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Feb 13, 2020

ASCO Daily News: Welcome to the ASCO Daily News Podcast. Joining me today is Dr. Clement Adebamowo. He is a Professor of Epidemiology and Public Health, Associate Director in Population Science, Greenbaum Comprehensive Cancer Center at the University of Maryland School of Medicine, and he's also a research scientist at the Institute of Human Virology, Nigeria, and Center for Bioethics and Research, also in Nigeria. Additionally, he is the President of the Society of Oncology and Cancer Research of Nigeria, which is a professional society modeled after ASCO. Welcome to the podcast.

Dr. Clement Adebamowo: Thank you very much. Thank you for having me.

ASCO Daily News: I'm so glad you're here. Today, we are talking about global cancer health and some of the challenges people face around the world. Let's start with cancer prevention and screening. What are some of the barriers to cancer screening for people in sub-Saharan Africa?

Dr. Clement Adebamowo: Thank you for asking that question. I think the barriers to cancer screening for people in sub-Saharan Africa include limited public and health care professionals' knowledge, such that population is not aware of their availability and the methods of cancer screening and health care professionals often do not have up to date information about the methods that are applicable in their particular environments.

Dr. Clement Adebamowo: Secondly, there is the issue of poor funding, which prevents patients from taking advantage of screening opportunities even when they're there, and even when this screening is offered at the point of service as a free service, because the individuals who have to take advantage of the service will still have to endure some cost in order to take advantage of the service. So that poor funding certainly limits the access of people to cancer prevention services.

Dr. Clement Adebamowo: And there is also the challenge of poor infrastructure, where many of the institutions in low- and middle-income countries do not have the resources that they need to implement systematic, widespread population-based screening programs that make a difference in the incidence of cancer in their environment. So those are the main reasons that I think-- those are the main barriers to cancer screening in sub-Saharan Africa.

ASCO Daily News: Let's talk about cancer prevention. What are some of the opportunities and challenges in cancer types such as breast cancer and cervical cancer?

Dr. Clement Adebamowo: Very good. So these two concerns in many sub-Saharan Africa constitute more than 50% of the cancer that affect women, so it's very important that we are proactive in identifying ways of preventing them. Cervical cancer in particular has many opportunities and resources, including taking advantage of interventions like the program for HIV-positive women. And because of this, organizations like the WHO think that there is the possibility that over the next few decades we may be able to eliminate eliminate cervical cancer as a public health problem in different parts of the world.

Dr. Clement Adebamowo: So the technologies, many of which are very refined and studied, and new technologies are also becoming available that are adapted to the low resource environment where the incidence of cervical cancer is so very high.

Dr. Clement Adebamowo: Breast cancer is a different kettle of fish, because there is no appropriate systematic screening tool for low resource environments at this time, particularly given that the [INAUDIBLE] of breast cancer in those countries tends to present in people younger than 40, 50 years of age, at which time the commonest evidence-based intervention, which is a screening mammography, is not optimal for early detection and diagnosis. In addition, it requires a lot of further infrastructure in order to actually diagnose the screen detected lesion and give optimal treatment.

Dr. Clement Adebamowo: However, methods of increasing awareness of the disease and improving the stage at diagnosis so that women present at earlier stages are much more valuable and are currently being researched by different groups, in order to improve the currently dismal outlook of breast cancer in many low- and middle-income countries.

ASCO Daily News: What can be done to improve early diagnosis in diseases such as breast cancer?

Dr. Clement Adebamowo: So with breast cancer, the situation is slightly different. So the current evidence-based intervention for breast cancer screening is systematic population-based mammography. Now, given the [INAUDIBLE] of breast cancer in many sub-Saharan African countries and the average life expectancy of the population, mammographic screening is probably not a suitable intervention at population level.

Dr. Clement Adebamowo: So we're focused on examining methods that can lead to downstaging of the breast cancer at presentation, so that patients no longer present with advanced disease where there is limited opportunity for care and methods of treatments that preserve the overall body image. And we're looking at ways of increasing both the public and professional awareness and promoting breast awareness, so that women notice when there is something different in their breast and they pretend to appropriate hospitals, where they can get good quality care.

ASCO Daily News: Absolutely. And then what's the role of genomics and genetic testing for these populations?

Dr. Clement Adebamowo: So in most African countries, there are limited resources and infrastructure for genomics and genetic testing. But as you know, the technologies are evolving very rapidly, and the prices are coming down very rapidly. And this opens up opportunities, both for research and clinical care, for patients who will benefit from having genomic testing, either because of family history of breast cancer, which means they're at increased risk of having familial breast cancer, or using genomics to test the breast tumor and identifying the best treatment interventions that these individuals can have.

Dr. Clement Adebamowo: So some practices in Africa are already adopting the genetic testing of tumors. And there are [INAUDIBLE] projects going on familial breast cancer. In addition, there are projects examining the genetic risk factors for breast cancer in African populations in general, and these different projects are likely to contribute significantly to world literature in the next few years.

ASCO Daily News: I wonder if resources such as telemedicine would help countries improve cancer care.

Dr. Clement Adebamowo: Telemedicine has been explored for management of patients with cancer in Africa for several years. My evaluation is that it is now coming together very nicely in different ways. Telemedicine is being used, of course, for training, and so many health care providers in Africa are able to use telemedicine to update their knowledge without needing to travel, and a cure what can sometimes be substantial expenses in order to update their knowledge and skills.

Dr. Clement Adebamowo: Then the pathology is also increasingly used where remotely located trend specialists can provide their expert knowledge for diagnosis and make recommendations for treatment of patients in sub-Saharan Africa while there are thousands of miles away. We are also seeing telemedicine playing roles in interventions like [INAUDIBLE] for screening, either as the primary intervention, or to give second opinion to the onsite [INAUDIBLE].

Dr. Clement Adebamowo: So there are many ways in which telemedicine is gradually revolutionizing cancer care in Africa, and the low costs of some of the new technologies, because of miniaturization, nanotechnology, the widespread availability of cells phone and cell phone networks and data plans is increasing the penetration of these technologies into even rural areas, where it's leading to a substantial reduction in cost and improved patient outcomes.

ASCO Daily News: What do you think is on the horizon for cancer care in sub-Saharan Africa?

Dr. Clement Adebamowo: I think that for cancer in sub-Saharan Africa, we're about to enter a period of flourishing. We now are beginning to see widespread availability of technologists of resources persons who have been trained, sometimes in cancer programs, sometimes from other training programs, but they are applying their skills in cancer care.

Dr. Clement Adebamowo: We're seeing the introduction of technologies, telemedicine, nanotechnology, and artificial intelligence adapted for use in low resource environments, so that together all of this interventions will reduce many of the barriers that patients face, including high cost of currently available diagnostics and treatment, limited availability of resource persons, and poor infrastructure.

Dr. Clement Adebamowo: So as these technologies penetrate further and gets even better, we're going to see improvements as patients access treatments and prevention of cancer.

ASCO Daily News: That's wonderful. It sounds like some very good things are happening in the future. Well, it's been a pleasure speaking with you. Thank you for being on our podcast today.

Dr. Clement Adebamowo: Thank you. Thank you for giving me the opportunity to talk about these issues.

ASCO Daily News: And to our listeners, thank you for tuning in to the ASCO Daily News Podcast. You can find all of our ASCO podcasts on podcasts.asco.org. If you're enjoying the content, we encourage you to rate us and review us on Apple Podcast.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.