ABSTRACT
Aim.Review the literature from 1990 to 2013 to determine known anatomic sites; risk factors; treatments; and outcomes of head and neck squamous cell carcinoma (HNSCC) in sub-Saharan Africa.Methods.Using a systematic search strategy; literature pertaining to HNSCC in sub-Saharan Africa was reviewed and patient demographics; anatomic sites; histology; stage; treatment; and outcomes were abstracted. The contributions of human immunodeficiency virus (HIV); human papillomavirus (HPV) and behavioural risk factors to HNSCC in the region were assessed. Results of the 342 papers identified; 46 were utilized for review; including 8611 patients. In sub-Saharan Africa; the oropharyngeal/oral cavity was found to be the most common site; with 7750 cases (90% of all cases). Few papers distinguished oropharyngeal from oral cavity; making identification of possible HPV-associated oropharyngeal squamous cell carcinoma (SCC) difficult. SCC of the nasopharynx; nasal cavity; or paranasal sinuses was identified in 410 patients (4.8% of all cases). Laryngeal SCC was found in 385 patients (4.5% of all cases); and only 66 patients (0.8% of all cases) with hypopharyngeal SCC were identified. In 862 patients with data available; 43% used tobacco and 42% used alcohol; and reported use varied widely and was more common in laryngeal SCC than that of the oropharyngeal/oral cavity. Toombak and kola nut use was reported to be higher in patients with HNSCC. Several papers reported HIV-positive patients with HNSCC; but it was not possible to determine HNSCC prevalence in HIV-positive compared to negative patients. Reports of treatment and outcomes were rare.Conclusions The oropharyngeal/oral cavity was by far the most commonly reported site of HNSCC reported in sub-Saharan Africa. The roles of risk factors in HNSCC incidence in sub-Saharan Africa were difficult to delineate from the available studies; but a majority of patients did not use tobacco and alcohol