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?