Cervical cancer in the Bamenda Regional Hospital, North West Region of Cameroon: a retrospective study

Introduction Cervical cancer is ranked the 7th most common cancer in the world. Cancer of the cervix is the second most commonly diagnosed cancer after breast cancer and the third leading cause of cancer deaths among females in less developed countries. Incidence rates are highest in countries with low income. Nearly 90% of cervical cancer deaths occur in developing parts of the world. The study researchers therefore, carried out a retrospective study to determine the proportion of cervical cancer among other types of cancer in the cancer registry of the Bamenda Regional Hospital. Methods The objective of this study was to determine the proportion of cervical cancer among other types of cancers in the cancer registry of the Bamenda Regional Hospital, North West Region of Cameroon from past records. We reviewed all records from the registry of patients who attended the Bamenda Regional Hospital to screen and/or be operated upon for cervical cancer and other types of cancer. Socio-demographic and clinical characteristics of cases were captured using a data collection sheet: age, type of cancer, stage of cancer, type of surgery carried out and date of surgery. Data were entered and analysed in Statistical Package for Social Sciences (SPSS) version 25 software. Results 59 cancer cases were received in the center between 2012 and 2017. Of these, 31 (52%) had cervical cancer. Most patients who screened positive for cancer of the cervix were of the 50-54 age groups. Most of these patients (47.5%), were received at late stages (stages 3 and 4). Conclusion Over half (52%) of the patients receiving cancer care in this center have cervical cancer and generally turn up late for management.


Introduction
Cervical cancer is ranked the 7 th most common cancer in the world.
Cervical cancer is the second most commonly diagnosed cancer after breast cancer and the third leading cause of cancer deaths among females in less developed countries. Incidence rates are highest in countries with low income. Nearly 90% of cervical cancer deaths occurred in developing parts of the world. The cervix is divided into two halves; the endo-cervix, which is made up of columnar epithelium and the exo-cervix made up of squamous epithelium. The two halves merge at the squamo-columnar junction The global incidence of cervical cancer is greater than 530 000 annually, with death approaching 275 000 per year [5]. The prevalence of cervical cancer worldwide is estimated by [6] to be 12%. One of the most important reasons for the incidence of cervical cancer in developing countries is the lack of early detection of pre-cancerous lesions and treatment of the lesions before they progress [7].
Among the newly diagnosed cases, 86% are reported in poor countries. Also, 88% of deaths resulting from cervical cancer are in the low-income countries [8]. In Africa, the incidence is 80 000 per annum, with an annual mortality of 75%; most of the cases are seen in sub-Saharan Africa [8]. It was shown that cervical cancer prevalence was up to 13.8%; this is based on a study carried out in the capital city Yaounde [9]. More than 6 million Cameroonian females who are aged 15 and above are at risk of developing cervical cancer, and there are 1993 new cases of cervical cancer yearly, of which 1120 die of the disease annually [3]. In poor countries, awareness as well as uptake of cervical cancer screening services has remained poor over the years. Several studies done in communities and among women in sub-Saharan Africa revealed that knowledge were generally poor [10]. Risk factors of cervical cancers have also been highly demonstrated among Cameroonian women, especially the rural women [11]. Mogtomo and colleagues [12] have In a study carried out by [14][15][16][17], they demonstrated that the level of awareness of HPV infection and prevention of cervical cancer is moderately low in Cameroon. Gardasil for HPV 6 and 11, and Cervarix for HPV 16 and 18 are available in the market for cervical cancer [17]. Exclusion criterion: All negative results.

Methods
Sample size and sampling: All patients' records were checked.  Figure 1).

Cervical cancer types and stages:
Cancer of cervix, cervical lesion, precancerous cervix, squamous cell carcinoma and cervical dysplasia were the types of cervical cancer, we found cancer of the cervix occuring the highest with 16 out of the 31 cases. Stage III was the most frequent stage of cervical cancer diagnosed (Table 2).
Cervical cancer ranked first in all cases reported during this period with 31(52%) cases ( Figure 2).

Discussion
Cancer of the cervix was the predominant type of cancer (52.2%) in the Bamenda Regional Hospital. This was far higher than 13.8% reported by [9] 2012 in Yaounde-Cameroon, and 29.9% reported by [17] 2013 in Yaounde-Cameroon. Their study results were derived from pathology results while ours was derived from surgery. It was also, different from a study conducted in 6 regions in Cameroon to determine the prevalence of cervical premalignant lesions from where; the national prevalence was 3.9% [15]. This difference could be due to the fact that, Tebeu and colleagues [15] had a larger sample size than our study and their study was representative. One of the most important reasons for the incidence of cervical cancer in developing countries is the lack of early detection of pre-cancerous lesions and treatment of the lesions before they progress [7].
Atashili and colleagues [16] also, reported a prevalence of 11.5% of SIL due to cervical disease in women receiving HAART in Cameroon.
This was far lower than the 52% obtained in our study, it could however be different because our study was not limited to HIV/AIDS patients receiving HAART. Torre and colleagues [7] reported that cervical cancer is the second most commonly diagnosed cancer after breast cancer and the third leading cause of cancer deaths among females in less developed countries. From our study, cervical cancer ranked first, followed by breast cancer. This difference could be due Page number not for citation purposes 4 to the fact that our study concentrated on just one region while that of Torre and colleagues [7] was carried out in several other regions.
The highest age group with cervical cancer was 50-54; this is similar to the age at high risk of many types of cancer. Completeness of registration of cancer cases in this population was estimated at about 50%.

What this study adds
 Over half (52%) of cancers managed in the Bamenda Regional Hospital are cervical cancers;  Most cancer patients seen are above 50 years of age;  Most cancer cases are referred late in the disease course.

Competing interests
The authors declare no competing interests.

Acknowledgments
We are grateful to the Directorate of the Bamenda Regional Hospital for allowing us to have access to their data.     Figure 1: Proportions of different cancer types in patients consulting at the cancer registry of Bamenda Regional Hospital