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critical values | July 2016
critical values | volume 9 | issue 3
Workforce and Technology
Innovative Technology
and Collaboration
Move Cancer Diagnostics to the
Forefront in Sub-Saharan Africa
By Susan Montgomery
10.1093/crival/vaw012
As African economic development improves, the prevalence of non-communicable diseases (NCDs) will increase,
with cancer at the forefront. NCDs such as cardiovascular
disease, cancer, chronic respiratory diseases, and diabetes
are often associated with the “globalization of unhealthy
lifestyles,” such as unhealthy diets, physical inactivity,
exposure to tobacco smoke, or the effects of alcohol.1
Over the next five years, the annual number of new cancer cases is predicted to increase to 1 million.2 The economic costs associated with cancer—both immediate
healthcare costs and loss of productivity—are threatening continued development and prosperity. Deaths from
preventable cancers mean catastrophic health expenditures, lower household income, and potential impoverishment. Globally, the World Economic Forum projects
that the NCD epidemic will inflict $21.3 trillion in losses in
develop­ing countries over the next two decades.3
Pathology is important for diagnosing and treating cancer,
ASCP President David N.B. Lewin, MD,
FASCP, left, and ASCP CEO E. Blair
Holladay, PhD, SCT(ASCP)CM, ­review
the first biopsied breast ­cancer image
uploaded from Rwanda.
but the countries in Sub-Saharan Africa lack pathologists
and trained laboratory personnel, infrastructure, and adequate opportunities for professional training.
©American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: [email protected]
July 2016 | critical values
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Leveraging Leapfrog Technology
upload their findings. Third, local clinicians are able to
In October 2015, the American Society for Clinical Pathol­
access the results within 24 to 72 hours after the spe-
ogy (ASCP) and a coalition of partners committed to provide patients in underserved areas of Sub-Saharan Africa
cimen has been uploaded for reading and implement
patient management.
and Haiti access to rapid cancer diagnostics and appropriate treatment. The ASCP-led coalition is developing an
economical, scalable, and secure telepathology approach
that will evolve into a cloud-based system to register
specimens, record findings, and disseminate diagnostic
results to local clinicians, and will build capacity to provide care and treatment options for patients. Leveraging
this technology will allow local clinicians to upload biopsy
images and receive diagnostic results from pathologists
in the United States within 24 to 72 hours.
Delivering Care
ASCP anticipates diagnostics will be delivered to hundreds
of thousands of people, 75 percent of whom will be female.
ASCP will draw from its 8,000 anatomic pathologist members to provide diagnostic services, and its 91,000 laboratory professional members to provide support and training
to laboratory professionals on the ground. To date, 350
pathologists have been recruited to review cases. ASCP
provides oversight and project management, working with
While telepathology is becoming more of a reality in the
developed world, this level of diagnostic care is currently
scarce or unavailable in Sub-Saharan Africa. ASCP is providing quality diagnostics through three key steps. First,
automated histopathology equipment and systems for
preparing and scanning biopsy slides are being estab­
lished in locations with the greatest population density,
and servers have been placed in laboratories for file
transfers, beginning immediately in Botswana. Botswana
has already implemented automated histopathology and
is currently implementing whole slide imaging and cloud-
coordinating partners and ministries of health, and building
capacity through workforce development initiatives.
World-renowned partners are contributing their expertise and best-in-class practices to implement this commitment. Sakura Finetek has provided histopathology
in­struments for preparing biopsies. Omnyx LLC has provided telepathology equipment, workflow software,
supplies, and technical/operational support for the systems used to scan and display patient biopsied images.
Technossus is providing a cloud-based laboratory infor-
based diagnostic systems under the leadership of ASCP.
mation management platform that will be used to inte-
Other sites in this initial phase are in Rwanda: the
Technossus is also providing a cloud-based pathology
grate partner instruments and manage testing process.
Butaro Cancer Center of Excellence (BCCOE), the University Teach­ing Hospital of Kigali, and the University Teaching Hospital of Butare. Local clinicians collect biopsy
specimens that are transported to laboratories for processing and scanning by locally trained lab technicians.
The BCCOE was established in 2012 at the Butaro District Hospital in rural Rwanda by the Rwanda Ministry
of Health in collaboration with Partners in Health (PIH),
a global public health organization and member of the
Partners for Cancer Diagnostics and Treatment, and the
portal that will be used by ASCP pathologists to access,
review, and diagnose patient cases.
“Technology serves as an enabler of clinician collaboration, and we believe that patients benefit the most,”
says Mamar Gelaye, CEO of Omnyx. “We are proud to be
en­gaged in an effort that has such a positive impact on
rural/community health in Africa.”
Meanwhile, Roche Diagnostics is providing immunohis-
2
tochemistry equipment. The National Cancer Institute at
Marking a major milestone in May 2016, ASCP president
the National Institutes of Health will supply high-level
Dana-Farber/Brigham and Women’s Cancer Center.
David N.B. Lewin read the first slide from Rwanda using
scientists to determine the best manner of caring for
the telepathology system.
patients identified with malignancies, crafting treatment
Second, through cloud technology, ASCP pathologists
nership with the local ministers of health, is coordinating
view the processed samples, diagnose the patient, and
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critical values | July 2016
protocols that are both ethical and effective. PIH, in partcare and treatment in Rwanda and Haiti, and care delivery
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critical values | volume 9 | issue 3
Country Operational Approach
models will be developed in the other program countries.
Exciting new developments continue to unfold for Part-
Pfizer has supported the initiative via philanthropic cash
ners for Cancer Diagnosis and Treatment in Africa. New
donation. The Institute for Health Measurement and
partner organizations are coming on board, and aware-
­Evaluation will provide data measurement and evaluation
ness of the initiative continues to expand. Watch for more
of the initiative.
details in the coming months.
Next Steps
References
The article “Implementation and Validation of Telepathology Triage at Cancer Referral Center in Rural Rwanda,”
1.
published online in January 2016 in the Journal of Global Oncology, outlined the initial phase of an anatomic
telepathology triage system, which was implemented
2.
and validated at Butaro District Hospital.4 “Challenges to obtaining a correct and complete diagnosis with
telepathology alone included the need for immunohis-
3.
tochemistry, assessment of the quality of images, and
the lack of images representing an entire sample,” states
the article, co-authored by Daniel A. Milner, Jr., MD, MSc,
a pathologist with Brigham and Women’s Hospital and
a volunteer for Partners in Health. “The next phase of
the system will assess the effect of telepathology triage
on turnaround time and the value of on-site immunohistochemistry in reducing that metric and the need for
evaluation outside of telepathology.”4
4.
Non-communicable Diseases Fact Sheet. World Health
Organization. 2015. Available at: http://www.who.int/
mediacentre/factsheets/fs355/en/. Accessed April 21,
2016.
Stefan D, Masalu N, Ngendahayo L et al. Pathology and
oncology in Africa: education and training for the future
in cancer research– East African Regional Meeting. Infectious Agents and Cancer. 2015;10(1).
Non-communicable Diseases in Developing Countries
Emerging as a Global Health Crisis, Warns CFR Task
Force. Council on Foreign Relations. 2014. Available at:
http://www.cfr.org/diseases-noncommunicable/noncommunicable-diseases-developing-countries-emerging-global-health-crisis-warns-cfr-task-force/p33890.
Accessed April 21, 2016.
Mpunga T, Hedt-Gauthier B, Tapela N et al. Implementation and Validation of Telepathology Triage at Cancer
Referral Center in Rural Rwanda. Journal of Global Oncology. 2016;2(2):76-82.
Ms. Montgomery is a Communications Writer for ASCP.
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