Cervical cancer: survival and associated prognostic factors in the western province of Sri Lanka

Cervical cancer is the second commonest cancer among Sri Lankan females. Countrywide Pap smear screening programme was introduced in Sri Lanka in 1996. The present study determines the survival probabilities of cervical cancer patients diagnosed in 2008 in the Western Province of Sri Lanka and the associated prognostic factors. Details of the cervical cancer patients of the Western Province diagnosed in 2008 were obtained from hospital-based cancer registry. All 177 records were traced, and patients were followed up in the community to assess survival status at five years and associated prognostic factors. Observed survival rates at years one, three and five were calculated using Kaplan Meier product limit method. Covariates found to be potentially important prognostic variables with probability of 0.2 in log rank test were included in multivariate analysis using Cox proportional hazards model. Among 177 patients, mean ± SD (in years) for age was 56.3 ± 12.4 and 41 (23.1 %) had died within the five-year period. A majority 70 (56.0 %) were in stage III A and B. Overall one-, three- and five-year survival rates were 86 %, 70.0 % and 62.5 %, respectively. District, clinical stage, and undergoing surgery were statistically significant factors in univariate analysis (p<0.05). Only clinical stage was found to be significant in multiple Cox regression analysis (p<0.05). Women in stage III and IV were 3.5 times more likely to die compared to those in stage I and II at diagnosis. The study concludes that in Sri Lanka, five-year cervical cancer survival rate of 62.5 % among patients is slightly higher in comparison to other developing countries. A majority have been diagnosed at III A or III B stages and strengthening of preventive strategies is recommended.