Review: Head and neck squamous cell carcinoma in sub-Saharan Africa|
Faggons, C.E.; Mabedi, C.; Shores, C.G. & Gopal, S.
Review the literature from 1990 to 2013 to determine known anatomic
sites, risk factors, treatments, and outcomes of head and neck squamous
cell carcinoma (HNSCC) in sub-Saharan Africa.
Using a systematic search strategy, literature pertaining to HNSCC in
sub-Saharan Africa was reviewed and patient demographics, anatomic
sites, histology, stage, treatment, and outcomes were abstracted. The
contributions of human immunodeficiency virus (HIV), human
papillomavirus (HPV) and behavioural risk factors to HNSCC in the
region were assessed.
Of the 342 papers identified, 46 were utilized for review, including 8611
patients. In sub-Saharan Africa, the oropharyngeal/oral cavity was found
to be the most common site, with 7750 cases (90% of all cases). Few
papers distinguished oropharyngeal from oral cavity, making identification
of possible HPV-associated oropharyngeal squamous cell carcinoma
(SCC) difficult. SCC of the nasopharynx, nasal cavity, or paranasal sinuses
was identified in 410 patients (4.8% of all cases). Laryngeal SCC was
found in 385 patients (4.5% of all cases), and only 66 patients (0.8% of
all cases) with hypopharyngeal SCC were identified. In 862 patients with
data available, 43% used tobacco and 42% used alcohol, and reported
use varied widely and was more common in laryngeal SCC than that of
the oropharyngeal/oral cavity. Toombak and kola nut use was reported to
be higher in patients with HNSCC. Several papers reported HIV-positive
patients with HNSCC, but it was not possible to determine HNSCC
prevalence in HIV-positive compared to negative patients. Reports of
treatment and outcomes were rare.
The oropharyngeal/oral cavity was by far the most commonly reported
site of HNSCC reported in sub-Saharan Africa. The roles of risk factors
in HNSCC incidence in sub-Saharan Africa were difficult to delineate
from the available studies, but a majority of patients did not use tobacco