Carol G. Shores, MD, PhD, is developing several lines of cancer research in the southeastern African country of Malawi. She works closely with the UNC Project, located at Kamuzu Central Hospital (KCH) in the capital, Lilongwe. The UNC Project (http://www.med.unc.edu/wrkunits/2depts/medicine/id/malawi/) was established by the UNC Division of Infectious Diseases in 1990 to conduct HIV clinical trials. The program is now expanding to include surgical research in cancer and trauma care.
Burkitt’s lymphoma is a common pediatric head and neck tumor in sub-Saharan Africa and is associated with Epstein Barr virus. The virus is in a latent form in the cancer, when it is resistant to treatment with antiviral therapy. Dr. Shores and Paula Harmon, MD, (UNC PGY3) in collaboration with Margaret Gully, MD, (UNC Pathology) collected tumor samples from 30 children with Burkitt’s lymphoma before and after treatment. The results indicate that the virus switch to a lytic infection, and should therefore be sensitive to antiviral medications, very early after the first round of chemotherapy. This suggests that pre-treating children with antiviral therapy prior to the first round of chemotherapy my increase the number of tumor cells killed. A clinical trial is planned to answer this question, pending funding.
Ameloblastomas are odontogenic tumors that occur primarily in teenagers and young adults. The incidence of ameloblastomas in Africans is 10 fold higher than Caucasian Americans and 5 fold higher than African Americans. This suggests an environmental factor, possibly a viral infection. To determine this, Jessica Smyth, MD, (UNC PGY1) in collaboration with Dirk Dittmer, PhD, (UNC Department of Microbiology & Immunology) wrote a protocol to collect 25 samples of ameloblastomas from patients at KCH and analyze them for the presence of virus known to be associated with human tumors. Drs. Smyth and Shores traveled to Malawi in June 2009 to initiate the study.
Understanding the incidence of cancer is key to designing cost effective prevention and treatment plans. There is currently no tumor registry in Malawi, and the WHO depends on local registries for accurate assessments of cancer incidence. Dr. Elizabeth Bigger (PGY3, Vanderbilt University) will begin a year long Fogarty Fellowship in July to set up a cancer database and registry in Lilongwe. Dr. Shores and Mina Hosseinipour MD (UNC Associate Professor Infectious Disease who is full time in Malawi) are her advisors. Dr. Bigger’s project will also examine the relationship of HIV status with cancer presentation and outcomes.
Cancer is primarily a surgical disease in Malawi, as there is no radiation oncology facility and chemotherapy is too expensive for most patients. Trauma and congenital anomalies are also surgical diseases, and treatment of these depends on consistent presence of well trained surgeons. Toward this goal, Dr. Shores has worked with the surgeons in Lilongwe and UNC surgeons Anthony Charles, MD, (Trauma Surgery) and Clara Lee, MD, (Plastic Surgery) to establish a surgery resident training program at KCH. Four new residents will begin in this College of Surgeons of East, Central &. Southern Africa approved program in July 2009. Dr. Shores is committed to traveling to Malawi at least once a year to teach in this program, and Dr. Charles and she are applying for funding to teach surgical research to the new residents.