1
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Chapman H, Ntemi PS, Gisiri M, Vasudevan L, Kashaigili HJ, Schroeder K. Retrospective analysis of pediatric patients with Burkitt lymphoma treated in Tanzania following the implementation of the 2016 National Treatment Guidelines: Poor outcomes to current standard-of-care therapy. Pediatr Blood Cancer 2024; 71:e31145. [PMID: 38924656 DOI: 10.1002/pbc.31145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/06/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Despite the excellent outcomes achieved in the treatment of pediatric Burkitt lymphoma (BL) in high-income countries (HICs), outcomes remain poor in low- and middle-income countries (LMICs). Efforts to improve BL outcomes in Tanzania included the creation of National Treatment Guidelines in 2016. However, disease outcomes in Tanzania following the creation of these guidelines have not been reported to date. PROCEDURE Historical records from 2016 to 2021 for patients 0-18 years of age with a diagnosis of BL and seen at Bugando Medical Centre (BMC), in Mwanza, Tanzania, were curated into an electronic database and analyzed descriptively. Patients in this cohort were treated per the Tanzanian National Treatment Guidelines, which include six cycles of cyclophosphamide, vincristine, and methotrexate (COM) chemotherapy with intrathecal methotrexate and cytarabine. RESULTS In total, 92 BL patients' records were eligible for analysis. Patients in this cohort were most commonly Murphy stage II (28%) or stage III (34%). Nearly all, 91%, met International Network for Cancer Treatment and Research (INCTR) high-risk criteria at presentation. Forty-two percent of patients did not receive a biopsy and were treated with a presumed diagnosis of BL alone. A 1-year event-free survival of 29.6% (95% confidence interval [CI]: 20.3%-39.5%) and a 1-year overall survival of 38.5% (95% CI: 28%-48.9%) were observed. A high rate of treatment abandonment (34%) was also observed. CONCLUSION In a historical cohort of pediatric patients with BL treated per the 2016 Tanzanian National Treatment Guidelines, we observed poor outcomes and a high rate of abandonment. These outcomes appear inferior to those achieved in the INCTR clinical trial that informed the guidelines' creation, and highlights the importance of "real-world" outcomes data in LMICs. These data reinforce the idea that continued clinical research and capacity building efforts are necessary to improve BL outcomes in LMICs.
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Affiliation(s)
- Hutton Chapman
- Duke University Hospital, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | | | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, North Carolina, USA
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Heronima J Kashaigili
- Bugando Medical Centre, Mwanza, Tanzania
- Catholic University of Allied and Health Sciences, Mwanza, Tanzania
| | - Kristin Schroeder
- Duke University Hospital, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
- Bugando Medical Centre, Mwanza, Tanzania
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2
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van Wyk AC, Lal P, Ogunbiyi JO, Kyokunda L, Hobenu F, Dial C, Jalloh M, Gyasi R, Oluwole OP, Abrahams AD, Botha AR, Mtshali NZ, Andrews C, Mante S, Adusei B, Gueye SM, Mensah JE, Adjei AA, Tettey Y, Adebiyi A, Aisuodionoe-Shadrach O, Eniola SB, Serna A, Yamoah K, Chen WC, Fernandez P, Robinson BD, Mosquera JM, Hsing AW, Agalliu I, Rebbeck TR. Multinational, Multicenter Evaluation of Prostate Cancer Tissue in Sub-Saharan Africa: Challenges and Opportunities. JCO Glob Oncol 2024; 10:e2300403. [PMID: 38870437 PMCID: PMC11191871 DOI: 10.1200/go.23.00403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/08/2024] [Accepted: 04/16/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE Prostate cancer disproportionately affects men of African descent, yet their representation in tissue-based studies is limited. This multinational, multicenter pilot study aims to establish the groundwork for collaborative research on prostate cancer in sub-Saharan Africa. METHODS The Men of African Descent and Carcinoma of the Prostate network formed a pathologist working group representing eight institutions in five African countries. Formalin-fixed paraffin-embedded prostate tissue specimens were collected from Senegal, Nigeria, and Ghana. Histology slides were produced and digitally scanned. A central genitourinary pathologist (P.L.) and eight African general pathologists reviewed anonymized digital whole-slide images for International Society of Urological Pathology grade groups and other pathologic parameters. Discrepancies were re-evaluated, and consensus grading was assigned. A virtual training seminar on prostate cancer grading was followed by a second assessment on a subcohort of the same tissue set. RESULTS Of 134 tissue blocks, 133 had evaluable tissue; 13 lacked cancer evidence, and four were of insufficient quality. Post-training, interobserver agreement for grade groups improved to 56%, with a median Cohen's quadratic weighted kappa of 0.83 (mean, 0.74), compared with an initial 46% agreement and a quadratic weighted kappa of 0.77. Interobserver agreement between African pathologist groups was 40%, with a quadratic weighted kappa of 0.66 (95% CI, 0.51 to 0.76). African pathologists tended to overgrade (36%) more frequently than undergrade (18%) compared with the reference genitourinary pathologist. Interobserver variability tended to worsen with a decrease in tissue quality. CONCLUSION Tissue-based studies on prostate cancer in men of African descent are essential for a better understanding of this common disease. Standardized tissue handling protocols are crucial to ensure good tissue quality and data. The use of digital slide imaging can enhance collaboration among pathologists in multinational, multicenter studies.
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Affiliation(s)
- Abraham C. van Wyk
- Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Priti Lal
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Cherif Dial
- Hôpital Général Idrissa Pouye, Dakar, Sénégal
| | - Mohamed Jalloh
- Hôpital Général Idrissa Pouye, Dakar, Sénégal
- Ecole Doctorale Universite Iba Der Thiam, Thiés, Sénégal
| | | | - Olabode P. Oluwole
- University of Abuja, Abuja, Nigeria
- Cancer Science Centre, Abuja and University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | - Adam R. Botha
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | - Nompumelelo Zamokuhle Mtshali
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
| | | | | | | | | | | | | | - Yao Tettey
- Korle-Bu Teaching Hospital, Accra, Ghana
| | - Akin Adebiyi
- University College Hospital/University of Ibadan, Ibadan, Nigeria
| | - Oseremen Aisuodionoe-Shadrach
- University of Abuja, Abuja, Nigeria
- Cancer Science Centre, Abuja and University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Sefiu Bolarinwa Eniola
- University of Abuja, Abuja, Nigeria
- Cancer Science Centre, Abuja and University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Amparo Serna
- Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Kosj Yamoah
- Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Wenlong Carl Chen
- National Cancer Registry, National Institute for Communicable Diseases a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pedro Fernandez
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | - Ann W. Hsing
- Stanford Cancer Institute, Stanford School of Medicine, Palo Alto, CA
- Stanford Prevention Research Center, Stanford School of Medicine, Palo Alto, CA
| | - Ilir Agalliu
- Albert Einstein College of Medicine, New York, NY
| | - Timothy R. Rebbeck
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg, South Africa
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Ngabonziza E, Ghebre R, DeBoer RJ, Ntasumbumuyange D, Magriples U, George J, Grover S, Bazzett-Matabele L. Outcomes of neoadjuvant chemotherapy and radical hysterectomy for locally advanced cervical cancer at Kigali University Teaching Hospital, Rwanda: a retrospective descriptive study. BMC Womens Health 2024; 24:204. [PMID: 38555423 PMCID: PMC10981286 DOI: 10.1186/s12905-024-03024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Half of countries in Africa lack access to radiation (RT), which is essential for standard treatment of locally advanced cervical cancers. We evaluated outcomes for patients treated with neoadjuvant chemotherapy (NACT) followed by radical hysterectomy in settings where no RT is available. METHODS We performed a retrospective descriptive study of all patients with FIGO stage IB2-IIA2 and some exceptional stage IIB cases who received NACT and surgery at Kigali University Teaching Hospital in Rwanda. Patients were treated with NACT consisting of carboplatin and paclitaxel once every 3 weeks for 3-4 cycles before radical hysterectomy. We calculated recurrence rates and overall survival (OS) rate was determined by Kaplan-Meier estimates. RESULTS Between May 2016 and October 2018, 57 patients underwent NACT and 43 (75.4%) were candidates for radical hysterectomy after clinical response assessment. Among the 43 patients who received NACT and surgery, the median age was 56 years, 14% were HIV positive, and FIGO stage distribution was: IB2 (32.6%), IIA1 (7.0%), IIA2 (51.2%) and IIB (9.3%). Thirty-nine (96%) patients received 3 cycles and 4 (4%) received 4 cycles of NACT. Thirty-eight (88.4%) patients underwent radical hysterectomy as planned and 5 (11.6%) had surgery aborted due to grossly metastatic disease. Two patients were lost to follow up after surgery and excluded from survival analysis. For the remaining 41 patients with median follow-up time of 34.4 months, 32 (78%) were alive with no evidence of recurrence, and 8 (20%) were alive with recurrence. One patient died of an unrelated cancer. The 3-year OS rate for the 41 patients who underwent NACT and surgery was 80.8% with a recurrence rate of 20%. CONCLUSIONS Neoadjuvant chemotherapy with radical hysterectomy is a feasible treatment option for locally advanced cervical cancer in settings with limited access to RT. With an increase in gynecologic oncologists skilled at radical surgery, this approach may be a more widely available alternative treatment option in countries without radiation facilities.
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Affiliation(s)
| | - Rahel Ghebre
- University of Rwanda, Kigali, Rwanda
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | - Urania Magriples
- University of Rwanda, Kigali, Rwanda
- Yale School of Medicine, New Haven, CT, USA
| | | | | | - Lisa Bazzett-Matabele
- University of Rwanda, Kigali, Rwanda.
- Yale School of Medicine, New Haven, CT, USA.
- Department of OBGYN, University of Botswana, Sir Ketumile Masire Teaching Hospital, Pvt Bag, 00713, Gaborone, Botswana.
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4
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GNANGNON FHR, SEIDOU F, LALEYE CM, ODIDI FP, FLENON NAKOU A, TONATO BAGNAN JA, DENAKPO JL, HOUINATO DS, GBESSI DG. [Adequacy of histopathology request forms and pathological reports of breast cancer surgical specimens in Benin]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2023; 3:mtsi.v3i4.2023.348. [PMID: 38390014 PMCID: PMC10879892 DOI: 10.48327/mtsi.v3i4.2023.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/05/2023] [Indexed: 02/24/2024]
Abstract
Introduction Breast cancer requires multidisciplinary management. Pathologists and physicians communicate using the histopathology request form and the pathology report. There are some minimal criteria that both should respect. Objective We assessed the adequacy of histopathology request forms and pathology reports in the management of female breast cancer specimens in Southern Benin. Method This was a cross-sectional, descriptive and analytical study, with retrospective data collection over 57 months (4 years and 9 months). The adequacy of the histopathology request forms and pathology reports was assessed on the basis of the recommendations of the Haute Autorité de Santé (HAS) of France. Data processing was done using SPSS software. We checked frequencies with the Chi2 test, with a significance level set at 5%. Results 31.3% of histopathology request forms complied with HAS recommendations. Pathology reports were presented in a narrative way in 92.7% of cases and 68.8% met the minimal criteria. The presence of vascular embolus, of hormone receptors and the HER2 status were all reported in only 29.2% of the reports. Discussion The draft of histopathology request forms and pathology reports did not comply to the required minimal criteria. This situation could mainly be explained by the inexistence of consensus between physicians and pathologists and by the lack of immunohistochemistry. Editing national referentials and using synoptic reports would give better results.
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Affiliation(s)
- Freddy Houéhanou Rodrigue GNANGNON
- Clinique universitaire de chirurgie viscérale, Centre national hospitalier universitaire Hubert Koutoukou Maga (CNHUHKM), Cotonou, Bénin
- INSERM U1094, IRD U270, Université de Limoges, EpiMaCT (Épidémiologie des maladies chroniques en zone tropicale), Institut d’épidémiologie et de neurologie tropicale, OmegaHealth, Limoges, France
- Laboratoire d’épidémiologie des maladies chroniques et neurologiques (LEMACEN), Faculté des sciences de la santé de Cotonou, Université d'Abomey-Calavi (FSS-UAC), Bénin
| | | | - Christel Marie LALEYE
- Clinique universitaire de chirurgie viscérale, Centre national hospitalier universitaire Hubert Koutoukou Maga (CNHUHKM), Cotonou, Bénin
| | - Fèmi Perez ODIDI
- Clinique universitaire de chirurgie viscérale, Centre national hospitalier universitaire Hubert Koutoukou Maga (CNHUHKM), Cotonou, Bénin
| | - Arielle FLENON NAKOU
- Laboratoire d'anatomie pathologique, Centre confessionnel Padre Pio, Cotonou, Bénin
| | | | | | - Dismand Stephan HOUINATO
- INSERM U1094, IRD U270, Université de Limoges, EpiMaCT (Épidémiologie des maladies chroniques en zone tropicale), Institut d’épidémiologie et de neurologie tropicale, OmegaHealth, Limoges, France
- Laboratoire d’épidémiologie des maladies chroniques et neurologiques (LEMACEN), Faculté des sciences de la santé de Cotonou, Université d'Abomey-Calavi (FSS-UAC), Bénin
| | - Dansou Gaspard GBESSI
- Clinique universitaire de chirurgie viscérale, Centre national hospitalier universitaire Hubert Koutoukou Maga (CNHUHKM), Cotonou, Bénin
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Gao W, Wang D, Huang Y. Designing a Deep Learning-Driven Resource-Efficient Diagnostic System for Metastatic Breast Cancer: Reducing Long Delays of Clinical Diagnosis and Improving Patient Survival in Developing Countries. Cancer Inform 2023; 22:11769351231214446. [PMID: 38033362 PMCID: PMC10683375 DOI: 10.1177/11769351231214446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Breast cancer is one of the leading causes of cancer mortality. Breast cancer patients in developing countries, especially sub-Saharan Africa, South Asia, and South America, suffer from the highest mortality rate in the world. One crucial factor contributing to the global disparity in mortality rate is long delay of diagnosis due to a severe shortage of trained pathologists, which consequently has led to a large proportion of late-stage presentation at diagnosis. To tackle this critical healthcare disparity, we have developed a deep learning-based diagnosis system for metastatic breast cancer that can achieve high diagnostic accuracy as well as computational efficiency and mobile readiness suitable for an under-resourced environment. We evaluated 4 Convolutional Neural Network (CNN) architectures: MobileNetV2, VGG16, ResNet50 and ResNet101. The MobileNetV2-based diagnostic model outperformed the more complex VGG16, ResNet50 and ResNet101 models in diagnostic accuracy, model generalization, and model training efficiency. The ROC AUC of MobilenetV2 (0.933, 95% CI: 0.930, 0.936) was higher than VGG16 (0.911, 95% CI: 0.908, 0.915), ResNet50 (0.869, 95% CI: 0.866, 0.873), and ResNet101 (0.873, 95% CI: 0.869, 0.876). The time per inference step for the MobileNetV2 model (15 ms/step) was substantially lower than that of VGG16 (48 ms/step), ResNet50 (37 ms/step), and ResNet110 (56 ms/step). The visual comparisons between the model prediction and ground truth have demonstrated that the MobileNetV2 diagnostic models can identify very small cancerous nodes embedded in a large area of normal cells which is challenging for manual image analysis. Equally Important, the light weight MobleNetV2 models were computationally efficient and ready for mobile devices or devices of low computational power. These advances empower the development of a resource-efficient and high performing AI-based metastatic breast cancer diagnostic system that can adapt to under-resourced healthcare facilities in developing countries.
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Affiliation(s)
- William Gao
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, USA
| | | | - Yi Huang
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, USA
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6
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Watermeyer G, Katsidzira L, Nsokolo B, Isaac Alatise O, Duduyemi BM, Kassianides C, Hodges P. Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective. Therap Adv Gastroenterol 2023; 16:17562848231184986. [PMID: 37457138 PMCID: PMC10345935 DOI: 10.1177/17562848231184986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.
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Affiliation(s)
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Bright Nsokolo
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Olusegun Isaac Alatise
- Division of Gastrointestinal/Surgical Oncology, Department of Surgery, Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Babatunde M. Duduyemi
- Department of Pathology, College of Medicine and Allied Health Sciences/Teaching Hospitals Complex Highest University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Phoebe Hodges
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
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7
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Hicks ML, Mwanahamuntu M, Butler R, Bloomfield H, Mutombo A, Anaclet MM, Sylvain MK, Chinula L, Kachingwe J, Parham GP. The evolution of a novel approach to building surgical capacity for cervical cancer in Africa. Ecancermedicalscience 2022; 16:1469. [PMID: 36819807 PMCID: PMC9934882 DOI: 10.3332/ecancer.2022.1469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Indexed: 11/09/2022] Open
Abstract
The human, financial, and infrastructural resources required to effectively treat invasive cancer of the cervix are grossly inadequate in the African region, inclusive of a paucity of surgeons capable of performing life-saving radical pelvic surgery for early-stage disease, and the requisite medical ecosystem (blood banking, anesthesia, laboratory, imaging, diagnostics, etc.) Death without treatment, therefore, is a common sequela of cervical cancer in Africa. As African American gynaecologic oncology sub-specialists working in Africa and its Diaspora, we set out to find a way to alter these circumstances. Herein, we provide an overview of our efforts and how they evolved into a novel method of training that rapidly builds surgical capacity for the treatment of early-stage cervical cancer in resource-constrained environments.
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Affiliation(s)
- Michael L Hicks
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia,St. Joseph Mercy Oakland, Michigan Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48341, USA
| | - Mulindi Mwanahamuntu
- Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
| | - Raleigh Butler
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Nassau, Bahamas
| | - Homer Bloomfield
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Nassau, Bahamas
| | - Alex Mutombo
- Department of Obstetrics and Gynaecology, Princess Margaret Hospital, Nassau, Bahamas
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuka Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Lameck Chinula
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,Department of Obstetrics and Gynaecology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - James Kachingwe
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Groesbeck P Parham
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, 101 Manning Dr., Chapel Hill, NC 27514, USA,Department of Obstetrics and Gynaecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
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8
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Sharma K, Sayed S, Saleh M. Promoting Best Practice in Cancer Care in Sub Saharan Africa. Front Med (Lausanne) 2022; 9:950309. [PMID: 35872798 PMCID: PMC9299371 DOI: 10.3389/fmed.2022.950309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
Promoting best practice in the management of a cancer patient is rooted in the application of new knowledge derived through various sources including population science, laboratory advances, and translational research. Ultimately, the impact of these advances depends on their application at the patient's bedside. A close collaboration between the oncologist and the pathologist is critical in underwriting progress in the management of the cancer patient. Recent advancements have shown that more granular characteristics of the tumor and the microenvironment are defining determinants when it comes to disease course and overall outcome. Whereas, histologic features and basic immunohistochemical characterization were previously adequate to define the tumor and establish treatment recommendation, the growing capability of the pathologist to provide molecular characterization of the tumor and its microenvironment, as well as, the availability of novel therapeutic agents have revolutionized cancer treatment paradigms and improved patient-outcomes and survival. While such capacity and capability appear readily available in most developed high-income countries (HIC), it will take a concerted and collaborative effort of all stakeholders to pave the way in the same stride in the low and middle-income countries (LMIC), which bear a disproportionate burden of human illness and cancers. Patients in the LMIC present with disease at advanced stage and often display characteristics unlike those encountered in the developed world. To keep stride and avoid the disenfranchisement of patients in the LMIC will require greater participation of LMIC patients on the global clinical trial platform, and a more equitable and affordable sharing of diagnostic and therapeutic capabilities between the developed and developing world. Key to the success of this progress and improvement of patient outcomes in the developing world is the close collaboration between the oncologist and the pathologist in this new era of precision and personalized medicine.
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Affiliation(s)
- Karishma Sharma
- Clinical Research Unit, Aga Khan University Cancer Center, Aga Khan University, Nairobi, Kenya
| | - Shahin Sayed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Mansoor Saleh
- Clinical Research Unit, Aga Khan University Cancer Center, Aga Khan University, Nairobi, Kenya
- Department of Hematology and Oncology, Aga Khan University Hospital, Nairobi, Kenya
- *Correspondence: Mansoor Saleh
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9
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Waljee AK, Weinheimer-Haus EM, Abubakar A, Ngugi AK, Siwo GH, Kwakye G, Singal AG, Rao A, Saini SD, Read AJ, Baker JA, Balis U, Opio CK, Zhu J, Saleh MN. Artificial intelligence and machine learning for early detection and diagnosis of colorectal cancer in sub-Saharan Africa. Gut 2022; 71:1259-1265. [PMID: 35418482 PMCID: PMC9177787 DOI: 10.1136/gutjnl-2022-327211] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/17/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Akbar K Waljee
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA .,Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA.,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA
| | - Eileen M Weinheimer-Haus
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA,Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA
| | - Amina Abubakar
- Institute for Human Development, The Aga Khan University, Nairobi, Kenya
| | - Anthony K Ngugi
- Department of Population Health, The Aga Khan University, Nairobi, Kenya
| | - Geoffrey H Siwo
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA,Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA,Eck Institute for Global Health, University of Notre Dame, South Bend, Indiana, USA,Center for Research Computing, University of Notre Dame, South Bend, Indiana, USA
| | - Gifty Kwakye
- Department of Surgery, Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Amit G Singal
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA,Department of Internal Medicine, Division of Digestive and Liver Diseases, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Arvind Rao
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA,Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sameer D Saini
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA,Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew J Read
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica A Baker
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA,Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA
| | - Ulysses Balis
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Christopher K Opio
- Department of Medicine, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Ji Zhu
- Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan, USA,Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Mansoor N Saleh
- O'Neal Comprehensive Cancer Center, The University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Hematology-Oncology, Aga Khan University Hospital Nairobi, Nairobi, Kenya
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10
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Watermeyer G, Katsidzira L, Setshedi M, Devani S, Mudombi W, Kassianides C. Inflammatory bowel disease in sub-Saharan Africa: epidemiology, risk factors, and challenges in diagnosis. Lancet Gastroenterol Hepatol 2022; 7:952-961. [DOI: 10.1016/s2468-1253(22)00047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 02/07/2023]
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11
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Vanderpuye V, Dadzie MA, Huo D, Olopade OI. Assessment of Breast Cancer Management in Sub-Saharan Africa. JCO Glob Oncol 2021; 7:1593-1601. [PMID: 34843373 PMCID: PMC8624034 DOI: 10.1200/go.21.00282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To document progress and bottlenecks in breast cancer management in sub-Saharan Africa, subsequent to a 2013 pilot survey conducted through the African Organization for Research and Treatment in Cancer (AORTIC) network. METHODS An anonymous survey of breast cancer management was conducted in 2018 among AORTIC members. Results concerning respondent specialty, access to tumor boards, treatment accessibility, diagnostic services, and factors influencing treatment outcomes were compared with the 2013 findings. RESULTS Thirty-seven respondents from 30 facilities in 21 sub-Saharan Africa countries responded. The majority (92%) were clinical oncologists. Radiotherapy facilities were available in 70% of facilities. Seventy-eight percent of these had linear accelerators, and 42% had cobalt60 machines. Eighty percent of facilities had multidisciplinary tumor boards. Immunohistochemistry was routinely performed in 74% of facilities, computed tomography scan in 90%, bone scan in 16%, and positron emission tomography scans in 5%. Anthracyclines, taxanes, tamoxifen, letrozole, anastrozole, and zoledronic acid were available in the majority; trastuzumab, fertility, and genetic counseling were available in 66%, 58%, and 16%, respectively. There were a 50% increase in oncologist respondents over 2013 and a > 50% increase in radiotherapy facilities, particularly linear accelerators. Availability of trastuzumab, aromatase inhibitors, and taxanes increased. Immunohistochemistry capacity remained the same, whereas facilities harvesting at least 10 axillary lymph nodes increased. Bone scan facilities decreased. Responses suggested improved diagnostic services, systemic therapies, and radiotherapy. Sociocultural and economic barriers, system delays, and advanced stage at presentation remain. CONCLUSION Clinicians in sub-Saharan Africa have basic tools to improve breast cancer outcomes, recording positive strides in domains such as radiotherapy and systemic therapy. Socioeconomic and cultural barriers and system delays persist. Workforce expansion must be prioritized to improve quality of care to improve outcomes. This study highlights the current state of breast cancer management in Sub Saharan Africa, documenting key advancements , challenges and bottlenecks encountered in the sub region. Aside the major aspects of management, pertinent areas such as multidisciplinary tumour board engagements, fertility , genetic counselling and factors affecting outcome were explored. Majority of institutions manage breast cancer patients within a multidisciplinary setting using standard treatment guidelines. The high out of pocket cost of cancer treatment and advanced stage at presentation transcends in many sub Saharan countries negatively impacting outcomes. These results should serve as a benchmark to stakeholders , to guide urgent interventions required to further improve outcomes.
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Affiliation(s)
- Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Mary-Ann Dadzie
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL
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12
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Jinadu FO, Odunaiya Z, Uvie-Emegbo YOK, Ottun AT, Olumodeji AM. Correlation of sonographic and cytologic patterns of thyroid nodules. Pan Afr Med J 2021; 39:220. [PMID: 34630832 PMCID: PMC8486945 DOI: 10.11604/pamj.2021.39.220.28505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/11/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction thyroid nodules are palpable in about 8% of adults. It is necessary to differentiate benign nodules from malignant ones by the non-invasive ultrasonography thereby reducing the frequency of the invasive fine needle aspiration cytology (FNAC). The study assessed the sonographic and FNAC patterns of thyroid nodules for benign and malignant features in a black African population. Methods this was a hospital-based, cross-sectional study design over a 1-year period in which one hundred and seven (107) consenting patients between 15 to 80 years of age with palpable thyroid masses by convenience sampling, were consecutively recruited to have both thyroid ultrasound scan and FNAC of their thyroid mass sequentially. Frequency, percentages and two-by-two contingency table were employed for data analysis. Results the sonographic features of the thyroid nodules varied from round 80 (74.8%) to oval 25 (23.4%) masses, the presence of thin peripheral halo 83 (77.6%), heterogeneous echo-pattern 104 (97.2%) with cystic component and peripheral vascularity 75 (70.1%). One hundred and five (98.1%) study participants showed benign features on sonography while two had features suspicious of malignancy; however FNAC result in the same group of patients was suggestive of benign masses in all 107 (100%) patients. Histology however confirmed malignancy in the 2 participants with ultrasound features suggestive of malignant thyroid nodules. Conclusion ultrasonography is very sensitive in the characterization of thyroid nodules into benign or suspicious for malignancy in black African population.
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Affiliation(s)
| | - Zainab Odunaiya
- Department of Radiology, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Yemisi Oluseyi Kila Uvie-Emegbo
- Department of Pathology, Lagos State University College of Medicine/ Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Abimbola Tawaqualit Ottun
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Ayokunle Moses Olumodeji
- Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Lagos, Nigeria
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13
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Hassell LA, Afzal A. Flattening the World of Pathology Education and Training and Shortening the Curve of Pathology Learning. Am J Clin Pathol 2021; 156:176-184. [PMID: 33978156 DOI: 10.1093/ajcp/aqab034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We review how the pandemic-related education disruption may interplay with pathology manpower worldwide and shifts in disease burden to identify workable solutions. METHODS Literature related to pathology education, pathology services in low-resource settings, and application of digital tools to pathology education was reviewed for trends and training gaps. Publications covering pathology manpower and cancer incidence worldwide were also included to assess needs. RESULTS Pandemic-related virtual teaching has produced abundant online training materials. Pathology learning resources in low- to middle-income countries remain considerably constrained and dampen pathology manpower growth to meet current needs. Projected increases in disease burden toward the developing world thus pose a major challenge. Digital pathology resources have expanded and are beginning to appear beyond the developed countries. CONCLUSIONS This circumstance offers a unique opportunity to leverage digital teaching resources to enhance and equitize training internationally, potentially sufficient to meet the rising wave of noncommunicable diseases. We propose four next steps to take advantage of the current opportunity: curate and organize digital training materials, invest in the digital pathology infrastructure for education and clinical care, expand student exposure to pathology through virtual electives, and develop further competency-based certification pathways.
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Affiliation(s)
- Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anoshia Afzal
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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14
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YouYou TG, Mathieu KM, Hicks ML, Henry-Tillman R, Mutombo A, Anaclet MM, Sylvain MK, Hicks MM, Pinder L, Kanda L, Kanda M, Parham GP. Leveraging a matrix of stakeholders to facilitate access to chemotherapy for women's cancers in the Democratic Republic of the Congo. Ecancermedicalscience 2021; 15:1234. [PMID: 34221117 PMCID: PMC8225332 DOI: 10.3332/ecancer.2021.1234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 11/06/2022] Open
Abstract
Background Cancer incidence is increasing worldwide. Over the next 20 years, the growing proportion of cases in low- and middle-income countries (LMICs) will account for an estimated 70% of all cancers diagnosed. The vast majority of cancer patients in LMICs will require chemotherapy, due to the advanced stage of their disease at the time of initial presentation. Unfortunately, the availability of cancer drugs in these environments is sparse, resulting in premature death and years of life lost. In an effort to lay a foundation for women’s cancer control in the Democratic Republic of the Congo (DRC), we implemented a programme which combined workforce development, infrastructure creation and cancer drug access. This manuscript reports on our experience with the latter. Methods A private sector healthcare facility was selected as the programme implementation site. Workforce capacity was developed through a south–south partnership with an African national cancer centre. Cancer drugs were procured through a global cancer medicine access initiative. Results A new chemotherapy infusion unit was successfully established at the Biamba Marie Mutombo Hospital in Kinshasa, DRC. A team of Congolese healthcare providers was trained at the Cancer Disease Hospital in Zambia to safely and effectively administer chemotherapy for breast and cervical cancer. Over 100 breast and cervical cancer patients have been treated with 337 courses of chemotherapy, without any serious adverse events. Conclusion Common barriers to cancer drug access and its administration can be eliminated using regional educational resources to build oncologic workforce capacity, private sector healthcare facilities for infrastructure support and pharmaceutical consortiums to procure low-cost cancer medicines. By leveraging a matrix of global, regional and local stakeholders, the prevailing status quo of very limited access to chemotherapy for women’s cancers was creatively disrupted in DRC, Africa’s largest fragile, conflict and violence-affected country.
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Affiliation(s)
- Tankoy Gombo YouYou
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Kabongo Mukuta Mathieu
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Michael L Hicks
- Department of Obstetrics and Gynaecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynaecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,St Mary Mercy Cancer Center 36475 Five Mile Rd, Livonia, MI 48154, USA.,St Joseph Mercy Oakland Cancer Center 44405 Woodward Ave, Suite 202, Pontiac, MI 48324, USA.,McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA.,https://orcid.org/0000-0002-1819-155X
| | - Ronda Henry-Tillman
- Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham, Slot #725, Little Rock, AR 72205, USA.,https://orcid.org/0000-0002-1782-9523
| | - Alex Mutombo
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuku Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Maya M Hicks
- Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA.,https://orcid.org/0000-0002-1993-3367
| | - Leeya Pinder
- Department of Obstetrics and Gynaecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, Washington, DC 98195, USA.,https://orcid.org/0000-0002-8929-7810
| | - Louis Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Mirielle Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Groesbeck P Parham
- Department of Obstetrics and Gynaecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynaecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,https://orcid.org/0000-0001-5922-5990
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15
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Selemane C, Jamisse L, Arroz J, Túlsidas S, Morais AG, Carrilho C, Modcoicar P, Sidat M, Rodrigues J, Moreira-Gonçalves D, Ismail M, Santos LL. Demographic, clinical and pathological characterisation of patients with colorectal and anal cancer followed between 2013 and 2016 at Maputo Central Hospital, Mozambique. Ecancermedicalscience 2021; 15:1205. [PMID: 33912230 PMCID: PMC8057776 DOI: 10.3332/ecancer.2021.1205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study was to investigate colorectal cancer (CRC) data and anal cancer data from Maputo Central Hospital (MCH), the largest hospital and a reference for oncological diseases in Mozambique, with the aim of characterising the disease profile in view to define an appropriate control programme. Methods MCH records from the Pathology and Surgery Services and MCH Cancer Registry database were assessed to obtain retrospective clinical and pathologic data of patients with CRC or anal cancer admitted to and treated between 13 December 2013 and 23 March 2016. Results The female gender was more prevalent (54.8%), even when anal cancers were excluded. Median age was 54 years (20–99). Most patients (51.6%) lived in the city of Maputo. The most common presenting symptom was found to be rectal bleeding. Adenocarcinoma was the most frequent histological type, and the most prevalent anatomical site was the rectum. Most of the cases were diagnosed at MCH in advanced stages. Colostomy was the most frequent surgical procedure and performed in 38.7% of the patients. Most cases of anal cancer occurred in human immunodeficiency virus-infected patients. Most patients had a poor prognosis due to advanced stage at first diagnosis. Conclusion We observed an increase in cases of CRC and anal cancer in Mozambique and mostly diagnosed at advanced stages, which anticipates a dismal prognosis. Our data supports the urgent need of a comprehensive public health programme dedicated to solving this growing concern.
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Affiliation(s)
- Carlos Selemane
- Surgical Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Luisa Jamisse
- Pathology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Jorge Arroz
- Save the Children, P.O.Box 1854, Rua de Tchamba nº 398, Maputo, Mozambique
| | - Satish Túlsidas
- Medical Oncology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - António Gudo Morais
- Radiotherapy Service, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Carla Carrilho
- Pathology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Moçambique
| | - Prassad Modcoicar
- Gastroenterology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique
| | - Moshin Sidat
- Department of Community Health, University of Eduardo Mondlane, 1653 Av Eduardo Mondlane, Maputo, Mozambique.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon,R. da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Jessica Rodrigues
- Epidemiology Service, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal
| | - Daniel Moreira-Gonçalves
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, R. Dr. Plácido da Costa 91, 4200-450, Porto, Portugal.,Experimental Pathology and Therapeutics Research Group, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal
| | - Mamudo Ismail
- Pathology Department, Maputo Central Hospital, 1653 Av Eduardo Mondlane, Maputo, Mozambique.,Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Moçambique
| | - Lúcio Lara Santos
- Experimental Pathology and Therapeutics Research Group, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal.,Surgical Oncology Department, Portuguese Institute of oncology, Rua Dr. António Bernardino de Almeida 4200-072, Porto, Portugal.,ONCOCIR-Education and Care in Oncology, Lusophone , Africa, Rua de Quires 168-10J, Moreira da Maia , Portugal
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16
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Fatiregun OA, Lasebikan N. High burden of postoperative cancer mortality in LMICs. Lancet 2021; 397:349-351. [PMID: 33516321 DOI: 10.1016/s0140-6736(21)00187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 12/24/2022]
Affiliation(s)
| | - Nwamaka Lasebikan
- Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
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17
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Parra-Herran C, Romero Y, Milner D. Pathology and Laboratory Medicine in cancer care: A global analysis of national cancer control plans. Int J Cancer 2020; 148:1938-1947. [PMID: 33152147 DOI: 10.1002/ijc.33384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/29/2020] [Indexed: 11/11/2022]
Abstract
In order to understand the structure and effectiveness of national cancer control systems, the International Cancer Control Partnership, the World Health Organization, the National Cancer Institute and the Union for International Cancer Control underwent a review of available national cancer health plans (NCCPs) and noncommunicable diseases plans (NCDPs) worldwide. Pathology and Laboratory Medicine (PALM) plays a major role in cancer management, from prevention and screening to patient care (diagnosis and treatment) and population-level cancer surveillance. This review concentrates on the analysis of elements in national cancer care plans pertaining to PALM. Of 157 countries surveyed, 90 (57%) had a NCCP and 123 (78%) had a NCDP. While 54% of plans included guidelines on cancer diagnosis or plans to develop standards protocols for diagnosis, only 14% included PALM as a component of the plan. PALM-related variables such as synoptic pathology reporting, cancer staging guidelines and cancer genetics programs were similarly underrepresented (being mentioned in only 6%, 17% and 16% of plans, respectively). Absence of PALM-related variables tended to be more frequent in lower-income countries. Our analysis highlights an important gap in national cancer control initiatives worldwide represented by the overall lack of inclusion of PALM resources. Cancer control will only be effective if laboratory sciences are placed as a priority. Based on the data presented herein, there is a need to increase awareness about the importance of PALM in cancer care, and to incorporate this discipline in the design and implementation of multilevel cancer control strategies.
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Affiliation(s)
- Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yannick Romero
- Union for International Cancer Control, Geneva, Switzerland
| | - Danny Milner
- American Society for Clinical Pathology, Chicago, Illinois, USA
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18
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Lin LL, Lakomy DS, Chiao EY, Strother RM, Wirth M, Cesarman E, Borok M, Busakhala N, Chibwesha CJ, Chinula L, Ndlovu N, Orem J, Phipps W, Sewram V, Vogt SL, Sparano JA, Mitsuyasu RT, Krown SE, Gopal S. Clinical Trials for Treatment and Prevention of HIV-Associated Malignancies in Sub-Saharan Africa: Building Capacity and Overcoming Barriers. JCO Glob Oncol 2020; 6:1134-1146. [PMID: 32697667 PMCID: PMC7392698 DOI: 10.1200/go.20.00153] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to review the current status of clinical trials for HIV-associated malignancies in people living with HIV in sub-Saharan Africa (SSA) and efforts made by the AIDS Malignancy Consortium (AMC) to build capacity in SSA for HIV malignancy research. METHODS All malignancy-related clinical trials in 49 SSA countries on ClinicalTrials.gov were reviewed and evaluated for inclusion and exclusion criteria pertaining to HIV status. Additional studies by AMC in SSA were compiled from Web-based resources, and narrative summaries were prepared to highlight AMC capacity building and training initiatives. RESULTS Of 96 cancer trials identified in SSA, only 11 focused specifically on people living with HIV, including studies in Kaposi sarcoma, cervical dysplasia and cancer, non-Hodgkin lymphoma, and ocular surface squamous neoplasia. Recognizing the increasing cancer burden in the region, AMC expanded its clinical trial activities to SSA in 2010, with 4 trials completed to date and 6 others in progress or development, and has made ongoing investments in developing research infrastructure in the region. CONCLUSION As the HIV-associated malignancy burden in SSA evolves, research into this domain has been limited. AMC, the only global HIV malignancy-focused research consortium, not only conducts vital HIV-associated malignancies research in SSA, but also develops pathology, personnel, and community-based infrastructure to meet these challenges in SSA. Nonetheless, there is an ongoing need to build on these efforts to improve HIV-associated malignancies outcomes in SSA.
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Affiliation(s)
- Lilie L. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David S. Lakomy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Dartmouth Geisel School of Medicine, Hanover, NH
| | - Elizabeth Y. Chiao
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Margaret Borok
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Naftali Busakhala
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
| | - Carla J. Chibwesha
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC
- Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Lameck Chinula
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
- UNC Project-Malawi, Lilongwe, Malawi
| | - Ntokozo Ndlovu
- Department of Radiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Warren Phipps
- Uganda Cancer Institute, Kampala, Uganda
- Department of Medicine, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Vikash Sewram
- African Cancer Institute, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Samantha L. Vogt
- Department of Medical Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Joseph A. Sparano
- Montefiore-Einstein Cancer Center, Montefiore Medical Center, Bronx, NY
| | - Ronald T. Mitsuyasu
- Center for Clinical AIDS Research and Education, University of California, Los Angeles, Los Angeles, CA
| | | | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD
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