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Increasing clinical and research capacity for cancer in Mozambique. A multi-center collaboration between the U.S, Brazil and Mozambique

Melissa S. Lopez

6 Collaborator(s)

Cancer is a leading cause of death worldwide with over 17 million new cases and 8.5 million cancer-related deaths per year. Globally, the number of deaths from cancer exceeds the number of deaths from HIV, malaria and tuberculosis combined. Global cancer rates are rising dramatically with a predicted 23.6 million new cases per year worldwide by 2030. More than 50% of all cancer cases and 65% of related deaths occur in low and middle-income countries (LMICs). In LMICs, many of these cancers are gynecologic in origin, with cervical cancer being the most predominant. While cervical cancer is now relatively uncommon in high-income countries primarily due to introduction of the Papanicolaou (Pap) test coupled with the introduction of organized screening programs, such screening and prevention programs are rare in LMICs. This results in cervical cancer being the first or second leading cause of cancer and related deaths among women. Women in low-resource regions often present with cancer that is at an advanced stage and is difficult to treat. Unfortunately, palliative care is also frequently unavailable leading to significant suffering for the women and their families. Mozambique is located in Southeast Africa with a population of ~26 million people. It is a former colony of Portugal, gaining independence in 1975 to become the People’s Republic of Mozambique. The official language is Portuguese. The country ranks among the lowest in GDP per capita, human development and measures of inequality. The prevalence of HIV is 11.5% and the average life expectancy is 51 years. The country is medically underserved with 3 doctors per 100,000 people and a total of 9 pathologists and 7 medical oncologists in the country. There are no surgical oncologists and no gynecologic oncologists in Mozambique. The 5 medical schools in Mozambique graduate about 150 new physicians annually. Cervical cancer is the leading cancer in incidence and mortality among Mozambican women with 3,690 cases and 2,356 related deaths per year. These high rates of cervical cancer and related deaths are primarily due to a lack of access to screening programs, limited public education and a limited number of health care providers trained to diagnose and treat pre-invasive cervical disease. Most women present with advanced disease, and there are limited options for treatment, including a lack of operating radiotherapy capability in Mozambique. MD Anderson Cancer Center has partnered with the Mozambique Ministry of Health (MOH) and clinicians from Hospital Central de Maputo (HCM) since late 2014. This partnership was developed in conjunction with MD Anderson’s three Sister Institutions in Brazil (Barretos Cancer Hospital, Hospital Israelita Albert Einstein, AC Camargo Cancer Center) at the request of the former First Lady of Mozambique, Maria da Luz Guebuza, after she served as the chairwoman of the Forum of African First Ladies Against Breast & Cervical Cancer and hosted the annual conference in Maputo in 2013. Subsequently, the former and current First Lady, Isaura Nyusi, and members of the MOH have attended the MD Anderson Sister Institution Network annual conferences and visited the Sister Institutions in Brazil to further this collaboration. During the past three years the teams from MD Anderson and Brazil have worked to develop an understanding of the state of health care, availability of resources, and the challenges of providing cancer care, including preventive, diagnostic, therapeutic and palliative services, in Mozambique. In addition, we have worked toward developing relationships and partnerships with key personnel and interested parties in Mozambique, including clinicians, managers, representatives from the Ministry of Health, other health care personnel working in Mozambique (academic, NGO), and potential industry partners. Scarce resources in Mozambique affect the capability to provide services for primary and secondary prevention, diagnosis, treatment and palliative care of all cancers. Capacity building efforts should include several strategies related to cancer prevention, diagnosis and management, including the supply chain and availability of medications. In partnership with the MOH, the priorities for these strategies and for development of specific capabilities, targeting specific cancers, should be defined. The most comprehensive focus of the MD Anderson partnership in Mozambique is on cervical cancer screening and management. These activities can serve as a foundation upon which to build and expand other cancer prevention, diagnostic and treatment services. At the same time, at the request of the local physician community in Maputo, and at the request of the MOH, specialist support and training through regular videoconferences, in – country workshops and educational exchanges have been developed for breast cancer, head and neck cancers, pathology, radiology and palliative care.

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