ASCP Center for Global Health Update for May 2019

Expanding Borders and Breaking Language Barriers in Pathology Training

Below are highlights of the past month’s achievements. If you have any questions, please contact Dan A. Milner, Jr., MD, MSc(Epi), FASCP, ASCP Chief Medical Officer, dan.milner@ascp.org. 

Updates

- Côte d'Ivoire—ASCP and Seattle-based BIO Ventures for Global Health (BVGH) jointly held a cancer diagnostic workshop for pathologists and oncologists in Côte d'Ivoire on April 16-18. In partnership with the Ivorian Society of Pathology, the breast pathology workshop was held at the University Hospital Center, Treichville. The goals of the workshop were to improve the efficiency and throughput of the pathology laboratory, the technical capacity of pathology laboratory staff, and record-keeping and patient management processes. Experts from the University of Montreal, Canada, led the workshop in French. Participants came from neighboring Francophone countries, including Senegal, Cameroon, and Guinea.

- Cambodia/Myanmar—Jane E. Brock, MBBS, PhD, Chief of Breast Pathology and Medical Director of Surgical Pathology Grossing Room at Brigham and Women's Hospital (BWH), Boston, travelled to Cambodia and Myanmar from March 9-11 with an ASCP delegation, including Carrie Robinson, MD, and Gary Levine, MD, to teach a multi-organ cancer pathology diagnosis and cancer reporting workshop. The goal was to build on work already done by ASCP and C/CAN 2025, working with pathologists in Yangon last fall, where Dr. Brock and other ASCP volunteers—Delia Liepins, PA(ASCP)^CM, Elizabeth Fowler, MD, Jeanette Guarner, MD, FASCP—taught a basic lab management course and Dr. Brock presented a one-day breast cancer workshop.

"We covered the basics of diagnosing, grossing and reporting the most frequent cancers seen in Myanmar, cervix, breast, non-Hodgkin lymphoma, gastrointestinal, and ovary," says Dr. Brock. "Teaching international standards, while understanding the limited access they have to diagnostic support with adjunct immunohistochemistry, and no access to cytogenetics or basic molecular diagnostics. This type of education is just the first step in creating high quality cancer diagnoses and reports. The real progress comes when they apply this knowledge to their cases, write their reports to an international standard, and then having the diagnostic slides reviewed and their reports critiqued by an expert, or even by peers, so they can really improve their knowledge and skills.”

"This kind of quality improvement work is where the telepathology system comes in. While the telepathology system allows for diagnoses of difficult and rare pathologies, these cases are the exception rather than the routine for most surgical pathology practice (perhaps with the exception of hematopathology and pediatric pathology with limited access to immunohistochemistry),” she continues. “The goal is to use the telepathology service as a source of feedback, ensuring high quality pathology diagnoses are rendered across the board, for all cancers diagnosed in Yangon. It also allows feedback on the quality of the tissue processing, histology techniques utilized, and immunohistochemistry, if performed."

To provide this expert diagnostic support, the ASCP delegation is establishing a group of 16 BWH-based pathology experts to form the new South East Asia Telepathology Group. Future plans include providing this expertise for routine cancer diagnoses in Myanmar and providing feedback for their pathology diagnoses. "We also reviewed progress following our last teaching on laboratory management, reviewing their excellent first efforts at writing standard operating procedures for their workflows. We were thrilled to find that hospitals are working together to support each other in this endeavor, and this is truly a step forward for Yangon," Dr. Brock says. “In addition, they have realized a key point, that they have to write them themselves. They can't just copy another hospital's SOP and have it be meaningful and reflect their own workflow. This is a huge achievement, and we will continue to support their efforts to write policies, procedures and SOPs for all their workflows, so that they can achieve and maintain high quality lab workflows.”

- Uganda - Dr. Brock is now in Uganda with multiple staff from the Fred Hutchinson Cancer Research Center, Seattle until May 3 to teach oncologists in Kampala the basics of cancer diagnosis/prognostic factors as they relate to treatment options in hematopathology, and the most frequent solid tumors seen in Uganda (breast, cervix, colon, esophagus, liver, stomach, prostate, and lung), plus an introduction to immunohistochemistry. In addition, Dr. Brock is teaching Kampala pathology residents-in-training, reviewing the basics of breast cancer grossing, diagnosis and reporting.

Volunteers

- Mount Sinai Hospital, in cooperation with Pathologists Overseas/ASCP, is currently recruiting volunteer pathologists with cytology expertise to visit Liberia and assist with early stage epidemiological and diagnostic programs of training and service.

- The Partners for Cancer Diagnosis and Treatment in Africa project is looking for foreign language speakers in Spanish and Burmese initially, as well as members with experience in lab design and implementation to serve on the advisory committee for C/Can 2025: City Cancer Challenge.

- Opportunities are also emerging for ASCP members to lead country teams and assist with critical functions such as case assignment and team communications. If this is of interest, please contact ASCP Chief Medical Officer Dan A. Milner, Jr., MD, MSc(Epi), FASCP, at dan.milner@ascp.org. 

Meetings

- ASCP Chief Medical Officer Dan A. Milner, Jr., MD, MSc(Epi), FASCP, will attend the Minimally Invasive Tissue Sampling (MITS) meeting in Seattle, WA, on May 19–21, as well as the American Society of Clinical Oncology (ASCO) Annual Meeting, which takes place May 31 through June 4 in Chicago.

- ASCP’s Center for Global Health will participate in a session at the 2019 ASCO Annual Meeting, entitled "City Cancer Challenge: Changing the Future of Cancer in Urban Populations," on June 2 in Chicago. ASCP Chief Medical Officer Dan A. Milner, Jr., MD, MSc(Epi), FASCP, will present during the session, discussing ASCP’s participation in the City Cancer Challenge.

Launched in January 2017, the City Cancer Challenge is a multi-sectoral initiative encouraging cities to take the lead in the design, planning and implementation of cancer treatment solutions. The City Cancer Challenge aims to increase the number of people with access to quality cancer treatment in cities around the world through a network of motivated partners, including city leaders, governments, nongovernmental organizations, United Nations agencies, and domestic and international businesses.