Cancer Diagnostics in the Developing World

Today, the White House Office of Science and Technology Policy hosted a roundtable meeting to discuss how innovative combinations of technology and pathology are being deployed to provide cancer diagnostics, care, and treatment in pilot sites in the developing world. At the meeting, a cross-sector coalition of industry, non-profits, and professional societies announced a $26.5 million commitment of infrastructure, funding, and in-kind resources to improve pathology services in low- and middle- income countries (LMIC) in support of the goals of the World Health Organization’s (WHO) Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCD). Additionally, the National Cancer Institute Center for Global Health announced that it will host a workshop in the spring of 2016 focused on how to build pathology capabilities for diagnosing cancer in the developing world.

According to the WHO, almost three quarters of NCD deaths occur in LMICs. In 2013 alone, NCDs killed eight million people before their 60th birthday, with cancer, cardiovascular disease, diabetes, and chronic lung disease being the leading killers. Today’s roundtable participants discussed the critical role that pathology and accurate diagnosis play as a first step in effective cancer care. Highly skilled pathologists and laboratory professionals utilize complex techniques and advanced technology to perform this vital function in the United States, where there is one pathologist per 20,000 people. In many LMICs, this ratio is much worse. For example, in sub-Saharan Africa, this ratio is closer to one pathologist per million people, which means that many cases of cancer go undiagnosed, or are diagnosed too late for effective care.

In response to OSTP’s call to action, the American Society for Clinical Pathology (ASCP), the Institute for Health Metrics and Evaluation, Omnyx, LLC / GE Healthcare, Pfizer, Inc., Partners in Health, Roche Diagnostics, and Sakura Finetek announced plans to establish pilot projects to improve pathology services in Botswana, Rwanda, Swaziland, Lesotho, Liberia, and Haiti. Members of the ASCP will use telepathology to diagnose cancers remotely, interpreting cloud-based images of specimens prepared with modern automated equipment installed locally. Starting in Botswana, with plans to expand to sites in Rwanda, Swaziland, Lesotho, Liberia, and Haiti, professionals based in the United States will be able to contribute to patient care and medical education in these six countries.   

Care and treatment support will be coordinated initially with Partners in Health (an organization with 15,000 African employees). Partners in Health will oversee and provide access to care and treatment for patients in a medically, scientifically, and ethically sound manner, and additional organizations will be brought on board to help with care and treatment as needed.

Improving health care in resource-constrained settings is a complex endeavor that requires careful measurement of effectiveness. Today’s roundtable participants recognized the importance of research to evaluate the effectiveness of NCD interventions. To address this important issue, the National Cancer Institute (NCI) Center for Global Health recently announced a new request for applications for grants to facilitate the planning, designing, and initial research focus of regional centers of research excellence for NCDs, including cancer, in LMICs. Through these grants, the NCI seeks to combine the expertise of global-health academic researchers in high-income countries with regional investigators in LMICs to explore better ways to control NCDs. The research priorities will be defined by assessing local needs through active engagement of local experts.

OSTP applauds all of the participants in today’s meeting for their commitment to addressing the burden of NCDs in lower and middle-income countries. The energy on display today is a model for building effective programs based on the creative use of new technology, sharing of expertise, and careful evaluation.

Jo Handelsman is Associate Director for Science at the White House Office of Science and Technology Policy.

Robbie Barbero is Assistant Director for Biological Innovation at the White House Office of Science and Technology Policy.