence of cervical cancer in Lusaka and Southern and Western provinces of Zambia.
  
  
  METHODS
  Data for 2007 to 2012 were obtained for the 3 provinces. Data included age, residence, year of diagnosis, marital status, occupation, human immunodeficiency virus (HIV), stage, radiotherapy, and chemotherapy. Expected incidence in Southern and Western provinces was calculated based on observed incidence for Lusaka province, adjusting for HIV.
  
  
  RESULTS
  Crude and age-standardized incidence rates (ASRs) in Lusaka were 2 to 4 times higher than incidence in the other 2 provinces. Lusaka had a rate of 54.1 per 10(5) and ASR of 82.1 per 10(5) in the age group of 15 to 49 years. The Southern province had a rate of 17.1 per 10(5) and ASR of 25.5 per 10(5); the Western province had a rate of 12.3 per 10(5) and ASR rate of 17.2 per 10(5). The observed cervical cancer incidence rates in the Southern and Western provinces were lower than the rate in Lusaka, possibly because of the uncertainty of underreporting/underdiagnosis or actual lower risk for reasons yet unclear. The HIV seroprevalence rates in patients from the 3 provinces were 46% to 93% higher than seroprevalence in the respective general populations.
  
  
  CONCLUSIONS
  Cervical cancer is significantly underestimated in Zambia, and HIV has a significant role in pathogenesis. Future studies should establish methods for case ascertainment and better utilization of hospital- and population-based registries in Zambia and other similar developing countries.
authors.affiliation: *Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE; †Cancer Diseases Hospital, Lusaka, Zambia; ‡Faculty of Medical Radiation Sciences, Lusaka Apex Medical University, Lusaka, Zambia; §Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha; ∥Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE; and ¶Department of Epidemiology, MD Anderson Cancer Center, University of Texas, Houston, TX.
authors.forename: Mulele
authors.initials: M
authors.lastname: Kalima
authors.forename: Kennedy
authors.initials: K
authors.lastname: Lishimpi
authors.forename: Jane L
authors.initials: JL
authors.lastname: Meza
authors.forename: Shinobu
authors.initials: S
authors.lastname: Watanabe-Galloway
authors.forename: Susan C
authors.initials: SC
authors.lastname: Msadabwe
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Mwaba
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Shibemba
authors.forename: Lewis
authors.initials: L
authors.lastname: Banda
authors.forename: Charles
authors.initials: C
authors.lastname: Wood
authors.forename: Robert M
authors.initials: RM
authors.lastname: Chamberlain
authors.forename: Amr S
authors.initials: AS
authors.lastname: Soliman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology