Cancer has become a major public-health issue in low- and middle-income countries (LMICs). Approximately 70 percent of worldwide cancer deaths occur in LMICs. Improvements in the approach to oncology treatment and research are crucial to improving patient care in these areas. Memorial Sloan Kettering is leading this effort. The mission of the initiative is to improve outcomes for cancer patients in sub-Saharan Africa through collaborative research and training efforts.
Research must focus on:
- building cancer registries
- determining the biology of cancers in LMICs
- evaluating cost-effective screening methods and therapies
- providing palliative care options
- implementing social programs to remove the stigma associated with cancer
By collecting data and understanding how cancer affects LMICs, we can study the implementation of tiered guidelines that can be applied across contexts with differing resources. MSK and our collaborators have initiated several projects to address these goals, under the leadership of 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.
West Africa – African Research Group for Oncology (ARGO)
In 2010, MSK partnered with Obafemi Awolowo University Hospital (OAU) in Nigeria and identified colorectal cancer as a cancer priority in the country. Dr. Kingham and Isaac Alatise from OAU founded the African Colorectal Cancer Group (since renamed the African Research Group for Oncology, or ARGO) in 2013. This NCI-recognized consortium of five Nigerian hospitals and MSK was awarded one of the first pilot grants from the National Cancer Institute’s new Center for Global Health. The formation of ARGO has created 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, more than 100 physicians from 13 states in Nigeria attended a colorectal cancer master class with faculty from Nigeria, MSK, and the United Kingdom. In 2015, the consortium expanded to include breast cancer research and training initiatives. ARGO’s two prospective studies are described below.
Nigeria – Collection of demographic and genetic data from patients with colorectal cancer
Colorectal cancer in sub-Saharan Africa has never been studied prospectively in depth. To this end, ARGO created a full-time research team consisting of a Nigerian research physician, nurse, and coordinator. The team is collecting data on patient demographics, disease presentation, staging, and outcomes. More than 180 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.
Nigeria – Identifying high-risk populations to diagnose colorectal cancer at earlier stages
Many patients in Nigeria present to the hospital with advanced colorectal cancer. It is important to develop methods to screen high-risk people to identify patients at an early stage of disease; this will improve patient outcomes and reduce the high costs of treating patients with advanced cancers. In 2015, ARGO finished a 100-patient pilot study that provided colonoscopy for patients over 45 years old with rectal bleeding. Using this pilot study, the team created a predictive model that is being tested in a 225-patient study. This project will allow ARGO to create screening recommendations for patients at high risk of developing colorectal cancer in sub-Saharan Africa.
Nigeria – Breast cancer programs
Breast cancer rates are high in Nigeria: There is an annual incidence of 52 per 100,000 in the southwest area of the country. Mortality from breast cancer in Nigeria far exceeds that of high-income countries. ARGO recently expanded to include breast cancer as a focus of the consortium. The team started three projects in 2015 to investigate the system of breast cancer care for patients in Nigeria. The projects will seek to implement a routine breast screening program in the community, to understand how socio-demographic factors play into Nigerian women’s usage of breast screening programs, and to investigate whether shorter admissions following breast surgery have any impact on wound complications, cost of treatment, and patient satisfaction.
The Mammadi & Alireza Soudavar Traveling Fellowships
The Mammadi Soudavar Memorial Fellowship was established by Fereidoon and Shamsi Soudavar to honor their son, Mammadi, as well as to promote cancer education and research. The fellowship allows physicians from across the world to study at MSK and bring their knowledge back to their home country. More than 10 surgeons from sub-Saharan Africa have received fellowships. For more information and eligibility requirements, please visit www.mskcc.org/hcp-education-training/fellowships/mammadi-alireza-soudav….
The Memorial Sloan Kettering Cancer Center Global Cancer Disparities Pilot Grant was established to provide funding to 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. Get more information and see eligibility requirements.