Background/Purpose Stage at diagnosis is an important metric in
treatment and prognosis of cancer, and also in planning and evaluation
of cancer control. In sub-Saharan Africa (SSA), for the latter, the only
data source is the population-based cancer registry (PBCR). For
childhood cancers, the “Toronto Staging Guidelines” have been
developed to facilitate abstraction of stage by cancer registry
personnel. Although the feasibility of staging using this system has
been shown, there is limited information on the accuracy of staging.
Methods A panel of case records of 6 common childhood cancers
was established. 51 cancer registrars from 20 SSA countries staged these
records, using Tier 1 of the Toronto guidelines. The stage that they
assigned was compared with that decided by two expert clinicians.
Results The registrars assigned the correct stage for 53-83%
of cases (71% overall), with the lowest values for acute lymphocytic
leukaemia (ALL), retinoblastoma and non Hodgkin lymphoma (NHL), and the
highest for osteosarcoma (81%) and Wilms tumour (83%). For ALL and
NHL, many unstageable cases were mis-staged, probably due to confusion
over the rules for dealing with missing data; for the cases with
adequate information, accuracy was 72-73%. Some confusion was observed
over the precise definition of three stage levels of retinoblastomas.
Conclusions A single training in staging resulted in an
accuracy, for solid tumours, that was not much inferior to what has been
observed in high income settings. Nevertheless, some lessons were
learned on how to improve both the guidelines, and the training course.