Metabolic syndrome and cervical cancer among women utilizing cancer prevention and treatment services at Mbarara Regional Referral Hospital.

Abstract

ABSTRACT Background: Low and middle-income countries (LMICs) experience three times the number of new cases and six times the number of deaths from cervical cancer compared to high income countries (HICs). Additionally, up-to-date data to inform improvements in cervical cancer prevention is scarce in most LMICs. Since HPV is a necessary but not sufficient cause of cervical cancer, there's need to explore other factors like metabolic syndrome (MetS) that may potentially modify the risk for cervical cancer. The objectives of this study were i)To determine the magnitude and trends of cervical cancer in comparison to other gynecological malignancies at Mbarara regional referral hospital between 2017 and 2022; ii)To determine the association between metabolic syndrome and cervical cancer among women utilizing cervical cancer prevention and treatment services at Mbarara regional referral hospital and ; iii) To compare the histological findings ,stage at diagnosis and the mortality within one year after diagnosis among cervical cancer patients with and without MetS at Mbarara regional referral hospital.

Methods: For Objective 1, a retrospective records review of charts of patients admitted with gynecological malignancies on the gynecological ward of Mbarara Regional Referral Hospital (MRRH) between January 2017 and December 2022 was conducted. For objective 2, We conducted an unmatched case-control study 470 participants (157 cervical cancer cases and 313 controls. We assessed for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We used a multivariable binary logistic regression analysis to determine the association between MetS and its components with cervical cancer. For objective 3, we conducted a prospective cohort study for one year on 132 women with a new diagnosis of cervical cancer.

Results: Over a 6-year period, 82.4% (721/875) of the patients admitted with gynecological malignancies had cervical cancer. Cervical cancer cases increased proportionately by 17% annually compared to other gynecological cancers (OR:1.17; 95% CI 1.06-1.28, p = 0.0046); with the majority of patients cervical cancer patients (92.7%, n=668) having squamous cell carcinoma. Most patients (87.9%, n=634) had late-stage disease.

MetS was independently associated with cervical cancer (aOR 1.66; 95% CI 1.07-2.57). Age ≥ 50 years (aOR:2.20; 95% CI 1.35-3.56), HIV infection (aOR 2.51, 95% CI 1.56-4.05), increasing parity (aOR 1.16, 95% CI 1.06-1.26), and a lack of formal education (aOR 6.41, 95% CI 1.33-30.86) were also associated with cervical cancer diagnosis. None of the individual components of MetS was associated with cervical cancer. There was no difference in histology, stage at diagnosis in patients with and without MetS. The overall cumulative incidence of mortality in cervical cancer patients at one year following diagnosis was 42.3% (95% CI: 34.2-51.4). The cumulative incidence of mortality in cervical cancer patients with and without MetS was 44.1% (95% CI: 33.4-57.2) and 39.9% (95% CI: 28.9-53.2), respectively. There was no difference in cumulative incidence of mortality at one year following diagnosis in patients with and without MetS (Log-rank statistic =0.13, p=0.720).

Conclusions and recommendations: The burden of cervical cancer among women at MRRH is high compared to other gynecological malignancies, with a significant annual increase. Majority of the cervical cancer patients at MRRH have squamous cell carcinoma and present with the late stage of the disease at diagnosis. Close to half of the patients diagnosed with cervical cancer at MRRH die within one year after diagnosis. MetS increases the risk of cervical cancer but does not affect the histology, stage at diagnosis and one-year mortality. We recommend scaling up of cervical cancer screening services with incorporation of screening for metabolic syndrome to reduce the burden of both morbidities.