Grand Challenges: Life Saving Cancer Pathology in Africa

Monday March 5, 2012 | Abby White, WE C Hope CEO.

When Lucy’s eye was removed because of retinoblastoma, it was sent to a specialist ocular pathology lab for careful examination.  An expert pathologist found Lucy’s cancer was contained in her eye.  The detailed report he provided 10 days after surgery helped her doctors determine she needed no more treatment.  Lucy quickly recovered from surgery and continued to enjoy her childhood in the heartland of America, free from cancer.

When Linda’s eye was removed because of retinoblastoma, her eye was sent to a general pathology lab, where it sat unattended for more than six months.  The lab’s one pathologist served the entire hospital and surrounding regions, and had no expertise in eye pathology.  Knowing this would happen and unsure her need for more treatment, Linda’s doctors started her on precautionary chemotherapy.

The arduous journey from her rural home through the African bush drained her family’s energy.  She frequently missed treatments due to lack of money for bus fare and medical bills, or simply because the medications were not available.  Her blood counts dropped and she struggled to fight infection.  Then one day she was diagnosed with malaria.  Weakened from chemotherapy, she could not fight the infection, and it eventually took her life.

Careful microscopic examination of Linda’s eye could have spared her the trauma of chemotherapy, preserved the scarce drugs for children in genuine need, and saved her family money.  Ultimately she might still be alive.

Removing an eye with retinoblastoma offers the best chance of saving the child’s life, but prompt examination of the removed eye is crucial to guide post-operative care.  If the cancer has not spread, no further treatment is needed for that eye.  If cancer has spread to outer layers of the eye, the optic nerve or front of the eye, more treatment is needed.

In 2009, we established the Retinoblastoma Collaborative Laboratory (RbCoLab) in Nairobi to compliment existing general pathology services and provides accurate, timely reports that guide post-operative care for each child.

We funded comprehensive ocular pathology training in Canada for the RbCoLab lead pathologies, Dr. Elizabeth Dimba, Kenya’s first specialist ocular pathologist.  Dr. Dimba has led development of a standard Rb pathology form to capture all information required by both the pathologist and ophthalmologist.

Thanks to Aurora and Bioimagene, we have also donated specialist equipment  to enable internet-based consultations and training of pathologists outside Nairobi.  However, the potential of this telemedicine program has been limited by lack of funding and intermittent server connection.

Our Global Rb Scientist, Dr. Helen Dimaras, is now leading a major initiative to advance digital pathology consultations, thanks to a $100,000 grant from Grand Challenges Canada.  The independent non-profit supports researchers focusing on practical solutions to global health disparities. Funded by the Canadian government, this award is one of 15 handed out in the second of three grant rounds.

Investment in digital pathology capabilities of the RbCoLab will increase efficiency and availability of accurate pathology reports, informing more individualised patient care.  As the pathology slides can be reviewed online in microscopic detail, the lab will also support education of clinicians and pathologists outside Nairobi and even in neighbouring countries.

Families who can afford to pay for consultation will be charged a reasonable fee, and the income will finance free consultation to families who cannot pay.

The digital RbCoLab will significantly improve care for each child by rapidly identifying their true risk and need for further treatment, regardless of where they live or whether or not they are treated in Nairobi.

The Grand Challenges grant offers a further $1million funding opportunity to expand successful projects.  We hope the success of this initial phase will lay the foundations for developing a molecular pathology program, enabling high level analysis of cerebrospinal fluid and bone marrow in children at very high risk of tumour spread.  Early diagnosis of such relapse is critical to effective patient care, giving each child the very best possible opportunities in the resource limited setting.

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