{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:05:31Z","timestamp":1790888731587,"version":"4.1.0"},"reference-count":33,"publisher":"BMJ","issue":"2","funder":[{"name":"Fight for Sight","award":["1956A"],"award-info":[{"award-number":["1956A"]}]},{"name":"UCL","award":["Overseas Research Scholarship"],"award-info":[{"award-number":["Overseas Research Scholarship"]}]},{"name":"The Desmond Foundation","award":["Unrestricted"],"award-info":[{"award-number":["Unrestricted"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>To describe the incidence and epidemiology of conjunctival squamous cell carcinoma (CSCC) in South Africa over a 25-year period (1994\u20132018), with particular reference to the HIV epidemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Incident cases of histologically diagnosed CSCC were identified from the pathology-based South African National Cancer Registry. Crude and direct age-standardised incidence rates (ASIRs) per 100 000 persons (Segi World Standard Population) were calculated using national population statistics and compared by age, sex and ethnicity. Trends in the incidence and demographic features of CSCC were described and analysed. Incidence rates were compared with national HIV-related statistics for the same time period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, there were 9016 reported CSCC cases (women: 56.6%, black: 86.8%, mean age: 41.5 years). The overall ASIR was 0.78 per 100 000. Two distinct epidemiological patterns were identified: (1) older white men, and (2) younger black women. There was a sixfold increase in CSCC incidence rates between 1994 and 2009 with a corresponding shift from the first to the second disease profile. Despite rising HIV seroprevalence, CSCC incidence rates have declined since 2009. A strong ecological correlation (<jats:italic>r<\/jats:italic>=0.96) between CSCC incidence and widespread antiretroviral therapy (ART) provision was identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study highlights the evolving trends and disease burden of CSCC in South Africa. Widespread ART provision is ecologically correlated with declining CSCC rates over the last decade. These findings are in keeping with reported trends for other HIV-related cancers and have important implications for future incidence studies and public health policy.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjo-2022-322456","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T18:20:14Z","timestamp":1671042014000},"page":"175-180","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Incidence and epidemiology of conjunctival squamous cell carcinoma in relation to the HIV epidemic in South Africa: a 25-year analysis of the National Cancer Registry (1994\u20132018)"],"prefix":"10.1136","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7353-8774","authenticated-orcid":false,"given":"Kelsey Vernon","family":"Stuart","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel John","family":"Shepherd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Lombard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4375-2224","authenticated-orcid":false,"given":"Roland","family":"Hollhumer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazvita","family":"Muchengeti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,14]]},"reference":[{"key":"2024012903300910000_108.2.175.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2004.02.013"},{"key":"2024012903300910000_108.2.175.2","first-page":"109","article-title":"Conjunctival Tumors: Review of Clinical Features, Risks, Biomarkers, and Outcomes--The 2017 J. Donald M. Gass Lecture","volume":"6","author":"Shields","year":"2017","journal-title":"Asia Pac J Ophthalmol"},{"key":"2024012903300910000_108.2.175.3","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12203"},{"key":"2024012903300910000_108.2.175.4","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1038\/bjc.2013.539","article-title":"HIV and HPV infections and ocular surface squamous neoplasia: systematic review and meta-analysis","volume":"109","author":"Carreira","year":"2013","journal-title":"Br J Cancer"},{"key":"2024012903300910000_108.2.175.5","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2014.79"},{"key":"2024012903300910000_108.2.175.6","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s40123-018-0140-z","article-title":"Clinical management of ocular surface squamous neoplasia: a review of the current evidence","volume":"7","author":"Cicinelli","year":"2018","journal-title":"Ophthalmol Ther"},{"key":"2024012903300910000_108.2.175.7","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1038\/s41433-021-01422-3","article-title":"Ocular surface squamous neoplasia: management and outcomes","volume":"35","author":"H\u04e7llhumer","year":"2021","journal-title":"Eye"},{"key":"2024012903300910000_108.2.175.8","unstructured":"United Nations Statistics Division . UN Data: South Africa [Internet], 2022. Available: https:\/\/data.un.org\/en\/iso\/za.html [Accessed 20 Jul 2022]."},{"key":"2024012903300910000_108.2.175.9","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00162-X"},{"key":"2024012903300910000_108.2.175.10","doi-asserted-by":"crossref","first-page":"S213","DOI":"10.1097\/QAD.0000000000002355","article-title":"Global, regional and country-level 90-90-90 estimates for 2018: assessing progress towards the 2020 target","volume":"33 Suppl 3","author":"Marsh","year":"2019","journal-title":"AIDS"},{"key":"2024012903300910000_108.2.175.11","doi-asserted-by":"crossref","first-page":"107","DOI":"10.7196\/SAMJ.8858","article-title":"South African National Cancer Registry: effect of withheld data from private health systems on cancer incidence estimates","volume":"105","author":"Singh","year":"2015","journal-title":"S Afr Med J"},{"key":"2024012903300910000_108.2.175.12","unstructured":"Jensen OM , Parkin DM , MacLennan CS , et al . Cancer registration: principles and methods. Lyon, France: International Agency for Research on Cancer, 1991."},{"key":"2024012903300910000_108.2.175.13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002468"},{"key":"2024012903300910000_108.2.175.14","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.canep.2019.06.007","article-title":"The burden of squamous cell carcinoma of the conjunctiva in Africa","volume":"61","author":"H\u00e4mmerl","year":"2019","journal-title":"Cancer Epidemiol"},{"key":"2024012903300910000_108.2.175.15","unstructured":"Boniol M , Heanue M . Chapter 7: Age-standardisation and denominators. In: Curado MP , Edwards B , Shin HR , et al , eds. Cancer incidence in five continents. Lyon, France: International Agency for Research on Cancer, 2007: 99\u2013102."},{"key":"2024012903300910000_108.2.175.16","unstructured":"Segi M . Cancer mortality for selected sites in 24 countries (1950\u201357). Sendai, Japan: Department of Public Health, Tohoku University School of Medicine, 1960."},{"key":"2024012903300910000_108.2.175.17","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-15-0578"},{"key":"2024012903300910000_108.2.175.18","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z"},{"key":"2024012903300910000_108.2.175.19","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/j.1442-9071.1997.tb01514.x","article-title":"Retrospective study of ocular surface squamous neoplasia","volume":"25","author":"Lee","year":"1997","journal-title":"Aust N Z J Ophthalmol"},{"key":"2024012903300910000_108.2.175.20","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.83.1.98"},{"key":"2024012903300910000_108.2.175.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)91685-2"},{"key":"2024012903300910000_108.2.175.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)90870-6"},{"key":"2024012903300910000_108.2.175.23","first-page":"28","article-title":"A historical perspective of registered cases of malignant ocular tumors in Zimbabwe (1990 to 1999). Is HIV infection a factor?","volume":"54","author":"Masanganise","year":"2010","journal-title":"Cent Afr J Med"},{"key":"2024012903300910000_108.2.175.24","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.1016\/j.ophtha.2009.09.031","article-title":"Demographics, etiology, and behavior of conjunctival squamous cell carcinoma in the 21st century","volume":"116","author":"Karcioglu","year":"2009","journal-title":"Ophthalmology"},{"key":"2024012903300910000_108.2.175.25","doi-asserted-by":"publisher","DOI":"10.1097\/00003226-200301000-00001"},{"key":"2024012903300910000_108.2.175.26","doi-asserted-by":"crossref","first-page":"45","DOI":"10.4314\/gmj.v45i2.68927","article-title":"Review of orbital exenterations in Korle-Bu teaching hospital","volume":"45","author":"Ackuaku-Dogbe","year":"2011","journal-title":"Ghana Med J"},{"key":"2024012903300910000_108.2.175.27","first-page":"196","article-title":"Orbital exenterations and squamous cell carcinoma of the conjunctiva at Sekuru Kaguvi Eye Unit, Zimbabwe","volume":"47","author":"Masanganise","year":"2001","journal-title":"Cent Afr J Med"},{"key":"2024012903300910000_108.2.175.28","unstructured":"UNAIDS . Country factsheet, South Africa [Internet], 2018. Available: https:\/\/www.unaids.org\/en\/regionscountries\/countries\/southafrica [Accessed 06 Jun 2022]."},{"key":"2024012903300910000_108.2.175.29","doi-asserted-by":"crossref","unstructured":"Meyer-Rath G , Johnson LF , Pillay Y , et al . Changing the South African national antiretroviral therapy guidelines: the role of cost modelling. PLoS One 2017;12:e0186557.doi:10.1371\/journal.pone.0186557","DOI":"10.1371\/journal.pone.0186557"},{"key":"2024012903300910000_108.2.175.30","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ijid.2020.10.020","article-title":"The impact of the South African antiretroviral treatment programme on the age-standardised incidence rate of Kaposi sarcoma, 1999-2016: an interrupted time series analysis","volume":"102","author":"Majaya","year":"2021","journal-title":"Int J Infect Dis"},{"key":"2024012903300910000_108.2.175.31","doi-asserted-by":"crossref","first-page":"87","DOI":"10.7326\/M16-2094","article-title":"Association of viral suppression with lower AIDS-defining and non-AIDS-defining cancer incidence in HIV-infected veterans: a prospective cohort study","volume":"169","author":"Park","year":"2018","journal-title":"Ann Intern Med"},{"key":"2024012903300910000_108.2.175.32","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1080\/09286586.2021.2013900","article-title":"The incidence of retinoblastoma in South Africa: findings from the South African National Cancer Registry (2004-2018)","volume":"29","author":"Stuart","year":"2022","journal-title":"Ophthalmic Epidemiol"},{"key":"2024012903300910000_108.2.175.33","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-053460"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2022-322456","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T11:34:17Z","timestamp":1706528057000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2022-322456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,14]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1,29]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/bjo-2022-322456"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2022-322456","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,14]]}}}