CASE EXAMPLE: USING ADVANCED DIAGNOSTIC TECHNIQUES TO IMPROVE CANCER DIAGNOSIS IN CÔTE D'IVOIRE

Since the end of its second civil war in 2011, Côte d'Ivoire has experienced increasing economic growth and stability. Despite this period of peace and prosperity, a new threat looms over the country. At Côte d'Ivoire’s three main teaching hospitals, University Hospital Center (CHU) Cocody, CHU Treichville, and CHU Yopougon, doctors are reporting an alarming increase in the rates of cancer. Non-communicable diseases, which include cancer, account for 31% of total deaths in Côte d'Ivoire. In 2018, 14,484 new cases of cancer were reported in the country, with breast cancer being the most prevalent malignancy.

Despite the growing rate of cancer in Côte d'Ivoire, there are only fifteen trained pathologists available in the public sector to serve the entire country. The insufficient number of healthcare workers devoted to diagnosing cancer in Côte d'Ivoire means that cancer cases are not diagnosed as often or as early as they need to be to save patients’ lives. Many of the country’s pathologists also lack training in advanced diagnostic techniques, which are critical to the accurate diagnosis and effective treatment of cancer patients.

Partnership with BVGH

Since 2017, CHU Cocody, CHU Treichville, and CHU Yopougon have been participating in BVGH’s African Access Initiative (AAI) to address the country’s cancer crisis. AAI partner, Professor Mohenou Isidore Diomande, who is CHU Cocody’s Head of the Anatomic Pathology Lab and President of the Ivorian Society of Pathology (SIPath), is responsible for educating a majority of Côte d'Ivoire's and Francophone Africa’s future pathologists. In April 2019, Prof. Diomande, along with nearly 100 pathology lab staff from ten Francophone African countries, participated in a three-day breast pathology workshop organized by BVGH, the American Society for Clinical Pathology (ASCP), Côte d’Ivoire’s Ministry of Health and Public Hygiene, and SIPath. “My colleagues and I gained important current information on best practices in diagnosing and sub-typing breast cancers, which has allowed us to more accurately diagnose cancer at an earlier stage, when patients have a higher chance of survival” says Prof. Diomande.

Advanced Diagnostic Pathology Fellowship

While the pathology workshop in Abidjan was highly impactful, there remained a critical need for pathologists in Côte d’Ivoire to gain hands-on experience performing advanced diagnostic techniques such as immunohistochemistry (IHC). These tests are used by pathologists to determine the type of treatment that patients will respond to best (e.g., hormone therapy, targeted therapy, immunotherapy, radiotherapy, and surgery). Successful implementation of IHC can significantly improve cancer patient outcomes.

In February 2020, through funding from Friends of Cancer Patients – The Ameera Fund, BVGH organized a two-week fellowship program in Seattle, WA at PhenoPath Laboratories, a Quest Diagnostics Company, for Prof. Diomande and his colleague, Dr. N’Da Marcelin Homian. Expert pathologists at PhenoPath trained Prof. Diomande and Dr. Homian on interpreting results of IHC tests, which is useful for cancer diagnosis and treatment. To further their research studies, the Ivorian doctors brought forty breast and colon tissue samples to study at PhenoPath. With PhenoPath’s support, the tissue samples were cut and stained with a panel of immunostains, resulting in an impressive library of around 700 slides. This wealth of data will have far-reaching impact beyond the two-week fellowship. The slides will provide the Ivorian doctors with unprecedented insight into the unique features of colon and breast cancers in their patient populations. Prof. Diomande notes, “This information may lead us to come up with more effective treatment options for cancer patients. We also plan to collaborate closely with PhenoPath to publish the results of these tests to benefit the wider medical community."

Although Côte d'Ivoire has plans to treat the most aggressive forms of breast cancer with immunotherapy, the country’s pathologists currently lack formal training in conducting diagnostic tests to determine which patients are eligible for immunotherapy treatment. To address this gap, PhenoPath trained Prof. Diomande on interpreting immunotherapy biomarkers, such as programmed death-ligand 1 (PD-L1), to determine which patients could benefit the most from immunotherapy. Being able to correctly interpret PD-L1 biomarkers is particularly significant for improving patient outcomes in Côte d’Ivoire as immunotherapy offers a dramatic shift in the way cancer is treated. Immunotherapy drugs target the immune system to fight disease without harming healthy cells, a toxic side effect of untargeted chemotherapies and radiation. Prof. Diomande remarks, “Accurate interpretation of immunotherapy biomarkers by pathologists will be very important for our breast and colon cancer patients. I plan to teach my pathology students what I have learned so the knowledge can be passed on and we can save more lives.”

"Friends of Cancer Patients congratulates BVGH for carrying out a successful fellowship program and wishes continued success to the Ivorian doctors who participated in the program." - Dr. Sawsan Al Madhi, Director General of Friends of Cancer Patients Charity, UAE

Building on the breast pathology workshop led by BVGH in collaboration with ASCP in April 2019, Prof. Diomande visited ASCP’s headquarters in Chicago following his fellowship at PhenoPath. He met with Dr. Dan Milner, Chief Medical Officer of ASCP, to discuss opportunities for future partnership and visited the pathology departments at Northwestern University Hospital and the University of Illinois at Chicago Hospital to learn about their clinical services. On behalf of SIPath, Prof. Diomande values the ongoing collaboration with ASCP, which continues to provide technical and advisory support to Ivorian pathologists.

The Road Ahead

Even though there is much work ahead in diagnosing and treating cancer in Côte d'Ivoire, there have been striking advancements in the past few years, backed by strong government commitment. Today, the country has three IHC machines, a radiotherapy center, and perhaps one of the greatest assets of all - skilled and committed healthcare workers such as Prof. Diomande who are dedicated to improving patient lives. Prof. Diomande recently launched Sante Education Developpement Côte d'Ivoire, a non-governmental organization (NGO), to promote health, education, and sustainable development in rural areas of the country. Juggling between his roles as a pathologist, educator, and NGO President, Prof. Diomande believes Côte d'Ivoire’s future is bright -- "A healthy, well-educated, and literate person undeniably remains an effective agent of development for his community, his country, and the whole of humanity. Training programs such as the PhenoPath fellowship are important mechanisms to ensure my country is able to achieve its potential.”

Prof. Diomande and Dr. Homian express their heartfelt thanks to the entire PhenoPath team - Dr. Allen Gown, Dr. Steve Kussick, Dr. Harry Hwang, Dr. Cigdem Ussakli, Dr. David Hoak, Dr. Shawna Pyott, Dr. Ying Li, and Dr. Sandra Bohling.

BVGH is grateful to PhenoPath and Friends of Cancer Patients – for their efforts to make this fellowship a success – and our AAI program partners, Takeda Pharmaceutical Co., Ltd., Johnson & Johnson, and Faber Daeufer & Itrato PC.