A call to action: molecular pathology in Brazil

Cunha, Isabela Werneck da; Coudry, Renata de Almeida; Macêdo, Mariana Petaccia de; Assis, Emílio Augusto Campos Pereira de; Stefani, Stephen; Soares, Fernando Augusto

doi:10.1186/s42047-021-00096-1

Cited by 6 publications

(5 citation statements)

References 125 publications

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“…Adequate institutional protocols and quality-control standards to regulate sample preparation are not standard across laboratories ( 49 ). Suboptimal practices within the tissue sample journey, including insufficient sample quantities, create technical challenges to BRAF testing.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, vast inequities exist in access between the regional private and public healthcare systems. Molecular testing demands an infrastructure comprising technological, financial, and human resources, which few institutions in LA possess ( 45 ). The complex technologies and processes are mostly only available in highly specialized centers, usually concentrated in major cities, leaving large populations underserved.…”

Section: Methodsmentioning

confidence: 99%

“…In countries in LA where targeted therapies are approved, BRAF testing is sometimes provided cost-free by the pharmaceutical industry, making it available to a large portion of the population for as long as the sponsored programs exist ( 45 ). Although this offers a short-term solution to access, it is not without problems.…”

Section: Methodsmentioning

confidence: 99%

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Addressing the unmet needs of patients with BRAF-mutated melanoma in Latin America: Expert perspective

Salman¹,

Melo

Rico-Restrepo

et al. 2023

Front. Oncol.

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Melanoma represents an increasing public health burden with extensive unmet needs in Latin America (LA). A mutation in the BRAF gene is present in approximately 50% of all melanomas in White populations and is a target of precision medicine, with the potential to dramatically improve patient outcomes. Thus, increased access to BRAF testing and therapy is LA must be explored. At a multi-day conference, a panel of Latin American experts in oncology and dermatology were provided with questions to address the barriers limiting access to testing for BRAF mutation in patients with melanoma in LA, who may be eligible for targeted therapy to improve their prognosis. During the conference, responses were discussed and edited until a consensus on addressing the barriers was achieved. Identified challenges included ignorance of BRAF-status implications, limited human and infrastructural resources, affordability and reimbursement, fragmented care delivery, pitfalls in the sample journey, and lack of local data. Despite the clear benefits of targeted therapies for BRAF-mutated melanoma in other regions, there is no clear path to prepare LA for a sustainable personalized medicine approach to this disease. Due to melanoma’s time-sensitive nature, LA must aim to provide early access to BRAF testing and consider mutational status within treatment decision making. To this end, recommendations are provided and include establishing multidisciplinary teams and melanoma referral centers and improving access to diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Addressing the unmet needs of patients with BRAF-mutated melanoma in Latin America: Expert perspective

Salman¹,

Melo

Rico-Restrepo

et al. 2023

Front. Oncol.

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“…Adequate quality is often cited as a barrier in resource-limited settings; thus, highly trained surgical and clinical oncology personnel, bioinformatics, pathology, genetic counseling, and molecular biology must avoid pre-analytical issues. [78] While physicians are more likely to order molecular tests for cancers such as lung and breast, training on adequate testing for cancers such as sarcomas and central nervous system is limited due to a lack of TT access. Consequently, in LA, reagents sometimes expire because MT is not ordered, further dissuading hospital administrations from acquiring the tests in the first place.…”

Section: Lack Of Local Genomic Datamentioning

confidence: 99%

Adopting Molecular Testing for Solid Tumors in Latin America: Challenges and Opportunities

Araujo¹,

Costa²,

Parra³

et al. 2022

RAS Oncology &Amp; Therapy

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Introduction: The advent of precision medicine, including molecular testing (MT), has revolutionized the cancer care landscape and may provide a path forward in the sustainability of cancer care. Methods: Americas Health Foundation (AHF) identified a panel of seven experts in MT with backgrounds in clinical oncology, molecular pathology, and bioethics from Argentina, Brazil, and Colombia. They convened for a three-day virtual meeting on November 10-12, 2021, to discuss the need for widespread access and adoption of MT for solid tumors in Latin America (LA). Results: The authors identified challenges in MT access in molecular medicine (MM) in LA and proposed suggestions to manage them. Development and implementation of human talent, infrastructure, and policy strategies are essential to provide MT in LA. This review outlines the substantial challenges faced by countries in LA to the widespread adoption of MT in oncology and provides recommendations on overcoming them. Conclusions: Despite the many advantages of MT for solid tumors, the challenges for implementation in LA healthcare systems are sizable and multidimensional. These include regional deficiencies in trained teams, fragmented healthcare systems, and inefficiently distributed budget allocations.

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“…The burden of breast cancer continues to increase worldwide, particularly in developing countries, notwithstanding the great achievements of the past decades in terms of mammographic screening, increased understanding of genetic and environmental risk factors, and treatment 1,3,4 . Like many countries, Brazil faces an increasing challenge in providing health care to cancer patients; in this country, breast cancer is now the most frequent non-cutaneous malignant tumor in both sexes combined 5 , but several barriers need to be overcome in the attempt to provide comprehensive diagnosis and treatment for our patients at the national level [6][7][8] . Moreover, Brazil has a dual health-care system, whereby nearly 75% of the population relies on medical care provided by a government-funded public system, and the remaining 25% has access to private health insurance 9 .…”

Section: Introductionmentioning

confidence: 99%

Optimizing pathological assessment of breast cancer in Brazil: recommendations from a multidisciplinary working group on the tumor-tissue journey

et al. 2022

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Timely and correct assessment of histopathological, immunohistochemical and molecular features of biopsy and surgical specimens is of paramount importance in the provision of care to patients with breast cancer, particularly in the current era of precision oncology. In order to ensure that tissue samples are obtained, processed, analyzed and reported in an optimal way, a concerted effort is required by institutions and individuals, taking into account state-of-the-art scientific and technical knowledge and circumventing logistic and operational constraints. This may be particularly challenging in some settings due to several sources of economic, structural, organizational and communication inefficiencies. In the current article, we present a brief review of breast cancer epidemiology and challenges in the disease diagnosis, especially in Brazil, and report the results of a multidisciplinary working group convened in May 2020 in an expert panel to identify and discuss the barriers and challenges related to the journey of breast cancer samples in Brazil. Following the identification of the issues, the working group also discussed and proposed recommendations for improving the journey and quality of breast cancer samples based on their professional experience and the current scientific literature, including guidelines of national and international health organizations (e.g. World Health Organization), consensus of medical societies and other published literature on the topic. We outline the most salient issues related to that journey in Brazilian public and private medical institutions, based on the experts’ clinical experience, since all of them are actively working at both sectors, and discuss current recommendations to address these issues aiming at mitigating and preventing preanalytical and analytical issues affecting diagnostic and therapeutic decisions. Such issues are grouped under four headings pertaining to education, communication, procedures in the operating room and sample transportation, and procedures in the pathology laboratory. Selected recommendations based on the current literature and discussed by the group of Brazilian experts are reviewed, which may mitigate the issues identified and optimize diagnostic and therapeutic decisions for patients with breast cancer, currently the most frequent malignant tumor worldwide and in Brazil. This paper has been submitted and published jointly, upon invitation and consent, in both the Surgical and Experimental Pathology and the Mastology journals.

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A call to action: molecular pathology in Brazil

Cited by 6 publications

References 125 publications

Addressing the unmet needs of patients with BRAF-mutated melanoma in Latin America: Expert perspective

Addressing the unmet needs of patients with BRAF-mutated melanoma in Latin America: Expert perspective

Adopting Molecular Testing for Solid Tumors in Latin America: Challenges and Opportunities

Optimizing pathological assessment of breast cancer in Brazil: recommendations from a multidisciplinary working group on the tumor-tissue journey

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