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Incidence and epidemiology of conjunctival squamous cell carcinoma in relation to the HIV epidemic in South Africa: a 25-year analysis of the National Cancer Registry (1994–2018)
  1. Kelsey Vernon Stuart1,2,
  2. Daniel John Shepherd3,
  3. Amy Lombard4,
  4. Roland Hollhumer4,5,
  5. Mazvita Muchengeti6,7
  1. 1Institute of Ophthalmology, University College London, London, UK
  2. 2NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  3. 3Department of Oral and Maxillofacial Surgery, Northwick Park Hospital, Harrow, London, UK
  4. 4Division of Ophthalmology, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
  5. 5The Cornea Foundation, Johannesburg, Gauteng, South Africa
  6. 6National Cancer Registry, National Health Laboratory Service, Johannesburg, Gauteng, South Africa
  7. 7Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
  1. Correspondence to Dr Kelsey Vernon Stuart, Institute of Ophthalmology, University College London, London, London, UK; kelsey.stuart.20{at}ucl.ac.uk

Abstract

Aims To describe the incidence and epidemiology of conjunctival squamous cell carcinoma (CSCC) in South Africa over a 25-year period (1994–2018), with particular reference to the HIV epidemic.

Methods Incident cases of histologically diagnosed CSCC were identified from the pathology-based South African National Cancer Registry. Crude and direct age-standardised incidence rates (ASIRs) per 100 000 persons (Segi World Standard Population) were calculated using national population statistics and compared by age, sex and ethnicity. Trends in the incidence and demographic features of CSCC were described and analysed. Incidence rates were compared with national HIV-related statistics for the same time period.

Results In total, there were 9016 reported CSCC cases (women: 56.6%, black: 86.8%, mean age: 41.5 years). The overall ASIR was 0.78 per 100 000. Two distinct epidemiological patterns were identified: (1) older white men, and (2) younger black women. There was a sixfold increase in CSCC incidence rates between 1994 and 2009 with a corresponding shift from the first to the second disease profile. Despite rising HIV seroprevalence, CSCC incidence rates have declined since 2009. A strong ecological correlation (r=0.96) between CSCC incidence and widespread antiretroviral therapy (ART) provision was identified.

Conclusion This study highlights the evolving trends and disease burden of CSCC in South Africa. Widespread ART provision is ecologically correlated with declining CSCC rates over the last decade. These findings are in keeping with reported trends for other HIV-related cancers and have important implications for future incidence studies and public health policy.

  • epidemiology
  • conjunctiva
  • neoplasia
  • public health

Data availability statement

Data are available upon reasonable request. National Cancer Registry data supporting the findings of this study are available on request from the South African NCR (https://www.nicd.ac.za/centres/national-cancer-registry/). Population statistics were derived from published Statistics South Africa reports (https://www.statssa.gov.za). HIV and ART data were derived from published Thembisa Project reports (https://thembisa.org).

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Data availability statement

Data are available upon reasonable request. National Cancer Registry data supporting the findings of this study are available on request from the South African NCR (https://www.nicd.ac.za/centres/national-cancer-registry/). Population statistics were derived from published Statistics South Africa reports (https://www.statssa.gov.za). HIV and ART data were derived from published Thembisa Project reports (https://thembisa.org).

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Footnotes

  • Presented at This paper was presented in part at the 38th World Ophthalmology Conference (WOC 2022), 9–12 September 2022, China (virtual), and the 18th International Conference on Malignancies in HIV/AIDS (ICMH 2022), 24–26 September 2022, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA (virtual).

  • Contributors KVS and DJS were responsible for the conception and design of the work. KVS, DJS and MM were responsible for data acquisition. KVS, DJS and AL were responsible for data analysis, with input from RH and MM. KVS was responsible for drafting the work, with input from all authors. All authors were responsible for critically revising the work and providing final approval. All authors agree to be accountable for all aspects of the work. KVS acts as the guarantor of this work.

  • Funding KVS is in receipt of a UCL Overseas Research Scholarship and is supported by grants from Fight for Sight (London) (1956A) and The Desmond Foundation (unrestricted).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.