Providing pathology support in low-income countries

The burden of cancer is on the rise. More than 7 million people per year die as a result of cancer, and it is responsible for more deaths worldwide than AIDS, malaria, and tuberculosis combined. According to the International Agency for Research on Cancer, there were an estimated 14.1 million new cancer cases in 2012. That number is projected to increase to more than 20 million each year by 2030. Nearly 60% of these new cases occur in the developing world with an expected increase to more than 70% in the next 15 years. Despite these alarming statistics, the proportion of the national budget allocated to health in most lowand middle-income countries (LMICs) is less than 5%, contrary to the Abuja Declaration of 2001 in which heads of state of African Union countries1 pledged to set a target of at least 15% of the national budget being allocated to improvements in the health sector. Pathology is a key component in the management of patients with cancer. Pathology as a core discipline in the clinical decision-making process encompasses a broad range of specialties such as histology, cytology, hematology, microbiology, chemical pathology, immunology, and molecular pathology. All have a key role in managing cancer effectively. An accurate diagnosis is critical for the treatment of cancer and clearly has implications in the patient’s prognosis and follow-up care. Screening for cancer, assessing margins in tumor excision specimens using frozen sections, determining prognostic and predictive tumor markers, interacting with clinical colleagues in multidisciplinary teams and on tumor boards, and, more recently, interpreting the significance of molecular test results have propelled the traditionally limelight-shy pathologist to the forefront of cancer management