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Background To assess population-based quality of cancer care in sub-Saharan Africa and to identify specific gaps and joint opportunities, we assessed concordance of diagnostics and treatments with National Comprehensive Cancer Network Harmonized Guidelines for leading cancer types in 10 countries. Methods Adult patients with female breast cancer, cervical cancer, colorectal cancer, non-Hodgkin lymphoma, and prostate cancer were randomly drawn from 11 population-based cancer registries. Guideline concordance of diagnostics and treatment was assessed using clinical records. In a subcohort of 906 patients with potentially curable cancer (stage I-III breast cancer, cervical cancer, colorectal cancer, prostate cancer, aggressive non-Hodgkin lymphoma [any stage]) and documentation for more than 1 month after diagnosis, we estimated factors associated with guideline-concordant treatment or minor deviations. Results Diagnostic information based on guidelines was complete for 1030 (31.7%) of a total of 3246 patients included. In the subcohort with curable cancer, guideline-concordant treatment was documented in 374 (41.3%, corresponding to 11.7% of 3246 patients included in the population-based cohort): aggressive non-Hodgkin lymphoma (59.8%/9.1% population based), breast cancer (54.5%/19.0%), prostate cancer (39.0%/6.1%), colorectal cancer (33.9%/9.5%), and cervical cancer (27.8%/11.6%). Guideline-concordant treatment was most frequent in Namibia (73.1% of the curable cancer subcohort/32.8% population based) and lowest in Kampala, Uganda (13.5%/3.1%). Guideline-concordant treatment was negatively associated with poor ECOG-ACRIN performance status, locally advanced disease stage, origin from low Human Development Index countries, and a diagnosis of colorectal cancer or cervical cancer. Conclusions The quality of diagnostic workup and treatment showed major deficits, with considerable disparities among countries and cancer types. Improved diagnostic services are necessary to increase the share of curable cancer in sub-Saharan Africa. Treatment components within National Comprehensive Cancer Network Guidelines for several cancers should be prioritized. [ABSTRACT FROM AUTHOR] more...

Trends in the incidence of cancer in the population of Kyadondo County, Uganda—which comprises the city of Kampala and a peri‐urban hinterland—are presented for a period of 25 years (1991‐2015) based on data collected by the Kampala Cancer Registry. Incidence rates have risen overall—age‐adjusted rates are some 25% higher in 2011 to 2015 compared with 1991 to 1995. The biggest absolute increases have been in cancers of the prostate, breast and cervix, with rates of some 100% (prostate), 70% (breast) and 45% (cervix) higher in 2010 to 2015 than in 1991 to 1995. There were also increases in the incidence of cancers of the esophagus and colon‐rectum (statistically significant in men), while the incidence of liver cancer—the fifth most common in this population—increased until 2007, and subsequently declined. By far the most commonly registered cancer over the 25‐year period was Kaposi sarcoma, but the incidence has declined, consistent with the decreasing population‐prevalence of HIV. Non‐Hodgkin lymphomas, also AIDS‐related, increased in incidence until 2006/2007 and then declined—possibly as a result of availability of antiretroviral therapy. The trends reflect the changing lifestyles of this urban African population, as well as the consequences of the epidemic of HIV/AIDS and the availability of treatment with ARVs. At the same time, it highlights the fact that the decreases in cancer of the cervix observed in high and upper‐middle income countries are not a consequence of changes in lifestyle, but demand active intervention through screening (and, in the longer term, vaccination). What's new? The Kampala Cancer Registry (KCR), established in 1951 as a means of recording data on incident cancer cases among residents of Kyadondo County, Uganda, houses the longest time series of cancer incidence in Africa. In this study, analysis of KCR data for the period 1991‐2015 reveals significant changes in the incidence of cancers in the population of Kyadondo County. Incidence rates increased in particular for cancers of the prostate, breast, and cervix, with marked elevations from 2010‐2015. Early increases in the incidence of AIDS‐related malignancies, including Kaposi sarcoma and non‐Hodgkin lymphoma, were followed by declines, particularly after 2006. [ABSTRACT FROM AUTHOR] more...