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In the U.S., cancer diagnosis often involves costly biopsies and tests. In the south African country of Malawi, where the average annual income is around $300, patients can rarely afford such procedures 鈥� yet accurate diagnoses remain essential.

To help, staff of the long-standing are in the first phase of developing a low-cost genetic tumor sequencing method for making cancer diagnosis. 鈥淭hat would be a game-changer and useful throughout the world,鈥� said program co-director

Fedoriw is the Labcorp Distinguished Professor in the UNC School of Medicine鈥檚 pathology and laboratory medicine department, global cancer pathology director for the UNC Institute for Global Health and Infectious Diseases and a member of the UNC Lineberger Comprehensive Cancer Center.

Also working on the tumor sequencing project is Jeremy Wang, associate professor in the medical school鈥檚 genetics and pathology and laboratory medicine departments. Fedoriw and Wang are using a basic sequencer to test samples from Malawi and validate the process. With Malawian bioinformatician Benjamin Kumwenda, they have applied for an NIH grant to move the next phase into Malawi entirely. They also want to train Malawian researchers to run the program autonomously and to build infrastructure for in-country tumor testing.

The cancer program, a collaboration between UNC Lineberger Comprehensive Cancer Center and the Institute for Global Health and Infectious Diseases, operates in partnership with the Malawi Ministry of Health. It is part of , which began in the 1990s with research on HIV and sexually transmitted infections. About 300 UNC doctors, researchers, students and staff work in the program, which has expanded to focus on women鈥檚 health and HIV-associated cancers such as cervical cancer, lymphoma, esophageal cancer and Kaposi sarcoma.

Co-directors of UNC Project Malawi Cancer Program Dr. Tamiwe Tomoka (Left) and Dr. Yuri Fedoriw (Right).

The cancer program develops and supports diagnostic and clinical services, including the Kamuzu Central Hospital Lymphoma Study, AIDS Malignancy Consortium and NIH-funded clinical trials. Co-director with Fedoriw is , head of pathology at Malawi鈥檚 Kamuzu Central Hospital.

鈥淚n Malawi, access to critical cancer care resources such as radiation therapy and digital microscopy is extremely limited. Cancer therapeutics are sometimes not available,鈥� Fedoriw said. 色中色faculty are working with Malawian colleagues to help patients and improve diagnosis and treatment.

While the work focuses on global health, it can help researchers and clinicians better understand cancer and other health issues to help patients in North Carolina.

Developing global cancer research leaders

The institute and Lineberger train and support cancer research leaders in Malawi and at 色中色through the Malawi Cancer Outcomes Research Training Program. Ten investigators focus on cancer-specific projects, and six are 色中色faculty. More than 20 Malawian clinicians and staff in the project are largely dedicated to cancer work.

Since its first NIH grant in 1998, the project has centralized work in Malawi鈥檚 capital city of Lilongwe at Kamuzu Central Hospital and partnered with Kamuzu College of Health Sciences in Blantyre. Carolina鈥檚 building, adjacent to the National Cancer Hospital, houses Malawi鈥檚 only public pathology lab. In Malawi, there is one pathologist per 5 million people, compared to 65 to 70 pathologists per million in the U.S.

Fedoriw spends several weeks in Malawi every year overseeing the project. He interacts with Malawi staff frequently from Chapel Hill, including weekly Zoom meetings with pathologists to review scans of tumor tissue samples from Malawian patients.

He鈥檚 joined on these calls by other medical school faculty like assistant professor Dr. Amy Brownlee. A pathologist, Brownlee also directs global rotations for pathology medical residents and supports Tomoka in developing Malawi鈥檚 first pathology training program.

鈥淯NC staff are most proud of and see the most hope not just in our patients, but also in the fact that we鈥檙e developing researchers who will do this for their mother country,鈥� Fedoriw said.