Abstract
Purpose
Reducing time between cancer screening, diagnosis, and initiation of treatment is best achieved when services are available in the same hospital. Yet, comprehensive cancer centers are typically unavailable in low- and middle-income countries (LMICs), where resources are limited and services scattered. This study explored the impact of establishing an in-house pathology laboratory at the largest public cancer hospital in Tanzania on the downstaging of cervical cancer.
Methods
We examined clinical datasets of 8,322 cervical cancer patients treated at the Ocean Road Cancer Institute (ORCI). The first period included patients treated from 2002 to 2016, before establishment of the pathology laboratory at ORCI; the second period (post-pathology establishment) included data from 2017 to 2020. Logistic regression analysis evaluated the impact of the pathology laboratory on stage of cervical cancer diagnosis.
Results
Patients treated during the post-pathology period were more likely to be clinically diagnosed at earlier disease stages compared to patients in the pre-pathology period (pre-pathology population diagnosed at early disease stage: 44.08%; post-pathology population diagnosed at early disease stage: 59.38%, p < 0.001). After adjustment for age, region of residence, and place of biopsy, regression results showed patients diagnosed during the post-pathology period had higher odds of early stage cervical cancer diagnosis than patients in the pre-pathology period (OR 1.35, 95% CI (1.16, 1.57), p < 0.001).
Conclusions
Integrated and comprehensive cancer centers can overcome challenges in delivering expedited cervical cancer diagnosis and treatment. In-house pathology laboratories play an important role in facilitating timely diagnosis and rapid treatment of cervical and possibly other cancers in LMICs.
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Data availability
The data that support the findings of this study are available from the Ocean Road Cancer Institute, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the Ocean Road Cancer Institute.
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Funding
Caroline Fuss was supported by the Cancer Epidemiology and Education in Special Populations (CEESP) Program through funding from the National Cancer Institute Grant R25CA112383 (PI: Amr Soliman, MD, PhD).
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Institutional Review Board approvals were obtained from George Washington University and by the Ocean Road Cancer Institute’s Academic, Research, Publications and Ethics Committee.
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Fuss, C.G., Msami, K., Kahesa, C. et al. The impact of in-house pathology services on downstaging cervical cancer in Tanzania over an 18-year period. Cancer Causes Control 35, 93–101 (2024). https://doi.org/10.1007/s10552-023-01768-x
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DOI: https://doi.org/10.1007/s10552-023-01768-x