Challenges of Cancer Diagnosis in Resource Limited Settings Optimizing Pathology Support Ann Marie Nelson, M.D. AIDS and Infectious Disease Pathology Joint Pathology Center, USA Sub-Saharan Africa CFAR May 2011 Kampala,Uganda

What Are the Goals of Pathology?  Provide consistently high quality diagnoses linked to  Capacity to interpret and utilize information for  Treatment  Follow-up  Establishment of registries and biorepositories

What is Required?  Health workforce  Infrastructure  Reliable source of supplies  Quality assurance program  Interdisciplinary training and communication

Health Work Force  Primary Care  Knowledge of cancer epidemiology/ddx  Information on when and where to refer  Oncologists  Surgeons  Radiologists/Clinical Laboratories  Pathologists  Technicians and clerical staff

Infrastructure and Supplies -Surgery  Materials and SOPs for collection, documentation, fixation, and hand off of specimens  Clinical and surgical information  Specimen description and margins  Appropriate fixation for routine and special procedures - tissue fixation must be rapid and documented  Efficient transfer of material to pathology

Infrastructure and Supplies -Pathology  Standardized system for receipt and documentation of specimens, case tracking, reporting and archiving  Basic working equipment for tissue evaluation and processing  Adequate supply of good quality reagents

Quality Assurance  Standard operating procedures and training of personnel at all levels  Quality control of specimen collection, fixation, processing, tissue sections and staining  Quality assurance of diagnosis - internal and external review  Documentation of errors with remediation

Interdisciplinary Training and Communication  Tumor Boards  Oncology, surgery, radiology, pathology etc  Before and after definitive procedures  Cancer Registries and Repositories  Data sharing and dissemination  Cross-training at post-graduate level  Surgeons, oncologists, pathologists and radiologists should rotate in each specialty

Challenges  What requirements does your institution lack?  How to implement change?  How to get buy-in from all parties including government and funding agencies?  When and how to introduce new technologies?