By Calum MacAulay, Martial Guillaud and Pierre Lane
CANCER
Fluorescence
Imaging and Automated Microscopy for Cancer Management in the Developed and Developing World
Cancer is a common, tragic and expensive disease. While more than 1/3 of the population of North American will be diagnosed with cancer at some time in their lives, and the cost of cancer in the US exceeded $219 billion in 20081, the situation is even worse in the developing world where even less resources are available and the human costs of cancer can be even higher. Most cancers arise from precancerous lesions, and effective detection and removal of precancerous tissue may be the best, most cost-effective means to improve cancer survival and reduce cancer incidence. Early detection of cancer dramatically improves survival; when detected late, treatment is less effective, has greater morbidity, and is more expensive. One of the greatest success stories in cancer management is based upon early cancer detection and is that of cervical cancer screening. Cervical cancer screening is based upon the visual analysis of cytological samples (cells removed by brushing or scrapping and deposited on a slide) to identify patients requiring observation of the cervix using a magnified view (colposcopy). Areas suspect for precancerous or cancerous lesions are biopsied and if pathologically confirmed treatment is applied. Done effectively on a population basis this can reduce cervical cancer incidence and mortality by a factor of 42. Any drug with these characteristics would be considered to be an almost un-
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believable blockbuster. While such screening programs have been widely implemented in the developed world, they are not available in much of the developing world due to infrastructure and training costs of such programs. Thus while cervical cancer is not a large killer in the developed world in the developing world it is one of the most common forms of cancer in women and a leading cancer killer3. There have been many efforts to develop clinical systems for the automated or semi- automated interpretation of cervical cytology, while most were technically successful wide spread adoption of these technologies has not occurred in the developed world where they must compete with existing conventional screening laboratories. Rapid advances in affordable computational power over the last several decades and improved understanding of the performance requirements needed for an effective cervical cancer screening program have made it possible to construct automated cervical cytology devices which can be effective components of cervical cancer screening programs in the developing world. An example of this is the implementation of the automated quantitative cytology system initially developed in at the BCCA for the cervical cancer screening4. In partnership with a Chinese company this technology has been clinically implemented in economically successful private clinics and public sponsored clinics in China which have screened over 350,000 women to date. Further this approach is undergoing controlled studies to determine its feasibility as part of a publically funded program. In collaboration with colleagues at Rice University, MD Anderson Cancer Center and Drexel University we have also set up two of these automated quantitative cytology systems in Nigeria to assess their
