A prospective ascertainment of cancer incidence in sub-Saharan Africa: The case of Kaposi sarcoma

Aggrey Semeere, Megan Wenger, Naftali Busakhala, Nathan Buziba, Mwebesa Bwana, Winnie Muyindike, Erin Amerson, Toby Maurer, Timothy Mccalmont, Philip Leboit, Beverly Musick, Constantin Yiannoutsos, Robert Lukande, Barbara Castelnuovo, Miriam Laker-Oketta, Andrew Kambugu, David Glidden, Kara Wools-Kaloustian, Jeffrey Martin

Research output: Contribution to journalArticle

22 Scopus citations


In resource-limited areas, such as sub-Saharan Africa, problems in accurate cancer case ascertainment and enumeration of the at-risk population make it difficult to estimate cancer incidence. We took advantage of a large well-enumerated healthcare system to estimate the incidence of Kaposi sarcoma (KS), a cancer which has become prominent in the HIV era and whose incidence may be changing with the rollout of antiretroviral therapy (ART). To achieve this, we evaluated HIV-infected adults receiving care between 2007 and 2012 at any of three medical centers in Kenya and Uganda that participate in the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium. Through IeDEA, clinicians received training in KS recognition and biopsy equipment. We found that the overall prevalence of KS among 102,945 HIV-infected adults upon clinic enrollment was 1.4%; it declined over time at the largest site. Among 140,552 patients followed for 319,632 person-years, the age-standardized incidence rate was 334/100,000 person-years (95% CI: 314-354/100,000 person-years). Incidence decreased over time and was lower in women, persons on ART, and those with higher CD4 counts. The incidence rate among patients on ART with a CD4 count >350 cells/mm3 was 32/100,000 person-years (95% CI: 14-70/100,000 person-years). Despite reductions over time coincident with the expansion of ART, KS incidence among HIV-infected adults in East Africa equals or exceeds the most common cancers in resource-replete settings. In resource-limited settings, strategic efforts to improve cancer diagnosis in combination with already well-enumerated at-risk denominators can make healthcare systems attractive platforms for estimating cancer incidence.

Original languageEnglish (US)
Pages (from-to)914-928
Number of pages15
JournalCancer Medicine
Issue number5
StatePublished - May 1 2016


  • Africa
  • Antiretroviral therapy
  • Incidence
  • Kaposi sarcoma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Semeere, A., Wenger, M., Busakhala, N., Buziba, N., Bwana, M., Muyindike, W., Amerson, E., Maurer, T., Mccalmont, T., Leboit, P., Musick, B., Yiannoutsos, C., Lukande, R., Castelnuovo, B., Laker-Oketta, M., Kambugu, A., Glidden, D., Wools-Kaloustian, K., & Martin, J. (2016). A prospective ascertainment of cancer incidence in sub-Saharan Africa: The case of Kaposi sarcoma. Cancer Medicine, 5(5), 914-928. https://doi.org/10.1002/cam4.618