ASCP at AORTIC 2025: Building Telepathology Networks to Transform Care Across Africa

In early November ASCP Director of the Center for Global Health Kenneth Landgraf, MS, traveled to Hammamet, Tunisia, to speak at the 2025 conference of the African Organization for Research and Training in Cancer (AORTIC), a biannual meeting that brings together leaders from across the cancer care continuum. 

ASCP sponsored a session this year focused on pathology to help bring attention to the critical need for improved diagnostic systems in Africa. 

“One takeaway from just about every session I attended is that diagnostic access is a key barrier to improved health outcomes. Regardless of the topic, diagnostics just kept coming up as a critical missing piece that we need to strengthen. Another theme was the importance of implementation research in oncology,” Mr. Landgraf says. 

Like many parts of the world, many African countries are facing a severe shortage of pathologists. This has devastating downstream impacts on treatment and survival rates. According to Mr. Landgraf, the U.S. and UK, for example, have one pathologist per 20,000 people. But many low- and middle-income countries (including countries in Africa) have as few as one pathologist per million people. In addition to fewer pathologists, there are also fewer training programs and hardly any subspecialty training.  

This shortage is emerging as cancer is on the rise across Africa. As people live longer, cancer rates are projected to more than double over the next 15 years. Disparities in diagnosis rates and treatment also lead to poor health outcomes. According to Mr. Landgraf, the five-year survival rate for breast cancer in Sub-Saharan Africa is 40 percent, compared to high-income countries like the U.S. where the five-year survival rate is over 90 percent. 

Scaling AI and telepathology to improve diagnosis 
Across the African continent, pathology services in public healthcare systems remain chronically underfunded; however, the practice is evolving rapidly as laboratories and academic centers embrace digital technologies to strengthen diagnostic capacity.  

In his presentation at AORTIC, “Transforming Diagnostics: Digital Pathology and AI Partnerships in Africa,” which Mr. Landgraf co-presented with Dr. Shaheen Sayed, from Aga Khan University in Kenya and Dr. Alex Mremi, from Kilimanjaro Christian Medical Center in Tanzania, he shared lessons learned from establishing and scaling ASCP’s telepathology network across Africa. 

In 2015, ASCP launched the Partners for Cancer Diagnosis and Treatment Initiative, a program conceived to expand access to cancer diagnostics in low and lower-middle income countries (LMICs). ASCP has worked with laboratories in 28 countries, conducting site assessments, hands-on training for laboratory staff, and virtual training and mentorship programs. Where feasible, ASCP also deployed telepathology platforms (i.e. whole slide imaging systems) to facilitate remote consultation by ASCP member volunteers. 

Now, building upon the digital pathology infrastructure they built, ASCP is working with Massachusetts General Hospital and collaborators across Africa to create a diverse and representative data set of breast cancer cases across eight or nine countries. This dataset will be used to train a deep learning model to accurately predict patient response to ER and HER2-directed therapies based on a standard hematoxylin and eosin slide. The team hypothesizes that the diversity within their training data set will contribute to an algorithm that generalizes better for patients of African descent. 

Mr. Landgraf is optimistic about the potential digital pathology and AI hold to improve diagnosis and treatment in the countries of Sub-Saharan Africa and other LMICs. 

“Studies have shown how different AI tools can decrease the amount of time it takes for a pathologist to review a case. However, an algorithm is only as equitable as the data it learns from. Without diverse, representative datasets, AI in pathology will work best for the patients who already have the most access—and that’s exactly what we are trying to change.” Mr. Landgraf says.