A comparison of oesophageal cancer between the public and private sectors in KwaZulu-Natal

  • Augustin Lutakwa University of KwaZulu-Natal
  • Emil Loots
  • Eleez Loots
  • Michelle Smith University of KwaZulu-Natal
  • Damian Luiz Clarke University of KwaZulu-Natal
Keywords: oesophageal cancer, public and private sectors, comparison, KwaZulu-Natal

Abstract

Background: The frequency of the occurrence and type of oesophageal cancer from pathology laboratory data from the private and public sector has never been compared in KwaZulu-Natal (KZN). This study aims to compare data from the public and private pathology services in the province.

Methods: All the malignant and pre-malignant oesophageal biopsies at the academic department of histopathology and at three private laboratories in the KZN were retrieved for comparison.

Results: Between January 2012 and December 2014, there were a total of 1087 new diagnoses of an oesophageal malignancy or pre-malignant diagnosis. There were 613 specimens from the private laboratories in KZN and 474 from IALCH. The sex distribution was (41%) females and (59%) males. In the private sector, the mean age was 61.6 years and in the public sector it was 62.7 years. (Range 18–75 years) Africans comprised 63% of the total, Whites 28% and Indians 7%. In the public sector 89.5 % of patients were African whereas in the private sector, Africans comprised 45.7% and Whites made up 46% of the total. Eighty-eight per cent of biopsy specimens were malignant lesions of which 68% were squamous carcinoma. Squamous carcinomas accounted for 87.5% and 54% of all lesions in the public and private sectors respectively. Pre-malignant lesions accounted for 5% and 23% of diagnoses in the public and private sectors respectively. Pre-malignant lesions in the public sector showed mainly dysplastic squamous cell dysplasia whereas dysplastic Barrett’s oesophagus lesions accounted for the majority in the private sector.

Conclusion: Oesophageal cancer is a major public health problem in KZN. Although squamous carcinoma predominates, adenocarcinoma is a significant problem in the White population. It would appear that surveillance for oesophageal adenocarcinoma is taking place in the private sector albeit in a non-systematic or coordinated fashion. This does not appear to be the case in the state sector.

Author Biographies

Augustin Lutakwa, University of KwaZulu-Natal

Department of Specialized Surgery, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal

Emil Loots

Private Practice, Entabeni Hospital Durban

Eleez Loots

Private Practice, Entabeni Hospital Durban

Michelle Smith, University of KwaZulu-Natal

Department of Surgery, Pietermaritzburg Hospital Complex, Pietermaritzburg, University of KwaZulu-Natal

Damian Luiz Clarke, University of KwaZulu-Natal

Department of Surgery, Pietermaritzburg Hospital Complex, Pietermaritzburg, University of KwaZulu-Natal and  Department of Surgery, University of the Witwatersrand, Johannesburg

Published
2019-05-14
How to Cite
Lutakwa, A., Loots, E., Loots, E., Smith, M., & Clarke, D. (2019). A comparison of oesophageal cancer between the public and private sectors in KwaZulu-Natal. South African Journal of Surgery, 57(2), 16-19. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2871
Section
General Surgery