PhD student: Brenda MALLON
Title: Childhood Cancer Epidemiology in the French speaking African population
Supervisor: Doctor Jacqueline Clavel
Doctoral school: École doctoral 393 Pierre Louis de Santé Publique – Epidemiologie and Sciences of Biomedical information.
Promotion: 2023
Funding: Gustave Roussy
Thesis abstract:
The Epidemiological profile of childhood cancer in French speaking African is predominantly based on what is known in HIC or estimations from nearby countries where data exists. While international studies measuring incidence, survival and mortality, and the burden of disease for childhood cancer uses data from LMIC there are only a few countries in Africa with population-based cancer registries. When these registers are combined they cover around 5% of the childhood population of Africa (IICC-3 resource at http://iicc.iarc.fr/), with an estimation of 50 000 new cases every year in Africa. Making quality data a precious tool for service providers and national planning.
In 2016 the French African Pediatric Oncology Group (GFAOP) a Non-government Organisation (NGO) whose aim is to treat African children with a cancer in Africa by trained local teams, created a centralised Hospital Based Cancer Registry (HBCR) in its paediatric oncology units. The aim of this PhD work is to improve epidemiological information on childhood cancer in western sub-Saharan Africa, based on the GFAOP hospital-based-registry. Which will include describing the data recorded in the GFAOP HBCR, evaluate data quality to identify weaknesses/shortcomings for the use of such data in comparative studies. Analyze the feasibility of implementing standardized staging (Toronto Paediatric Cancer Stage Guideline) for international comparison of survival. Then finally evaluate the feasibility of establishing a regional population-based cancer registry for the region of Dakar, starting from the existing HBCR, identify sources and pathways to expand identification of cases not seen in the POU of Dakar.
This work is important because of the announce in 2018 by the World Health Organization (WHO) of a target of 60% survival for all children with cancer by 2030 (Global initiative for childhood cancer (GICC), urging the need for scaling-up of hospital-based cancer registries (HBCR in LMIC). This announce encouraged the GFAOP to consider expanding the scope of the registry so that the collected data could be used on both a national and international level for use in comparative studies with population based registries. Analysis of existing data from the registry was essential as a first step to understand their potential, and to evaluate if adaptations were required to render these data compatible for use in other international data sets.
This selection of two countries in Africa was part of the Cure all Program, Morocco was chosen in North Africa and Senegal was selected as a sub-Saharan country in 2020 by WHO for aid in the development of a national Cancer Plan. Because of this selection, the Dakar region was considered as a good candidate for a feasibility study to look at the possibility of the extension of the HBCR into a regional population-based cancer registry. While this existing HBCR provides reliable routine epidemiological data it cannot inform on cases who never reach the unit.
Dakar had relatively favourable conditions for childhood cancer care including the existence of a specialized oncology paediatric service and member of the GFAOP since its conception in 2000. Dakar also had a well-established public health system, with willingness of the Institut de Santé et Development (Pr. A. Faye) to develop cancer registration in the region.
