Unlocking Africa’s Genetic Diversity in Oncology: A Collaborative Initiative to Bridge Cancer Disparities Globally
The problem: Alarming cancer disparities in Africa
The reality of cancers in Africa is different from that in western parts of the world and one might call the marked difference outrightly unfair, and perhaps even unjust. To be clear, cancer anywhere in the world is a devastating disease and should be treated everywhere. However, the disparities in Africa are considerably higher than in western populations. For example, in the United States, breast cancer fatalities stand at 19% whereas, in Nigeria they soar to 51% according to the Nigerian National Cancer Control Plan (2018–2022)¹. This is not different for prostate cancers where the 5 year survival rate in the UK is 85% and the US is 97%. However, although data is not conclusive, 45% — 55% of Nigerian men would survive within 5 years²³⁴. This means that if 100 men are diagnosed with prostate cancer in the US or UK, 97 and 85 of them respectively may survive another 5 years at least, whereas in Nigeria 45 to 55 of 100 men would die within 5 years of being diagnosed⁵. These examples represent just 2 cancers out of many.
There are several reasons for these disparities. Cancer is not a single disease but a heterogenous disease. Even cancers affecting a specific organ, such as breast cancer or colon cancer, are heterogeneous due to multiple driver mutations and a complicated tumor microenvironment. Each of these may require a different targeted therapy or standard of care. Cancers in non-African populations, and particularly in caucasian populations, have been well or at least better studied. However, there is a growing body of evidence that the drivers of cancer-causing mutations in Africans and the African Diaspora might be different from those in non-African populations. Given that most current diagnostic and treatment regimen for cancers are based on research carried out in mostly caucasian and non-African populations, the current standard of care may actually not accurately cater to what would be one of the top two largest populations in the world in the next 25 years — Africa and its diaspora, and to people from all ethnicities who may share genetic variation commonly found in African populations.
Another reason for the disparity is the limited availability of Next Generation Sequencing (NGS) based technologies at scale in Africa, and the resulting lack of targeted therapeutics. These have become major bottlenecks that prevent African patients from accessing life-saving care when it exists elsewhere. There are a few routes via which targeted therapeutics can get to a patient including: the patient or health insurer buying the drug, patient access programs that allow patients who may not be able to afford the drug get these innovative medicines, and via clinical trials that ensure participants get access to the most innovative drugs in the pipelines of pharmaceutical companies. Unfortunately, these routes are grossly inadequate in Africa. To be clear, this is an ecosystem issue rather than the fault of one party or the other, and requires ecosystem solutions to overcome them.
The Paradox: Africa’s genetic diversity is both the challenge and opportunity in curing cancers globally
But herein lies the challenge: Africa is highly heterogeneous with about 2,000 ethnolinguistic groups (and different genetics, adaptations, selection history, etc.!!!) and treating a highly heterogeneous disease in this population of 1.4 billion people across 54 countries is challenging, but necessary. However, this challenge also provides one of the most promising opportunities for curing cancer in our lifetime. The “scale of Africa, and the depth of its genetic diversity may also hold the clues for cancers and not just for people of African ancestry but people all over the world” (I am quoting a friend and colleague who is doing great work in curing cancers globally!). While there has been and continues to be interest from patients, their caregivers, the cancer research community, drug manufacturers, patient advocacy groups, and governments to solve this problem, the complexities of providing Next Generation Sequencing (NGS) based diagnostics solutions to Africans in a highly complex geographical and operational environment persist. Although studying oncology genetic data from Africa may hold the key, any solution must first be patient-centric, ensuring that cancer patients in Africa get access to life-saving diagnostics and therapeutics that they have not typically had access to.
The solution: Harnessing Africa’s genetic diversity
So where do we go from here? What do we do? Because regardless of ethnicity, this disparity affects us all, perhaps some (like me) more than others.
In order to effectively address the challenge of cancer, it is crucial to improve our understanding of the complexities of cancer, both within Africa and worldwide. Achieving this goal requires the collaborative efforts of ecosystem stakeholders, both private and public, combining their resources and expertise. This is why we have joined forces with Nigeria’s National Institute for Cancer Research and Treatment (NICRAT) to initiate the “Cancer Genome Nigeria’’ project in one of Africa’s most diverse regions.
NICRAT was established by law in 2017 by the Federal Government of Nigeria, and launched in 2023, with the mandate to provide national leadership in Cancer Research, Treatment, and Control in Nigeria, and to guide scientific advancements in cancer prevention, treatment, and cure. In Nigeria, NICRAT coordinates all cancer research and treatment at a national level. It is our belief that to create a country-wide solution that improves the diagnosis and treatment of cancer patients in Nigeria, and that adds to our ability to cure cancers perhaps in a lifetime, a national approach is needed such that the benefits of such studies and potential access programs and clinical trials can be more equitably distributed across the country and not only available in selected regions. In solving the issue that one’s geographical location (Africa vs the West) should not determine their access to life-saving care, we need to ensure that our proffered solutions are widespread across the country, reaching all geo-political zones, irrespective of location.
Cancer Genome Nigeria Project
The Cancer Genome Nigeria Project aims to provide NGS diagnostics to cancer patients in Nigeria and will be carried out as a real time study where the participants get in-time genetic sequencing reports for incorporation into their clinical care. The pilot phase of the Cancer Genome Nigeria Project will start by sequencing the top 50 genes implicated in 5 of the most prevalent cancers in Nigeria (breast, prostate, head and neck, liver, and colorectal cancers) seeking for driver mutations that can direct the selection of targeted therapeutic to be used in the cancers. For the pilot phase, we will sequence 20 patients for each of the cancers from Nigeria’s 6 geopolitical zones for a total of 100 cancer patients and we will work with NICRAT to onboard the first set of hospitals in these geographical zones. All participants will be consented for preclinical and clinical research (clinical trials). Following the pilot phase, we will be onboarding additional partners to expand the scope of cancers covered (e.g. to include hematological cancers and familial cancers), the types of sequencing tests performed (e.g. minimal residual disease, liquid biopsies), additional research and support services (e.g. cancer clinical trial participation and patient access programs), and the number of patients who can benefit. This study would follow the national ethical guidelines for carrying out this type of work and the informed consented data generated from this study would be used to understand the mutational signatures in cancers in Nigeria (and many people of Nigerian ancestry in the US, UK, Brazil, the Caribbeans, and more) and their frequencies.
In addition, we will work with NICRAT to provide supplementary training in precision medicine to participating physicians to ensure that they can take full advantage of the opportunity in providing tailored treatment solutions to the patient, and genetic counseling services or their equivalent to the participating patient.
In conclusion
Many of us have been affected by cancer. Whether we are survivors, currently undergoing treatment, or have witnessed loved ones facing the disease. For some of us, including myself, we know people who cancer has taken away. Cancer is that one disease that affects us all irrespective of class, wealth, geography, and even age. For me, I have witnessed family members die from cancers such as prostate cancer, a disease that is no longer seen as a death sentence in certain parts of the world. And within our team some of us have experienced cancer more intimately than I have.
Having collectively spent the better part of 4 decades involved in genomics and cancer research in institutions such as Barts Cancer Institute UK, Cancer Research UK, and Mount Sinai Hospital New York, and more, my team and I at Syndicate Bio are honored at the opportunity of working with NICRAT to provide a much needed solution, first to the patients, but also the country at large, and I suspect the impact of this project will be felt in countries across the world.
References
- Ministry of Health. (2018). Nigeria National Cancer Control Plan 2018–2022.
- Office for National Statistics. (2019). Cancer Survival in England: adults diagnosed between 2013 and 2017 and followed up to 2018. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/cancersurvivalratescancersurvivalinenglandadultsdiagnosed
- Siegel, D. A., O’Neil, M. E., Richards, T. B., Dowling, N. F., & Weir, H. K. (2020). Prostate Cancer Incidence and Survival, by Stage and Race/Ethnicity — United States, 2001–2017. MMWR Morb Mortal Wkly Rep, 69, 1473–1480. https://dx.doi.org/10.15585/mmwr.mm6941a1
- International Agency for Research on Cancer. (2021). GLOBOCAN 2020: Nigeria Fact Sheet. https://gco.iarc.fr/today/data/factsheets/populations/566-nigeria-fact-sheets.pdf
- Sharma, R., Aashima, Nanda, M., Fronterre, C., Sewagudde, P., Ssentongo, A. E., Yenney, K., Arhin, N. D., Oh, J., Amponsah-Manu, F., & Ssentongo, P. (2022). Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020. Frontiers in Public Health, 10, 839835. https://www.frontiersin.org/articles/10.3389/fpubh.2022.839835 DOI:10.3389/fpubh.2022.839835
About Syndicate Bio
Syndicate Bio is a platform biotech driving genomics and precision medicine initiatives across the world’s most diverse regions. Syndicate Bio uses large scale partnerships with governments, pharma companies, and other stakeholders to drive local precision medicine impact while creating powerful datasets that can be used for drug discovery and development.
About National Institute of Cancer Research and Treatment
The National Institute for Cancer Research and Treatment (NICRAT) was established by the Federal Government to provide National leadership in Cancer Research, Treatment and Control in Nigeria. The NICRAT Establishment Act 2017 also empowers the Institute to guide scientific improvement to cancer prevention, treatment and care; and to among others, coordinate and liaise with the wide range of groups and health care providers with interest in cancer.
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