Background: We carried out a pilot phase for cervical cancer screening in the Mwanza and Mara Reg... more Background: We carried out a pilot phase for cervical cancer screening in the Mwanza and Mara Regions (Tanzania), reporting on the diagnostic performance of procedure and on the association between demographic, socioeconomic and health-related characteristics of attending women and their probability of being diagnosed with high-grade cervical disease and invasive cervical carcinoma. Methods: The pilot targeted 7 districts and was launched in 2012 after a community-level information campaign.Women aged 15-64 years were invited to take part. Women were interviewed using a structured questionnaire and were offered the visual inspection of the cervix with acetic acid (VIA) and Pap smear. Patients resulting positive with VIA who were ineligible for immediate cryotherapy were invited to the Bugando Medical Centre (BMC) of Mwanza for colposcopy. Pap smears were evaluated by pathologists of BMC. Results: We evaluated data from the first consecutive 2,500 women. Those women presenting with a clinically overt cervical cancer and those with missing data were excluded. 2,342 women (median age 38 yrs) were eligible. We reported 572 (24.4%) subjects with previous diagnosis of sexually transmitted diseases and 192 (6.6%) HIV-positive subjects. Women with VIA findings suggestive of high-grade cervical disease and carcinoma were 7.3%, with positive predictive value of 64.7% and detection rate of 47.0‰.The corresponding figures of the Pap smear were 6.1%, 59.2%, and 35.9‰. In multivariate analysis, the factors independently associated with the prevalence of disease included district of residence, history of untreated sexually transmitted diseases, parity and negative HIV test (inverse association). The probability for affected patients to have an invasive versus a pre-invasive disease varied significantly between districts, and was lower in HIV-positive women and in women practicing breast self-examinationthe latter being the strongest determinant. Conclusions: The performance of VIA compared well with Pap smear. Factors associated with the prevalence of disease were used to target the promotion of attendance. The inverse association between breast self-examination and the probability to have an invasive versus a pre-invasive disease is probably due to a previous spontaneous cervical screening practice and confirms the potential value of cancer awareness and education for sub-Saharan women.
A 70-year-old female patient, from a rural area presented to local paramedics with generalised we... more A 70-year-old female patient, from a rural area presented to local paramedics with generalised weakness and a blackish painful umbilical nodule. Her blood pressure was 130/80 mmHg and random blood sugar was 12.5 mmol/l. US of abdomen revealed “anterior abdominal wall sinus/abscess”. So dressing and antibiotics were advised. After 4 months, she visited our hospital, where an inflamed umbilical nodule, 2x3 cm with no ulcer was found (Figure 1).
Breast cancer, although reported to be the commonest female malignancy worldwide has not been ext... more Breast cancer, although reported to be the commonest female malignancy worldwide has not been extensively studied in north-western Tanzania. The aim of this retrospective review was to describe in our setting, the stage at diagnosis, clinicopathological and treatment patterns among patients with breast cancer. Data were analyzed using SPSS software system. A total of 384 patients were studied. The median age was 45 years (range 21 to 78 years). The male to female ratio was 1: 46.8. Most of the patients were premenopausal (63.8%) and presented late with advanced breast cancer disease. Majority of patients (63.0%) presented with stage III disease. Lymph node and distant metastasis at the time of diagnosis was reported in 70.8% and 21.4% of patients, respectively. Invasive ductal carcinoma (91.7%) was the most frequent histopathological type and most patients (63.8%) had poorly differentiated tumour. Patients with tumour size greater than 6cm had significantly high rate of lymph node m...
10063 Background: Retinoblastoma is the most common ocular tumor of childhood. Diagnosis times di... more 10063 Background: Retinoblastoma is the most common ocular tumor of childhood. Diagnosis times differ across the word, with diagnosis occurring significantly earlier in developed countries. Necrosis and invasion of the optic nerve are usually associated with poor prognosis and higher incidence of recurrence and metastases. Treatment options include surgery, radiotherapy, and chemotherapy while targeted therapies are still not available. The aim of this study was to investigate the protein signaling architecture of retinoblastomas to identify new druggable targets for personalized therapy. Methods: Six paraffin embedded retinoblastomas collected at the Bugando Medical Center (Mwanza, Tanzania) were analyzed in this feasibility study. Samples were collected from patients aged 2 to 10. Two tumors presented invasion of the optic nerve, 2 were free of invasion, and 2 tumors were unclassified. Four tumors were necrotic, while 2 displayed no signs of necrosis. Samples were subjected to laser capture microdissect...
The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some... more The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some hospitals in Tanzania. However, its validity and reliability has not been evaluated in any hospital in the country including the study area. This cross-sectional study was conducted at Bugando Medical Centre in northwestern Tanzania to determine the validity, reliability and applicability of triple assessment as an alternative to conventional open biopsy in the pre-operative diagnosis of breast cancer. A total of 212 female patients aged 35 years and above were studied. All patients underwent clinical evaluation, mammography and fine needle aspiration cytology. Histopathology was done to confirm the diagnosis. One hundred and twenty (56.6 %) patients with a median age of 36 years had benign lesions and the remaining ninety-two (43.4%) with a median age of 47 years had breast cancer (P = 0.002). With triple assessment, 92 patients were diagnostic for malignancy and 120 benign, respectively confirmed by histopathology. The Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy were 100.0%. There were no false positive or false negative results. The Kappa statistic for the combination was 1.0 implying excellent agreement with histopathology. The majority of patients (59.9%) underwent triple assessment on the same day with results being available to the patient within 24 to 72 hours. The triple assessment is an accurate and quick method for the evaluation of breast cancer and can be applied as a safe alternative for open biopsy when it is concordant..
Dermatological malignancies are among the most common form of cancers and the global incidence ha... more Dermatological malignancies are among the most common form of cancers and the global incidence has been increasing at an alarming rate. A retrospective study was conducted to determine the prevalence, histopathological pattern, anatomical distribution and treatment outcome of dermatological malignancies at Bugando Medical Centre in Northwestern Tanzania. Data were collected from patients' files kept in the Medical record department; the surgical wards, operating theatre and histopathology laboratory and analyzed using Statistical package for social sciences system. A total of 154 patients with a histopathological diagnosis of dermatological malignancy were studied. Generally, males outnumbered females by a ratio of 1.4:1. The majority of patients were in the 5th and 6th decades of life. Malignant melanoma was the most common dermatological malignancy (67.5%) followed by Kaposi's sarcoma (10.4%), Squamous cell carcinoma (8.4%) and Basal cell carcinoma(7.8%). The lower limbs were the most frequent site accounting for 55.8%. Wide local excision was the most common surgical procedure performed in 79.2% of cases. Post-operative wound infection was the most common complication in 58.3% of patients. Mortality rate was 3.8%. Dermatological malignancies are more prevalent in our setting. A high index of suspicion is needed to avoid labelling malignancies "chronic ulcers" and all suspected lesions should be biopsed.
Background Despite marked decreases in its incidence, particularly in developed countries, gastri... more Background Despite marked decreases in its incidence, particularly in developed countries, gastric cancer is still the second most common tumor worldwide. There is a paucity of information regarding gastric cancer in northwestern Tanzania. This study was undertaken to describe our experience, in our local setting, on the management of gastric cancer, outlining the clinicopathological and treatment outcome of these patients and suggesting ways to improve the treatment outcome. Methods This was a retrospective study of histologically confirmed cases of gastric cancer seen at Bugando Medical Centre between January 2007 and December 2011. Data were retrieved from patients’ files and analyzed using SPSS computer software version 17.0. Results A total of 232 gastric cancer patients were enrolled in the study, representing 4.5% of all malignancies. The male to female ratio was 2.9:1. The median age of patients was 52 years. The majority of the patients (92.1%) presented late with advanced ...
Background: Colorectal cancer is one of the most common cancers worldwide and its incidence is re... more Background: Colorectal cancer is one of the most common cancers worldwide and its incidence is reported to be increasing in resource-limited countries, probably due to the acquisition of a western lifestyle. However, information regarding colorectal cancer in Tanzania and the study area in particular is limited. This study was conducted in our local setting to describe the clinicopathological pattern of colorectal cancer and highlight the challenging problem in the management of this disease. Methods: This was a retrospective study of histologically confirmed cases of colorectal cancer seen at Bugando Medical Center between July 2006 and June 2011. Data were retrieved from patients' files and analyzed using SPSS computer software version 17.0. Results: A total of 332 colorectal cancer patients were enrolled in the study, representing 4.7% of all malignancies. Males outnumbered females by a ratio of 1.6:1. The median age of patients at presentation was 46 years. The majority of patients (96.7%) presented late with advanced stages. Lymph node and distant metastasis at the time of diagnosis was recorded in 30.4% and 24.7% of cases, respectively. The rectosigmoid region was the most frequent anatomical site (54.8%) involved and adenocarcinoma (98.8%) was the most common histopathological type. The majority of adenocarcinomas (56.4%) were moderately differentiated. Mucinous and signet ring carcinomas accounted for 38 (11.6%)and 15 (4.6%) patients, respectively. Three hundred and twenty-six (98.2%) patients underwent surgical procedures for colorectal cancer. Only 54 out of 321 (16.8%) patients received adjuvant treatment. Postoperative complication and mortality rates were 26.2% and 10.5%, respectively. The overall median duration of hospital stay was 12 days. Only nine out of 297 survivors (3.0%) were available for follow-up at the end of 5 years. Cancer recurrence was reported in 56 of 297 survivors (18.9%). Data on long-term survival were not available as the majority of patients were lost to follow-up. Conclusions: Colorectal cancer is not uncommon in our environment and shows a trend towards a relative young age at diagnosis and the majority of patients present late with advanced stage. There is a need for screening of high-risk populations, early diagnosis and effective cost-effective treatment and follow-up to improve outcome of these patients.
Introduction Cancer of the cervix rank the second most common cause of cancer related deaths amon... more Introduction Cancer of the cervix rank the second most common cause of cancer related deaths among women in Sub-Saharan Africa. It is estimated that 529, 409 new cases are diagnosed annually with a mortality rate approaching 274,883 per year. Cervical Intraepithelial Neoplasia (CIN) precedes almost all cervical cancers. The incidence rate of CIN among HIV infected women is five times higher as compared to the rate in HIV negative women. The screening for cervical dysplasia and an appropriate management in women with CIN are effective methods for preventing cervical cancer. This study was done to determine the prevalence and predictors of CIN among a HIV infected women attending Care and Treatment centre (CTC) at Bugando Medical Centre (BMC). Methods A cross sectional survey was undertaken among HIV infected women aged 18 years and above attending at BMC CTC clinic between February and March 2013. Visual Inspection with Acetic acid (VIA) was used as the screening method for detection...
To describe cancer incidence and treatment utilization patterns at the regional cancer referral c... more To describe cancer incidence and treatment utilization patterns at the regional cancer referral center for the Lake Zone of northwestern Tanzania from 2008 to 2016. Methods: This descriptive, retrospective study reviewed all cancer cases recorded in the Bugando Cancer Registry (BCR), a clinical and pathology based registry at the only cancer referral hospital in the region. Primary tumor site, method of diagnosis, HIV status, and cancer treatment were reported. Using census data, the 2012 GLOBOCAN estimates for Tanzania were scaled to the Lake Zone and adjusted for 2016 population growth. These estimates were then compared to BCR cases using one-sample tests of proportion. Results: A total of 2772 cases were reported from 2008−2016. Among these, the majority of cases (82.5 %, n = 2286) were diagnosed among adults. Most cases (85 %, n = 1923) were diagnosed by histology or cytology. Among adults, the most common cancers diagnosed were cervix (22.7 %, n=520), breast (12.6 %, n=288), and prostate (8.5 %, n=195). Among children, the most common cancers were non-Burkitt non-Hodgkin lymphoma (17.3 %, n=84), Burkitt lymphoma (16.5 %, n=80), and Wilms tumor (14.6 %, n=71). The 1116 BCR cases represent 12.2 % of the 9165 expected number of cancer cases for the Lake Zone (p < 0.001). 1494 cases (53.9 %) received some form of treatment-surgery, chemotherapy, radiation, or hormone therapy-while 1278 cases (46.1 %) had no treatment recorded. Conclusions: This comprehensive report of the BCR reveals cancer epidemiology and treatment utilization patterns typical of hospitals in low-resource settings. Despite being the only cancer center in the Lake Zone, BMC evaluates a small percentage of the expected number of cancer patients for the region. The BCR remains an important resource to guide clinical care and academic activities for the Lake Zone.
Additional file 1: Supplementary Table 1. Questionnaire variables/data elements and how they were... more Additional file 1: Supplementary Table 1. Questionnaire variables/data elements and how they were coded for exploratory factor analysis. Supplementary Table 2. Eigenvalue and variance explained by extracted factors shown for each imputed dataset and by study country. Supplementary Table 3. Odds ratios and 95% confidence intervals (CIs) of the association of factors with falciparum infection risk in controls, by country. Supplementary Table 4. Odds ratios and 95% confidence intervals (CIs) of the association of factors with eBL risk, by country.
Background Falciparum and endemic Burkitt lymphoma (eBL) are co-endemic in Africa, but the malari... more Background Falciparum and endemic Burkitt lymphoma (eBL) are co-endemic in Africa, but the malaria experience in eBL patients is unknown. A lower prevalence of falciparum has been reported in eBL patients, but those results are anecdotally attributed to pre-enrollment anti-malaria treatment. Methods We studied 677 eBL patients and 2920 community controls aged 0–15 years enrolled in six regions in Uganda, Tanzania, and Kenya during 2010–2016. Falciparum was diagnosed using thick blood film microscopy (TFM) and antigen-capture rapid diagnostic tests (RDTs). Guardians of the children answered a 40-item structured questionnaire about their child’s pre-enrollment lifetime malaria history and treatment, demographics, socioeconomics, animal exposures, fevers, and hospitalizations. We utilized exploratory factor analysis to reduce the 40 questionnaire variables into six factors, including Inpatient malaria and Outpatient malaria factors that were surrogates of pre-enrollment anti-malaria tr...
Background Endemic Burkitt lymphoma (eBL) is an aggressive B cell non-Hodgkin lymphoma associated... more Background Endemic Burkitt lymphoma (eBL) is an aggressive B cell non-Hodgkin lymphoma associated with antigenic stimulation from Plasmodium falciparum malaria. Whether eBL risk is related to malaria parasite density is unknown. To address this issue, children with eBL, asymptomatic and clinical malaria, as a surrogate of malaria parasite density, were assessed. Methods Malaria-related laboratory results (parasite density, haemoglobin, platelet count, and white cell count [WBC]) count) were compiled for 4019 eBL cases and 80,532 subjects evaluated for asymptomatic malaria or clinical malaria (severe malaria anaemia, hyperparasitaemia, cerebral malaria, malaria prostration, moderate malaria, and mild malaria) in 21 representative studies published in Africa (mostly East Africa) and 850 eBL cases and 2878 controls with primary data from the Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) case–control study in Uganda, Tanzania, and Kenya. The average value...
Introduction: Retinoblastoma (Rb) is the most common ocular paediatric malignancy and is caused b... more Introduction: Retinoblastoma (Rb) is the most common ocular paediatric malignancy and is caused by a mutation of the two alleles of the tumor suppressor gene, RB1. The tumor microenvironment (TME) represents a complex system whose function is not yet well defined and where microvesicles, such as exosomes, play a key role in intercellular communication. Micro-RNAs (mRNAs) have emerged as important modifiers of biological mechanisms involved in cancer and been able to regulate tumor progression. Methods: Co-culture of monocytes with retinoblastoma cell lines, showed a significant growth decrease. Given the interaction between Rb cells and monocytes, we investigated the role of the supernatant in the cross-talk between cell lines, by taking the product of the co-culture and then using it as a culture medium for Rb cells. Results: miR-142-3p showed to be particularly over-expressed both in the Rb cell line and in the medium used for their culture, comparing to control cell line and the normal supernatant, respectively. Therefore, we provided evidence that miR-142-3p is released by monocytes in the coculture medium's exosomes and that it is subsequently up-taken by Rb cells, causing the inhibition of proliferation of Rb cell line by affecting cell cycle progression. Conclusion: This study highlights the role of exosomic miR-142-3p in the TME of Rb and identifies new molecular targets, which are able to control tumor growth aiming the development of a forward-looking miR-based strategy.
Epstein-Barr virus (EBV) is associated with endemic Burkitt lymphoma (eBL), but the contribution ... more Epstein-Barr virus (EBV) is associated with endemic Burkitt lymphoma (eBL), but the contribution of EBV variants is ill-defined. Studies of EBV whole genome sequences (WGS) have identified phylogroups that appear to be distinct for Asian versus non-Asian EBV, but samples from BL or Africa, where EBV was first discovered, are under-represented. We conducted a phylogenetic analysis of EBV WGS and LMP-1 sequences obtained primarily from BL patients in Africa and representative non-African EBV from other conditions or regions using data from GenBank, Sequence Read Archive, or Genomic Data Commons for the Burkitt Lymphoma Genome Sequencing Project (BLGSP) to generate data to support the use of a simpler biomarker of geographic or phenotypic associations. We also investigated LMP-1 patterns in 414 eBL cases and 414 geographically matched controls in the Epidemiology of Burkitt Lymphoma in East African children and minors (EMBLEM) study using LMP-1 PCR and Sanger sequencing. Phylogenetic a...
SEE PROFILE All in-text references underlined in blue are linked to publications on ResearchGate,... more SEE PROFILE All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
The aim of our study was to assess the quality of Tanzanian cervical cancer specimens, evaluating... more The aim of our study was to assess the quality of Tanzanian cervical cancer specimens, evaluating telomerase alterations and human papilloma virus (HPV) infection in relation to histopathological characteristics since these biomarkers are not routinely analyzed. Thirty-two Tanzanian women with invasive cervical cancer were included in the study. Histopathological classification and all the analyses on tissue, including TERT immunohistochemistry, were performed at IRST IRCCS (Meldola, Italy). HPV typization was performed by pyrosequencing. FHACT™ was used to identify chromosomal aberrations. Nonparametric ranking statistics were used. The majority (75 %) of the cases analyzed were squamous carcinoma, while 12.5 % were adenocarcinoma. The presence of HPV infection was confirmed in 26/27 (96.3 %) cases. A high percentage of patients (88 %) were infected with HPV16 of whom 12 (44.4 %) with African type 1, and 4 (14.8 %) with African type 2. TERT expression evaluated in the entire case series showed a median H-score of 130 (range 3-270), with only one negative case. 88 % of the FISH-evaluable samples showed an amplification of the chromosomal region 3q26 (TERC) and/or 5p15, and 20q13, associated with a higher median expression of TERT (P = 0.0226). Despite pre-analytical problems in terms of sample fixation, we showed that the search for biomarkers such as HPV and telomerase is feasible in Tanzanian tissue. These markers could be important risk-stratification tools in this population.
One of the major problems facing healthcare systems in countries with poor socio-economic conditi... more One of the major problems facing healthcare systems in countries with poor socio-economic conditions is the need to strengthen the system through the training of physicians, nurses and other healthcare operators. Partnering with more affluent countries is the key for hospitals in these areas, but such alliances are often based on limited educational exchanges. We present a retrospective study of our experience in building a collaborative relationship between our cancer institute in Italy and a Medical Center in sub-Saharan Africa (Tanzania). The main purpose is to see the changes in the clinical practice after educational interventions on health personnel in a Tanzanian cancer center.
PURPOSE It is estimated that 50%-80% of patients with pediatric cancer in sub-Saharan Africa pres... more PURPOSE It is estimated that 50%-80% of patients with pediatric cancer in sub-Saharan Africa present at an advanced stage. Delays can occur at any time during the care-seeking process from symptom onset to treatment initiation. Referral delay, the time from first presentation at a health facility to oncologist evaluation, is a key component of total delay that has not been evaluated in sub-Saharan Africa. METHODS Over a 3-month period, caregivers of children diagnosed with cancer at a regional cancer center (Bugando Medical Centre [BMC]) in Tanzania were consecutively surveyed to determine the number and type of health facilities visited before presentation, interventions received, and transportation used to reach each facility. RESULTS Forty-nine caregivers were consented and included in the review. A total of 124 facilities were visited before BMC, with 31% of visits (n = 38) resulting in a referral. The median referral delay was 89 days (mean, 122 days), with a median of two faci...
e22248 Background: The debate on the association between Vit D deficiency and breast cancer risk ... more e22248 Background: The debate on the association between Vit D deficiency and breast cancer risk is still open. Some studies indicate that ethnic differences play a role in the circulating levels of serum Vit D. Moreover, single nucleotide polymorphisms (SNPs) in the Vit D receptor (VDR) have been associated with various types of cancer.The study evaluates Vit D and Binding Protein (DBP) levels, VDR and DBP polymorphisms in Tanzanian and Italian healthy donors (HD) and breast cancer patients (BCP). Methods: The study provides 200 adult women: 100 Tanzanian and 100 Italians (for each population: 50 donors, 25 primary and 25 advanced breast cancer patients). At first, analysis on serum Vit D concentrations has been performed until now on 25 HD and 25 BCP from Italy. The analysis on the overall population is ongoing. All bio-molecular characterization are performed at IRST IRCCS in Italy. The association between Vit D serum concentration and osteoporosis risk factors was evaluated. Results: From Sept to Dec ...
Background: We carried out a pilot phase for cervical cancer screening in the Mwanza and Mara Reg... more Background: We carried out a pilot phase for cervical cancer screening in the Mwanza and Mara Regions (Tanzania), reporting on the diagnostic performance of procedure and on the association between demographic, socioeconomic and health-related characteristics of attending women and their probability of being diagnosed with high-grade cervical disease and invasive cervical carcinoma. Methods: The pilot targeted 7 districts and was launched in 2012 after a community-level information campaign.Women aged 15-64 years were invited to take part. Women were interviewed using a structured questionnaire and were offered the visual inspection of the cervix with acetic acid (VIA) and Pap smear. Patients resulting positive with VIA who were ineligible for immediate cryotherapy were invited to the Bugando Medical Centre (BMC) of Mwanza for colposcopy. Pap smears were evaluated by pathologists of BMC. Results: We evaluated data from the first consecutive 2,500 women. Those women presenting with a clinically overt cervical cancer and those with missing data were excluded. 2,342 women (median age 38 yrs) were eligible. We reported 572 (24.4%) subjects with previous diagnosis of sexually transmitted diseases and 192 (6.6%) HIV-positive subjects. Women with VIA findings suggestive of high-grade cervical disease and carcinoma were 7.3%, with positive predictive value of 64.7% and detection rate of 47.0‰.The corresponding figures of the Pap smear were 6.1%, 59.2%, and 35.9‰. In multivariate analysis, the factors independently associated with the prevalence of disease included district of residence, history of untreated sexually transmitted diseases, parity and negative HIV test (inverse association). The probability for affected patients to have an invasive versus a pre-invasive disease varied significantly between districts, and was lower in HIV-positive women and in women practicing breast self-examinationthe latter being the strongest determinant. Conclusions: The performance of VIA compared well with Pap smear. Factors associated with the prevalence of disease were used to target the promotion of attendance. The inverse association between breast self-examination and the probability to have an invasive versus a pre-invasive disease is probably due to a previous spontaneous cervical screening practice and confirms the potential value of cancer awareness and education for sub-Saharan women.
A 70-year-old female patient, from a rural area presented to local paramedics with generalised we... more A 70-year-old female patient, from a rural area presented to local paramedics with generalised weakness and a blackish painful umbilical nodule. Her blood pressure was 130/80 mmHg and random blood sugar was 12.5 mmol/l. US of abdomen revealed “anterior abdominal wall sinus/abscess”. So dressing and antibiotics were advised. After 4 months, she visited our hospital, where an inflamed umbilical nodule, 2x3 cm with no ulcer was found (Figure 1).
Breast cancer, although reported to be the commonest female malignancy worldwide has not been ext... more Breast cancer, although reported to be the commonest female malignancy worldwide has not been extensively studied in north-western Tanzania. The aim of this retrospective review was to describe in our setting, the stage at diagnosis, clinicopathological and treatment patterns among patients with breast cancer. Data were analyzed using SPSS software system. A total of 384 patients were studied. The median age was 45 years (range 21 to 78 years). The male to female ratio was 1: 46.8. Most of the patients were premenopausal (63.8%) and presented late with advanced breast cancer disease. Majority of patients (63.0%) presented with stage III disease. Lymph node and distant metastasis at the time of diagnosis was reported in 70.8% and 21.4% of patients, respectively. Invasive ductal carcinoma (91.7%) was the most frequent histopathological type and most patients (63.8%) had poorly differentiated tumour. Patients with tumour size greater than 6cm had significantly high rate of lymph node m...
10063 Background: Retinoblastoma is the most common ocular tumor of childhood. Diagnosis times di... more 10063 Background: Retinoblastoma is the most common ocular tumor of childhood. Diagnosis times differ across the word, with diagnosis occurring significantly earlier in developed countries. Necrosis and invasion of the optic nerve are usually associated with poor prognosis and higher incidence of recurrence and metastases. Treatment options include surgery, radiotherapy, and chemotherapy while targeted therapies are still not available. The aim of this study was to investigate the protein signaling architecture of retinoblastomas to identify new druggable targets for personalized therapy. Methods: Six paraffin embedded retinoblastomas collected at the Bugando Medical Center (Mwanza, Tanzania) were analyzed in this feasibility study. Samples were collected from patients aged 2 to 10. Two tumors presented invasion of the optic nerve, 2 were free of invasion, and 2 tumors were unclassified. Four tumors were necrotic, while 2 displayed no signs of necrosis. Samples were subjected to laser capture microdissect...
The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some... more The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some hospitals in Tanzania. However, its validity and reliability has not been evaluated in any hospital in the country including the study area. This cross-sectional study was conducted at Bugando Medical Centre in northwestern Tanzania to determine the validity, reliability and applicability of triple assessment as an alternative to conventional open biopsy in the pre-operative diagnosis of breast cancer. A total of 212 female patients aged 35 years and above were studied. All patients underwent clinical evaluation, mammography and fine needle aspiration cytology. Histopathology was done to confirm the diagnosis. One hundred and twenty (56.6 %) patients with a median age of 36 years had benign lesions and the remaining ninety-two (43.4%) with a median age of 47 years had breast cancer (P = 0.002). With triple assessment, 92 patients were diagnostic for malignancy and 120 benign, respectively confirmed by histopathology. The Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy were 100.0%. There were no false positive or false negative results. The Kappa statistic for the combination was 1.0 implying excellent agreement with histopathology. The majority of patients (59.9%) underwent triple assessment on the same day with results being available to the patient within 24 to 72 hours. The triple assessment is an accurate and quick method for the evaluation of breast cancer and can be applied as a safe alternative for open biopsy when it is concordant..
Dermatological malignancies are among the most common form of cancers and the global incidence ha... more Dermatological malignancies are among the most common form of cancers and the global incidence has been increasing at an alarming rate. A retrospective study was conducted to determine the prevalence, histopathological pattern, anatomical distribution and treatment outcome of dermatological malignancies at Bugando Medical Centre in Northwestern Tanzania. Data were collected from patients' files kept in the Medical record department; the surgical wards, operating theatre and histopathology laboratory and analyzed using Statistical package for social sciences system. A total of 154 patients with a histopathological diagnosis of dermatological malignancy were studied. Generally, males outnumbered females by a ratio of 1.4:1. The majority of patients were in the 5th and 6th decades of life. Malignant melanoma was the most common dermatological malignancy (67.5%) followed by Kaposi's sarcoma (10.4%), Squamous cell carcinoma (8.4%) and Basal cell carcinoma(7.8%). The lower limbs were the most frequent site accounting for 55.8%. Wide local excision was the most common surgical procedure performed in 79.2% of cases. Post-operative wound infection was the most common complication in 58.3% of patients. Mortality rate was 3.8%. Dermatological malignancies are more prevalent in our setting. A high index of suspicion is needed to avoid labelling malignancies "chronic ulcers" and all suspected lesions should be biopsed.
Background Despite marked decreases in its incidence, particularly in developed countries, gastri... more Background Despite marked decreases in its incidence, particularly in developed countries, gastric cancer is still the second most common tumor worldwide. There is a paucity of information regarding gastric cancer in northwestern Tanzania. This study was undertaken to describe our experience, in our local setting, on the management of gastric cancer, outlining the clinicopathological and treatment outcome of these patients and suggesting ways to improve the treatment outcome. Methods This was a retrospective study of histologically confirmed cases of gastric cancer seen at Bugando Medical Centre between January 2007 and December 2011. Data were retrieved from patients’ files and analyzed using SPSS computer software version 17.0. Results A total of 232 gastric cancer patients were enrolled in the study, representing 4.5% of all malignancies. The male to female ratio was 2.9:1. The median age of patients was 52 years. The majority of the patients (92.1%) presented late with advanced ...
Background: Colorectal cancer is one of the most common cancers worldwide and its incidence is re... more Background: Colorectal cancer is one of the most common cancers worldwide and its incidence is reported to be increasing in resource-limited countries, probably due to the acquisition of a western lifestyle. However, information regarding colorectal cancer in Tanzania and the study area in particular is limited. This study was conducted in our local setting to describe the clinicopathological pattern of colorectal cancer and highlight the challenging problem in the management of this disease. Methods: This was a retrospective study of histologically confirmed cases of colorectal cancer seen at Bugando Medical Center between July 2006 and June 2011. Data were retrieved from patients' files and analyzed using SPSS computer software version 17.0. Results: A total of 332 colorectal cancer patients were enrolled in the study, representing 4.7% of all malignancies. Males outnumbered females by a ratio of 1.6:1. The median age of patients at presentation was 46 years. The majority of patients (96.7%) presented late with advanced stages. Lymph node and distant metastasis at the time of diagnosis was recorded in 30.4% and 24.7% of cases, respectively. The rectosigmoid region was the most frequent anatomical site (54.8%) involved and adenocarcinoma (98.8%) was the most common histopathological type. The majority of adenocarcinomas (56.4%) were moderately differentiated. Mucinous and signet ring carcinomas accounted for 38 (11.6%)and 15 (4.6%) patients, respectively. Three hundred and twenty-six (98.2%) patients underwent surgical procedures for colorectal cancer. Only 54 out of 321 (16.8%) patients received adjuvant treatment. Postoperative complication and mortality rates were 26.2% and 10.5%, respectively. The overall median duration of hospital stay was 12 days. Only nine out of 297 survivors (3.0%) were available for follow-up at the end of 5 years. Cancer recurrence was reported in 56 of 297 survivors (18.9%). Data on long-term survival were not available as the majority of patients were lost to follow-up. Conclusions: Colorectal cancer is not uncommon in our environment and shows a trend towards a relative young age at diagnosis and the majority of patients present late with advanced stage. There is a need for screening of high-risk populations, early diagnosis and effective cost-effective treatment and follow-up to improve outcome of these patients.
Introduction Cancer of the cervix rank the second most common cause of cancer related deaths amon... more Introduction Cancer of the cervix rank the second most common cause of cancer related deaths among women in Sub-Saharan Africa. It is estimated that 529, 409 new cases are diagnosed annually with a mortality rate approaching 274,883 per year. Cervical Intraepithelial Neoplasia (CIN) precedes almost all cervical cancers. The incidence rate of CIN among HIV infected women is five times higher as compared to the rate in HIV negative women. The screening for cervical dysplasia and an appropriate management in women with CIN are effective methods for preventing cervical cancer. This study was done to determine the prevalence and predictors of CIN among a HIV infected women attending Care and Treatment centre (CTC) at Bugando Medical Centre (BMC). Methods A cross sectional survey was undertaken among HIV infected women aged 18 years and above attending at BMC CTC clinic between February and March 2013. Visual Inspection with Acetic acid (VIA) was used as the screening method for detection...
To describe cancer incidence and treatment utilization patterns at the regional cancer referral c... more To describe cancer incidence and treatment utilization patterns at the regional cancer referral center for the Lake Zone of northwestern Tanzania from 2008 to 2016. Methods: This descriptive, retrospective study reviewed all cancer cases recorded in the Bugando Cancer Registry (BCR), a clinical and pathology based registry at the only cancer referral hospital in the region. Primary tumor site, method of diagnosis, HIV status, and cancer treatment were reported. Using census data, the 2012 GLOBOCAN estimates for Tanzania were scaled to the Lake Zone and adjusted for 2016 population growth. These estimates were then compared to BCR cases using one-sample tests of proportion. Results: A total of 2772 cases were reported from 2008−2016. Among these, the majority of cases (82.5 %, n = 2286) were diagnosed among adults. Most cases (85 %, n = 1923) were diagnosed by histology or cytology. Among adults, the most common cancers diagnosed were cervix (22.7 %, n=520), breast (12.6 %, n=288), and prostate (8.5 %, n=195). Among children, the most common cancers were non-Burkitt non-Hodgkin lymphoma (17.3 %, n=84), Burkitt lymphoma (16.5 %, n=80), and Wilms tumor (14.6 %, n=71). The 1116 BCR cases represent 12.2 % of the 9165 expected number of cancer cases for the Lake Zone (p < 0.001). 1494 cases (53.9 %) received some form of treatment-surgery, chemotherapy, radiation, or hormone therapy-while 1278 cases (46.1 %) had no treatment recorded. Conclusions: This comprehensive report of the BCR reveals cancer epidemiology and treatment utilization patterns typical of hospitals in low-resource settings. Despite being the only cancer center in the Lake Zone, BMC evaluates a small percentage of the expected number of cancer patients for the region. The BCR remains an important resource to guide clinical care and academic activities for the Lake Zone.
Additional file 1: Supplementary Table 1. Questionnaire variables/data elements and how they were... more Additional file 1: Supplementary Table 1. Questionnaire variables/data elements and how they were coded for exploratory factor analysis. Supplementary Table 2. Eigenvalue and variance explained by extracted factors shown for each imputed dataset and by study country. Supplementary Table 3. Odds ratios and 95% confidence intervals (CIs) of the association of factors with falciparum infection risk in controls, by country. Supplementary Table 4. Odds ratios and 95% confidence intervals (CIs) of the association of factors with eBL risk, by country.
Background Falciparum and endemic Burkitt lymphoma (eBL) are co-endemic in Africa, but the malari... more Background Falciparum and endemic Burkitt lymphoma (eBL) are co-endemic in Africa, but the malaria experience in eBL patients is unknown. A lower prevalence of falciparum has been reported in eBL patients, but those results are anecdotally attributed to pre-enrollment anti-malaria treatment. Methods We studied 677 eBL patients and 2920 community controls aged 0–15 years enrolled in six regions in Uganda, Tanzania, and Kenya during 2010–2016. Falciparum was diagnosed using thick blood film microscopy (TFM) and antigen-capture rapid diagnostic tests (RDTs). Guardians of the children answered a 40-item structured questionnaire about their child’s pre-enrollment lifetime malaria history and treatment, demographics, socioeconomics, animal exposures, fevers, and hospitalizations. We utilized exploratory factor analysis to reduce the 40 questionnaire variables into six factors, including Inpatient malaria and Outpatient malaria factors that were surrogates of pre-enrollment anti-malaria tr...
Background Endemic Burkitt lymphoma (eBL) is an aggressive B cell non-Hodgkin lymphoma associated... more Background Endemic Burkitt lymphoma (eBL) is an aggressive B cell non-Hodgkin lymphoma associated with antigenic stimulation from Plasmodium falciparum malaria. Whether eBL risk is related to malaria parasite density is unknown. To address this issue, children with eBL, asymptomatic and clinical malaria, as a surrogate of malaria parasite density, were assessed. Methods Malaria-related laboratory results (parasite density, haemoglobin, platelet count, and white cell count [WBC]) count) were compiled for 4019 eBL cases and 80,532 subjects evaluated for asymptomatic malaria or clinical malaria (severe malaria anaemia, hyperparasitaemia, cerebral malaria, malaria prostration, moderate malaria, and mild malaria) in 21 representative studies published in Africa (mostly East Africa) and 850 eBL cases and 2878 controls with primary data from the Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) case–control study in Uganda, Tanzania, and Kenya. The average value...
Introduction: Retinoblastoma (Rb) is the most common ocular paediatric malignancy and is caused b... more Introduction: Retinoblastoma (Rb) is the most common ocular paediatric malignancy and is caused by a mutation of the two alleles of the tumor suppressor gene, RB1. The tumor microenvironment (TME) represents a complex system whose function is not yet well defined and where microvesicles, such as exosomes, play a key role in intercellular communication. Micro-RNAs (mRNAs) have emerged as important modifiers of biological mechanisms involved in cancer and been able to regulate tumor progression. Methods: Co-culture of monocytes with retinoblastoma cell lines, showed a significant growth decrease. Given the interaction between Rb cells and monocytes, we investigated the role of the supernatant in the cross-talk between cell lines, by taking the product of the co-culture and then using it as a culture medium for Rb cells. Results: miR-142-3p showed to be particularly over-expressed both in the Rb cell line and in the medium used for their culture, comparing to control cell line and the normal supernatant, respectively. Therefore, we provided evidence that miR-142-3p is released by monocytes in the coculture medium's exosomes and that it is subsequently up-taken by Rb cells, causing the inhibition of proliferation of Rb cell line by affecting cell cycle progression. Conclusion: This study highlights the role of exosomic miR-142-3p in the TME of Rb and identifies new molecular targets, which are able to control tumor growth aiming the development of a forward-looking miR-based strategy.
Epstein-Barr virus (EBV) is associated with endemic Burkitt lymphoma (eBL), but the contribution ... more Epstein-Barr virus (EBV) is associated with endemic Burkitt lymphoma (eBL), but the contribution of EBV variants is ill-defined. Studies of EBV whole genome sequences (WGS) have identified phylogroups that appear to be distinct for Asian versus non-Asian EBV, but samples from BL or Africa, where EBV was first discovered, are under-represented. We conducted a phylogenetic analysis of EBV WGS and LMP-1 sequences obtained primarily from BL patients in Africa and representative non-African EBV from other conditions or regions using data from GenBank, Sequence Read Archive, or Genomic Data Commons for the Burkitt Lymphoma Genome Sequencing Project (BLGSP) to generate data to support the use of a simpler biomarker of geographic or phenotypic associations. We also investigated LMP-1 patterns in 414 eBL cases and 414 geographically matched controls in the Epidemiology of Burkitt Lymphoma in East African children and minors (EMBLEM) study using LMP-1 PCR and Sanger sequencing. Phylogenetic a...
SEE PROFILE All in-text references underlined in blue are linked to publications on ResearchGate,... more SEE PROFILE All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
The aim of our study was to assess the quality of Tanzanian cervical cancer specimens, evaluating... more The aim of our study was to assess the quality of Tanzanian cervical cancer specimens, evaluating telomerase alterations and human papilloma virus (HPV) infection in relation to histopathological characteristics since these biomarkers are not routinely analyzed. Thirty-two Tanzanian women with invasive cervical cancer were included in the study. Histopathological classification and all the analyses on tissue, including TERT immunohistochemistry, were performed at IRST IRCCS (Meldola, Italy). HPV typization was performed by pyrosequencing. FHACT™ was used to identify chromosomal aberrations. Nonparametric ranking statistics were used. The majority (75 %) of the cases analyzed were squamous carcinoma, while 12.5 % were adenocarcinoma. The presence of HPV infection was confirmed in 26/27 (96.3 %) cases. A high percentage of patients (88 %) were infected with HPV16 of whom 12 (44.4 %) with African type 1, and 4 (14.8 %) with African type 2. TERT expression evaluated in the entire case series showed a median H-score of 130 (range 3-270), with only one negative case. 88 % of the FISH-evaluable samples showed an amplification of the chromosomal region 3q26 (TERC) and/or 5p15, and 20q13, associated with a higher median expression of TERT (P = 0.0226). Despite pre-analytical problems in terms of sample fixation, we showed that the search for biomarkers such as HPV and telomerase is feasible in Tanzanian tissue. These markers could be important risk-stratification tools in this population.
One of the major problems facing healthcare systems in countries with poor socio-economic conditi... more One of the major problems facing healthcare systems in countries with poor socio-economic conditions is the need to strengthen the system through the training of physicians, nurses and other healthcare operators. Partnering with more affluent countries is the key for hospitals in these areas, but such alliances are often based on limited educational exchanges. We present a retrospective study of our experience in building a collaborative relationship between our cancer institute in Italy and a Medical Center in sub-Saharan Africa (Tanzania). The main purpose is to see the changes in the clinical practice after educational interventions on health personnel in a Tanzanian cancer center.
PURPOSE It is estimated that 50%-80% of patients with pediatric cancer in sub-Saharan Africa pres... more PURPOSE It is estimated that 50%-80% of patients with pediatric cancer in sub-Saharan Africa present at an advanced stage. Delays can occur at any time during the care-seeking process from symptom onset to treatment initiation. Referral delay, the time from first presentation at a health facility to oncologist evaluation, is a key component of total delay that has not been evaluated in sub-Saharan Africa. METHODS Over a 3-month period, caregivers of children diagnosed with cancer at a regional cancer center (Bugando Medical Centre [BMC]) in Tanzania were consecutively surveyed to determine the number and type of health facilities visited before presentation, interventions received, and transportation used to reach each facility. RESULTS Forty-nine caregivers were consented and included in the review. A total of 124 facilities were visited before BMC, with 31% of visits (n = 38) resulting in a referral. The median referral delay was 89 days (mean, 122 days), with a median of two faci...
e22248 Background: The debate on the association between Vit D deficiency and breast cancer risk ... more e22248 Background: The debate on the association between Vit D deficiency and breast cancer risk is still open. Some studies indicate that ethnic differences play a role in the circulating levels of serum Vit D. Moreover, single nucleotide polymorphisms (SNPs) in the Vit D receptor (VDR) have been associated with various types of cancer.The study evaluates Vit D and Binding Protein (DBP) levels, VDR and DBP polymorphisms in Tanzanian and Italian healthy donors (HD) and breast cancer patients (BCP). Methods: The study provides 200 adult women: 100 Tanzanian and 100 Italians (for each population: 50 donors, 25 primary and 25 advanced breast cancer patients). At first, analysis on serum Vit D concentrations has been performed until now on 25 HD and 25 BCP from Italy. The analysis on the overall population is ongoing. All bio-molecular characterization are performed at IRST IRCCS in Italy. The association between Vit D serum concentration and osteoporosis risk factors was evaluated. Results: From Sept to Dec ...
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