Three Years of Fighting Cancer Around the Globe, One Patient at a Time

The following is a summary of the ASCP Partners for Cancer Diagnosis and Treatment Initiative Three-Year Report.

For 40 years, HIV, tuberculosis, and malaria have dominated the global health agenda as these diseases ravaged the poorest parts of the world. Through funding programs, carefully designed interventions, and a unified voice to combat these diseases, these diseases are on the decline.

ASCP and a host of other partners have been part of this fight through our lab strengthening efforts with the Centers for Disease Control and Prevention and the President’s Emergency Plan for AIDS Relief (PEPFAR). But for all these gains, there are new challenges. Cancer is increasing in low- and middle-income countries (LMICs).  

Across the spectrum of cancer care, all personnel are lacking—oncologists, surgeons, pathologists, laboratory professionals, and ancillary supportive services. Without diagnostics, clinicians are unable to effectively screen for cancer, diagnose disease and develop care plans. The majority of cancers are not diagnosed until late stage.

In 2015, ASCP’s Center for Global Health (CGH) launched the Partners for Cancer Diagnosis and Treatment in Africa initiative out of the White House Office of Science and Technology Policy. Recognizing the value of pathology and laboratory medicine in this continuum, ASCP has created sustainable solutions that improve outcomes and save lives.

We have not been alone in this fight. In the last decade, many nongovernmental organizations have created, expanded, or deployed programs to combat cancer. The Union for International Cancer Control launched the C/Can 2025 City Cancer Challenge, and the World Health Organization (WHO) at the World Health Assembly passed a Cancer Resolution. In 2018, WHO launched its first cancer initiatives in cervical cancer and pediatric cancer. We now have a WHO Essential Diagnostics List, including tools for cancer, and a list of priority medical devices for cancer management.

To assume that any particular solution, whether out of the box or successful in a prior location,

will always be valuable in another location is a fallacy. Every population center that does not have an optimized cancer continuum will have a series of predictable, unique, and/or entirely unpredictable challenges that must be identified, rationalized, and, when possible, solved.

This approach underlies the program for ASCP in global health where we begin with assessment (internal and external) and use root cause analysis to create a list of sustainable interventions tailored to a given site. Since the launch of Partners, we have engaged in a range of activities including the following:

• In person site assessments, expert consultations, and training

• Procurement, delivery, installation, and training for equipment

• Procurement and delivery of educational aids for trainees

• Recruitment, training, and support for pathology volunteers

• Translation of pathology tools into multiple languages

• Creation and support of global online resources

• Foreign and domestic direct conference support

• Foreign and domestic conference support for attendees (foreign and domestic)

“Through ASCP, I have traveled to Biamba Marie Mutombo Hospital in the Democratic Republic of the Congo and JFK Hospital in Liberia to assess and set up histology laboratories as well as train the staff,” said ASCP member volunteer Linda Cherepow, HTL(ASCP).

At the heart of this program is the provision of whole slide image-based telepathology supported by teams of ASCP member volunteers remotely. When installed, this system allows for pathologists in our collaborating sites to have access to 15 or more pathology experts via cloud computing across all diseases, with a less than 24-hour turnaround time for consultations. Not every laboratory is ready for telepathology, and some laboratories need more advanced help. The assessment process is therefore crucial to designing a matching implementation plan for each site. ASCP’s impact in the last three years has been immense.

“Through the ASCP Global Health Travel Fellowship, I have worked alongside pathologists and laboratory professionals at Makerere University in Uganda to institute new lab protocols, documents and processes, digitize three years’ worth of reports for research and quality monitoring, and teach residents,” says ASCP member volunteer Jennifer Kasten, MD, MSc, FASCP.

ASCP CGH staff works closely with the ASCP membership to design and execute all of the CGH global health activities. This has led to ongoing engagement of ASCP members around the world, including the following:

• 45 members for 4 countries: board certified pathologists virtual (telepathology) volunteers
• 21 members to 8 countries: certify laboratory professionals in-country, training volunteers
• 11 members to 10 countries: pathologists (certify and in-training) in-country volunteers

Our overarching goal at ASCP in global health is 100 percent access to diagnostics and treatment for all patients everywhere. Our cancer focus is broad, as a histology slide can diagnose any cancer from all body sites. Our technical interventions have/can include(d) histology, immunohistochemistry, flow cytometry, clinical laboratory medicine, molecular diagnostics, and targeted therapies.

To real the full ASCP Partners for Cancer Diagnosis and Treatment Initiative Three-Year Report, click here. If you have any interest in further details about our plans, project impact, specific fiscal needs, or other programs, please reach out to ASCP directly at dan.milner@ascp.org.

Read the May 2019 Update for the ASCP Center for Global Health here.