EARLY DETECTION
MANAGING LYMPHOMAS IN AFRICAN
SETTINGS: IMPROVING DIAGNOSTIC
ACCURACY AND CARRYING OUT
RESEARCH PROJECTS
GIULIA DE FALCO, DEPARTMENT OF MEDICAL BIOTECHNOLOGY, UNIVERSITY OF SIENA, ITALY,
EMILY A ROGENA, DEPARTMENT OF MEDICAL BIOTECHNOLOGY, UNIVERSITY OF SIENA, ITALY AND
DEPARTMENT OF PATHOLOGY, UNIVERSITY OF NAIROBI, KENYA, KIKKERI NARESH, DEPARTMENT OF
CELLULAR PATHOLOGY HAMMERSMITH HOSPITAL CAMPUS, IMPERIAL COLLEGE LONDON, UK,
MARTINE RAPHAEL, DEPARTMENT OF HEMATOLOGY, BICÊTRE HOSPITAL, PARIS, FRANCE, IAN
MAGRATH, INTERNATIONAL NETWORK FOR CANCER TREATMENT AND RESEARCH, BRUSSELS,
BELGIUM AND LORENZO LEONCINI, DEPARTMENT OF MEDICAL BIOTECHNOLOGY, UNIVERSITY OF
SIENA, ITALY
Diagnostic accuracy may still be difficult in developing countries due to the lack of
infrastructure. It is imperative to bridge the existing gaps as diagnostic accuracy is a critical
factor in determining patient outcomes. In addition, a correct diagnosis is crucial to
meaningful research. Twinning between institutions in developing and developed countries
may have a positive impact on both the quality and quantity of research. However,
technology transfer is necessary if personnel from developing countries are to improve
their skills and knowledge and actively participate in local research. This review
summarizes the research experience about lymphoma pathogenesis performed with
collaborating African institutions.
Gaps and challenges in the management of If, therefore, we are to increase the survival rate, it will be
lymphomas in Africa necessary to improve diagnostic accuracy in Africa – which is
Although accurate estimates are difficult, given the paucity of presently impaired by a lack of phenotyping – and develop a
information, it is likely that approximately 30,000 non- clearer picture of how the incidence of NHL varies in different
Hodgkin’s lymphomas (NHL) occur in the equatorial belt of African regions and in relationship to other diseases such as
Africa each year and these tumours are among the top ten AIDS and malaria. The lower cure rate of NHL in Africa
causes of cancer in this geographical region. The fraction suggests that the difference in mortality will become even
associated with AIDS is not available, and varies with more pronounced in the future as populations continue to
geography, but in some regions may be as high as 50%. Since outgrow their health resources, while the burden of disease
the beginning of the AIDS epidemic, the incidence of NHL has continues to climb. Already there are striking gaps between
increased by 2–3 fold in some countries, and as much as 13 Equatorial African countries and regions such as Europe and
fold in others. A realistic estimate of the incidence of Burkitt the USA with respect to survival; paediatric oncology being
Lymphoma (BL) is 30–70 per million children in equatorial the most dramatic example. However, the information
African countries (Source Globocan), although the evidence available about cancer incidence, treatment and follow-up in
for a major impact of the AIDS epidemic in children is sparse, many sub-Saharan African countries is generally incomplete at
and a recent report from Malawi and our own unpublished best, since medical records are either rudimentary or do not
data suggest that there is little or no increase in BL in HIV exist. The importance of establishing and maintaining
positive children with BL. population-based cancer registries, to support and evaluate
At least one component of the worse outcome in African cancer control programmes is clear, and currently, the
patients with lymphomas is incorrect or incomplete diagnosis. INCTR’s Cancer Registries Programme, led by Max Parkin, is
CANCER CONTROL 2013 75