RESUMEN
BACKGROUND: Lymphomas are a relatively common complication of AIDS in western countries, but little is known of the impact of the AIDS epidemic in Africa on the risk of these tumours. OBJECTIVE: To investigate the types of non-Hodgkin lymphoma (NHL) occurring in Kampala, Uganda, their association with Epstein-Barr virus (EBV), and how their risk is modified by HIV and other variables. METHODS: A case-control study comparing NHL cases with age/sex-matched controls. Lymphoma cases included 50 histologically diagnosed adults (31 with validation and phenotyping) and 132 histologically diagnosed children (61 with validation and phenotyping). Controls were adults with cancers unrelated to HIV and children with non-infectious diseases. RESULTS: Most (90%) childhood lymphomas were EBV-positive Burkitt's lymphoma (BL), with no association with HIV. Adult lymphoma cases were mainly BL (mostly EBV positive) or diffuse B cell lymphomas (71%). Only a weak association was found with HIV infection; a more precise estimate was obtained with the total series (OR 2.2, 95% CI 0.9-5.1) than validated/phenotyped cases (OR 2.1, 95% CI 0.3-6.7). Higher socioeconomic status adults, who travelled away from home, or had a history of sexually transmitted diseases, appeared to have a moderately increased risk of lymphoma. CONCLUSION: Childhood lymphomas were predominantly endemic BL, the risk of which was not modified by HIV. In adults, the risk associated with HIV was much lower in Uganda than in western countries, possibly because of the poor survival of immunosuppressed HIV-positive individuals. Future studies will require careful attention to subtyping of lymphomas, to investigate the possible differences between them.
Asunto(s)
Infecciones por VIH/epidemiología , Linfoma Relacionado con SIDA/epidemiología , Linfoma no Hodgkin/epidemiología , Adolescente , Adulto , Linfoma de Burkitt/epidemiología , Linfoma de Burkitt/inmunología , Linfoma de Burkitt/patología , Estudios de Casos y Controles , Niño , Femenino , Herpesvirus Humano 4 , Humanos , Linfoma Relacionado con SIDA/inmunología , Linfoma Relacionado con SIDA/patología , Linfoma no Hodgkin/inmunología , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Uganda/epidemiologíaRESUMEN
A telephone questionnaire on primary prevention and cancer screening practices of general practitioners in the Rhône was administered to a sample of 191 general practitioners, 129 of which had been randomly sampled. Questions concerned primary prevention (tobacco, alcohol, diet, exposure to sunlight, occupation) and cancer screening (uterine cervix, breast, colo-rectum, prostate, other cancers). In addition, physicians were also interviewed on difficulties encountered in their practice, and about their initial and further medical training in this field. The response rate was high (85%). According to doctors' responses, smoking prevention is the best defined primary prevention strategy, unlike alcohol prevention and advice on diet with which physicians seem to have more difficulty. We noted a great diversity for screening, even for cancers for which a consensus on screening exists (uterine cervix, breast). For cancers of the colon and prostate, the interviewed physicians report screening on a wide scale but in many different ways. Analysis of the factors explaining these variations and non-compliance with existing recommendations seems to be necessary as well as studies comparing in this specific field our results with the actual practices of doctors. This will allow the implementation of well organised, well targeted and efficient primary prevention and screening in which the role of the general practitioner is clearly defined.