• Where We Work: Central America – Region-wide Projects

    Global Health in Central America

    • Cities: Guatemala City, Guatemala; San Salvador, El Salvador
    • Type of program: Education, Research and Capacity Building (Twinning)
    • Partners:
      • Guatemala:
        1. Unidad Nacional de Oncología Pediátrica (UNOP)
        2. Fundación Ayúdame a Vivir
      • El Salvador:

        1. Hospital Nacional de Niños Benjamin Bloom
        2. Fundación Ayúdame a Vivir
        3. St. Baldrick’s Foundation

    Program: Establishment of National Pediatric Cancer Registries in Central America

    • Start date: 7/1/2013

    drawing by patient in El SalvadorOne of the main limitations in advancing our understanding of childhood cancer is our limited knowledge of its causes. The differences in the incidence of cancer among children around the globe are very intriguing; it is possible that the interaction of environment, genetics, socioeconomic conditions, and ethnic factors influence the occurrence of cancer in some areas. In this regard, research on the epidemiology of childhood cancer in Central America can open the door to the study of potential causes. Cancer information in Central America is scarce (there is only one population-based cancer registry in Costa Rica). In addition, there are few researchers in Central America with expertise in childhood cancer epidemiology. The GHI has partnered with Unidad Nacional de Oncología Pediátrica (UNOP) and Hospital Nacional de Niños Benjamin Bloom in El Salvador to establish the first national pediatric cancer registry and create a childhood cancer epidemiology consortium in Central America.

    About cancer registries: Population-based cancer registries serve principally two purposes. The primary purpose is to provide the data for planning and evaluation of cancer control and treatment. Cancer registration allows health policy-makers to assess and address inequalities in prevention, access and care within and between countries according to factors such as ethnicity, occupation, socioeconomic status. Cancer registration is also used to assess the impact of interventions designed to promote early diagnosis, such as screening or provider education. The second purpose of cancer registration is to serve as the basis for epidemiological studies. For instance, using the limited data currently available, variations in incidence of pediatric cancer appear to be quite significant if one examines incidence rates in Low- and Middle-Income Countries versus High-Income Countries. The development of a population-based cancer registry is a critical step in the evolution of pediatric cancer care and evaluation in Central America and will directly inform the allocation of health resources and advance clinical, epidemiological, and health services research.

    Program: Centralized Pathology Review Pilot Study in Central America

    • Start date: 7/1/2014
    • End date: February 2016
    • Status: GHI activity completed

    cancer center in Central AmericaThis is a pilot study to evaluate the feasibility of establishing a centralized review program for specific solid tumors in Central America, while at the same time strengthening local capacity by training pathologists and transferring knowledge among pilot sites. This knowledge-exchange model is innovative as it goes beyond the typical mentor-mentee format and creates regional expertise which would eventually function independently.

    Impact: In addition to a large number of patients in the three pilot sites benefiting immediately from this project, we are also building a sustainable program that will impact many more patients in the future. It would be impossible for families and the local foundations in the selected Central American sites to pay for expert pathology consultation. Three local pathologists also directly benefit, but pathologists from all sites who are members in the Central America Association of Pediatric Hematologists and Oncologists (AHOPCA) will be included in the quarterly review sessions. In summary, the project is simultaneously beneficial to patients, physicians, and the center and through focus on development and mentoring of regional experts the longevity if its impact is maximized.

    About centralized pathology review: Centralized pathology review contributes to accurate diagnosis and correct therapeutic risk assignment for children with cancer. In North America, centralized pathology review has become standard practice in several collaborative studies; at least in part because the rate of diagnostic discrepancy between local and expert pathologists can be as high as 30%. In Central America, a region in which we have established long-term partnerships, general or pediatric pathologists must establish these diagnoses, yet opportunities to develop expertise are limited by the relatively low frequency of each disease at each center, lack of educational opportunities in pediatric oncologic pathology, and lack of a coordinated structure to provide regional mentorship. Finally, improving diagnostic accuracy would strengthen ongoing projects to improve pediatric cancer registration in the region.

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