Finding the Lethal Phenotype: Research Partnership Needs

Transcription

1 Finding the Lethal Phenotype: Research Partnership Needs Timothy R. Rebbeck Increases in Anti-Malaria Spending = Reductions in Malaria Deaths 1,000, , ,000 in Africa Deaths 700, , , , Year Malaria (World Malaria Report 2010)

2 700,000 While Cancer Deaths Increase 1,000, , ,000 Deaths in Africa 600, , , Year Malaria (World Malaria Report 2010) Cancer (GLOBOCAN 2008) Increasingly Elderly Population in the Developing World More Developed Countries Less Developed Countries World Cancer Report 2008 Changes in Lifestyle and Exposures (Concomitant Increase in Specific Cancers) Prevalence of BMI>25 (Men) WHO Global Infobase 2011

3 Number of People Served by Each Radiotherapy Center Sources: International Atomic Energy Agency, Directory of Radiotherapy Centers, Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision, and Jemal et al Percent of Population Covered by Cancer Registries (Number of Registries / Number of Countries Reporting) 83.0% (54/2) 5.5% (11/7) 1.1% (5/5) 32.5% (100/29) 4.0% (44/15) 80.5% (11/2) IARC-Compliant Tumor Registries (2010): Algeria, Egypt, Tunisia, Uganda, Zimbabwe Age Standardized Estimates (ASE) of Incidence and Mortality for Five Leading Cancers in Men of African Descent by Geography Incidence* Mortality* Location Cancer Number of Cases ASE** Cancer Number of Deaths ASE** CaP Mortality: Incidence Rate Ratio Prostate 39, Prostate 28, Liver 34, Liver 33, Africa Lung 20, Lung 19, Colorectal 19, Esophagus 16, Bladder 16, Colorectal 14, Prostate 15, Prostate 6, Lung 5, Lung 5, Caribbean Colorectal 3, Colorectal 2, Stomach 2, Stomach 1, Larynx 1, Liver 1, Prostate 30, Lung 9, Lung 11, Prostate 4, US (African Colorectal 8, Colorectal 3, American) Kidney 3, Pancreas 1, Bladder 2, Liver 1, *African and Caribbean incidence and mortality estimates from GLOBOCAN 2008 and include men of all races. US incidence rates from SEER-17 for the year 2008, estimated numbers of cases for the total US based on the SEER-17 rates, and US mortality data for the entire country for the year 2007; all include only African American men. ** ASE: Age-standardized Estimates per 100,000 population adjusted to the 1960 world population.

4 Prostate Cancer Deaths* (Globocan 2008) Year US Africa ,660 28, ,651 57,048 % Increase 87% 104% *All Races/Ethnicities What is needed to develop research capacity in Africa? Opportunities/Questions Logistical Goals: Develop Centers of Research Excellence Identify research partners Research exchanges Research resources: registry, biosample, laboratory, population, database, administrative Funding opportunities Scientific Goals: What are the leading cancer problems that require research? What are research opportunities unique to Africa? Basic research Population and behavioral research Clinical Research

5 Needs Capacity building: research and training relevant to local conditions and culture Provide common resources to achieve economies of scale: regional centers of excellence? Develop joint (collaborative, multicenter) projects not sample providers Advocacy (explaining why research is important): Community engagement Media and governments Academic/medical engagement: respect and understanding of research Critical Components Dedicated Influential Local PI: Maintain support of superiors Willingness to promote junior researchers Environment that fosters PIs: Research track Dedicated research time vs. clinic load Academic (not just scientific) training Research Focus: Achievable goals Realistic timeline Mentorship: Scientific and academic Regular communication with bidirectional visits Challenges Resource Limitations: Limited tumor registration No central investment in cancer research Limited research infrastructure in cancer (IRB, protocols, study staff, administration) Limited funding mechanisms Academic Issues: Lack of protected time for investigators No academic tracks Limited culture of research The vacation myth Lack of research training Education: Limited understanding about the importance of cancer in the population

6 Men of African Descent and Carcinoma of the Prostate (MADCaP) - Africa Establish Centers to: Create knowledge about cancer in Africa. Translate this knowledge to improved prevention, detection, and treatment of cancer in Africa. These Centers will: Offer high quality facilities for training, research and advocacy. Help to implement national cancer plans. Reduce dependence on foreign institutions for training and service and minimize brain drain. Key Components and Leverage Points Advisory Board: Afrox Representative AORTIC representatives: At Large President President-Elect Executive Director ASCP Representative IAEA Representative IARC Representative UICC Representative Academic Partnerships: Albert Einstein, New York (Ibadan) Fred Hutchinson Center, Seattle (Uganda) Harvard University (Botswana) Moffitt Cancer Center, Tampa (South Africa) NCI, Bethesda (Ghana) University of Chicago (Nigeria, Uganda), Philadelphia (Botswana, Senegal) University of Pittsburgh (Nigeria) University of Southern California, Los Angeles (Uganda) Dakar Cancer Consortium, Dakar, Senegal Univ. of Ibadan, Network Partnerships: Nigeria Prostate Cancer Mulago Hospital, Transatlantic Makerere University, Kampala, Uganda Consortium (CaPTC) Korle Bu Hospital, 37 Military Hospital, African Caribbean University of Accra, Cancer Consortium Ghana (AC3) NGO Partnerships: University of Botswana, Afrox, Oxford Gaborone, Botswana ASCP, Washington IAEA, Vienna IARC, Lyon Tygerberg Hospital, National Health Stellenbosch University, Laboratory Service, Cape Town, South Africa Johannesburg, South Africa Dakar Cancer Consortium: A Public-Private Partnership Private Lab Public Hospital University Foundation Hôpital Général de Grand Yoff Centre de Diagnostic et de Recherche en Medicine Moleculaire Université Cheikh Anta Diop Institut de Formation et de Recherche en Urologie Bio24 Hôpital Aristide le Dantec Institut Pasteur Clinical Data Accrual Laboratory Research Biobank

7 Developmental Process Development Implementation Evaluation African Centers: Accra, Benin City, Dakar, Kampala, Stellenbosch, Others Steering Committee, External Advisory Board Success Metrics AORTIC Strategic Planning Meeting, Dakar AORTIC Strategic Planning Report Identify Potential Centers and Partners Establish ACES Structure and Processes Report to AORTIC Council & Board Site Visits and Implementation Evaluation Distance Learning: IAEA-VUCC Pathology: ASCP Project Management: Afrox Registries: IARC Common Protocols Extramural Funding 12/ / /2012+ Acknowledgements PHS Grants R01-CA and P50-CA105641, AACR Landon Foundation Award, US State Department Fulbright Program Accra, Ghana Sunny Mante 37 Military Hospital Edward Yeboah Korle-Bu Hospital Benin City, Nigeria Michael Okobia University of Benin Bethesda, USA Ann Hsing NCI Cape Town, RSA Pedro Fernandez Stellenbosch University Chris Heyns Stellenbosch University Dakar, Senegal Serigne Gueye Hôpital Général de Grand Yoff Mohamed Jalloh Hôpital Général de Grand Yoff Ibadan, Nigeria A. Olupelumi Adebiyi University College Hospital M.C. Asuzu University College Hospital Oluwafemi Popoola University i College Hospital Johannesburg, RSA Chantal Babb National Health Laboratory Margaret Urban National Health Laboratory New York, USA Ilir Agalliu Albert Einstein University Thomas Rohan Albert Einstein University David W. Lounsbury Albert Einstein University Kampala, Uganda Stephen Watya Mulago Hospital, Makerere University Los Angeles, USA Chris Haiman University of Southern California Brian Henderson University of Southern California Philadelphia, USA Baoli Chang Shannon Lynch Elaine Spangler Sarah Tishkoff Amy Walker Charnita Zeigler-Johnson