MD Anderson is serving the underserved through cancer prevention

“Is it possible to make cancer history?”

That’s a question Ethiopian President Mulatu Teshome asked during a recent visit to MD Anderson.

“We believe so,” answered President Ronald DePinho, M.D., before adding, “but we’re not there yet.”

Getting there will require waging a global war against cancer, DePinho explained, with a focus not only on treatment, but also on prevention and early detection.

During an August trip to the United States, Teshome made a point to visit the leading cancer center, where he introduced the idea of collaboration.

The World Health Organization (WHO) predicts Africa, where infectious diseases such as malaria, HIV and, more recently, ebola have garnered the biggest slice of attention and resources, will have more cancer cases than any other country in the world by 2020. Sixty percent of global cancer cases will be in Africa, Asia and Central and South America, with the majority in Africa.

Therefore, the continent’s leaders are turning their attention to the looming epidemic, which their health systems currently can’t handle. And MD Anderson stands ready to help, according to Oliver Bogler, Ph.D., senior vice president for academic affairs.

“Our mission is to end cancer in Texas and the world. We take that very seriously,” says Bogler, who also heads the cancer center’s Global Academic Programs (GAP).

GAP manages the Sister Institution Network, a consortium of researchers at 29 premier academic cancer institutions in 22 countries.

In May 2012, in a small hotel conference room overlooking Stavanger, Norway, the network’s directors assembled for their annual meeting. For the first time, the leadership made a commitment to pool their resources and expertise to address the cancer burden in Africa.

The GAP team then began identifying other U.S.-based organizations already working with African institutions and governments.

“Instead of doing it alone and learning as we go, it’s more realistic and more useful for us to partner with organizations that are already engaging with Africa. They have the experience, are familiar with the territory and know how best to put all of our resources together to make an impact ,” says GAP project director Shubhra Ghosh, M.D.

Sharing knowledge

In 2013, MD Anderson signed a memorandum of understanding with the Union for International Cancer Control (UICC), a membership-based, nongovernmental organization headquartered in Switzerland. UICC is made up of 760 organizations across 155 countries that join together to help the global health community accelerate the fight against cancer.

The memorandum called for MD Anderson to help increase cancer care in sub-Saharan Africa and develop care models that can be implemented across the continent.

The initial focus is on educating and training doctors and other health care workers, who are in extremely short supply.

For instance, Zambia has a population of about 13.8 million, but only 15 gynecologists to treat women with cervical cancer.

MD Anderson is working with the UICC to host two training workshops for clinicians in Zambia and Mozambique. These workshops will include “train-the-trainer” programs, in which local physicians teach what they learn to other health care workers and create a “pass-it-along” knowledge chain. After workshops conclude, providers in Africa will participate in Project ECHO (Extension for Community Healthcare Outcomes), a telementoring initiative developed by the University of New Mexico to make knowledge and expert-level care more accessible to underserved communities. Through Project ECHO, local providers present cases and get feed-back from MD Anderson specialists through biweekly video conferencing.

This initiative is modeled after a current project that’s using ECHO for cervical cancer prevention in a community along the Texas-Mexico border.

A preventable cancer

One disease where education will have a dramatic impact is cervical cancer. In the U.S., the Pap test, introduced in the 1940s, has dropped cervical cancer rates by 70% (No. 14 on the list of most common female cancers). The HPV vaccine and HPV detection test are expected to further reduce the disease over time. (See "The cancer prevention vaccine")

But in Africa, Latin America and the Caribbean, cervical cancer is at or near the top of the list of cancers in women. The highest incidence is in Africa.

“It’s terrible that your chance of getting cervical cancer depends on where you live and if you have access to screening,” says Kathleen Schmeler, M.D., associate professor in Gynecologic Oncology and Reproductive Medicine. “We have a responsibility to share our expertise and knowledge with the rest of the world.”

Streamlining screening

Last year, MD Anderson signed a memorandum of understanding with the newly formed African Cancer Institute (ACI) at Stellenbosch University in Stellenbosch, South Africa — the institution’s first African research partner — to advance the prevention, diagnosis and management of cancer across the continent. The first collaborative initiative, led by Schmeler, will study the use of high-resolution microendoscopy (HRME) to diagnose and prevent cervical cancer.

This innovative technique, developed by researchers at Rice University, uses a fiber optic probe, placed on a patient’s cervix, to transmit cervical images to a cell phone. Immediately, clinicians can detect whether the patient has precancer and needs treatment. This method potentially can be used in areas where no gynecologist, pathologist or lab is available.

“The idea is that someone, like a primary doctor, nurse or community health worker, could go out into an underserved area and perform a cervical cancer screening and precancer treatment in one visit, close to the patient’s home,” Schmeler explains. “Then, the few people who need cancer treatment can travel for care. It gives them an option where there wasn’t one.”

Latin America

Many of the cervical cancer prevention measures planned for Africa were first launched and tested in underserved areas of Latin America.

For example, the HRME technique currently is being studied in Latin American trials.

The initial pilot studies were made possible by a grant from the Sister Institution Network Fund. Large studies of more than 10,000 women will begin soon in Brazil, El Salvador and Houston with grants from the National Cancer Institute.

Ripple effect

OB/GYN medical residents in Central America are learning how to better prevent, diagnose and treat gynecologic cancers through the Central American Gynecologic Oncology Education Program (CONEP).

Two gynecologic oncologists — volunteers from MD Anderson and other institutions — travel to Guatemala, Honduras, El Salvador, Nicaragua, Panama and Costa Rica for three to five days every six to 12 months. During each visit, physicians lecture, teach, make patient rounds and provide hands-on surgical training to medical residents.

Since CONEP’s launch in 2009, about 100 Central American medical residents and faculty have participated in each of the visits. Some of the residents then visit MD Anderson for one- to three-month observerships.