Cancer
Determinants of Survival in Cervical Cancer: The Critical Role of Early Detection and Treatment in Resource-Limited Settings Citlalli Lopez* Citlalli Lopez Sithembiso S. Msibi Joseph L. Su
Eswatini has one of the highest prevalence rates of HIV at 25.9% and only recently implemented an HPV vaccine in 2023.1 The country also reported the highest incidence and mortality rates of cervical cancer in 2021, estimated at 84.5 and 55.7 per 100,000 female population, respectively. 2 This study aimed to examine the impact of clinical and demographic factors on cervical cancer survival outcomes. The Eswatini Cancer Registry was screened for participants from 2016-2024, yielding a total of 2,210 cervical cancer patients, of whom 561 deaths were analyzed using the Cox proportional hazards model. The primary analysis assessed the association between cancer stage at diagnosis and survival, adjusting for potential confounders (age, smoking status, HIV status, treatment, and basis of diagnosis). The models were stratified by Stage at diagnosis and Basis of diagnosis to uphold proportional hazards assumptions. Interaction terms were introduced to evaluate whether the effect of treatment and cancer stage on survival varied by HIV status. Advanced cancer stages (Stages 3 and 4) were significantly associated with increased hazard of death, with diagnosis at Stage 4 lowering the chance of survival by approximately 4.4-fold compared to Stage 1, highlighting the importance for early detection and screening. Treatments (chemotherapy, radiation, surgery) reduced the hazard of death by 17% (HR: 0.83, 95% CI: 0.68-0.99, p <0.001). Interaction analysis revealed no statistically significant difference in treatment or cancer stage effects by HIV status. However, we observed a marginally significant lower risk of death for HIV-positive patients diagnosed at Stage 1 (HR = 0.24, 95% CI: 0.06-1.24, p = 0.05), likely due to increased clinical attention. Despite the uncertainty of this confidence interval, it warrants further investigation. Our findings confirm that diagnosis at advanced cancer stages significantly worsens survival outcomes, underscoring the importance of screening, early detection, and access to effective treatment options for patients.