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
Affiliations
Johannes J. Fagan MBChB, MMed, FCS
Division of Otolaryngology, University of Cape Town, South Africa
Julie Wetter MBChB, MMed, FCRadOnc
Department Radiation Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
Jeffrey Otiti MBCHB, MMed
Uganda Cancer Institute, Kampala, Uganda
Joyce Aswani MBChB, MMed
Department of Surgery, College of Health Sciences, University of Nairobi, Nairobi, Kenya
Anna Konney MD, FWACS, FGCPS
ENT Department, Komfo Anokye Teaching Hospital, Kumasi, Ghana
Evelyne Diom
Division of Otolaryngology, Hôpital de la Paix, Universite Assane Seck, Ziguinchor, Senegal
Kenneth Baidoo MD, FWACS, FGCS
Korle Bu Teaching Hospital, Accra, Ghana
Paul Onakoya MBBS
University of Ibadan/University College Hospital, Ibadan, Nigeria
Rajab Mugabo MMed
The Aga Khan Hospital, Dar es Salaam, Tanzania
Patrick Noah MBBS, FCS
College of Medicine, Blantyre, Malawi
Victor Mashamba MD, MMed
Muhimbili National Hospital, Dar Es Salaam, Tanzania
Innocent Kundiona MBChB, MMed
Harare, Zimbabwe
Chege Macharia MBChB, FCS
AIC Kijabe Hospital, Kenya
Mohammed Garba Mainasara MBBS, PGDM, FWACS
National Ear Care Centre Kaduna Nigeria, Kaduna, Nigeria
Melesse Gebeyehu MD
Bahir dar University, Ethiopia
Mesele Bogale MD
Adama General Hospital, Adam, Ethiopia
Khaled Twier MMed, FCS
Oshakati, Namibia and Libya
Marco Faniriko MD, FCS
Lutheran Hospital Salfa Sambava, Madagascar
Getachew Beza Melesse MD
Hawassa University Referral Hospital, Hawassa, Ethiopia
Mark G. Shrime MD, PhD, MPH
Program in Global Surgery and Social Change, Harvard Medical School and Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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.
