KeyNote Session on “Bridging the gap by leapfrogging”: Cost effective molecular diagnostics to solve health disparity in cancer

Using molecular techniques for the care of patients or population has been proven to be very effective. However, infrastructure constraints and cost constraints have limited their utility in many parts of the world.  The utilization of molecular techniques to solve health disparity will be discussed in detail. Two cancers with the highest health care disparity between the western and eastern countries are cervical cancer and pediatric acute lymphoblastic leukemia.

1. In cervical cancer, a simple Pap smear-based screening had systematically reduced disease incidence by more than 60% in the last 4 decades (NIH RePORT). More recently, HPV based molecular screening has been very effective in detecting high-risk population. However, cost constraints have limited their utility. We present data utilizing next-generation sequencing and a paper chip-based method (Rodriguez et al.) to show that low-cost screening methods can be easily implemented for effective population-based screening. 
2. Pediatric B-acute lymphoblastic leukemia is another disease with an outcome disparity; while 95% of pediatric B-ALL is curable in western countries, more than 80% of pediatric leukemia do not survive 5 years in eastern countries. The use of NGS based sequencing technologies have guided high-risk, low-risk subgroups and furthermore enabled precision medicine, dosage adjustments for appropriately triaging and treating patients with ALL.

Finally, treatment selection and modification of Ph+ ALL in adults using molecular techniques can lead to significantly better outcomes.

Rajan Dewar MD PhD

University of Michigan, USA

Rajan Dewar has completed his MD at Madras University, Ph.D. from IIT Bombay. After completing his graduate studies at UT Southwestern Medical center, he trained as a pathologist at Yale and his fellowships in Hematopathology & Molecular Pathology at Stanford University School of Medicine. Before moving to The University of Michigan as the director of the hematology laboratory, he was at Harvard Medical School for a decade, where he started his global health implementation research. He has published more than 45 papers in reputed journals and has been leading several social research and social entrepreneurial activities in the United States and India.

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