2023 Technical Fellowships and Bourses pour l'Afrique Francophone awarded Fellows

Empowering lung cancer screening in primary care settings in India through the learning development of a point-of-care device via liquid biopsy is a significant and innovative objective that holds the potential to revolutionize the early detection and management of lung cancer. Lung cancer screening with Low Dose CT scan has been proven to be lifesaving in view of mortality benefits shown in NLST and Nelson trials. Though the burden of lung cancer is higher in India, effective lung cancer screening program is not in place because of logistic issues. Despite the continuous efforts, uptake for lung cancer screening is very low which emphasizes the need for public awareness, easy-to-perform blood-based test for which acceptability among Indians is very high.

Newer modalities like molecular biomarkers, may help in reducing the screening costs with high sensitivity and specificity, along with the advantage of being non-invasive and easy to implement with higher acceptability among high-risk individuals in relation to smoking and exposure to air pollution.

As we have planned to do the biomarkers testing for lung cancer screening at the community level, it will be imperative to learn the concept of biomarker selection and validation in the laboratory to finally identify the appropriate biomarkers in lung cancer screening. Research by Prof Sia Samuel from Columbia University has identified 4 biomarkers in coded form to screen lung cancer at an early stage
with a sensitivity of 87% and specificity of 98% with a minimum cost which could be a major breakthrough for the success of screening programs in LMICs including India.

Our project will focus on the development of a point-of-care device for screening early-stage lung cancer in primary care settings via liquid biopsy. It is an innovative and timely endeavor that could significantly improve the prognosis of lung cancer in all LMICs where LDCT might not be a suitable screening option. There is a need for technology beyond conventional low-dose CT (LDCT) scans to perform lung cancer screening in high-risk individuals at the community level where LDCT is not feasible.

I will be more confident in assisting my colleagues from different LMICs with my improved understanding and wisdom of biomarkers-based lung cancer screening being a committee member of IASLC. Implementation and Disparity research is of utmost use in most of the LMICs where we find lots of disparities in care and outcome in lung cancer screening along with challenges in implementing at ground level. Our work can give a different dimension to lung cancer screening esp. in LMICs if it’s found to be useful in a community setting.

In Mauritania, a national cancer control plan has been established and implemented since the creation of the National Oncology Center (CNO) in 2009. This national plan aims to contribute to reducing morbidity, mortality, and other burdens related to cancer.

Medical imaging technology has become an indispensable tool in many branches of the biomedical and health area, as well as in research. It plays a vital role in training professionals in these fields, providing not only tools, technologies, and knowledge but also fostering community engagement through training projects.

Various advanced image analysis methods have been developed for ultrasound-guided procedures. However, transitioning from analyzing image algorithms to clinical feasibility testing as part of an interventional system requires integrating multiple components, including imaging and tracking devices, data processing algorithms, and visualization software.

Our Faculty of Medicine has established a center with the goal of garnering support from national governments and international development organizations for the nationwide rollout of its point-of-care ultrasound image-guided therapy (POCUS IGT) program.

The POCUS IGT system was developed using free open-source guidance software, supporting low-cost ultrasound machines and consumables. It is ready to be deployed for prospective clinical trials at the National Center for Image-Guided Therapy in Mauritania, offering similar features and performance to leading systems at a fraction of the cost.

Leveraging the momentum generated by this program, a successful launch of the POCUS IGT in the National Center for Image-Guided Therapy program can lead to paradigm shifts in national healthcare in Mauritania and provide a practical model for West Africa.

The objective of our work is to study and provide more information about the 3D-Slicer medical image processing program, including visualization, segmentation, and Slicer IGT, and how it can be utilized for training residents in radiology and surgical specialties at the Faculty of Medicine.

Cancer is the leading cause of death worldwide, accounting for approximately 10 million deaths in 2020, i.e., one in six deaths. The most common cancer types are breast, lung, colon and rectum, and prostate cancers. The main causes of cancer include tobacco use, high body mass index, low fruit and vegetable intake, and lack of physical activity.

Currently, 30 to 50% of various cancers can be prevented by avoiding risk factors and implementing evidence-based prevention strategies. This can be achieved through early detection of cancer and applying appropriate treatment options with a higher degree of precision and accuracy. The second important factor is cancer screening, as it identifies individuals with findings suggestive of a specific cancer or pre-cancer before symptoms appear.

However, the success of both of these strategies depends on the choice and optimum operation of equipment as per vendor specifications with precise treatment dose delivery. Therefore, regular quality assurance is required for both screening and early diagnosis programs, helping in the optimization of patient radiation doses. In this phase, the role of medical physics becomes crucial as they are involved in treatment planning and quality assurance procedures applying concepts and techniques of physics in medicine for the diagnosis and treatment of diseases and protection of staff.

The role of medical physicists in the quality assurance of mammography, general X-ray, and CT scan becomes very crucial, as the images must be of high quality if cancers are to be found at the earliest possible time. This demands a robust and dedicated quality assurance program, as the performance of a complex imaging system may drift over time; therefore, quality control procedures must be in place to ensure that all components of the imaging chain are operating properly and consistently over time, regarding both image quality and patient doses.

Comprehensive QA & QC procedures remain mandatory for digital mammography and general radiography digital systems. This includes the diagnostic workstations (imaging software and medical-grade diagnostic monitors) used for image interpretation and diagnosis. In digital mammography and radiography, increasing the dose may improve image quality but at the cost of high patient dose. An advantage of digital image in QC is the availability of images in a digital format offering opportunity to improve efficiency by using automated methods of image quality testing and collection of patient dose-related metrics.

In conclusion, to detect breast cancer accurately at the earliest possible time, all factors influencing the acquisition, display, and interpretation of the mammogram, general radiography system, and CT scan must be optimized, and those optimum conditions must be maintained over time, which is possible by the implementation of a rapid and comprehensive QA/QC program under the supervision of a Medical Physicist.

Pediatric cancers in Iraq present a pressing and complex challenge, characterized by disparities in early detection, treatment, and outcomes. Addressing this requires a blend of rigorous research, global expertise, and local insights. To this end, I have proposed a fellowship program focused on the systematic mapping of pediatric cancers in Iraq, to be hosted by the esteemed International Agency for Research on Cancer (IARC).

The five-week fellowship, meticulously structured, aims to leverage IARC's unparalleled expertise in cancer research. Given the agency's advanced methodologies and tools, the project promises to provide a comprehensive understanding of pediatric cancer landscapes in Iraq. The objectives are multifaceted: from data collection and in-depth analysis to the formulation of actionable strategies tailored for Iraq's unique challenges.

Choosing IARC as the host institute is a strategic decision rooted in prior collaborations. My participation in two modules of IARC's summer school on cancer epidemiology, as a full participant and an observer in the early detection and prevention module in June this year, has not only provided foundational knowledge but also fostered valuable connections within IARC. These established relationships will be instrumental in ensuring the project's success, facilitating seamless collaborations and expert guidance throughout the fellowship.

The importance of this project cannot be overstated. With pediatric cancer care disparities looming large in Iraq, the insights and strategies derived from this fellowship have the potential to transform the landscape, ensuring equitable care for all children. IARC, with its global perspective and commitment to capacity building, is the ideal environment to nurture and execute this vision.

In essence, this fellowship represents more than just a research initiative; it's a mission to usher in a new era of pediatric cancer care in Iraq. Through systematic mapping, expert collaborations at IARC, and strategic interventions, the project aspires to create a lasting impact, charting a brighter future for Iraq's youngest citizens.

The incidence of Head & Neck Cancer (HNC) is tremendous in India according to World Health Organization (WHO) GLOBOCAN data 2020. Oral cancer is the second most common cancer in India. The number of patients affected by HNC is increasing exponentially in India. The impact of HNC is multifactorial, significantly affecting the quality of life, such as speaking, breathing, eating, drinking, and the psychological well-being of patients, as well as their caregivers/relatives. Patients diagnosed with HNC after completing cancer treatment may also experience financial burdens and challenges returning to work. Oncologists focus on cancer control, and allied health teams, such as speech-language therapists/pathologists (SLT/SLP), Clinical Nurse Specialists (CNS), and Dieticians, focus on functional improvement and quality of life. Oncologists and allied health teams must work cohesively with patients and family members for cancer control with realistic expectations and a focus on quality of life.

Oncologists and allied health teams are essential in comprehensive care, with a particular focus on the role of SLT/SLP in Head Neck Cancer. Speech Language Therapists are key members in Head Neck Cancer management, initiating assessment prior to cancer treatment and preparing patients for surgery or (chemo)radiation. SLT/SLP have been using a proactive approach in managing HNC for 15 years. Pre-habilitation, which includes baseline functional evaluation and instrumental evaluation such as Flexible Endoscopic Evaluation of Swallowing (FEES) or Videofluoroscopic Swallowing Study (VFSS), is essential for optimizing swallowing function.

SLT/SLP intervention continues before, during, and after treatment, especially for patients undergoing (chemo)radiation therapy. Patients may experience acute and late toxicities, including dryness of mouth, burning sensation, loss of taste/altered taste, weight loss, difficulty in swallowing (dysphagia), risk of cough after eating or drinking (aspiration), lung infection, fever, nausea, generalized weakness, swelling of face and neck (lymphedema), and fibrosis. These toxicities require evaluation and evidence-based intervention. Patients who undergo Oral Cancer Surgery or Laryngectomy require intensive speech and swallowing rehabilitation. However, the availability of highly trained SLT/SLP is limited in India. Lymphedema management is an area where SLT/SLP support is lacking, thus training support is crucial.

GLOBOCAN 2020 estimated that there were 20,508 new cancer cases and 13,629 deaths due to cancer in 2020 in Nepal, with the estimated age-standardized cancer incidence and mortality rates at 80.9/100,000 and 54.8/100,000, respectively. The burden of cancer is increasing rapidly every year due to ongoing demographic and epidemiological transitions. Nepal lacks a national cancer control program, and routine cancer screening services are not in place. Poor access to cancer prevention and treatment services has led to higher cancer morbidity and mortality. Cancer prevention and screening services are the most cost-effective tools for addressing the burden of cancer in low-resource settings like Nepal.

The purpose of this fellowship in the Department of Cancer Prevention and Survivorship Care at the University of Texas MD Anderson Cancer Center is to observe and learn from different cancer prevention programs and survivorship care.

Specific Objectives:

• To learn about the multidimensional strategies in cancer prevention programs.
• To learn about different programs for the prevention of new cancers and screening for second primaries.
• To learn from successful intervention strategies for cancer prevention and early detection.
• To acquire skills in palliative/end-of-life care.
• To understand quality-of-life issues, including psychological distress and spiritual, financial, and legal concerns.
• To foster collaboration and build networks with experts working in cancer prevention research and practice.

Cervical cancer remains a significant cause of death among women in sub-Saharan Africa, particularly those living with HIV, due to their compromised immune systems. Despite efforts to improve cervical cancer screening, coverage among high-risk populations remains low. This proposal aims to address this critical issue by integrating robust reporting mechanisms and targeted interventions. Rwanda has made strides in HPV vaccination, yet women born before the program remain vulnerable. Opportunistic screening campaigns have been initiated, but data remains fragmented. Moreover, cervical cancer screening for women with HIV lacks an effective tracking system, impacting follow-up and interventions. To bridge these gaps, an integrated reporting system connecting screening data with the national cancer registry is proposed.

Through a fellowship, lessons will be gleaned from countries with established reporting systems. Best practices for data collection, analysis, and reporting will be observed, informing the enhancement of Rwanda's screening program. Collaborative discussions with experts will identify innovative solutions. Upon return, key factors affecting low screening coverage in Rwanda will be addressed. Targeted interventions will be designed based on lessons learned, aiming to increase participation rates among high-risk populations. This initiative holds the promise of improving screening rates, early detection, and outcomes for women at risk.

Key Questions: Lessons from countries with established screening reporting systems will be adapted to create an efficient and effective reporting system in Rwanda. Factors contributing to low screening coverage among high-risk populations will be identified, and interventions will be designed to increase participation rates.

Cancer prevention encompasses multifaceted strategies aimed at reducing the incidence of cancer. Tobacco consumption, in the form of smoking or smokeless tobacco, is a primary modifiable risk factor for numerous cancers, including lung, oral, esophageal, and more. The carcinogenic compounds present in tobacco products exert a detrimental impact on cellular DNA, instigating mutagenic changes that initiate and fuel tumorigenesis. As such, curtailing tobacco use emerges as an integral component of cancer prevention initiatives.

Furthermore, the significance of tobacco dependence treatment extends to the realm of cancer treatment. For cancer patients, continued tobacco use can impede treatment efficacy and compromise overall outcomes. Tobacco compounds may interact with therapeutic agents, diminish treatment response, and exacerbate treatment-related toxicities. Thus, integrating tobacco cessation interventions into cancer treatment plans can enhance the effectiveness of therapies, improve patients' quality of life, and potentially augment survival rates.

Effective tobacco dependence treatment encompasses a spectrum of approaches, including pharmacotherapies, behavioral interventions, and support systems. Incorporating these strategies into clinical practice and public health programs holds the potential to yield substantial benefits. By reducing tobacco use rates, these interventions contribute directly to diminished cancer incidence. Moreover, for individuals diagnosed with cancer, successful tobacco cessation fosters a more conducive environment for treatment success and overall well-being.

In conclusion, the necessity of tobacco dependence treatment in cancer prevention and treatment is resoundingly evident. Addressing tobacco use not only mitigates the risk of cancer development but also enhances the therapeutic landscape for cancer patients. Embracing comprehensive tobacco dependence treatment within the broader context of cancer control strategies is imperative in our ongoing pursuit of reducing the global burden of cancer.

The TDT Fellowship Program at King Hussein Cancer Center offers an excellent opportunity for me to enhance my skills in treating both cancer and non-cancer smokers. As a preventive medicine physician in Egypt, I am deeply involved in counseling and treating individuals struggling with tobacco dependence. This program aims to support my growth through hands-on training and utilizing KHCC's comprehensive TDT services.

In Egypt, tobacco smoking is a major concern, with over 30% of the population being smokers, and 80-90% of lung cancer cases directly linked to tobacco use. Despite existing smoking cessation clinics, there is a pressing need to improve our capabilities for better care. Joining this advanced training at KHCC will help me bridge this gap effectively.

Through the TDT Fellowship Program, I will acquire skills to create personalized treatment plans, combining behavioral interventions and medication for tobacco users. I will also learn to manage challenges faced by both cancer and non-cancer smokers. This training will enable me to play a crucial role in reducing smoking-related diseases and cancers. Moreover, I will gain invaluable insights to support the continuous development of smoking cessation services upon my return.

Breast cancer, cervical cancer, and pediatric acute leukemias are the most commonly occurring cancers in Ethiopia. Most of these cancers have either known preventable risk factors or available screening programs for early detection and treatment that have a paramount impact on clinical outcomes. However, in Ethiopia, although there is a good cancer prevention policy, there is a huge gap in the implementation of cancer prevention modalities due to a lack of properly trained healthcare providers. The purpose of this fellowship is to receive further training in cervical cytopathology for early cervical cancer screening, breast pathology, and hands-on training in flow cytometry to improve the diagnostic capacity of pediatric acute leukemias. I believe that I will be equipped with more advanced skills that are very important in improving the diagnostic capacity of our pathology laboratory. I will use the learned skills at my current center and share my acquired skills with my students and colleagues.

Specific Objectives:

• To learn basic techniques of immunohistochemistry.
• To receive basic training on the basic principles of flow cytometry and interpretation of flow cytometry results.
• To receive basic training in cervical cytology for the early detection of cervical cancer.
• To gain experience in the diagnosis of neoplastic diseases of the breast and their mimics.
• To gain experience in the diagnosis of precursors of mammary neoplasia.
• To gain experience in the diagnosis of non-neoplastic lesions of the breast and their mimics.
• Develop an understanding of special techniques for pathologic characterization of diseases of the breast.

Contexte : La Côte d'Ivoire, à l'instar des pays à ressources limitées, a mis en œuvre un programme de dépistage du cancer du col de l'utérus basé sur l'inspection visuelle/cryothérapie depuis 2010. Dans l'optique de l'élimination de ce cancer vers 2030, l'OMS prône le test HPV, et la thermoablation en alternative à la cryothérapie pour pallier aux défis logistiques. Trois régions (Abidjan, Bouaké et Daloa) supportent un programme d'envergure basé sur ces approches innovantes. Leur impact ainsi que les défis du passage à l'échelle de ces programmes nécessitent d'être documentés.

Objectifs : Notre objectif principal est d'évaluer l'impact de la mise en œuvre du test HPV et de la thermoablation sur la demande de dépistage et l'accès à un traitement des lésions précancéreuses du col utérin. Les objectifs secondaires sont : (i) décrire la cascade de dépistage et de traitement des lésions précancéreuses du col de l'utérus selon le statut VIH ; (ii) évaluer l'influence du temps et des interventions sur la demande de dépistage des lésions précancéreuses de 2010 à 2024 ; (iii) décrire les obstacles au passage à l'échelle du dépistage secondaire du cancer du col par le couple « Test HPV/Thermoablation » ; (iv) estimer la couverture du dépistage du cancer du col de l'utérus selon les régions ; (v) estimer la proportion de cancer invasif du col découverts à l'occasion d'un dépistage systématique ; et (vi) étudier les facteurs associés à la positivité du test de dépistage, au suivi effectif et à la guérison 12 mois post-traitement.

Méthodes : Une étude quasi-expérimentale de type avant-après avec groupe témoin sera conduite en Côte d'Ivoire dans les régions d'Abidjan, Bouaké et Daloa. Les fiches individuelles de dépistage issues de patientes consultant de 2010 à 2024 au sein des sites de dépistage, participant ou non aux projets d'intégration du test HPV et de la thermoablation seront collectées puis saisies dans une base de données dédiée conçue sur ReDCap. La régression sur discontinuité ou une série temporelle permettra de décrire les tendances calendaires des indicateurs de la cascade de dépistage des CCU entre 2010 et 2021, selon le statut VIH et le contexte décentralisé ; et de mesurer l'impact d'événements socio-sanitaires marquants sur les principaux indicateurs de cette cascade. Un modèle de régression logistique permettra l'étude des facteurs associés à la positivité des tests, à la visite effective, et à la guérison 12 mois post-traitement.

Résultats attendus : Ce projet fournira un aperçu global des succès et défis des programmes de dépistage du CCU tout en mettant en lumière les goulots d'étranglement de l'intégration des approches innovantes de prévention secondaire. Elle documentera la faisabilité à large échelle de ces stratégies et mettra en évidence les dynamiques temporelles et structurelles dans le contexte mondial d'initiatives pour l'accélération de l'élimination du CCU d'ici à 2030.

OBJECTIVE: Acquiring advanced skills in breast and cervical cancer control to enable the screening of 150 women every quarter during outreach programs under the Catholic Diocese of Kontagora.

METHOD: To participate in a Fellowship program on cancer control at the Cameroon Baptist Convention Health Services to acquire advanced skills in population-based screening and early detection of breast and cervical cancers. To gain hands-on experience in procedural activities involved in the care of patients with precancerous lesions. To acquire advanced knowledge on the coordinated and integrated management of patients with cancer. To gain practical experience in advancing population-based cancer control programs.

Cervical and breast cancers are among the leading causes of death in women worldwide. Despite the fact that cervical cancer is preventable through early detection and treatment of precancerous lesions, evidence from gynecological clinics in Kebbi State, Nigeria, shows that most women present with late-stage disease. Kebbi State has one of the poorest health indices in Nigeria. The reasons for the late presentation of affected women to healthcare facilities for proper evaluation are multifactorial: The majority of affected women live in rural areas with minimal healthcare services due to long distances and poor access roads. In recent times, many communities have been destabilized due to insecurity, resulting in loss of lives and livelihoods, internal displacement, and low awareness of cervical and breast cancer. This has led to the development of myths and beliefs around health challenges, delaying seeking help from healthcare facilities. Our facility, located in a rural community, is the only center offering population-based screening for women in the surrounding area spanning over a 120-kilometer radius. Participating in this fellowship will broaden my knowledge and skills to coordinate care for more women, detecting those with precancerous lesions or early-stage disease for prompt intervention.

In the twin island state of Antigua and Barbuda, cervical cancer ranks as the third leading cause of cancer-related deaths among women. It is also the most prevalent gynecological cancer referred to the oncology department at the island's sole public hospital, the Sir Lester Bird Medical Centre (SLBMC). These findings align with data from 2001-2005, which showed an incidence rate of 23.05 cases per 100,000 per year and a death rate of 6.78 per 100,000 per year in Antigua and Barbuda. Many of the women diagnosed with cervical cancer are already beyond stage 1 and require chemotherapy and radiation for treatment.

HPV testing was introduced as part of the national cervical screening program in September 2022, during which 1569 women were screened over four months. Findings revealed a high-risk HPV positivity rate of 21%. Women who tested positive for HPV type 16 or 18/45 were directly referred to colposcopy, while those positive for other high-risk types underwent cytology triage to determine the need for colposcopy. Sixty-one percent of women with high-risk HPV required colposcopy, representing a significant increase in the demand for colposcopy services at the SLBMC.

While colposcopy remains the gold standard for managing screen-positive women, it is subjective and becomes less sensitive in non-cytology-based screening programs like the one adopted in Antigua and Barbuda. Artificial intelligence (AI) offers the potential for objective cervical assessment and more reproducible findings to enhance lesion detection. The use of Automated Visual Evaluation (AVE) to capture and analyze colposcopy images allows AI to assist in improving healthcare providers' colposcopy skills by comparing findings with cervigrams and histopathology for quality control. More accurate identification of precancerous lesions will facilitate tailoring colposcopy algorithms for treatment, potentially reducing the need for cytology triage. The use of AVE also offers the possibility of providing treatment during the initial colposcopy visit, thereby improving patient compliance and treatment rates.

This project aims to establish the role of this technology in Antigua and Barbuda, with plans to later implement it in Jamaica and Trinidad and Tobago, with the hope that other Caribbean countries will benefit from this approach. The successful expansion of this technology in colposcopy in our region would also enable improvements in cervical pre-invasive disease care for islands lacking trained colposcopists. The use of AVE may serve as another tool in the Caribbean's colposcopy armamentarium, bringing our region closer to eliminating cervical cancer.

Cervical cancer is the second most common cancer among women in Nigeria, leading to significant morbidity and mortality. Consequently, it is a priority cancer in the current National Cancer Control Plan.

In Anambra State, there is an ongoing cervical screening program using VIA (Visual Inspection with Acetic Acid), which has been allocated funding for only six months. VIA-positive women detected during screening receive immediate treatment with thermal ablation or LEEP (Loop Electrosurgical Excision Procedure), while those with suspicious lesions or lesions unsuitable for treatment undergo referral.

However, the program is expected to abruptly end after the scheduled six months, reflecting the typical pattern of cancer programs in the country. Often, these programs are initiated, run for a limited period, and then terminated, resulting in the loss of initial progress made.

The objectives of my visit are:

1. To learn about the processes and strategies involved in incorporating an exit strategy during the planning and design phases of a cancer screening program.
2. To develop a sustainable project for screening and early detection of cervical cancer using the acquired skills, with the aim of implementing it in my State upon my return.
3. To establish a network with other professionals working in cancer control for collaboration and knowledge sharing.

Pain, along with other symptoms and psychosocial distress, is highly prevalent among cancer patients with advanced diseases, significantly impacting their quality of life. Palliative care aims to alleviate suffering in all its forms, including physical pain, psychological symptoms, social distress, and spiritual discomfort, while also maximizing the quality of life for patients and their families. Despite being considered a fundamental human right accessible to all, palliative care remains largely inaccessible in resource-limited settings like Rwanda.

In these settings, cancer patients in advanced stages are often discharged from the healthcare system without adequate follow-up, leaving them vulnerable to severe symptoms and socio-economic challenges, while their families experience heightened stress. To address this gap, we propose to develop and test model palliative care services tailored for Rwanda and other low- and middle-income countries.

Family members play a crucial role in caring for patients, bearing significant financial and caregiving responsibilities. However, existing models for advanced care planning and end-of-life decision-making primarily reflect Euro-American clinical and cultural perspectives. Through this fellowship, we aim to create a locally relevant and people-centered model for psycho-oncology in Rwanda. This model will prioritize the dignity and humanity of patients and align with the priorities and values of the Rwandan community.

I have been selected for an international fellowship at Wills Eye Hospital in Philadelphia, a renowned figure in the field of Ocular Oncology. This specialization, focusing on the study and treatment of eye cancers, is critically needed in my home country, India. Despite a higher prevalence of childhood eye cancer in India, the survival rates and quality of life outcomes lag behind those of developed nations.

Retinoblastoma stands as the most common eye cancer among children, presenting a hereditary nature. While survival rates were minimal half a century ago, medical advancements have transformed it into a highly treatable cancer, especially when diagnosed early. However, in developing countries, delayed diagnoses and limited access to specialized healthcare pose significant threats to both the eyesight and lives of children with retinoblastoma. It is imperative to inspire young ophthalmologists to take up the challenge of reducing the mortality and morbidity associated with eye cancer.

Having received initial training in ocular oncology at the Centre for Sight in Hyderabad, I have been granted a one-year fellowship opportunity at Wills Eye Hospital in Philadelphia. This research fellowship, conducted full-time alongside clinical fellows, aims to provide a comprehensive understanding of eye cancer detection, treatment modalities, and prognostic factors.

My supervisor shares my aspiration of equipping trained ocular oncologists to return to their home countries, particularly in developing regions, to deliver optimal eye cancer treatment worldwide. Despite being an unpaid fellowship, the invaluable experience gained will significantly contribute to enhancing cancer treatment services in our part of the world. The healthcare system in India has long grappled with the challenge of providing affordable healthcare while ensuring a sufficient number of well-trained healthcare professionals.

My alma mater, Christian Medical College in Vellore, possesses the necessary infrastructure and supportive departments to foster the growth of ocular oncology services. However, the scarcity of well-trained ocular oncologists in the region presents formidable obstacles. Training under my supervisor at Wills Eye Hospital promises immense benefits for my community and country. I aim to return to India equipped not only with the requisite skills for optimal cancer care but also with the determination to bridge the existing gaps in healthcare delivery.

The high incidence of oral cancer poses a significant challenge, particularly in low and middle-income countries. Unfortunately, about half of these patients do not survive the disease, often due to late-stage diagnosis. Various patient- and healthcare-provider-related factors influence the delay between diagnosis and treatment. Screening for oral cancer holds promise for early detection and intervention. While some studies highlight the benefits of screening high-risk populations, sustaining such programs in regions with prevalent high-risk behaviors may prove costly and impractical.

Currently, most professional bodies advise against screening asymptomatic adults for oral cancer due to these challenges. Identifying individuals who should undergo high-risk screening remains a significant obstacle. A novel risk-stratification model, the Oral Cancer Likelihood Evaluator (OraCLE), offers a simple approach to categorize individuals as high or low risk based on their behavior. Factors such as smoking, smokeless tobacco use, and alcohol consumption contribute to oral cancer risk and inform the OraCLE's design.

This fellowship aims to refine the OraCLE tool using the host institute's resources and expertise, validating its proof of concept. Additionally, it seeks to design a multicentric trial in collaboration with the host supervisor to evaluate OraCLE's efficacy prospectively in real-world settings. These efforts not only enhance screening strategies but also provide valuable research experience and networking opportunities for future endeavors in screening and prevention strategies in India.

In 2016, Romania faced a significant challenge with only around 500 doctors available to treat nearly 100,000 newly diagnosed cancer patients per year, as reported by the Health Ministry. Breast cancer emerged as the leading cause of cancer-related deaths among females, consistently representing between 12% and 16% of all cancer-related fatalities. This highlights a critical public health concern in Romania, exacerbated by the absence of population-based cancer screening programs and the diagnosis of most cases at advanced stages. Urgent action is imperative to address these issues, necessitating substantial efforts and resources to establish universal access to breast screening and ensure high-quality treatment for eligible women, thereby narrowing the health disparity gap between Romania and the European Union.

Over the past decade, neoadjuvant systemic therapy (NST) has gained prominence as the standard treatment for advanced breast cancer and selected early-breast cancer subtypes. NST aims to minimize surgical morbidity in the breast and axilla, facilitating breast-conserving surgery (BCS) by downstaging the tumor and reducing the need for extensive axillary surgery. However, safe de-escalation of surgical procedures requires specialized techniques such as oncoplastic surgical procedures and sentinel lymph node biopsy (SLNB), among others, enabling personalized breast cancer surgery even in advanced stages.

While Romanian University Hospitals boast advanced technology and infrastructure comparable to developed nations, there remains a deficiency in the education and training of healthcare professionals. The lack of national guidelines for diagnosis and treatment, coupled with the absence of mandatory formal surgical training in breast surgical oncology, contributes to outdated practices such as radical mastectomy or BCS with axillary lymph node dissection (ALND), despite favorable tumoral/nodal responses after NST. Addressing these challenges requires comprehensive training and education initiatives to ensure the delivery of high-quality treatment, improved quality of life, and reduced morbidity for Romanian oncologic patients.

Mexico, a middle-income country situated in North America, boasts a vast territory spanning over 2 million square kilometers and a population of approximately 130 million, making it the 13th largest and 10th most populous nation globally. Similar to many developing nations, Mexico has witnessed continuous improvements in life expectancy, currently standing at 74.9 years, with projections indicating that by 2050, approximately 17% of Mexicans will be aged 65 or older.

In my current role at the National Institute of Medical Sciences and Nutrition, I co-lead the Comprehensive Clinic for Cancer Care in the Older Adult, which stands as Mexico's pioneering geriatric oncology clinic. Within this clinic, we conduct a spectrum of activities encompassing clinical practice, education, and research initiatives, including investigations into leveraging mobile technology to enhance cancer care for older adults in resource-constrained settings.

The primary objective of this fellowship is to augment my proficiency in devising and analyzing mobile health studies tailored to older adults with cancer. Under the guidance of my host supervisor, Dr. Shabbir Alibhai, who spearheads a mobile health study focused on monitoring older patients with prostate cancer in Canada, I aim to acquire skills in mobile health data analysis and study design. Subsequently, I intend to apply this acquired expertise to analyze data generated from our study in Mexico. Furthermore, this fellowship offers an invaluable opportunity to gain fresh insights into effective leadership strategies for managing a successful geriatric oncology clinic akin to the one established at my institution, as well as to refine my skills in mentoring fellows in geriatric oncology.

The objective of this observership is to engage fully in the management of head and neck, thyroid, and cervicofacial cancers at the Centre Léon Bérard, focusing particularly on participation in multidisciplinary meetings and modern radiotherapy procedures. The aim is to enhance my decision-making skills and radiotherapy practice. Additionally, I plan to actively contribute to a prospective study comparing in silico planning and dose distribution between supine and upright positions for radiotherapy in head and neck cancers.

This experience will enable me to enhance my practice back home, where I primarily treat head and neck cancer patients with radiotherapy. It will positively impact the development of our department and improve patient treatment at our Institute of Oncology Ljubljana. Notably, our department is the sole provider of radiotherapy for head and neck cancer patients in Slovenia, underscoring the national significance of improving clinician skills.

Given my keen interest in research, I intend to participate in clinical research at the Centre Léon Bérard and continue this research upon my return. The research project will evaluate the efficacy of upright patient positioning for head and neck cancer radiotherapy, aiming to compare planing and dose distribution between supine and upright positions. This simple intervention may influence organ volume, positioning, and movement, potentially improving radiotherapy treatment outcomes.

In addition to benefiting my clinical practice and research at home, this training will facilitate further education and provide our department with much-needed expertise in head and neck cancers, which is nationally important. The duration of this clinical training and research is agreed upon as four months, as two months would not suffice to achieve the outlined objectives.

In Vietnam, despite the establishment of the first cancer registry in 1987, the quality of data needs improvement. I have served as the national coordinator for cancer registry activities in the National Cancer Control Program since 2018. Our efforts are focused on developing standard procedures for the cancer registry and effectively utilizing registry data.

Recognizing the high quality of the Korea National Cancer Registry, I see the fellowship as an opportunity to enhance my skills in managing and contributing to the advancement of the cancer registry in Vietnam. Additionally, I aim to leverage evidence-based data for the implementation of the NCCP in Vietnam.

During the fellowship, I intend to focus on two main objectives:

1. Reviewing and comparing the standard procedures of the cancer registry in Vietnam with those in Korea, particularly in linking multiple health information systems.
2. Utilizing cancer registry data to effectively communicate messages to policymakers and the general public as part of the cancer control program.

Le cancer du col de l'utérus est un problème de santé publique à travers le monde et en Afrique subsaharienne en particulier. Nous sollicitons cette bourse pour suivre une formation complémentaire de 8 semaines axée sur la prévention et la détection précoce de cette pathologie, responsable de millions de décès chaque année. En effet, le virus du papillome humain (VPH) a été identifié comme l'agent étiologique principal de cette affection, et il serait judicieux de se former dans les nouvelles technologies permettant son identification. Cela entraînerait un taux de diagnostics précoces plus élevé et, par conséquent, de nombreuses vies pourraient être sauvées. Ce projet débutera le 10 avril 2023 et se terminera le 4 juin 2023. Il permettra d'acquérir des connaissances très précieuses pour pouvoir retourner dans mon pays et améliorer le diagnostic des lésions précancéreuses et cancéreuses précoces du col.

Le rhabdomyosarcome est une tumeur solide maligne fréquente chez les enfants et les adolescents, représentant 60 à 70% des cas dans la population âgée de 0 à 14 ans et de 15 à 19 ans, avec une fréquence de 4,3 pour un million.En République Démocratique du Congo, une étude récente a montré que les rhabdomyosarcomes représentent 50% des tumeurs des tissus mous et autres tumeurs extra-osseuses. Malgré cette proportion élevée, les RMS restent un cancer pour lequel nous disposons de moins de connaissances sur sa fréquence, ses aspects diagnostiques, histologiques et immunohistochimiques. Cela souligne l'importance d'une étude approfondie sur ce cancer chez la population pédiatrique et adolescente. L'objectif principal de ce projet est d'améliorer le diagnostic et la prise en charge des rhabdomyosarcomes chez les enfants et les adolescents congolais.

The International Agency for Research on Cancer (IARC) has identified law as a double-edged sword that can either promote cancer control, as exemplified by the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and many similar policies, or become a barrier to cancer control, as exemplified by laws regulating the use of morphine as controlled drugs, which made morphine inaccessible for palliative care. However, the application of law for cancer control has not been extensively studied or explored. This project therefore seeks to explore the role of legislation in cancer control through the adoption of legislation on free cervical cancer screening in Nigeria. Through the technical fellowship supported by the UICC, the End Cervical Cancer Nigeria Initiative (ECCNI) will collaborate with the International Institute of Legislative Affairs (IILA) on the project. IILA, as the host organization, will provide ECCNI with technical skills, knowledge transfer, and experience sharing on legislation advocacy in designing and implementing legislation advocacy. IILA is a nonprofit organization in Kenya that advocates for the development and implementation of policies and legislation promoting the prevention of non-communicable diseases and injuries, including cancers. ECCNI has the overarching goal of putting Nigeria on the path to cervical cancer elimination in line with WHO's elimination strategies. As the executive director of ECCNI, I am therefore hoping to acquire skills that will lead to the development of relevant laws and legislation towards achieving cervical cancer elimination in Nigeria through my visit to IILA.

Background
Lung and nasopharyngeal cancer (NPC) are the leading causes of cancer mortality in Vietnam. Established risk factors for these cancers include cigarette smoking and other environmental factors. While cigarette smoking is widely studied, the role of waterpipe tobacco smoking in cancer development, both in Vietnam and globally, has been neglected. There is a need for prospective cohort studies to investigate the association between waterpipe smoking and the risk of these cancers.
Purpose
i) To prospectively analyze the association between waterpipe tobacco use, intake of heterocyclic amines (HCAs) including MeIQx, PhIP, DiMeIQx, and the risk of lung and nasopharyngeal cancers using data from the existing Hanoi Prospective Cohort Study (2007-2019), and ii) To pool-analyze the association between waterpipe tobacco use and the risk of lung and nasopharyngeal cancers using available cohort studies from the U.S. and Asia.
Methods
In 2007, a total of 52,325 individuals from 12,746 households were recruited into our prospective cohort study in nine communes in Hung Yen, Phu Pho, and Hanoi in Northern Vietnam. The Nurses Health Study, initiated in 1976, recruited 121,000 female nurses aged 30–55 years in the U.S., while the Health Professionals Follow-up Study recruited 51,529 male health professionals aged 40–75 years in the U.S.
Access to available cohort studies at the UPMC Cancer Pavilion in Pittsburgh, United States, will also be utilized. A pooled analysis will investigate the association between waterpipe tobacco use and the risk of lung and nasopharyngeal cancers. In the Hanoi Prospective Cohort Study, participants were assessed using a questionnaire covering exclusive waterpipe and cigarette smoking, demographic characteristics, dietary intake, and other indicators. Over 12 years of follow-up (2007-2019), 2,494 cases of all-cause mortality, including 46 NPC and 121 lung cancer cases, were recorded in Vietnam. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders. Estimates from both cohorts were pooled using random-effects meta-analysis.
Expected Results and Conclusions
The study will evaluate overall smoking, dual waterpipe-cigarette smoking, exclusive waterpipe smoking, exclusive cigarette smoking, HCA intake, and the risk of NPC and lung cancer in each cohort. Pooled analysis results will provide insights into the association between tobacco use and the risk of NPC and lung cancer.

Colorectal cancer (CRC) was the third most diagnosed malignancy in 2020. Screening has proven effective in reducing mortality and potentially preventing CRC occurrence. Pilot screening programs for CRC have been underway in China for several years, including a provincially organized program targeting 1,600,000 residents aged 50 to 74 years old in 2020. However, the qualitative and quantitative performance of these programs has not been systematically evaluated. Poor quality assurance could attenuate the screening yield and benefits.

In 2022, the International Agency for Research on Cancer (IARC) initiated the Cancer Screening in Five Continents (CanScreen5) project to measure screening performance with harmonized indicators for improved program management and policy-making. An expert group convened by IARC has defined performance indicators for CRC screening. Currently, no quantitative data on CRC screening programs in China is included in CanScreen5. Measuring the performance of our program with CanScreen5 indicators will be mutually beneficial to China and IARC.

Thus, the aims of this application for a Technical Fellowship of UICC include:

Quality Evaluation of CRC Screening Program:
The primary purpose of this one-month fellowship is to learn and understand the full criteria of quality assurance for cancer screening programs proposed by IARC. Subsequently, we aim to summarize and analyze the qualitative and quantitative performance indicators of CRC screening in Zhejiang Province. Based on this analysis, further improvements will be made to enhance the quality of CRC screening programs in Zhejiang province, in collaboration with IARC.

Research Collaboration:
Since 2020, data from the Zhejiang Colorectal Cancer Screening Program have been collected. More than 7,600,000 residents have completed the risk-evaluation questionnaire and fecal immunochemical test, and over 460,000 participants identified as positive have undergone colonoscopy examinations and pathological diagnosis. CRC incidence and mortality outcomes were further acquired by linking the provincial cancer registry and death surveillance system. The intermediate results and screening yield can be evaluated with guidance from the IARC group. Additionally, more research collaboration opportunities can be explored, such as the development of a CRC risk prediction model and the evaluation of novel screening techniques in China.

Selon les données de la revue Globocan, on recense 7871 nouveaux cas de cancer en Guinée, avec le cancer du col de l'utérus en tête chez les femmes, représentant 50,1 % des cas avec un taux de mortalité de 71 %. Diverses initiatives de lutte sont en cours dans le pays grâce à la collaboration de partenaires et d'ONG locales.

Ces initiatives comprennent des activités de dépistage des lésions précancéreuses dans certains centres de santé, bien que les traitements soient limités en raison du manque d'équipements et de financements.

Actuellement, il n'y a pas de programmes de dépistage et de vaccination contre le HPV en Guinée. Pourtant, la prévalence du HPV dans le pays est estimée à 52 % au sein de la population générale. Malgré ces chiffres, il n'existe toujours pas de test HPV disponible dans notre pays. L'introduction de ce test permettrait d'améliorer considérablement le dépistage du cancer du col de l'utérus et de se conformer aux recommandations de l'Organisation mondiale de la santé.

C'est pourquoi nous souhaitons nous inspirer de l'expérience réussie au Burkina Faso, en partenariat avec JHPIEGO, dans la mise en œuvre du dépistage du cancer du col de l'utérus grâce au test HPV.

Cameroon, a low-middle income country with a population now estimated at 26 million inhabitants, has had a national program for cancer control at the Ministry of Public Health since 1990.

Breast cancer ranks as the most common cancer among women in Cameroon. According to the Cameroon fact sheet (Globocan 2020), the country recorded a total of 4170 new cases of breast cancer in 2020, accounting for 20.1% of all cancers in the population. Cervical cancer follows closely as the second most common cancer among Cameroonian women after breast cancer. Despite being preventable, cervical cancer remains a significant public health challenge. It can be prevented through vaccination against Human Papilloma Viruses (HPV), the leading cause of the disease, as well as through screening and treatment of precancerous lesions that precede the cancer by many years. However, breast and cervical cancers continue to pose major public health concerns in Cameroon, consistent with high morbidity and mortality rates observed in sub-Saharan Africa, where they account for 85% of cancer cases among women in 2020. Alarmingly, 70-80% of women diagnosed with breast and cervical cancer in Cameroon are identified at advanced stages with metastasis.

To address this growing burden, the Committee for the Fight against Cancer has been conducting periodic screening campaigns, often in collaboration with the Cameroon Baptist Convention Health Services (CBCHS). The CBCHS, a significant partner of the Cameroon Ministry of Health, has established the Women's Health Program across seven out of the ten regions of Cameroon. This program offers routine screening for breast and cervical cancer, as well as vaccination against HPV-related cancers.

This fellowship opportunity, scheduled from September 15th, 2023 to October 15th, 2023, aims to achieve several objectives:

• Understand the inception and progression of the program
• Gain insights into its planning and execution, including the annual clinic planner for women
• Participate in awareness programs for prevention and learn from various approaches
• Engage in planning processes and strategic management approaches
• Develop a proposal for implementation within the CBCHS.

The knowledge acquired during this fellowship will empower the CBCHS to enhance the quality of its services, ensure well-trained staff, and increase its visibility, further advancing the Women's Health Program.

It has been reported that a subset of patients have a probability of becoming long-term survivors, indicating that with certain therapies targeting specific markers, survival rates improve.

In patients with non-small cell lung cancer (NSCLC), survival following first-line chemotherapy has been prolonged with recent immune checkpoint inhibitor therapies, extending up to 24-26 months in some cases, although this is not the norm. Unfortunately, access to such therapies remains limited for many patients at this stage of the disease.

For the past 20 years, the Center for Molecular Immunology has been conducting clinical trials involving therapeutic products targeting tumor antigens associated with NSCLC. Through the analysis of over 3900 patients from clinical trial databases nationwide, it was observed that approximately 20% of patients achieved long-term survival, exceeding 24 months, when treated with immunotherapies. A smaller percentage of control patients, around 10%, also demonstrated long-term survival.

To identify correlations between various significant parameters in treated patients (such as targeted therapy recipients, levels of systemic immunological inflammation, disease stage at diagnosis, histological type, age, gender, habits, among others) and long-term survival, a covariate classification tree analysis was performed. The study's primary objective is to establish a therapeutic algorithm predicting efficacy for selecting appropriate treatments for NSCLC patients at different disease stages.

As secondary objectives, the study aims to identify factors or covariates predicting long-term survival in treated patients, explore the potential of combining therapies, and develop a methodology for analyzing other oncological indications using similar statistical techniques.

Breast cancer ranks as the fourth leading cause of cancer-related deaths worldwide. Certain types of breast cancer disproportionately affect individuals of specific ancestries, with triple negative breast cancer being a prime example, notably impacting black individuals. Triple negative breast cancer is characterized by the absence of cancer receptors—estrogen, progesterone, and human epidermal growth factor receptor 2—commonly found in other breast cancer subtypes and targeted by treatment therapies. Given that the majority of patients are diagnosed at advanced stages (3 and 4) and the lack of these receptors, treating this cancer subtype is challenging, with an average prognosis of 5 years post-diagnosis. Therefore, it is crucial to develop methods for detecting the risk of triple negative breast cancer and other subtypes in black women, with polygenic risk scores emerging as an innovative tool for this purpose. Polygenic risk scores are a burgeoning method for stratifying individuals in a population based on their disease risk and are currently prominent in research on common diseases such as diabetes, coronary artery disease, and breast cancer. This research fellowship aims to explore the utility of polygenic risk scores in assessing breast cancer risk in African populations, particularly in Nigeria.

Le cancer colorectal (CCR) constitue un problème de santé publique dans le monde car il s'agit du 3ème cancer le plus fréquent. Au Burkina Faso, nous n’avons pas de données en population générale permettant d’estimer sa prévalence réelle. Une étude de prévalence rétrospective de janvier 1986 à décembre 2006, réalisée par les anatomopathologistes dans trois laboratoires de la ville de Ouagadougou, retrouvait 4 004 cas de cancers histologiquement diagnostiqués parmi lesquels le cancer colorectal occupait la 7ème place avec 201 cas soit 5,02% (Goumbri/lompo olga et al. J Afr.Cancer 2009;1:207-211). D'autres données les plus récentes, publiées en 2001 sur les cancers colorectaux sont basées sur des séries endoscopiques (Damien et al 2021, www.hsd-fmsb.org) sous-estimant forcément la prévalence de cette affection (moyenne de 7 cas confirmés par an). En Afrique, l'examen proctologique (zone anorectale) est souvent redouté des patients pour des raisons de pudeur ou encore socio-culturelles ce qui entraîne la plupart du temps un diagnostic tardif des CCR. Le recours fréquent à la médecine traditionnelle est également un autre facteur de retard au diagnostic des patients dans notre contexte. Pour toutes ces raisons nous pensons qu'un dépistage en population générale est une solution pour nos populations. Récemment nous avons obtenu dans un laboratoire de la place, des tests de détection par immunofluorescence de sang dans les selles à Ouagadougou, à un coût abordable. Cependant quelle est la limite d'âge pour ce test chez le sujet africain ? Les seuils de sensibilité du test sont-ils les mêmes en sachant que la population africaine a les particularités suivantes : exposée à des parasitoses digestives, alimentation différente, traitements traditionnels entre autres. Quelles sont les conditions de conservation des selles dans ces pays tropicaux chauds ?
Nous pensons que ce projet pourrait permettre de répondre à certaines de ces questions et d'atteindre plusieurs objectifs :

• Objectif principal : offrir au terme de l'étude un dépistage du CCR en population générale
• Objectifs secondaires

1. Valider les tests de dépistage sur une population africaine .
2. Mieux sélectionner les patients sujets à une endoscopie digestive basse
3. Offrir un diagnostic précoce endoscopique des lésions de CCR
4. Organiser le circuit de prise en charge de ces patients à risque pour éviter la survenue du CCR
5. Organiser et maintenir un réseau de collaboration anticancer avec les oncologues, chirurgiens, anatomopathologistes, nutritionnistes, etc.

Le cancer du col utérin reste un problème de santé publique dans les pays en développement en général et au Burundi en particulier. La plupart des patientes consultent à des stades tardifs, au moment où la prise en charge adéquate nécessite une radiothérapie ou un traitement palliatif. La réduction de la mortalité liée à cette pathologie devra passer par la lutte contre les facteurs favorisants, par la détection précoce et par un traitement adapté au stade. Les auteurs rapportent les résultats d'une étude rétrospective de 35 cas de cancers du col utérin colligés en 8 ans (de janvier 2008 à décembre 2016) dans le département de gynécologie obstétrique du CHU de Kamenge. Il ressort de cette étude que le cancer du col utérin représente 37,3 % des cancers gynécologiques enregistrés au CHU de Kamenge. La moyenne d'âge des patientes était de 43,09 ans.
Le délai entre l'apparition des premiers symptômes et la confirmation du diagnostic était en moyenne de 8,6 mois. Les stades I, IIa, IIb, III et IV selon la FIGO représentaient respectivement 5,70 % ; 17,14 % ; 31,43 % ; 34,30 % et 11,43 % des cas. Les auteurs montrent les difficultés de prise en charge des patientes aux stades inopérables, la radiothérapie étant encore inexistante au Burundi.

In Indian females, cervical cancer and breast cancer are the leading cancers. Cervical cancer has the huge potential to be prevented by the use of HPV vaccines given completely and timely. The screening test available in the form of Pap testing or VIA can help us detect precancerous and early cancerous lesions. Complete management can prevent further progression of the disease. Breast cancer is the other most common cancer seen in Indian females. Fortunately, early detection even in this site can aid in getting a complete cure.

The majority of healthcare facilities are centered in and around cities. The rural population in India is still under the fear of "cancer being a death sentence" and is totally unaware of the screening protocols and advantages of early detection in cancer treatment. Even those who are aware are unable to reach the oncology setups for the requisite testing, counseling, and management.

For this, I intend to get a mobile cancer screening and early detection van with facilities of mammography, Pap smear/VIA, simple biopsies/FNACs, etc. These visits shall also be used to spread awareness about cancer, preventive measures, early detection, early signs and symptoms of cancer, tobacco cessation, breast self-examination, and also for the follow-up of cancer patients. In order to increase the reach of the program, I wish to include and train our ASHA (accredited social health activists) workers, who are one of the key components of our National Rural Health Mission program. They are more aware of the population and their needs, and the rural people, particularly the females, are more at ease with them. This opportunity shall also be utilized to let the rural population know about the presence, utility, and efficacy of the HPV vaccine. Further, with India coming with its indigenous cervical cancer vaccine, we can also incorporate it for mass immunization. Additionally, I shall be using the opportunity provided by the fellowship in learning how to set up a cancer prevention lounge at our institute in India such that total cancer prevention and screening can be provided under one roof.

The electronic information system is poorly developed in our country, and hence there is a lack of assurance of the quality of the screening programs. The major reasons for this are poor maintenance of the systematic data collection from different service delivery points to estimate the key performance indicators. Further, paper-based records and improper collection of data hinder the tracking of the screen-positive individuals to ensure their compliance with further management and follow-up. To overcome this, I intend to gain insight into the development of a robust screening information system to ensure the quality of the screening program.

According to the International Agency for Research on Cancer (IARC), over 124,000 new cancer cases were reported in Nigeria in 2021. The Nigeria Cancer Control Plan recognizes the lack of a screening program as a major contributing factor and aims to ensure that 50% of eligible individuals with breast, cervical, and colorectal cancers are screened appropriately within the next five years.

Establishing a comprehensive screening program with proper data management is crucial for achieving this goal. However, existing screening programs in Nigeria face challenges such as a lack of structure, consensus on term definitions, and non-uniform data collection tools, making data collation and interpretation difficult.

This project aims to carry out a mapping of cervical cancer screening facilities in Nigeria, using cluster sampling of the country’s six geopolitical zones. Data accrued from the mixed-method research shall be used to identify barriers and challenges as well as form the basis of inclusion of Nigeria into the IARC CanScreen5, a successful project implemented worldwide to support national screening programs.

The training in IARC will include capacity building on a systematic approach to collecting and analyzing breast, colorectal, and cervical screening data, and other aspects of data management. The training will also include the provision of a toolkit to train sub-national collaborators in Nigeria. There shall be continuous mentorship and support after the training program to ensure Nigeria is fully integrated into the CanScreen5 project, thereby enhancing the quality of screening programs.

The project will be collaborating with the National Institute for Cancer Research and Training (NICRAT), an organization tasked with the control of cancer in Nigeria. This will ensure the sustainability of the program's implementation and progress.

Implementing a data-driven screening program and utilizing CanScreen5 in Nigeria will help reduce the cancer burden by improving early detection and timely treatment of breast, cervical, and colorectal cancers. This will ultimately contribute to better health outcomes for the population.

Background and objective: Using opium, a highly addictive narcotic drug, has recently been classified as carcinogenic to humans by the International Agency for Research on Cancer (IARC), based on sufficient evidence for causing cancer in the lung, larynx, and bladder, and limited evidence to cause cancer in the esophagus, pharynx, pancreas, and stomach. Despite the significant contribution of opium use to the overall cancer burden in Iran, opium use control and prevention have been largely neglected in the country's cancer control programs. The existing evidence highlights the need for an effective surveillance system to prevent, monitor, and control opium use in Iran. The objective of the current study is to evaluate the potential impact of using opium on the future cancer burden in Iran, where 40% of the world opium is consumed. Additionally, the study aims to project the number of new cancer cases that could be prevented by 2035 in Iran if opium use is reduced by 10%, 30%, and 50% of the current prevalence.

Material and methods: This study will be conducted to investigate the role of opium consumption and different strategies to decrease its prevalence on future cancer burden in Iran. For this purpose, we will use four different data sources including: a) national cancer incidence, b) age- and gender-specific prevalence of opium use, c) relative risk for various cancer sites in relation to opium use, d) annual change in incidence rate for different cancer sites. Age-specific population attributable fraction (PAF) will be estimated stratified by cancer site and gender using Levin’s formula. Similar calculations were conducted using the prevalence of opium use in the alternative counterfactual scenarios, where the prevalence was reduced by 10%, 30%, and 50% compared to the current level. This allows for the estimation of the PAF under these alternative scenarios. To calculate the overall PAF for each specific cancer site, age and gender standardization will be performed. This project could help me to improve my research skills and will be a new path to advocacy for further research regarding the role of opium in cancer prevention in Iran. We will use different approaches to communicate with different key stakeholders.

The management of malignant tumors of the skull base remains a challenging problem. Skull base surgery is a rapidly expanding surgical subspecialty that brings together the sophisticated surgical skills of head and neck surgeons. Newly described surgical approaches to the skull base have made possible greater surgical ablation of the skull base region, resulting in large defects and thus heightening the need for reconstructing these regions.
Endoscopic skull base surgery is employed in the management of diverse skull base pathologies. Skull base surgery requires a unique set of knowledge that is hard to obtain in Kazakhstan. The current proposed project will help me obtain enough expertise from world-renowned surgeons performing hundreds of these surgeries every year in a premier cancer center. My institution currently has enough equipment to start performing these surgeries locally, and my experience as a head and neck surgeon will allow me to acquire knowledge within a short timeframe.

Cancer starts when cells in the body begin to grow out of control, and this can occur in any part of the body. According to the latest statistics from the International Agency for Research on Cancer (IARC), Prostate Cancer (PCa) is the most common cancer affecting men in Africa, including Mauritius, with a significant mortality rate. An ideal strategy to improve the survival rate of patients suffering from PCa is early diagnosis and improved prognosis. Multi-omics approaches have the potential to uncover the unique molecular features resulting in different phenotypic manifestations of cancer hallmarks, as well as predict the survival of patients and identify novel biomarkers with diagnostic and prognostic value.
Multi-omics approaches, based on computational methods, can integrate multiple omics datasets generated from patients and identify specific molecular or clinical features across different datasets. This approach can identify patient subgroups and molecular subtypes to overcome current challenges in treating the disease. Furthermore, it can help understand the onset and progression of cancer and design effective predictive models to validate novel therapies and drugs.
Hence, during my proposed fellowship, I plan to study how multi-omics contribute to the heterogeneity of prostate cancer phenotype and prognosis in African descent men, and learn from computational omics researchers and cancer experts in Boston.

Childhood cancers are rare, but when measured in terms of potential life years lost, they represent the fourth most important malignancy after lung, breast, and colorectal cancer. Pediatric cancer differs significantly from adult cancers; they respond well to therapy and are often curable. According to the recent global survey of radiotherapy practice patterns by the International Atomic Energy Agency (IAEA), more than 80% of all childhood cancers and over 90% of all deaths from childhood cancers occur in less developed regions. The ratio of annual deaths to new cases of childhood cancer is 17.83% in more developed regions compared to 55.96% in less developed regions. The incidence of pediatric cancers in India is on the rise, especially due to improved diagnostic accuracy. Cure rates for childhood cancer in India could be improved by applying the most appropriate, cost-effective, and evidence-based practices. 

Through this technical fellowship, my primary objective would be to understand how to harness technology to minimize radiation-related adverse effects, optimize radiotherapy for children, and leverage biology to risk-stratify the prognostic groups of various pediatric cancers to optimize adjuvant therapy in a multidisciplinary manner. This includes determining the ideal adjuvant regimen, optimal radiotherapy technique, planning, choice of dose fractionation, and execution. Few pediatric cancers warrant high precision radiotherapy techniques such as stereotactic body radiotherapy, which involves meticulous planning, preparation, and implementation. I would observe the procedures involved in such high-end radiotherapy technology planning and delivery. Additionally, I would utilize this fellowship to observe case selection, application, and execution of radiotherapy delivered in close contact to the tumor in musculoskeletal cancers, given its advantage of high conformity to reduce normal tissue exposure significantly.

Upon returning to my home institute in India, the objectives learned during the fellowship would help in the utilization of appropriate radiotherapy technology along with a biological understanding of various pediatric cancers to maintain standardization of care, safety monitoring, and initiate access to new treatments. It will help in conducting a multi-disciplinary decision-making process, assessing tumor biology, and making individualized personalized treatment plans. It would also aid in improving radiotherapy protocol compliance, leading to reduced local control and minimizing deviations to decrease the risk of treatment failure and mortality risk. It will guide in prospective review of treatment plans, which are critical to reducing the risk of systematic errors and supporting ongoing improvement. Finally, it will assist in learning advanced treatment planning systems to understand standardized evidence-based guidelines for volume delineation, treatment planning, and execution.

Primary liver cancer ranks as the sixth most commonly diagnosed cancer and the third leading cause of cancer death worldwide in 2020, with approximately 906,000 new cases and 830,000 deaths. Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. It is the fifth most common cancer in men and the eighth most common in women, ranking fourth in annual cancer mortality rates. Cholangiocarcinoma is the most common biliary and the second most common primary hepatic malignancy, accounting for less than 2% of all malignancies but ranking as the ninth most common gastrointestinal malignancy. Hepatobiliary malignancies collectively account for 13% of overall cancer-related mortality worldwide.

The liver is the most frequent target for metastatic spread of tumors, with hepatic metastases occurring in 40% to 50% of adult patients with extrahepatic primary malignancies. The incidence of hepatic metastases is more common than that of primary liver cancer itself. Hepatic metastases commonly originate from primary sites in the distribution of the portal venous system, including the pancreas, stomach, and colon, while tumors of the lung and breast are the most common origins of hepatic metastases outside this distribution.

Treatment options for primary hepatobiliary cancer and secondary liver cancer vary, ranging from various thermoablative therapies to interventional radiological methods such as transarterial chemoembolization. Surgical methods include various types of hepatectomy and even liver transplantation. However, managing Hilar cholangiocarcinoma surgically can be particularly challenging, with extended liver resections sometimes resulting in liver failure and patient death.

The Leeds Liver Unit provides a large tertiary referral service for liver cancer, seeing patients with hepatocellular carcinoma, cholangiocarcinoma, and other rare primary liver cancers. The multidisciplinary cancer team at Leeds includes hepatobiliary and transplant surgeons, hepatologists, specialist liver radiologists, oncologists, pathologists, and clinical nurse specialists. Mr. Raj Prasad, one of the consultants and clinical directors of Hepatobiliary Surgery and Transplantation, has a special interest in liver tumors, especially cholangiocarcinoma, and will supervise this fellowship.

The aim of the fellowship is to learn the practices followed in treating liver cancers at the Hepatobiliary and Transplant Centre at Leeds, with a focus on managing Hilar cholangiocarcinoma. This knowledge will aid in managing similar patients at our center and may help reduce mortality rates. Given the advanced surgical techniques involved, an eight-week duration for the fellowship is necessary.

A variety of advanced image analysis methods have been developed for ultrasound-guided procedures. However, transitioning from image analysis algorithms to clinical feasibility testing as part of an interventional system requires the integration of multiple components, including imaging and tracking devices, data processing algorithms, and visualization software. 

The objective of our work is to study and provide more information about the 3D Slicer medical image processing program, including its visualization, segmentation, and Slicer IGT functionalities. We aim to explore how this program could be utilized for training residents in radiology and surgical specialties within the faculty of medicine.

Neuroendocrine tumors (NET) are classified as the development of cancerous cells in endocrine glands, which are hormone-producing organs in our body. NET comprises a broad family of tumors, among which the most common are carcinoid and pancreatic neuroendocrine tumors. Other potential sites of NET are parathyroid, adrenal, and pituitary glands, as well as in calcitonin-producing cells of the thyroid (causing medullary thyroid carcinoma).

With an increase in the incidence of NET worldwide, various diagnostic and treatment strategies have been developed, which facilitate the treating oncologists and nuclear physicians in better management of such patients, hence resulting in better outcomes.

Among its various tumor markers and parameters for calculating the tumor’s mitotic proliferation rate, Selective Somatostatin Receptor (SSTR) expression is a feature of neuroendocrine differentiation that helps in specific receptor binding nuclear imaging via hybrid Positron Emission Tomography-Computed Tomography (PET-CT) scanning and Peptide Receptor Radionuclide Therapy (PRRT) for its treatment. Nuclear Molecular Imaging incorporates SSTR-specific antigens labeled with radioisotopes (Gallium-68 and Fluorine-18), which bind with regions of active NET growth and help in estimating the current disease burden, thereby facilitating the formulation of further treatment plans.

Likewise, good SSTR expression on NET and good uptake of radionuclide-labeled antigen on PET-CT help in the selection of patients for PRRT. Peptide Receptor Radionuclide Therapy is a novel line of treatment which includes the administration of radionuclide-labeled SSTR-specific pharmaceuticals that specifically bind with the NET and cause their destruction via continuous bombardment of radiation (Alpha radiations, Beta rays, and/or Gamma Rays).

Currently, the most common radioisotopes being utilized for this therapy are Lutetium 177 (177Lu), Actinium-225 (225Ac), and Yttrium-90 (90Y).

Therefore, in light of the mentioned background, my research proposal revolves around estimating the diagnostic accuracy and treatment efficacy of SSTR-positive NETs using radionuclides.