Reducing global cancer burden through research across low and middle-income countries (LMIC)
Cancer studies on diverse populations can generate a wealth of information that is both scientifically important and exciting. Much emphasis for such studies has been placed on the upper-income countries. However, in order to reduce worldwide cancer burden and improve global health, it is essential to include the low and middle income countries as well. Professor Teh Bin Tean, Deputy Medical Director of National Cancer Centre Singapore (Research) shares why.
To understand how diverse population and environmental differences may contribute to the development of various cancers, cancer genomic and epigenomic studies have been carried out within and across countries. There are many factors that may affect the development and outcome of each cancer type, such as ethnicity-related genetics, social and dietary habits, pathogen and pollution exposure, and even local health-care practices and policies.
For example, Cholangiocarcinoma (CCA), also known as biliary duct cancer, is a relatively uncommon cancer in upper-income countries. But in the north east of Thailand and its neighbouring countries, Laos and Cambodia, there are more than ten thousand CCA cases per year. The high prevalence of CCA in these countries is due to chronic infection with a liver fluke, as locals frequently consume uncooked liver fluke-infected fish caught from the region. By comparison, in upper-income countries, CCA is associated with primary sclerosing cholangitis (a type of autoimmune disease), hepatolithiasis and choledochal cysts.
In recent studies, we have also found that a high percentage of CCA patients from Taiwan carry aristolochic acid (AA)-related mutations. AA is natural compound found in many herbal medicines.
These examples suggest that the same cancer type in different populations presents distinct molecular targets, which most likely require different therapies.
Cancer studies should be done with the objective of better prevention, early detection and/or cost-effective treatment for the local populations. Studies of diverse populations can raise local as well as international awareness of a particular health problem in a specific region or country.
These may result in attracting the attention of international health organisations or charity foundations, which can contribute towards providing necessary resources, such as financial backing and relevant expertise, to alleviate the problem. How the international community came together in the fight against the AIDS epidemic in Africa was a great example of this.
In addition, fruitful research collaborations can generate goodwill between countries and improved health diplomacy. They may involve transfer of knowledge and expertise, as well as the training of next-generation scientists in low and middle-income countries.
Today, many cancer patients in low and middle-income countries have little access to treatments due to the high cost. In addition, there is little interest among pharmaceutical companies to develop drugs that are specific for cancers predominantly prevalent in those countries due to the commercial implications. However, the following considerations may beat these challenges:
1. If the science is successful in identifying a highly probable therapeutic target, it may shorten the timeline of drug development. By proving through clinical trials that the newly developed drug(s) is truly effective and has significant improvement in survival, there will be a better chance of convincing the local government and pharmaceutical companies to sponsor the treatment, as it would be a win–win situation.
2. One can solicit philanthropic funds to support some of the early-phase clinical trials, as positive outcomes of these trials will provide greater incentives for pharmaceutical companies to conduct larger late-phase trials.
3. Adopting approved treatments from the upper-income countries may not work for the low and middle-income countries, due to differences in the molecular profiles of tumours that arise in a different population.
More resources and support from international agencies or upper-income countries are needed to facilitate such studies in low and middle-income countries. Through these studies, cutting-edge technologies can be applied to bring scientific breakthroughs to all populations and, importantly, translate them into improved outcomes towards a truly better global health.
This article is
an abridged version of Prof Teh Bin Tean's Comment article which is
recently published in Nature Reviews Cancer. Nature Reviews journals
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