Problem: Over 70% of cancers in Africa are diagnosed at advanced stages when curative treatment possibilities are reduced. Advanced disease is a result of a long pathway to diagnosis, for which early identification and referral of suspected cancer needs to be achieved at lower levels of the health system, possibly through task sharing/shifting. 

We aim to evaluate whether screening for common cancers can be conducted as part of NCD check-up clinics based at health centres /district hospitals in Ethiopian and Tanzania. Egypt and South Africa EG and ZA have made progress in earlier diagnosis of cancer, nevertheless barriers persist which we will identify at the woman and health-system level for cervical and breast cancer. 

Problem: Cancer affect strategies, ethics and legal issues in cancer control with specific issues in the African context due to limited resources and prevalent attitudes towards cancer. These include cancer myths held by the community and/or health workers, belief that a taking of a biopsy accelerates death and beliefs in the curability of cancer. Non-disclosure of a cancer diagnosis to a patient is sometimes a family’s wish, having implications for informed consent and data inclusion in cancer registries. Cancer treatment and early detection research is faced with questions concerning resource-allocation, and the ethics of research when treatment options are highly limited. 

We aim to evaluate Africa-specific issues concerning cancer awareness, informed consent, disclosure, early detection and therapy and their ethical and legal implications. As this topic is broad and trans-disciplinary, a multi-disciplinary approach will be employed where Africa research scholars will be trained to conduct mixed and ethnographic studies identifying key ethical issues in cancer care and research in their contexts and develop input for local guidance. 

Problem: Cancer results from inherited/acquired genetic mutations, thus tumour biology needs to be evaluated amidst large genetic diversity of Africa’s populations. Further, cancer in Africa has unique features including young patients, multi-morbidities including infections that induce carcinogenesis (HIV, HPV, EBV, HCV, HBV, and others) as well as diet, and change in life styles. These understudied factors may lead to different tumour biology, pharmaco-genetics and kinetics alterations influencing treatment efficacy and tolerance.

 We aim to study regional various in cancer tumour biology and immunology and examine their correlations with infections and morbidities. All partners have access to hospitals with high cancer caseloads and good tumour biobanks, where tumour biology of common cancers breast, cervix, colorectal, and other than in Egypt, esophageal cancer will be studied. Systematic collection of a short patient health status, socio demographic data and outcome will be conducted. For Breast cancer We will investigate regional differences in tumour receptor status, molecular subtypes on RNA basis, underlying genetic polymorphisms and diversity on DNA level. We will also aim to study how co-infections, local immune reactions and microbiome affect treatment outcome as well as prognosis of patients with different tumour types. These investigations will pave the way to personalized and effective breast cancer treatment in Africa. For Cervical cancer we will assess whether dominant HPV types are included in bivalent and other HPV vaccines. Evaluations will be conducted overall and by demographic factors (age, vulnerable populations, and women living with HIV). The data will form baseline information to commence precision testing with aim for implementing on-the-spot rapid tests in the different regions. For Gastro-intestinal cancers we will study the tumour microbiome and inflammatory markers pertaining to esophageal cancer, a common environmentally driven. We will investigate these tumours in the context of the different populations and distinct dietary habits. We expect unique characteristics of the populations’ microbiomes, co-infections and inflammatory markers. We will also explore molecular features such as copy-number variations, genetic polymorphisms and outcome.