OTO Open (Jul 2020)

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

  • Johannes J. Fagan MBChB, MMed, FCS,
  • Julie Wetter MBChB, MMed, FCRadOnc,
  • Jeffrey Otiti MBCHB, MMed,
  • Joyce Aswani MBChB, MMed,
  • Anna Konney MD, FWACS, FGCPS,
  • Evelyne Diom,
  • Kenneth Baidoo MD, FWACS, FGCS,
  • Paul Onakoya MBBS,
  • Rajab Mugabo MMed,
  • Patrick Noah MBBS, FCS,
  • Victor Mashamba MD, MMed,
  • Innocent Kundiona MBChB, MMed,
  • Chege Macharia MBChB, FCS,
  • Mohammed Garba Mainasara MBBS, PGDM, FWACS,
  • Melesse Gebeyehu MD,
  • Mesele Bogale MD,
  • Khaled Twier MMed, FCS,
  • Marco Faniriko MD, FCS,
  • Getachew Beza Melesse MD,
  • Mark G. Shrime MD, PhD, MPH

DOI
https://doi.org/10.1177/2473974X20938313
Journal volume & issue
Vol. 4

Abstract

Read online

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.