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

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, as shown in the NLST and Nelson trials. Though the burden of lung cancer is higher in India, an effective lung cancer screening program is not in place due to logistic issues. Despite continuous efforts, uptake for lung cancer screening is very low, emphasizing the need for public awareness and an easy-to-perform blood-based test for which acceptability among Indians is very high.

Newer modalities like molecular biomarkers may help in reducing 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 conduct biomarker 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 my host supervisor from Columbia University has identified four biomarkers in coded form to screen lung cancer at an early stage, with a sensitivity of 87% and specificity of 98%, at 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 are of utmost use in most LMICs where we find lots of disparities in care and outcome in lung cancer screening, along with challenges in implementing at the ground level. Our work can give a different dimension to lung cancer screening, especially in LMICs if it’s found to be useful in a community setting.

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, a 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 the 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 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 a medical physicist 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 a digital image in QC is the availability of images in a digital format, offering an opportunity to improve efficiency by using automated methods of image quality testing and the 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.

GLOBOCAN 2020 estimated that there were 20508 new cancer cases, and 13629 deaths due to cancer in 2020 in Nepal with the estimated age-standardized cancer incidence and mortality to be 80.9/100,000 and 54.8/100,000 respectively. The burden of cancer is increasing rapidly every year with the ongoing demographic and epidemiological transition. Nepal lacks a national cancer control program, and routine cancer screening services are not in place. There is poor access to cancer prevention and treatment services. This has led to higher cancer morbidity and mortality. Cancer prevention and screening services are the most cost-effective tool 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 in 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 the different programs for prevention of new cancers and screening for second primaries;
•    To learn from the successful intervention strategies for cancer prevention and early detection.
•    To learn and acquire skills on palliative/end-of-life care; and 
•    To learn about quality-of-life issues, including psychological distress and spiritual, financial and legal issues.
•    To foster collaboration and build network 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.

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'm 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's 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'll acquire skills to create personalized treatment plans, combining behavioral interventions and medication for tobacco users. I'll 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'll gain invaluable insights to support continuous development of smoking cessation services upon my return.

Contexte: La Cote 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 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 thermo ablation 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 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 et 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 quarterly outreach under the Catholic Diocese of Kontagora.

METHOD: To participate in a Fellowship program on cancer control in Cameroon Baptist Convention Health Services in order to acquire advanced skills in population based screening and early detection of breast and cervical cancers.  To have a hands-on learning experience on some procedural activities employed in the care of patients with precancerous lesions. Gaining advanced knowledge on the coordinated and integrated management of patient with cancer. To have a working experience of how to advance in the management of a population based cancer control program.

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 gynaecological clinics in Kebbi State, Nigeria shows that most of the women present with a late stage of the disease. Kebbi State has one of the poorest health indices in Nigeria. The reasons for the late presentations of the affected women to a health care facility for proper evaluation are multifactorial:  Majority of the women in this area who are the most affected by these cancers, live in rural areas with only very minimal health care services available to them due to very long distances with very poor access roads. In recent times, many of those communities have been distabilised as a result of insecurity, so many families have lost their loved ones and/or their entire means of livelihood as a result of the banditry activities and a large number have been kept hostage by their abductors. sequel to these, those who survived and escaped have been internally displaced into nearby towns and bigger villages. The level of awareness on the cervical and breast cancer and other diseases is generally very low in this environment. As a result, the people have developed all kinds of myths and believes around almost every health challenge and disease. The effect of these is that they resolve to seeking help by taking herbal remedies, consulting soothsayers and religious leaders to help deliver them from the bad air and evil spirits they believe are the causative agents of their diseases. These only contribute in delaying their presentation to health facilities for proper review and management. Our facility which is located in a rural community, is the only center which offers the population based screening opportunity for women in our immediate surroundings that span over 120 kilometers radius. Having the opportunity for this fellowship will broaden my knowledge and skills to be able to coordinate more care and activities for many more women in order to detect those with precancerous lesions or early stage of the disease for prompt appropriate interventions.

In the twin island state of Antigua and Barbuda, cervical cancer is the third leading cause of death from cancer amongst women. It is also the most common gynaecological cancer referred to the oncology department at the island’s sole public hospital- the Sir Lester Bird Medical Centre (SLBMC). These findings are in keeping with 2001-2005 data which revealed an incidence of 23.05 cases per 100,000 per year and death rate of 6.78 per 100,000 per year in Antigua and Barbuda. Many of the women diagnosed with cervical cancer are beyond stage 1 and require chemotherapy and radiation for treatment. 

HPV testing was piloted as part of the national cervical screening program in September 2022. 1569 women were screened over 4 months. Findings revealed a high-risk HPV positivity rate of 21%. Women who were positive for HPV type 16 or 18/45 were referred directly to colposcopy while women positive for other high-risk types were referred for cytology triage to determine the need for colposcopy. 61% of women with high-risk HPV required colposcopy which represented a significant increase in the colposcopy service requirements at the SLBMC. 

While colposcopy remains the gold standard for the management of screen positive women, it is subjective and becomes less sensitive in a non-cytology based screening program such as the one now being used in Antigua and Barbuda. Artificial intelligence offers the possibility of objective assessment of the cervix and more reproducible findings to enhance detection of lesions. The use of Automated Visual Evaluation (AVE) to capture and analyse colposcopy images allows artificial intelligence to assist in improving healthcare providers colposcopy skills through comparison of findings with cervigrams and histopathology for quality control. More accurate identification of pre-cancerous lesions will facilitate tailoring of colposcopy algorithms for treatment, including the possibility of decreasing the need for cytology triage. The use of AVE also presents the possibility of offering treatment at the first colposcopy visit which would improve patient compliance and treatment rates.

This project will establish to role of this technology in Antigua and Barbuda with plans to later implement it in Jamaica and Trinidad and Tobago with hopes that other Caribbean countries will benefit from this approach. The successful expansion of this technology in colposcopy in our region would also allow improvement in cervical pre-invasive disease care for islands without trained colposcopists. The use of AVE may be another tool in the colposcopy armamentarium of the Caribbean that brings our region closer to cervical cancer elimination.

Cervical cancer is the second most common cancer among women in Nigeria with concomitant morbidity and mortality. It is therefore one of the priority cancers in the current National Cancer Control Plan. There is an ongoing cervical screening using VIA in Anambra State which has been slated for only 6 months given the duration of funding. Screened VIA positive women are treated at the point of detection with thermal ablation or LEEP while those with suspicious lesions or lesions not amenable to treatment using thermal ablation or LEEP are referred.
At the expiration of the scheduled 6 months, the program is expected to end abruptly as is the norm with various cancer programs in the country whereby programs are designed, run their course and end without being sustained and the initial gains recorded are lost. 
The aim of my visit is :
1.    To learn the processes and means of building in an exit strategy while planning and designing a cancer screening program. 
2.    To design a sustainable project on screening and early detection of cervical cancer using the acquired skill which can be implemented in my State upon my return. 
3.    To develop a network with other professionals working in cancer control.

The high incidence of oral cancer is one of the significant problems, particularly in low and middle-income countries. Around half of these patients tend to not recover from the disease, attributable to an advanced stage at diagnosis. A complex interplay between various patient- and healthcare-provider-related factors determine the time lapse between the diagnosis and treatment in these patients. In this regard, screening for oral cancer is supposed to be of help by picking up the cases in early stage. A few large studies have demonstrated the benefit of screening at-risk populations in reducing the overall incidence of oral cancer. However, to be beneficial, the screening program of a particular region should be continuous as long as the high-risk behavior is prevalent in the area. Also, the need for widespread coverage of such screening programs could render them cost-ineffective in resource constraint nations. As a result of these drawbacks, most professional bodies currently recommend against screening for oral cancer in asymptomatic adults. The working group of the International Agency for Research on Cancer acknowledges that selecting participants who should undergo high-risk screening for oral cancer is one of the significant challenges hindering the overall effectiveness of existing screening programs.
In this regard, a novel and simple risk-stratification model called Oral Cancer Likelihood Evaluator (OraCLE) could help sub-stratify the individuals with risk behavior as high-risk and low-risk, accordingly, could aid in the optimal utilization of screening programs. Several research studies and meta-analyses have provided the risk ratios of high-risk behavior such as smoking and smokeless (chewing) tobacco use. Studies have also found alcohol intake to be an independent risk factor for oral cancer and its synergistic effect with tobacco products. The observations of these studies are utilized for constructing the prototype of OraCLE, which needs to be refined further by analyses of appropriate design and large datasets. One of the purposes of this fellowship is to refine this tool by utilizing the resources of the host institute, including the retrospective dataset available and the expertise of the host supervisor, to validate the proof of concept of the OraCLE. The other objective is to design a multicentric trial, in collaboration with the host supervisor and team, to evaluate the efficacy of the OraCLE prospectively in the real-world effectiveness of this tool in at-risk-population. These works proposed as a part of this fellowship not only help in improving the efficacy of screening strategy (facilitates in reducing the burden of oral cancer), but the research experience and the network gained during this fellowship could be of immense value for planning and carrying out future research activities related to screening and preventive strategies, back at our center in India.

International Agency Research in Cancer (IARC) has identified law as a double-edged sword that can either promote cancer control as exemplified by the World Health organisation Framework Convention on Tobacco Control (WHO FCTC) and many similar policies; or become a barrier to cancer control as exemplified by laws to regulate use of morphine as control drugs that 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 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) in the project. IILA as the host organisation will provide ECCNI with technical skills, knowledge transfer and experience sharing on legislation advocacy in designing and running a legislation advocacy. IILA is a not-for-profit orgainsation in Kenya that advocates for the development and implementation of policy and legislation that promote 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 the WHO’s elimination strategies.  As the executive director of ECCNI, I am therefore hoping to acquire skills that will lead to development of relevant laws and legislation towards achieving cervical cancer elimination in Nigeria from my visitation to the IILA.

Background
Lung and nasopharynx cancer (NPC) is the leading cancer mortality in Viet Nam. The established risk of these cancers was cigarette smoking and other environmental factors. There are two common types of tobacco use in Viet Nam, such as cigarette and waterpipe tobacco smoking. There is a neglected investigation of the role of waterpipe in developing cancer in Viet Nam and worldwide. Prospective cohort studies for the association between waterpipe smoking and the risk of these cancers are timely. The power of cohort studies will be improved by pooling analysis of the existing running cohorts, including Nurse's Health Study, Health Professionals' Follow-up Study (at the Harvard T.H. Chan School of Public Health), Singapore and Shanghai Cohort Studies (Cooperate with UPMC Cancer Pavilion), and Hanoi Prospective Cohort Study. 

Purpose 
i) To prospectively analyze the association between Waterpipe Tobacco Use, heterocyclic amines intake (HCA including MeIQx, PhIP, DiMeIQx), and the risk of lung and nasopharynx cancers using the existing Hanoi Prospective Cohort Study, 2007-2019, and ii) To pooling-analyze the association between Waterpipe Tobacco Use and the risk of lung and nasopharynx cancers using the U.S. and Asian available Cohort Studies.

Methods
In 2007, 52,325 individuals from 12,746 households were recruited into our prospective cohort study. They belonged to nine communes in Hung Yen, Phu Pho, and Hanoi in Northern Vietnam. In 1976, the Nurses Health Study recruited 121,000 study participants in the U.S. female nurses, 30–55 years of age. The Health Professionals Follow-up Study recruited 51,529 U.S. male health professionals, 40–75 years of age.
We also have access to the available cohort studies at the UPMC Cancer Pavilion in Pittsburgh, United States. A pooled analysis will determine the association between Waterpipe Tobacco Use and the risk of lung and nasopharynx cancers. For the Hanoi Prospective Cohort Study, the exposure: A questionnaire on exclusive waterpipe and cigarette smoking, demographic characteristics, dietary intake, and other indicators was used to ask the participants. The outcome: After over 12 years of follow-up, 2007-2019, men and women combined, the outcome included 2,494 all cause-mortality, including 46 NCP and 121 lung cancer cases registered in Viet Nam. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) and to adjust for potential confounders. Estimates for both cohorts were pooled using random-effects meta-analysis.

Expected results and conclusions
Overall smoking, dual waterpipe-cigarette, exclusive waterpipe, and exclusive cigarette smoking, HCA intake, and NCP and lung cancer risk in each cohort study. The pooled analysis results of tobacco and NCP and lung cancer risk.

Colorectal cancer (CRC) is the third most diagnosed malignancy in 2020. Screening has been demonstrated to be effective in reducing mortality and potentially preventing the occurrence of CRC. Pilot screening programs for CRC have been implemented for a few years in China, including one provincially organized program targeting 1,600,000 residents aged 50 to 74 years old in 2020. However, the qualitative and quantitative performance have not been systematically evaluated.  The screening yield and benefit could be attenuated due to poor quality assurance. In 2022, the International Agency of Research on Cancer (IARC) launched the Cancer Screening in Five Continents (CanScreen5) project to measure screening performance with harmonized indicators for improved program management and informed policy-making. An expert group convened by IARC has defined the performance indicators of CRC screening. Currently, no quantitative data on CRC screening programmes in China is included in CanScreen5. Measuring performance of our programme with CanScreen5 indicators will be of mutual benefit to China and IARC. Thus, the aims of this application of Technical Fellowship of UICC include:
Quality Evaluation of CRC Screening Program 
The main purpose for this one-month fellowship is to learn and understand the full criteria of quality assurance for cancer screening program proposed by IARC, and then to summarize and analyze qualitative and quantitative performance indicator of CRC screening in Zhejiang Province. Based on analysis of performance further improvement will be made for improving the quality of CRC screening programs in Zhejiang province in collaboration with IARC.
Research Collaboration 
Since 2020, data of Zhejiang Colorectal Cancer Screening Program have been collected. More than 7,600,000 residents completed the risk-evaluation questionnaire and fecal immunochemical test, and more than 460,000 participants evaluated as positive undertook colonoscopy examinations and pathological diagnosis. The CRC incidence and mortality outcomes were further acquired by the linkage of provincial cancer registry and death surveillance system. The intermediate results and screening yield could be evaluated in the guidance from the IARC group. In addition, more research collaboration can be potentially achieved like development of CRC risk prediction model and evaluation on novel screening techniques in China.

Cameroon is a low-middle income country experiencing an increase in its population now estimated at 26 million inhabitants. It has a national program for the fight against cancer at the Ministry of Public Health which was put in place in 1990.
Breast cancer is the most common among women in Cameroon. According to the Cameroon fact sheet (Globocan 2020), Cameroon recorded a total of 4170 new cases of breast cancer in 2020 making 20.1% of cancer in the total population. Cervical cancer is the second most common cancer in Cameroonian women after breast cancer. Yet, it is a totally preventable cancer, through vaccination against the Human Papilloma Viruses (HPV) that cause it and through screening women for and treating pre-cancer lesions that precede the cancer by many years. However, breast and   Cervical cancer accounts for major public health concerns in Cameroon. This is consistent with high Breast and cervical cancer related morbidity and mortality in sub-Saharan Africa where they account for 85% of  cases of cancers among women in 2020. Among the women diagnosed with Breast and cervical cancer in Cameroon, 70-80% of them are diagnosed at very late stages with advance metastasis. With this increase in number of cases of Breast and cervical cancer, it is important that Public health interventions and clinical skills and knowledge be updated for screening, early detection and management of this disease which is a threat to women’s health.
The Committee for the fight against cancer has been carrying out periodic screening campaigns ranging from one to four times every year to diagnose women with breast and cervical cancer, most of these in collaboration with the Cameroon Baptist Convention Health Services (CBCHS).  CBCHS which is a major partner to the Cameroon ministry of health has put in place the women’s health program where women can routinely go for screening of breast and cervical cancer and also vaccination against HPV related cancers in seven out of the ten Regions of Cameroon.
This fellowship opportunity which is intended to be from September 15th 2023 to October 15th 2023 will enable me to:
•    Learn and understand how the program was started and its progress 
•     Learn how it is planned and run especially its yearly planner for the women clinic
•     Participate in Awareness for prevention programs and learn experientially from approaches being used
•     Participate and learn from planning processes and other strategic management approaches
•    Draft a proposal which will be implemented within the CBCHS.
These lessons learned will allow the CBCHS to set out on a long term journey for quality services, well trained staff and visibility from where the WHP of the CBCHS is as at now.

Breast cancer is the 4th largest cause of cancer-related deaths globally. Certain kinds of breast cancers affect people of particular ancestry, with a typical example being triple-negative breast cancer, which disproportionately affects black people. Triple-negative breast cancer is characterized by the primary hallmark of lacking cancer receptors, namely estrogen, progesterone, and human epidermal growth factor receptor 2, which typically present in other subtypes of breast cancer and are the target of treatment molecules. The fact that most patients are diagnosed at stages 3 and 4, coupled with the absence of these receptors, makes this subtype of cancer hard to treat, with prognosis averaging 5 years post-diagnosis. It is therefore of absolute importance to develop mechanisms that can detect the risk of these and other subtypes of breast cancer in black women, and polygenic risk scores serve as a growing innovative tool to achieve this goal. Polygenic risk scores are an emerging tool for stratifying individuals in a population based on their risk of developing a disease, and they are currently featuring prominently in research related to common diseases like diabetes, coronary artery disease, and breast cancer. This research fellowship will explore how polygenic risk scores can be used to infer breast cancer risk in African populations, especially in Nigeria.

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, cancer cervix and cancer breast 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’s testing or VIA can help us detect precancerous and early cancerous lesions .Complete management can prevent further progression of the disease. Cancer Breast is the other most common cancer seen in Indian females. Fortunately early detection even in this site can aid in getting complete cure. 
The majority of healthcare facilities are centred in and around cities. The rural population in India is still under the fear of ‘cancer being a death sentence” and are 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 set ups for the requisite testing, counselling and management.

For this I intend to get a mobile cancer screening and early detection van with facilities of mammography, pap’s 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 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 utilised 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 quality of the screening programs. The major reasons for this is a 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 to 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 to barriers and challenges as well 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 systematic approach to collecting and analyzing breast, colorectal and cervical screening data, and other aspects of data management. The training will also include provision of toolkit to training sub-national collaborators in Nigeria. There shall be continuous mentorship and support after the training program to ensure Nigeria is fully integrated 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 saddled to with 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 (1).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 skill, and will be a new paw to advocacy for further research regarding role of opium in cancer prevention in Iran. We will use different approaches to communicate different key stakeholders.