Finding the Lethal Phenotype: Research Partnership Needs Timothy R. Rebbeck

1. Finding the Lethal Phenotype: Research Partnership Needs Timothy R. Rebbeck

2. Increases in Anti-Malaria Spending…

3. = Reductions in Malaria Deaths… Year Malaria (World Malaria Report 2010)

4. …While Cancer Deaths Increase Year

5. Increasingly Elderly Population in the Developing World 2000 2050 MoreDeveloped Countries Less Developed Countries World Cancer Report 2008

6. Changes in Lifestyle and Exposures (Concomitant Increase in Specific Cancers) Prevalence of BMI>25 (Men) 2010 2002 WHO Global Infobase 2011

7. Number of People Served by Each Radiotherapy Center Sources: International Atomic Energy Agency, Directory of Radiotherapy Centers, http://www-nawebiaea.org/nuhu/dirac/, Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision, and http://esa.un.org/unpp. Jemal et al. 2011

8. Percent of Population Covered by Cancer Registries (Number of Registries / Number of Countries Reporting) 32.5% (100/29) 83.0% (54/2) 4.0% (44/15) 1.1% (5/5) 5.5% (11/7) 80.5% (11/2) IARC-Compliant Tumor Registries (2010): Algeria, Egypt, Tunisia, Uganda, Zimbabwe

9. Age Standardized Estimates (ASE) of Incidence and Mortality for Five Leading Cancers in Men of African Descent by Geography *African and Caribbean incidence and mortality estimates from GLOBOCAN 2008 and include men of all races. US incidence rates from SEER-17 for the year 2008, estimated numbers of cases for the total US based on the SEER-17 rates, and US mortality data for the entire country for the year 2007; all include only African American men. ** ASE: Age-standardized Estimates per 100,000 population adjusted to the 1960 world population.

10. Prostate Cancer Deaths* (Globocan 2008) *All Races/Ethnicities

11. What is needed to develop research capacity in Africa?

12. Opportunities/Questions • Logistical Goals: • Develop Centers of Research Excellence • Identify research partners • Research exchanges • Research resources: registry, biosample, laboratory, population, database, administrative • Funding opportunities • Scientific Goals: • What are the leading cancer problems that require research? • What are research opportunities unique to Africa? • Basic research • Population and behavioral research • Clinical Research

13. Needs • Capacity building: research and training relevant to local conditions and culture • Provide common resources to achieve economies of scale: regional centers of excellence? • Develop joint (collaborative, multicenter) projects – not “sample providers” • Advocacy (explaining why research is important): • Community engagement • Media and governments • Academic/medical engagement: respect and understanding of research

14. Critical Components • Dedicated Influential Local PI: • Maintain support of superiors • Willingness to promote junior researchers • Environment that fosters PIs: • Research track • Dedicated research time vs. clinic load • Academic (not just scientific) training • Research Focus: • Achievable goals • Realistic timeline • Mentorship: • Scientific and academic • Regular communication with bidirectional visits

15. Challenges • Resource Limitations: • Limited tumor registration • No central investment in cancer research • Limited research infrastructure in cancer (IRB, protocols, study staff, administration) • Limited funding mechanisms • Academic Issues: • Lack of protected time for investigators • No academic tracks • Limited culture of research • The “vacation myth” • Lack of research training • Education: Limited understanding about the importance of cancer in the population

16. Men of African Descent and Carcinoma of the Prostate (MADCaP) - Africa • Establish Centers to: • Create knowledge about cancer in Africa. • Translate this knowledge to improved prevention, detection, and treatment of cancer in Africa. • These Centers will: • Offer high quality facilities for training, research and advocacy. • Help to implement national cancer plans. • Reduce dependence on foreign institutions for training and service and minimize brain drain.

17. Key Components and Leverage Points • Advisory Board: • Afrox Representative • AORTIC representatives: • At Large • President • President-Elect • Executive Director • ASCP Representative • IAEA Representative • IARC Representative • UICC Representative Dakar Cancer Consortium, Dakar, Senegal • Network Partnerships: • Prostate Cancer Transatlantic Consortium (CaPTC) • African Caribbean Cancer Consortium (AC3) Univ. of Ibadan, Nigeria Mulago Hospital,Makerere University, Kampala, Uganda • Academic Partnerships: • Albert Einstein, New York (Ibadan) • Fred Hutchinson Center, Seattle (Uganda) • Harvard University (Botswana) • Moffitt Cancer Center, Tampa (South Africa) • NCI, Bethesda (Ghana) • University of Chicago (Nigeria, Uganda) • University of Pennsylvania, Philadelphia (Botswana, Senegal) • University of Pittsburgh (Nigeria) • University of Southern California, Los Angeles (Uganda) Korle-Bu Hospital, 37 Military Hospital, University of Accra, Ghana • NGO Partnerships: • Afrox, Oxford • ASCP, Washington • IAEA, Vienna • IARC, Lyon University of Botswana, Gaborone, Botswana National Health Laboratory Service, Johannesburg, South Africa Tygerberg Hospital, Stellenbosch University,Cape Town, South Africa

18. Dakar Cancer Consortium: A Public-Private Partnership Private Lab University Foundation Public Hospital Hôpital Général de Grand Yoff Centre de Diagnostic et de Recherche en Medicine Moleculaire Université Cheikh Anta Diop Bio24 Institut de Formation et de Recherche en Urologie Hôpital Aristide le Dantec Institut Pasteur Biobank Clinical Data Accrual Laboratory Research

19. Developmental Process Development Implementation Evaluation Steering Committee, External Advisory Board African Centers: Accra, Benin City, Dakar, Kampala, Stellenbosch, Others Success Metrics AORTIC Strategic Planning Meeting, Dakar AORTIC Strategic Planning Report Identify Potential Centers and Partners Establish ACES Structure and Processes Report to AORTIC Council & Board Site Visits and Implementation Evaluation Extramural Funding Common Protocols Distance Learning: IAEA-VUCC Pathology: ASCP Project Management: Afrox Registries: IARC 12/2010 12/2011 12/2012+

20. Acknowledgements PHS Grants R01-CA085074 and P50-CA105641, AACR Landon Foundation Award, US State Department Fulbright Program Accra, Ghana Sunny Mante 37 Military Hospital Edward Yeboah Korle-Bu Hospital Benin City, Nigeria Michael Okobia University of Benin Bethesda, USA Ann Hsing NCI Cape Town, RSA Pedro Fernandez Stellenbosch University Chris Heyns Stellenbosch University Dakar, Senegal Serigne Gueye Hôpital Général de Grand Yoff Mohamed Jalloh Hôpital Général de Grand Yoff Ibadan, Nigeria A. Olupelumi Adebiyi University College Hospital M.C. Asuzu University College Hospital OluwafemiPopoola University College Hospital Johannesburg, RSA Chantal Babb National Health Laboratory Margaret Urban National Health Laboratory New York, USA Ilir Agalliu Albert Einstein University Thomas Rohan Albert Einstein University David W. Lounsbury Albert Einstein University Kampala, Uganda Stephen WatyaMulagoHospital, MakerereUniversity Los Angeles, USA Chris Haiman University of Southern California Brian Henderson University of Southern California Philadelphia, USA Baoli Chang University of Pennsylvania Shannon Lynch University of Pennsylvania Elaine Spangler University of Pennsylvania Sarah Tishkoff University of Pennsylvania Amy Walker University of Pennsylvania Charnita Zeigler-Johnson University of Pennsylvania