Comparison of early-onset and later-onset cervical cancer clinical characteristics and trends in Eswatini.
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INTRODUCTION: Eswatini has the highest cervical cancer incidence and mortality rates globally. We conducted the first analysis of cervical cancer characteristics and trends by age at diagnosis in Eswatini, to inform surveillance strategies to reduce the country's high mortality burden from cervical cancer. METHODS: We studied women diagnosed with invasive primary cervical cancer from 2016 to 2022 in the Eswatini National Cancer Registry (N = 2099). Cancer stage, histological type, and HIV status distributions were examined by age at cervical cancer diagnosis (15-39, 40-49, and ≥50 years). Log-linear regression was used to obtain the annual percent change values for the cervical cancer proportion trends by age and stage at diagnosis. RESULTS: The mean age at cervical cancer diagnosis was 49.0 years. Histological type distributions significantly differed by age at cervical cancer diagnosis (p < 0.001), with adenocarcinoma being more common in later-onset patients diagnosed at age ≥ 50 years than in early-onset patients diagnosed at age 15-39 years or 40-49 years. For cervical cancer patients diagnosed at age 15-39 or ≥ 50 years, those with HIV had a higher proportion of metastatic cancer. From 2016-2022, the proportion of advanced-stage cervical cancer significantly declined for all study participants, whereas the proportion of early-stage cervical cancer significantly increased for those diagnosed at age 40-49 or ≥ 50 years. CONCLUSION: Despite the declining proportion of advanced-stage cervical cancer for both early-onset and later-onset patients in Eswatini, HIV-positive patients were more commonly diagnosed with metastatic cancer. Attention is warranted to decrease metastatic cancer diagnoses in HIV-positive women.