AORTIC 2011, Cairo, Egypt 30 November–2 December 2011
Developing research programs in Africa
Dr Timothy Rebbeck – University of Pennsylvania, Philadelphia, USA
We’ve been developing a number of cancer-related studies in Africa and I think the motivation for this work is that cancer has become an increasingly growing problem in Africa. With increasing lifespan, changes in demographics, changes in lifestyle and behaviours, cancer is set to become a greater problem than many infectious diseases in the coming decades. So we’ve been trying to develop research initiatives that allow us to begin to address research questions that will provide new knowledge about cancer in Africa and provide new ways of preventing, screening and treating cancer in a variety of ways.
Some of the work that we’re doing is focussed around prostate cancer; prostate cancer is the leading cancer in most of Africa right now. In addition, we know very little about prostate cancer in Africa so we’ve begun to use prostate cancer as a test case, a demonstration project that will allow us to begin to develop the resources that we need, to begin to have researchers, clinical staff, research facilities in order to do research on a variety of levels. When we have that in place for prostate cancer and we begin streams of funding to support that research, we hope to expand it to other cancers that are important in Africa – breast cancer, cervical cancer and others.
How is the research structured?
We’ve created a network of researchers around Africa, the network of prostate cancer researchers right now includes centres in Dakar, Accra, Kampala, Ibadan, Gaborone, Johannesburg and Cape Town, with a few developing centres elsewhere. The goal is to have this be a real pan-African initiative that covers both Anglophone and Francophone Africa, that covers geographically different regions of Africa with different needs, different kinds of health systems so that we can begin to address the African cancer problem on a very global scale.
How is the programme funded?
The money is coming from foundations and we are also putting grants into the National Institutes of Health in the United States and to other granting agencies. The funding has been small to this date but I think we have a number of grant applications that are going in in the coming year and so we hope to grow that in the coming months.
Are you involved in any other studies?
One of the talks that I’ve been doing is related to pathology in Africa so we’ve been developing pathology resources. I’m not a pathologist but I’m interested in the resources that are required to make research and improved clinical practice happen. So pathology is one of the key points that is limiting a lot of the clinical and research opportunities in Africa so we’ve been having a number of discussions and talks that hopefully will bring together some new resources so that pathology and laboratory medicine can be improved for a variety of purposes. I also have been interested in hereditary cancers through my interest in genetics and so I’ve spent one of my mornings here on a hereditary breast cancer session working with a number of others. Hereditary breast cancer is something that is poorly understood in Africa, the genetics of cancer in general are poorly understood in Africa but we understand from what we’ve observed about the patterns of cancer that they appear to be highly hereditary in nature. The patterns of cancer that we have observed look like hereditary cancers in the United States. The histopathology of those cancers appears to be the kind of histopathology that we see in genetically pre-disposed cancers in the United States and Europe and so we wonder whether the cause of these cancers in Africa might have a strong genetic component. So one of the sections that we have been discussing this week is to understand better and help the African researchers to understand better the nature of hereditary breast cancer and then to identify ways that we might be able to understand whether genetics play a role in Africa as well.
Once the genetics are proved to be the same, how will that help in Africa?
On the one level we have a lot of basic knowledge that we need to build about cancer in Africa, so some of this is a purely basic science kind of question or a basic fundamental knowledge question. We think that it’s important to develop fundamental knowledge about cancer, including genetics but also other kinds of molecular markers and other kinds of basic mechanistic research questions. This we think will help us to identify new treatments, new means of prevention or at least to better understand the nature of cancer so that we can optimise the way we study and approach cancer in Africa. Many of the things that we do now in Africa, or that have been proposed, are based around US or European research and the kinds of information that comes from studies in those locations. Some of the things that we find in Africa might be the same but until we’ve done the research and we know that they’re the same or they’re different, we won’t necessarily know whether we’re developing the correct treatments or preventative strategies. So some of this, again, is very basic, it might not have an immediate clinical translation but we hope that it will allow us to have a better basis for the cancer prevention, cancer treatment, cancer control strategies that get developed in Africa.
Is funding still available from the US despite the economic downturn?
Funding is always an issue, there is, however, a very big interest in global health in the United States even though funding is more limited than it used to be. The National Cancer Institute in the US, for example, has developed a brand new global health initiative and a global health centre which is something that they hadn’t had before at the level that they do now. They are beginning to develop special announcements for grant funding that are global health, including Africa, so while the money is not as freely flowing as it was many years ago, there is certainly a great interest in developing cancer research and funding cancer research in Africa. In addition, the NIH in general has a new plan called the H3 Africa Plan, the Human Heredity and Health Plan which is a large amount of funding coming from the US government and the Welcome Trust in the UK. This is a brand new initiative, again, that is bringing money directly into Africa for research which never existed before. So while funding and the economy haven’t been any help to us in getting funding for research going, there are some initiatives that make it look a little more hopeful than it might otherwise.
