Mansoor Saleh, M.D.’s, interest in working in East Africa stems from being born in Zanzibar, early school education in Tanzania and Kenya prior to completing medical education in Germany.
The scientific collaboration between the University of Alabama at Birmingham Comprehensive Cancer Center (UAB CCC) and Aga Khan University in Nairobi, Kenya originates from the breast cancer work of Drs. Albert LoBuglio and Andres Forero. Their objective was to identify the genomic signature for Triple Negative Breast Cancer (TNBC), which is an aggressive form of breast cancer. The LoBuglio/Forero team set out to identify the signature and responsiveness to therapy in patients with TNBC undergoing neo-adjuvant chemotherapy here at UAB. This work has since been published:
Forero A, Li Y, Chen D, Grizzle WE, Updike KL, Merz ND, Downs-Kelly E, Burwell TC, Vaklavas C, Buchsbaum DJ, Myers RM, LoBuglio AF, Varley KE. (2016). Expression of the MHC Class II Pathway in Triple-Negative Breast Cancer Tumor Cells Is Associated with a Good Prognosis and Infiltrating Lymphocytes. Cancer Immunol Res, 4(5):390-9. http://doi.org/10.1158/2326-6066.CIR-15-0243.
Varley KE, Gertz J, Roberts B S, Davis NS, Bowling K M, Kirby M K, Nesmith AS, Oliver PG, Grizzle WE, Forero A, Buchsbaum DJ, LoBuglio AF, Myers RM. (2014). Recurrent read-through fusion transcripts in breast cancer. Breast Cancer Research and Treatment, 146(2), 287–297. http://doi.org/10.1007/s10549-014-3019-2.
Building on this interest, UAB CCC established a collaboration with the Aga Khan University (AKU) in Nairobi, Kenya to collect tumor and normal tissue samples from Kenyan women with TNBC and study the genetic sequence and compare these with data derived from Caucasian and African-American women studied by the Forero et al team. This study is currently ongoing.
As an expansion of the collaboration with investigators at AKU Nairobi, UAB CCC currently has the following ongoing projects:
- Breast Cancer Awareness – screening and early detection (replicating work done by Dr. Edward Partridge and the Deep South Network which targets Alabama’s Black Belt and the Mississippi Delta)
- Clinical Investigator Training Program – training residents and junior faculty at AKU Nairobi in the science and art of human subject research and clinical trials
- Clinical Investigator Elective Rotation – an elective for clinical investigator from AKU Nairobi to spend 3 months on the Phase I Program at UABCCC
Based upon the success in Kenya, the early detection of breast cancer program to the Gorno-Badakhshan Oblast (GBAO) in the Pamir Mountains of Tajikistan has expanded. This work has been in collaboration between the Aga Khan Health Board for USA (AKHB, USA), Aga Khan Health Services Tajikistan (AKHSTj) and UABCCC.
- Early detection of breast cancer and training in clinical breast evaluation – training family medicine doctors in GBAO in clinical breast evaluation and diagnostic algorithm for an abnormal breast mass
- Training family medical doctors in VIA for the early detection of cervical dysplasia
- Training breast surgeon in cosmetically appropriate breast cancer surgery
Shahin S, Moloo Z, Ngugu A, Allidina A, Ndumia R, Mutuiri A, Wasike R, Wahome C, Abdihakin M, Kasmani R, Spears CD, Oigara R, Mwachiro EB, Busarla SVP, Kibor K, Ahmed A, Wawire J, Sherman O, Saleh M, Zujewski J, Dawsey SM. (2016). Breast camps for awareness and early diagnosis of breast cancer in countries with limited resources: A multidisciplinary model from Kenya. Oncologist, 21:1-11. http://doi.org/10.1634/theoncologist.2016-0004.
Talib Z, Shukurbekova I, Guldarbogh S, Alibekov Alibek, Jamshedov N, Moloo Z, Welji A, Amersi F, Muhammad AA, Jiwani A, Rais S, Nazrishoeva A, Ilnazarova S, Nuridinova S, Ukani H, Alwani S, Saleh M. (2016). A Community-Oriented Approach to Breast Cancer in a Low-Resource Setting: Improving Awareness, Early Detection and Treatment of Breast Cancer in Tajikistan. Breast Journal, 22(3): 330-334. http://doi.org/10.1111/tbj.12618.
The overall focus of this global health research initiative is to apply knowledge gained in the upper middle-income country (UMIC) setting to the lower middle-income country (LMIC) in a contextually relevant and appropriate manner, and train clinicians in LMIC to address clinical questions that are relevant to their patient population.
Such a partnership is a win-win recipe since we live in a world which is growing smaller and smaller and there are opportunities of transfer of knowledge and technology in both directions – UMIC to LMIC and vice versa.