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The impact of in-house pathology services on downstaging cervical cancer in Tanzania over an 18-year period

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Abstract

Purpose

Reducing time between cancer screening, diagnosis, and initiation of treatment is best achieved when services are available in the same hospital. Yet, comprehensive cancer centers are typically unavailable in low- and middle-income countries (LMICs), where resources are limited and services scattered. This study explored the impact of establishing an in-house pathology laboratory at the largest public cancer hospital in Tanzania on the downstaging of cervical cancer.

Methods

We examined clinical datasets of 8,322 cervical cancer patients treated at the Ocean Road Cancer Institute (ORCI). The first period included patients treated from 2002 to 2016, before establishment of the pathology laboratory at ORCI; the second period (post-pathology establishment) included data from 2017 to 2020. Logistic regression analysis evaluated the impact of the pathology laboratory on stage of cervical cancer diagnosis.

Results

Patients treated during the post-pathology period were more likely to be clinically diagnosed at earlier disease stages compared to patients in the pre-pathology period (pre-pathology population diagnosed at early disease stage: 44.08%; post-pathology population diagnosed at early disease stage: 59.38%, p < 0.001). After adjustment for age, region of residence, and place of biopsy, regression results showed patients diagnosed during the post-pathology period had higher odds of early stage cervical cancer diagnosis than patients in the pre-pathology period (OR 1.35, 95% CI (1.16, 1.57), p < 0.001).

Conclusions

Integrated and comprehensive cancer centers can overcome challenges in delivering expedited cervical cancer diagnosis and treatment. In-house pathology laboratories play an important role in facilitating timely diagnosis and rapid treatment of cervical and possibly other cancers in LMICs.

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Fig. 1

Source ORCI electronic medical records database, paper patient logbooks (2002–2011, n = 835); paper patient logbooks, paper medical records (2014–2018, n = 5,517); ORCI electronic medical records database, paper screening cards, paper pathology reports (2019–2020, n = 1,970)

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Data availability

The data that support the findings of this study are available from the Ocean Road Cancer Institute, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the Ocean Road Cancer Institute.

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Funding

Caroline Fuss was supported by the Cancer Epidemiology and Education in Special Populations (CEESP) Program through funding from the National Cancer Institute Grant R25CA112383 (PI: Amr Soliman, MD, PhD).

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Authors and Affiliations

  1. Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA

    Caroline G. Fuss

  2. Department of Cancer Prevention, Ocean Road Cancer Institute, Dar es Salaam, Tanzania

    Khadija Msami, Crispin Kahesa & Julius Mwaiselage

  3. Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Amanda Gordon

  4. Department of Community Health and Social Medicine, City University of New York School of Medicine, 160 Convent Avenue, New York, NY, 10031, USA

    Nancy Sohler & Amr S. Soliman

  5. Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA

    Lindsey J. Mattick

Authors
  1. Caroline G. Fuss
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  2. Khadija Msami
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  8. Amr S. Soliman
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Correspondence to Amr S. Soliman.

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The authors declare no conflicts of interests.

Ethical approval

Institutional Review Board approvals were obtained from George Washington University and by the Ocean Road Cancer Institute’s Academic, Research, Publications and Ethics Committee.

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Fuss, C.G., Msami, K., Kahesa, C. et al. The impact of in-house pathology services on downstaging cervical cancer in Tanzania over an 18-year period. Cancer Causes Control 35, 93–101 (2024). https://doi.org/10.1007/s10552-023-01768-x

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  • DOI: https://doi.org/10.1007/s10552-023-01768-x

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