Engaging Brazilian Partners in Collaborative Cancer Research
, by Doug Puricelli Perin
Brazil is a country of recent epidemiologic transition, where an aging population, progressive urbanization and adoption of unhealthy lifestyle has led to marked increases in cancer and other NCDs. On a week-long trip to Brazil, in September 2017, we covered large distances and saw very diverse realities. Barretos, our first stop, is a rural town in the state of São Paulo, over 260 miles inland from the state capital. Barretos has all the elements of a quaint Brazilian countryside town: friendly population, quiet and well-maintained streets, green main square. Nestled in this bucolic setting is the Barretos Cancer Hospital (BCH), an impressive state-of-the-art facility run by Dr. Edmundo Mauad that provides cancer care through Brazil’s public health system (SUS, by its Portuguese acronym). BCH is strongly committed to research, with the Teaching and Research Institute, molecular oncology labs that develop and maintain cell lines that represent the genetic background of the Brazilian population, and a biobank.
BCH is involved in several international research partnerships and scientific research studies, including NCI-CGH’s United States-Latin America Cancer Research Network (US-LA CRN). BCH was hosting the III Global Cancer Symposium, in partnership with Duke University, that targeted health professionals, journalists and students who are interested in global cancer control. The symposium offered high-quality presentations that discussed initiatives for cancer prevention and control in low- and middle-income countries, building capacity for cancer control and research globally, among other relevant themes. The symposium also connected offsite participants from Mozambique, who are part of ongoing South-South collaborative research and teaching activities. Among the many great talks, we had the pleasure to hear Dr. Kathleen Schmeler, from The University of Texas MD Anderson Cancer Center, describe the latest results on the high-resolution microendoscopy study for cervical cancer diagnosis, which is supported by NCI-CGH’s Cancer Detection, Diagnosis, and Treatment Technologies for Global Health (UH2/UH3). We were joined on the visit to Barretos by Dr. Amy Dubois, the U.S. DHHS Health Attaché to Brazil and Dailani Carrijo, Public Health Management Specialist, OGA, DHHS, who is also based in Brazil.
In Salvador, we were warmly hosted by Dr. Clarissa Mathias, medical oncologist and Director of Bahia Oncology Center (NOB, by its Portuguese acronym). Salvador is the capital of the State of Bahia, which has the largest population of persons of African ancestry in Brazil. We were interested in finding ways to work together on epidemiologic studies and clinical trials that might integrate this population into the broader context of NCI research into cancer biology and health disparities among African-Americans, Afro-Caribbeans, and West African populations. We visited Aristides Maltez, Salvador’s main public hospital, and NOB, a private clinic and research center. The contrast was remarkable. While both facilities were very clean and well-maintained, Aristidez Maltez Hospital attended approximately 1,000 patients per day which resulted in crowded reception and hallways, stretchers in the hallways, people sitting on the stairways between floors; on the other hand, NOB had many unused resources, with empty rooms facing a beautiful view of Salvador’s coastline. We also met the State Health Secretary, Dr. Fabio Vilas-Boas, a cardiologist, and the Vice-Governor of Bahia, João Felipe de Souza Leão, and learned about the expansion of Bahia’s cancer care system with the establishment of five new cancer centers across the state, which would decentralize care delivery from Salvador and reach very remote areas. Finally, we visited CIMATEC – Bahia’s Manufacturing and Technology Integrated Campus – which trains researchers and promotes innovation through robotics and materials testing labs, supercomputers used for health surveillance, and other state-of-the-art technologies. Dr. Amy Dubois also joined us in Salvador.
We ended our trip in Rio de Janeiro, which coincided with the Brazilian National Cancer Institute (INCA, by its Portuguese acronym) cancer symposium, commemorating the 80th anniversary of its founding. We had the opportunity to meet with the leadership of INCA, including the new director Dr. Ana Cristina Pinho Mendes Pereira, which led to a productive conversation regarding continued collaboration between NCI and INCA, including next steps for US-LA CRN (which INCA is also part of), possibilities for HIV-related cancer research, adapting and delivering our NCI Summer Curriculum program in Brazil, and supporting the creation of a PDQ website in Portuguese. Dr. Pereira is visiting NCI in November, which will allow us to strengthen our partnership further. In addition, we visited the historical and lush campus (we even spotted monkeys!) of Oswaldo Cruz Foundation (FIOCRUZ, by its Portuguese acronym) where we met with the Vice-President for Research, Dr. Rodrigo Correa-Oliveira; the Director of the National Institute of Infectiology, Dr. Valdilea Veloso; and, the Director of STD/AIDS Clinical Research Lab, Dr. Beatriz Grinsztejn. We agreed on the importance of continued joint work in HIV/HPV-related cancers, and discussed other infection-related research interests such as the association between Burkitt’s and malaria in Brazil.
Although Brazil faces challenges common to emerging economies, it is an upper-middle-income country with a strong health system where health is regulated as a human right, and enormous potential for research and innovation. NCI-CGH will continue to facilitate interactions with local partners that are beneficial to NCI’s cancer research goals and who want to join us in our mission to control and beat cancer.