Improving Diagnostic Pathology Capacity for Global Cancer Care

In this issue of the Journal , Dayal and colleagues1 report their findings on benign uterine tumors removed from women in north India. The study they conducted was straightforward: determine the type and incidence of a set of tumors from one geographic area at one point in time. As an observational study, it was designed and conducted well. The underlying question, however, was far more important and highlights one of the most vexing issues facing global health: how to diagnose and treat cancer.For those of us trained in America, Europe, or former Commonwealth countries, we often forget that much of what we know, what we do, and how we affect patient care simply does not exist in many parts of the world. At the most fundamental level, many regions and countries lack health statistics and epidemiologic data to such a degree that it is not possible for governments to rationally allocate resources and develop large-scale cancer diagnosis and treatment programs. This is particularly true for cancer epidemiology: there just are no data for many areas, and where data exist, the findings are often patchy in distribution, based on older classification schemes, and do not take into account substantial changes in demographics, movement of populations, emergence of new diseases, and changes in diagnostic methods. For too many regions and countries we do not know what cancers occur there, the relative prevalence of each cancer type, how these malignancies behave clinically and pathologically, how they affect morbidity and mortality for populations living in those areas, response to treatment, or prognosis. The effect of cancer on populations as a whole is even less well understood in terms of …