Abstract B180: Molecular pathology in cancer medicine: Our experience in Cameroon.

Background: Cameroon, located in Central Africa, is a developing country with a population of approximately 20,000,000 millions.Cameroon's Public Health Care System includes: • 1 University teaching hospital established 40 years ago; • 7 new faculties for medical studies established in the last 5 years, with few resources; • The Ministry of Public Health, for all of Cameroon, has an annual budget of approximately $7 millions; • HIV, malaria, and tuberculosis are the most common infectious diseases. Almost the entire budget is devoted to these three diseases, leaving very little to use for cancer care, which has a higher mortality rate than these three diseases combined. Cancer Facts in Cameroon: • Liver cancer is the most common cancer in Cameroon, with virtually a 100% mortality rate. • Cervical cancer and breast cancer each represent 11% of the total cancer cases in the population. • Only 10% of all cancer cases are confirmed through microscopy. 90% of cancer cases go undiagnosed either due to a lack of money or, in rural areas, as pathology facilities are not available. • There are fewer than 10 pathologists and 10 oncologists for the whole population of Cameroon. • A hospital based cancer registry was established in 1987. Since 2000, Cameroon has been working to include population based cancer statistics in the registry. • Radiology, ultrasonography, and endoscopy are only performed in the two main cities, Douala and Yaounde, which have only 20% of the general population. • Thoracic surgery, neurosurgery and radiotherapy are not readily available. Thus, very little can be offered for inoperable tumors. • Medical oncology/haematology services have just been introduced, but only a restricted spectrum of cancer chemotherapy drugs are available and the patient must pay for them. • 80% of undiagnosed cancer patients end up with late-stage cancer, with no palliative care available. These people resort to treatment by Marabout, who provide home grown “cures”. The result: death! In developed countries, molecular pathology techniques such as immunohistochemical staining is widely used in the diagnosis of abnormal cells such as those found in cancerous tumors and is now introduced in the new WHO classification of diseases. Most of these techniques can be used on paraffin-embedded specimens. Materials and Methods: In Cameroon, the above techniques are not available. We established a collaboration with few laboratories in developed countries including National Cancer Institutes, USA, Switzerland, and France. Paraffin blocks of diagnosed cancers have been sent abroad since January 2000. Immunohistochemistry has been performed free of charge. Results: A series of 130 cancer patients was included in this study. There were 47 malignant lymphomas, 20 cases of early stage Kaposi's sarcoma, 20 soft tissue tumours, 15 breast cancers, 5 brain tumours, 3 urethral cancers and 20 cases of colon cancers. The delay of sending specimens and receiving results via the Internet was one month. Apart from classifying and clarifying their diagnosis, none of these patients received TARGET treatment after the immunohistochemistry result to date as drugs are either expensive or not available. Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B180. Citation Format: Nkegoum Blaise, Mboumtou Liliane. Molecular pathology in cancer medicine: Our experience in Cameroon. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B180.