Late-stage diagnosis and its impact on survival in Pakistani women with cervical cancer: Findings from an institutional cancer registry

TL;DR

This study found that most cervical cancer patients in Karachi, Pakistan, are diagnosed at late stages, which significantly reduces their survival rates.

Contribution

The study provides survival data and identifies late-stage diagnosis as a major predictor of poor outcomes in cervical cancer patients in Pakistan.

Findings

The mean age at diagnosis was 51.3 years, with 83.9% of women diagnosed at an advanced stage.

Late-stage diagnosis and smoking history were identified as independent predictors of poorer survival.

One-, three-, and five-year survival rates were 86.6%, 78.5%, and 54.4%, respectively.

Abstract

This study aimed to analyze mean age, clinicopathological characteristics, and survival rates of cervical cancer patients in Karachi, Pakistan.

A retrospective cohort study was conducted using data from the Cancer Registry at Aga Khan University Hospital (AKUH) between January 1, 2010 to December 31, 2020. Kaplan-Meier estimates were used to calculate one-, three-, and five-year survival rates. Cox proportional hazards regression was employed to identify factors associated with survival. The analysis included 310 women diagnosed with primary cervical cancer between 2010 and 2020.

The mean age at diagnosis was 51.3 years (SD ± 11.3), with most women (83.9%) diagnosed at an advanced stage. Kaplan-Meier survival analysis revealed an overall mean survival time of 176.3 months (SD 18.1), with one-, three-, and five- years survival rates of 86.6%, 78.5%, and 54.4%, respectively. Cox proportional hazards regression identified late-stage diagnosis (HR = 3.64, 95% CI: 1.25-10.59) and smoking history (HR = 3.37, 95% CI: 1.27-8.97) as independent predictors of poorer survival.

The high frequency of late-stage disease and its impact on poor survival in our study highlight the critical challenge and the urgent need for targeted public health interventions. Strategies such as enhanced community awareness campaigns, the implementation of HPV vaccination, improved cervical cancer screening programs, and the promotion of timely medical consultations are essential to facilitate earlier diagnosis and improve survival outcomes.

List of abbreviations: Aga Khan University Hospital (AKUH), adjusted hazard ratios (aHR), confidence intervals (CI), Standard Deviation (SD), Interquartile Range (IQR), Hazard Ratio (HR), Human Papillomavirus (HPV), age standardized incidence rate (ASIR), World Health Organization (WHO), Lower Middle-Income Countries (LMICs), Squamous cell carcinoma (SCC), American Joint Committee on Cancer (AJCC).

Figures