Pathology and Cancer Screening in Low-Income Countries

While the science of pathology is on a rapid trajectory of discovery including artificial intelligence/machine learning, robotics, and miniaturized point-of-care testing, pathology in low- and middle-income countries (LMICs) is challenged with keeping outdated technology operable, insufficient numbers of adequately trained technologists, and the cost of consumable supplies.

Pathology lab set up at the clinic for the Men's Jornada
Pictured here is a pop-up pathology lab on a folding table in rural Honduras where 326 men were screened over two days for prostate, testicular, skin, oral, and colon cancer. The men also received a clinical follow-up as appropriate at our partnering cancer center La Liga Contra Cancer.

Dartmouth Cancer Center's research questions are concentrated on testing the utility and ability of newest technology to perform in the ordinary circumstances of LMICs that are frequently hot and dusty with bumpy roads and frequent power outages or surges. If the technology does not perform at rates concordant with those derived in our state-of-the-art laboratories at Dartmouth Hitchcock Medical Center in New Hampshire, USA, then we consider it insufficiently robust to rely on in an LMIC. Sometimes, we are able to develop a low-tech hack and are particularly fond of telling the story of the $30 rice cooker that was a key piece of equipment in DNA extraction for more than 1,700 cervical samples.

Related publications

Atkinson AA, Studwell CM, Tafe LJ, Tsongalis GJ, HPV genotyping of solid tumors using real time PCR and multi-color melt curve analysis Journal of Molecular Diagnostics (2017).

Bejarano SA and Tsongalis GJ, Cervical cancer screening as an example of a global health strategy in resource-limited countries presented at Scientific Session 70th AACC Annual Scientific Meeting & Clinical Lab Expo Chicago, IL  (2018).

Turner SA, Studwell C, Deharvengt SJ, Lyons KD, Plata JA, LaRochelle EPM, Zapata AM, Kennedy LS, Tsongalis GJ, Bejarano SA, High risk HPV genotypes identified in Northern Honduras abstract at World Cancer Congress / UICC, Kuala Lumpur, Malaysia (2018).

Atkinson AA, Studwell CM, Bejarano S, Zapata Castella AM, Plata Espinal JA, Deharvengt SJ, LaRochelle EPM, Kennedy LS, Tsongalis GJ, Rural Distribution of Human Papilloma Virus in Low and Middle-Income Countries, Journal Experimental and Molecular Pathology (2018).

Kennedy LS, Tsongalis GJ, Case Study: Introducing PCR Testing for hrHPV in Cancer Screening in the Developing World: Case Studies and Strategies from the Field, editor Madalon Finkel, UPNE (2017).

Atkinson AA, Studwell CM, LaRochelle EP, Kennedy LS, Deharvengt SJ, Espinal JA, Bejarano SA, Tsongalis GJ, Molecular-based HPV screening in resource limited countries. Journal of Molecular Diagnostics (2017).

Turner SA, Deharvengt SJ, Lyons KD, Plata Espinal JA, LaRochelle EPM, Bejarano S, Kennedy LS, Tsongalis GJ. Implementation of Multi-Color Melt Curve Analysis for hrHPV Detection in LMICs: A Pilot Study for Expanded Cervical Cancer Screening in Honduras, Journal of Global Oncology (2017).

Deharvengt SJ, Turner SA, Kennedy LS, Tsongalis GJ, Multiplex Real-Time PCR Melting Curve Assay for Identifying HPV Types Using the Cepheid SmartCycler, Journal of Molecular Diagnostics (2016).

Turner SA, Deharvengt SJ, Plata JA, LaRochelle EP, Bejarano SA, Kennedy LS, Tsongalis GJ, Evaluation of Methods for Point-of-Care Testing for High Risk HPV Screening in Low Resource Countries, Journal of Molecular Diagnostics (2016).

Turner SA, Bejarano SA, Alibozek RA, Kennedy LS, Williams SM, Tsongalis GJ, Evaluation of methods for high risk HPV screening in low resource countries, Journal of Molecular Diagnostics (2015).

Atkinson AE, Studwell C, LaRochelle EPM, Kennedy LS, Deharvengt SJ, Plata Espinal J, Bejarano SA, Tsongalis GJ, Molecular-based HPV screening in low resource countries Presentation Association of Molecular Pathology, Journal of Molecular Diagnostics (2017).