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Scientists seek new ways to improve testing for childhood cancers in Africa

Scientists at the University of Oxford in United Kingdom and African Field Epidemiology Network (AFENET) together with other East African Institutions are testing novel diagnostic tools to improve childhood and young adult lymphoma outcomes in sub-Saharan Africa. 

It is estimated that over 90% of children in the world with lymphomas are from sub-Saharan Africa, with these cancers caused by Epstein-Barr virus (EBV) infections, malaria and HIV. Although lymphomas are easy to treat and the therapy is free of charge, most patients are either diagnosed late, at which point the cancer is more difficult to treat, or remain undiagnosed. This is due primarily to the lack of reliable diagnostics services with enough surgeons and pathologists to establish the precise diagnosis fast enough. 

The study will evaluate two diagnostic tests that have been successfully used to diagnose cancers in high income countries: The first diagnostic technique is a liquid biopsy, a simple blood test that can measure circulating tumour DNA (ctDNA) to make the diagnosis of cancer. The team has now developed this non-invasive technology specifically for the EBV-related lymphomas in sub-Saharan Africa, but plan to use it for other cancer screenings across Africa in the future. The second diagnostic technology takes pictures of tissue biopsies with a small and affordable mobile camera that can be attached to any microscope. These pictures can then be sent anywhere in the world for a diagnosis. It means that fewer local pathologists would be required for diagnosis, which would make a huge difference in remote places. 

The teams are now in the process of validating this low-cost and low-maintenance technology, and enhancing local pathology services by making sure they have the immunostaining technology they need for the biopsy process, and that they can do second reviews.

At the end of this 4-year prospective case-control study, up to 300 children and young adults suspected with lymphoma will have been recruited from three-large oncology centers in East Africa. In Uganda, case enrollment kicked off in June 2020 following official launch of the project in Dar es Salaam in February 2020. A total of 166 participants have been enrolled in the study so far across the three sites. St. Mary’s Hospital Lacor in Gulu is the only Ugandan site for case recruitment and the hospital has already recruited 40 participants against the project goal of 50. While in Tanzania, Muhmibili National Hospital in Dar es Salaam and Kilimanjaro Christian Medical Center in Moshi have a target of 250 cases. 

The study has organized several trainings for scientists, doctors and pathologists in participating hospitals in Uganda and Tanzania. A team of Ugandan laboratory scientists recently received a specialised training in Next Generation DNA sequencing using the Illumina platform in Muhimbili University of Health and Allied Health Sciences- Dar es Salaam. The training was sponsored by the University of Oxford, through NIHR-RIGHT grant. The study has also directly procured equipment for diagnostics, state-of-art treatment with rituximab and efforts are underway to equip and operationalise a state-of-the art genomics laboratory to analyse DNA samples in the country.

Prof Anna Schuh, a consultant Haematologist and Director of Molecular Diagnostics at the University of Oxford is the Chief Investigator of the study. The East African investigators include Dr Clara Chamba- Co-PI Muhimbili University of Health and Allied Sciences (MUHAS), Dr Faraja Chiwanga and Dr Hadija Mwamtem- Co-PI Muhimbili National Hospital (MNH), Dr Elifurah Mkwizu- Co-PI Kilimanjaro Christian Medical Centre, Dr Sam Mbulaiteye – National Cancer Institute USA and Dr Martin Ogwang-Co-PI St Mary’s Hospital Lacor, Gulu Uganda. Whilst AFENET’s Dr Godfrey Kayita is the Project Manager.

Written by Ismail Legason