Case example: building cancer diagnostic capacity in francophone Africa
In 2015, Africa experienced a dramatic shift in health trends. That year for the first time, more Africans are estimated to have died from cancer than malaria. Thanks in part to concerted global efforts, the malaria death rate in Africa decreased more than half between 2003 (the year malaria death rates peaked on the continent) and 2017. Conversely, without any global action, deaths by cancer in Africa are projected to increase almost 50% over the next decade — reaching 1 million annual deaths by 2030. This shift in the burden of infectious diseases – such as malaria – to non-communicable diseases – such as cancer – represents a challenge for African health systems as they manage more patients with different needs than in the past.
One area where patient management differs between cancer and other diseases is diagnosis. An accurate and timely diagnosis of cancer can mean the difference between survival and death. Pathology – the identification and characterization of disease by studying cells and tissues under a microscope – is an essential healthcare discipline to render accurate cancer diagnoses, as pathologists determine the precise type and stage (severity) of cancerous tumors. Oncologists (specialists in cancer treatment) use this information to develop appropriate treatment plans, which may include drug therapy, radiation therapy, and/or surgery.
Late diagnosis of cancer is tragically common in Africa, partly due to the lack of trained pathologists and other laboratory professionals. In many sub-Saharan countries there is only one pathologist for every one million patients, a ratio approximately 50 times lower than in high-income countries. Beyond human resources and training, proper diagnosis of cancer requires equipment and materials that can be expensive and difficult to obtain, factors which add to the delay in patient diagnosis.
In response to the challenges cancer poses on the continent, BIO Ventures for Global Health (BVGH) issued a global call to action to address Africa’s cancer crisis with the launch of the African Access Initiative (AAI) in June 2017. Côte d’Ivoire was involved in the initiative from the outset, and is currently one of six AAI participating countries. From the beginning of its partnership with BVGH, the National Cancer Control Program (PNLCa) under the Ministry of Health and Public Hygiene, emphasized the need for improved pathology capacity to achieve their cancer control goals. Nowhere is the need greater than for breast cancer, the most common cancer type in the country.
Pathology is especially important for the proper management of breast cancer. Many breast lesions are not cancerous, and those that are malignant can have different characteristics – distinguishable via pathological assessments – that affect their responsiveness to commonly used drugs. With an estimated 2,700 new breast cancer cases identified each year in Côte d'Ivoire, the augmentation of diagnostic pathology capabilities in the country is critical.
In response to Côte d'Ivoire’s need for breast pathology training, BVGH partnered with the Center for Global Health at the American Society for Clinical Pathology (ASCP), Côte d’Ivoire’s Ministry of Health and Public Hygiene, and the Ivorian Society of Pathology (SIPath) to organize a three-day pathology workshop. The workshop, held in Abidjan, Côte d’Ivoire in April 2019, used didactic presentations, case study discussions, and question-and-answer sessions to teach the techniques used to diagnose and sub-type breast cancer. Three expert trainers from Maisonneuve-Rosemont Hospital in Montreal, Canada led the workshop sessions using training materials customized to the expertise, expectations, and needs of attendees, which were ascertained through pre-workshop surveys. This training provided the participants with up-to-date knowledge of best practices in collecting samples, diagnosing and sub-typing breast cancers, and improving laboratory efficiency, which will lead to patients receiving earlier and more accurate diagnoses.