Friday, April 8, 2011

A Case For Breast Tumour Banks To Complement Breast Cancer Research In Africa: By Benard Solomon, Pathology Dept. Unilorin Teaching Hospital, Nigeria

Breast cancer is a global health challenge both to women and men. However, women are the major population at risk.
In advance Countries, concerted effort have been made to reduce mortality rate and breast cancer risk among women. Besides establishing
research Institutes, the availability of Breast Tumour Banks(BTB) has significantly improved the diagnosis and management of breast cancer.

A recent search in google, the world's most popular search engine reveals that Breast Tumour Banks(BTB) are available in most European Countries,
North America, Canada, U.S.A., Asia, Australia and the Middle East. There is none in Africa!

This poses a great health challenge to African population especially women.

It is estimated that 153,100 new cases of cancer occur in Canada every year. 1, 354 die weekly. In Australia, it is also estimated that 15,409 women are expeccted
to be diagnosed with Breast cancer.
In India, an estimated 80,000 new cases are diagnosed annually.

Africa has the following incidences:
* 3, 785 cases occur in South Africa annually

* 10,000 cases in Nigeria annually

* 20.4 per 100,000 in Harare and 16.4 per 100,000 in Kampala

* Gambia has 3.4 per 100,000 while Egypt has 10,556 annually.

Although breast cancer incidence is lower in Africa, there is a consensus among experts that there will be increase in the coming years.
Pre-emptive and concerted effort in the area of cancer research becomes imperative. Establishment of BTB is a sine qua non in this direction.

What is a Breast Tumour Bank? A breast tumour bank is a kind of bio-repository. A bio-repository is a facility that collects, catalogs and stores samples of biological
materials for laboratory research. Since breast tumour bank is a human sample, it is important that medical information be stored along with a written consent to use the samples
for laboratory studies.

Facilities for BTB as modeled by the Texas Tumour Bank include:

Tissue Collection: This is a special software called TissueStation, an informatics system developed and
maintained by the Clinical Research Information Systems. This is used for storage of tissue collection data using an Oracle database accessible over the web via an Oracle Forms Client.
Data security is enhanced by the use of firewall and automated routine back-up with user authorisation.

Any BTB to be deployed should have the ability to communicate with internal clinical data repository systems especially the pathology laboratory information systems and clinical protocol-based tissue request system.

There should be a freezer security system to continuously monitor temperature with individual cryoprobes that record ambient temperatures in each freezer.
The cryoprobes should be linked to a centralized computer system in the institutional security office and manned twenty four hours a day. An alarm system that notifies monitoring services must also be installed.

Talking about breast tumour banks data in the world, a recent bio-banks data released by the global directory shows that Europe has 79 banks, 15 in North America, more than 156 in America, 24 in Asia, 11 in Australia, 4 in Middle Ease
with Israel and Iran having 3 and 1 respectively.

A closer look at the directory shows that across Europe there are Breast Tumour Banks in Vienna, Brussels, Bern, Granada, Madrid, Lyon, Marseille, Toulouse, Genoa, Birmingham, Cambridge, Cardiff, Liverpool, London and Southampton.
Cities with BTB in North America are Toronto, Vancouver and Winnipeg. A google search also shows that there is breast tumour banks in Manitoba.

In the U.S.A., BTB exist is Tucson, Atlanat, Augusta, Worcester, Frederick, Ann Arbor, Rochester, Durham, Philadelphia, Houston, Bainbridge Island, San Antonio and Galveston.
Across Asia, BTB are found in China, India, Japan, Korea, Malasia, Singapore and Thailand.

Furthermore, it is worth mentioning that BTB in Australia exists in Auchenflower and Westmead.

In the Middle East, Breast Tumour Banks have been established in Iran and Israel.

Although BTB could exist in other cities yet to be included in the global directory as compilation is still on-going, it is imperative to note that those Continents and Countries have instituted pragmatic efforts at promoting breast cancer research.

The African situation is pathetic! From South Africa to Zimbabwe, Egypt, Tunisia, Ghana and Nigeria, no single BTB has been established.
It is therefore not surprising that recent breakthrough in breast cancer research such as the success stories that led to the discoveries of Tamozifen and Herceptin came from Countries with Brest Tumour Banks especially America which has the largest number
of Breast Tumour Banks.

Incidence of breast cancer is lower among African Countries when compared with their counterparts in other Continents but that cannot be taken as an excuse because breast cancer is on the increase. One of the reasons for this is the adoption of Western lifestyle by African
middle class. The future generation are therefore at higher risk. Taking pre-emptive measures by establishing Breast Tumour Banks for the promotion of research with the objective of finding home-grown remedies that are scientifically tested becomes sensible and a duty African
Governments and Non-Governmental Organizations must attend to for an urgent intervention strategy.

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