Is AJCC/UICC Staging Still Appropriate for Head and Neck Cancers in Developing Countries?

Johannes J Fagan; Julie Wetter; Jeffrey Otiti; Joyce Aswani; Anna Konney; Evelyne Diom; Kenneth Baidoo; Paul Onakoya; Rajab Mugabo; Patrick Noah; Victor Mashamba; Innocent Kundiona; Chege Macharia; Mohammed Garba Mainasara; Melesse Gebeyehu; Mesele Bogale; Khaled Twier; Marco Faniriko; Getachew Beza Melesse; Mark G Shrime

doi:10.1177/2473974X20938313

Is AJCC/UICC Staging Still Appropriate for Head and Neck Cancers in Developing Countries?

OTO Open. 2020 Jul 6;4(3):2473974X20938313. doi: 10.1177/2473974X20938313. eCollection 2020 Jul-Sep.

Authors

Johannes J Fagan¹, Julie Wetter², Jeffrey Otiti³, Joyce Aswani⁴, Anna Konney⁵, Evelyne Diom⁶, Kenneth Baidoo⁷, Paul Onakoya⁸, Rajab Mugabo⁹, Patrick Noah¹⁰, Victor Mashamba¹¹, Innocent Kundiona¹², Chege Macharia¹³, Mohammed Garba Mainasara¹⁴, Melesse Gebeyehu¹⁵, Mesele Bogale¹⁶, Khaled Twier¹⁷, Marco Faniriko¹⁸, Getachew Beza Melesse¹⁹, Mark G Shrime²⁰

Affiliations

¹ Division of Otolaryngology, University of Cape Town, South Africa.
² Department Radiation Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
³ Uganda Cancer Institute, Kampala, Uganda.
⁴ Department of Surgery, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
⁵ ENT Department, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
⁶ Division of Otolaryngology, Hôpital de la Paix, Universite Assane Seck, Ziguinchor, Senegal.
⁷ Korle Bu Teaching Hospital, Accra, Ghana.
⁸ University of Ibadan/University College Hospital, Ibadan, Nigeria.
⁹ The Aga Khan Hospital, Dar es Salaam, Tanzania.
¹⁰ College of Medicine, Blantyre, Malawi.
¹¹ Muhimbili National Hospital, Dar Es Salaam, Tanzania.
¹² Harare, Zimbabwe.
¹³ AIC Kijabe Hospital, Kenya.
¹⁴ National Ear Care Centre Kaduna Nigeria, Kaduna, Nigeria.
¹⁵ Bahir dar University, Ethiopia.
¹⁶ Adama General Hospital, Adam, Ethiopia.
¹⁷ Oshakati, Namibia and Libya.
¹⁸ Lutheran Hospital Salfa Sambava, Madagascar.
¹⁹ Hawassa University Referral Hospital, Hawassa, Ethiopia.
²⁰ Program in Global Surgery and Social Change, Harvard Medical School and Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.

Abstract

By 2030, 70% of cancers will occur in developing countries. Head and neck cancers are primarily a developing world disease. While anatomical location and the extent of cancers are central to defining prognosis and staging, the American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) have incorporated nonanatomic factors that correlate with prognosis into staging (eg, p16 status of oropharyngeal cancers). However, 16 of 17 head and neck surgeons from 13 African countries cannot routinely test for p16 status and hence can no longer apply AJCC/UICC staging to oropharyngeal cancer. While the AJCC/UICC should continue to refine staging that best reflects treatment outcomes and prognosis by incorporating new nonanatomical factors, they should also retain and refine anatomically based staging to serve the needs of clinicians and their patients in resource-constrained settings. Not to do so would diminish their global relevance and in so doing also disadvantage most of the world's cancer patients.

Keywords: UICC/AJCC; cancer; developing countries; head and neck; oropharyngeal; p16; staging.