A. Luwaga’s research while affiliated with Mulago Hospital and other places

The objective was to investigate survival of breast cancer patients at Mulago Hospital. A retrospective study of the medical records of 297 breast cancer patients referred to the combined breast clinic housed in the radiotherapy department between 1996 and 2000 was done. The female/male ratio was 24 : 1. The age range was 22-85 years, with a median of 45 years and peak age group of 30-39 years. Twenty-three percent had early disease (stages 0-IIb) and 26% had metastatic disease. Poorly differentiated was the most common pathological grade (58%) followed by moderately differentiated (33%) and well-differentiated (9%) tumours. The commonest pathological type encountered was 'not otherwise specified' (76%). Of all patients, 75% had surgery, 76% had radiotherapy, 60% had hormonotherapy and 29% had chemotherapy. Thirty-six (12%) patients received all the four treatment modalities. The 5-year survival probabilities (Kaplan-Meier) for early disease were 74 and 39% for advanced disease (P=0.001). The overall 5-year survival was 56%, which is lower than the rates in the South African blacks (64%) and North American whites (82-88%).

Clinical specialties: General surgery, oncology, radiation oncology, internal medicine, palliation medicine, obstetrics and gynaeclology, family practice, radiologist, pathologist. Intended users: Doctors, nurses, clinical officers, allied health personnel, students, and patients. African Health Sciences 2008; 8(2): 126-132

Cancer of the cervix (Ca Cx) is the commonest gynecological malignancy among women in Uganda contributing about 80% of all female malignancies. The incidence rate is 40:100 000. It is the leading cause of cancer related deaths in females in Uganda. Unfortunately 80% of the patients present late and this makes treatment outcomes unsatisfactory. Most patients can only be treated palliatively. It is therefore important that the disease be detected in early stages so as to improve outcome.

The survival experience of 261 patients with cancer of the cervix registered by the Kampala population-based cancer registry, Uganda, in 1995-1997, is described. Vital status of the subjects was established by active methods including a search of hospital records and house visits. Of the 261 cases, 82 (31.4%) were dead and 105 (40.2%) were alive at the closing date of 31 December 1999; the remaining 74 cases (28.4%) were lost during the follow-up period. Overall observed and relative survival at 3 years was 52.4 and 59.9%, respectively. Of these cases, one-quarter (63) had been treated in the radiotherapy department. These cases had better survival (82.6%) than nontreated patients (78.5%) after 1 year of follow-up, but there was no difference at 3 years. HIV status was not significantly related to prognosis. Stage is an important determinant of survival: cases with distant metastasis had a risk of death some three times that of patients with localised disease. Early detection and prompt treatment should improve overall survival from cervix cancer, in the African context.

In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The incidence of cancer of stomach is 5.6/100,000 from 0.8/100,000 in the 1960s a seven fold increase.The purpose of this guideline document is to highlight the salient points in gastric cancer diagnosis and treatment in the Ugandan context. It doesn’t only outline what is practical and efficacious but also our aspirations of practice as resources committed to the whole area of Oncological care services improve in the country. The primary and secondary prevention strategies are outlined. The multistage process of gastric oncogenesis is discussed in relation to the scientific basis of diagnostic and screening procedures. The treatment modalities including surgery radiotherapy and chemotherapy are discussed. A prognostication scale is included. Traditionally gastric cancer presents late and with a poor prognosis. The greatest strategy we have for management is in primary and secondary prevention. However a better understanding of how it arises (risk factors) will be important in informing prevention and treatment strategies. The Uganda cancer-working group intends that this information is disseminated to wider readership in the region as part of the strategy of improving Oncological care service in the region.