Cancer care is a growing problem in low- and middle-income countries. By 2020, up to 70% of patients with cancer will live in low- and middle-income countries; however, little health-care infrastructure exists and few personnel are available for the care of patients1. Surgeons are central to cancer care in these regions and must be included in public health efforts to improve cancer care2,3. Murray Brennan, Vice President for International Programs, Director of the Bobst International Center, and Chairman Emeritus of the Department of Surgery; and Peter Kingham, Director of Global Cancer Disparity Initiatives are leading efforts at MSK to address this deficiency. Dr. Kingham has spent the past 15 years in developing countries training local medical professionals and delivering cancer care and treatment. In 2007, he co-founded Surgeons Overseas, a non-profit organization aimed at improving outcomes of surgery for patients in developing countries. Building upon Dr. Kingham’s established relationships in Tanzania, Sierra Leone, South Africa, Malawi, and Nigeria, Memorial Sloan Ketttering Cancer Center established the Global Cancer Disparity Initiatives in 2014 through the Bobst International Center. As Director of the Initiative, Dr. Kingham’s goal is to improve cancer outcomes in sub-Saharan Africa with collaborative research and training efforts4, initiated through several projects.
MSKCC has partnered with 5 Nigerian hospitals in a consortium (the African Research Group for Oncology, or ARGO) to build a team of surgeons, pathologists, and radiologists who work together to treat patients with colorectal cancer in the United States and Nigeria and to offer symposia to teach best practices for colorectal cancer care. In 2015, ARGO completed a 100-patient pilot study to provide colonoscopy for patients over 45 years old with rectal bleeding. Using this pilot study, the team created a predictive model that is now being validated in a 3-city 225 patient study. ARGO has also created a full-time research team consisting of a Nigerian research physician, nurse, and coordinator to prospectively build a colorectal database. More than 200 patients at the five collaborating hospitals in Nigeria have participated. The researchers are currently comparing the mutations and microsatellite instability status of colorectal cancers from Nigerian patients to patients in the United States and have already identified significant differences in presentation, metastatic pattern, and genomic profiling5. This NCI-recognized consortium was also awarded one of the first pilot grants from the National Cancer Institute’s new Center for Global Health. In 2016, ARGO also expanded to include breast cancer as a focus on the consortium. Two community-based and 1-hospital based study has been initiated to investigate the system of breast cancer care for patients in Nigeria. These projects will focus on determining the utility of breast self-examination, early hospital discharge after mastectomy, and work to establish a clinical database and specimen biobank.
MSKCC is currently in discussions with the Aga Khan Hospital Group (Nairobi, Mombassa, Dar es Salaam) to expand our collaborations in breast cancer research and training. We have already completed a population-based survey to estimate the prevalence of breast masses in Rwanda and Sierra Leone and to identify potential barriers in care6. We seek to initiate additional training and research programs in East Africa, as well as expand to the study of cervical cancer.
The Global Cancer Disparity Initiatives have received funding support from the Thompson Family, the NCI Center for Global Heath, and MSK’s SOAR outcomes group. In addition, 8 faculty members from sub-Saharan Africa have completed 3 month observerships at MSK with the support of the Soudavar Fellowship. We have also established our MSKCC Global Cancer Disparities Pilot Grant to provide funding for a physician from a low- or middle-income country to support a one-year pilot study in the area of cancer prevention, diagnosis, treatment or outcomes. For more information and eligibility requirements, click here.
- Jones SB. Cancer in the developing world: a call to action. BMJ (Clinical research ed) 1999;319:505-8.
- Kingham TP, Alatise OI, Vanderpuye V, et al. Treatment of cancer in sub-Saharan Africa. The Lancet Oncology 2013;14:e158-67.
- Sullivan R, Alatise OI, Anderson BO, et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. The Lancet Oncology 2015;16:1193-224.
- Kingham TP, Alatise OI. Establishing translational and clinical cancer research collaborations between high- and low-income countries. Annals of surgical oncology 2015;22:741-6.
- Saluja S, Alatise OI, Adewale A, et al. A comparison of colorectal cancer in Nigerian and North American patients: is the cancer biology different? Surgery 2014;156:305-10.
- Ntirenganya F, Petroze RT, Kamara TB, et al. Prevalence of breast masses and barriers to care: results from a population-based survey in Rwanda and Sierra Leone. Journal of surgical oncology 2014;110:903-6.