Changes in Cervical Cancer Stage at Diagnosis in Zambia over 15 years

Purpose This study explored the trend for change in the proportion of late-stage cervical cancer at one cancer center in Zambia from 2008–2022. Method This study included data of 5,755 cervical cancer patients seen at the Cancer Diseases Hospital (CDH) in Lusaka, Zambia between 2008 and 2022. The data included information about patient age, year of diagnosis, FIGO stage at diagnosis, HIV status, marital status, employment status, region of residence, and cervical screening history. We evaluated the stage at diagnosis over three time periods (2008–2012, 2013–2017, 2018–2022). Regression analysis identified the predictors of late-stage presentation. Results The proportion of late-stage presentation (Stages III and IV) decreased during 2013–2017 compared to the late stages during 2008–2012 (OR: 0.70, 95% CI: 0.60–0.80). Subsequently, late-stage presentation increased during 2013–2017 compared to 2018–2022 (OR: 0.80, 95% CI: 0.71, 0.91). Women who were divorced or widowed, unemployed, and lived in provinces distant from Lusaka were more likely to present with late-stage diagnoses, irrespective of the time period. Conclusion Although there was an initial decrease in late-stage diagnoses during 2008–2012 compared to 2013–2017, the trend reversed from 2018–2022. The increase in the proportion of late-stage presentations in 2018–2022 is probably due to lack of treatment availability and low visual inspection of the cervix with acetic acid (VIA) screening sensitivity. Increasing the accessibility and availability of cervical cancer treatment and educating the vulnerable and risk-groups about the importance of screening may lead to early detection and downstaging in Zambia and other low-income countries.