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Challenges of Cancer Diagnosis in Resource Limited Settings

Challenges of Cancer Diagnosis in Resource Limited Settings. Optimizing Pathology Support. Sub-Saharan Africa CFAR May 2011 Kampala,Uganda. Ann Marie Nelson, M.D. AIDS and Infectious Disease Pathology Joint Pathology Center, USA. What Are the Goals of Pathology?.

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Challenges of Cancer Diagnosis in Resource Limited Settings

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  1. Challenges of Cancer Diagnosis in Resource Limited Settings Optimizing Pathology Support Sub-Saharan Africa CFAR May 2011 Kampala,Uganda Ann Marie Nelson, M.D. AIDS and Infectious Disease Pathology Joint Pathology Center, USA

  2. What Are the Goals of Pathology? • Provide consistently high quality diagnoses linked to • Capacity to interpret and utilize information for • Treatment • Follow-up • Establishment of registries and biorepositories

  3. What is Required? • Health workforce • Infrastructure • Reliable source of supplies • Quality assurance program • Interdisciplinary training and communication

  4. Health Work Force • Primary Care • Knowledge of cancer epidemiology/ddx • Information on when and where to refer • Oncologists • Surgeons • Radiologists/Clinical Laboratories • Pathologists • Technicians and clerical staff

  5. Infrastructure and Supplies -Surgery • Materials and SOPs for collection, documentation, fixation, and hand off of specimens • Clinical and surgical information • Specimen description and margins • Appropriate fixation for routine and special procedures - tissue fixation must be rapid and documented • Efficient transfer of material to pathology

  6. Infrastructure and Supplies-Pathology • Standardized system for receipt and documentation of specimens, case tracking, reporting and archiving • Basic working equipment for tissue evaluation and processing • Adequate supply of good quality reagents

  7. Quality Assurance • Standard operating procedures and training of personnel at all levels • Quality control of specimen collection, fixation, processing, tissue sections and staining • Quality assurance of diagnosis - internal and external review • Documentation of errors with remediation

  8. Interdisciplinary Training and Communication • Tumor Boards • Oncology, surgery, radiology, pathology etc • Before and after definitive procedures • Cancer Registries and Repositories • Data sharing and dissemination • Cross-training at post-graduate level • Surgeons, oncologists, pathologists and radiologists should rotate in each specialty

  9. Challenges • What requirements does your institution lack? • How to implement change? • How to get buy-in from all parties including government and funding agencies? • When and how to introduce new technologies?

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