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Background To address the need for a skilled workforce in breast cancer (BC) pathology in sub-Saharan Africa (SSA), we implemented an education program to train laboratory technicians in manual immunohistochemistry (IHC). Methods A quality improvement education project was developed. Interactive webinars were held every six months with didactics and presentations from African experts with experience in IHC. We conducted knowledge assessments and surveys on current practice, equipment, and human resources. A digital mentorship platform (DMP) was created for discussions, sharing SOPs, and networking. For one year (2022–2023), we followed developments in pathology capacity, practice changes, and educational needs. A paired t-test was used to calculate the significance of changes in knowledge immediately after the webinar and comfort level with topics 35 days after the webinar. Results Two hundred and sixty six participants from 10 SSA countries attended the first webinar, a series of six lectures on IHC theory, methods, and practice. Ninety-five participants from nine SSA countries provided a baseline assessment of pathology capacity and feedback. Mean knowledge increased by 17.4% immediately after the webinar (from 41.8% pre-webinar to 59.2% post, p  =  < 0.0001). Self-reported comfort level in topics 35 days after the webinar increased by 11.3%, but this was not statistically significant (mean 3.36 pre- to 3.74 post, p  = 0.1). Over six months, recordings were accessed 412 times. After six months, the second webinar had 93 participants from eight SSA countries. Membership in the DMP increased from 64 to 172; recordings were viewed 412 times in six months; and 113 participants from nine SSA countries completed surveys. Among 74 respondents who perform IHC, 43.5% reported moderate or significant positive practice changes such as improved antigen retrieval techniques and optimization of preanalytical variables. Over half (52.7%, n  = 39) reported the quality of slides had moderately or significantly improved. After one year, a third webinar had 98 participants from eight SSA countries. Thirty-eight completed surveys, DMP membership increased to 199, and 1 reported launching IHC in a lab in Nigeria. Conclusions Our program 1) reached hundreds of participants and provided a baseline assessment of pathology capacity across nine SSA countries; 2) created a novel mechanism to build pathology capacity and assess progress with this cohort; and 3) improved practices and the preparation of slides for over half performing manual IHC. After one year, interest was sustained. Tracking impact on diagnosis and treatment of BC in the region is needed long-term.

Background Transportation barriers can hinder patients’ access to timely cancer diagnosis and treatment, particularly in low- and middle-income countries. In Rwanda, where cervical and breast cancer burdens are high, support through transport stipends can alleviate transportation barriers and improve patient outcomes. This study aims to understand the experiences and perspectives of women beneficiaries and program personnel involved in Rwanda’s Bugesera District transport stipend program. Methods Purposive sampling selected seventeen participants for in-depth interviews, including twelve women beneficiaries and five program personnel. Document review and household visits provided context. From September 2021 to May 2023, 204 women attended follow-ups for cervical and breast cancer screening and 75% of them received transport stipends. Results Five themes emerged from beneficiaries’ interviews: financial difficulties in accessing transportation for cancer care, impact of transport stipend on access to cancer services, barriers faced during transportation to cancer services, challenges in the process of receiving transport stipend, and recommendations to overcome stipend provision challenges. Five themes emerged from program personnel’s interviews: impact of transportation stipend on access to cancer services, challenges in the process of providing transport stipend, recommendations to overcome stipend provision challenges, recommendations for implementation of transport stipend in other settings, and sustainability. Conclusions The stipend was found to be impactful, but challenges in the provision process, including communication and delays, were identified. Insufficiency of the stipend was highlighted, with recommendations to expand coverage to other expenses. The study highlights the role of transport stipends in improving cancer early detection and linkage to needed follow-up and recommends strong partnerships and funding for program replication and sustainability. These findings can inform the planning of similar programs in low-income countries of Sub-Saharan Africa.

Abstract Objectives In response to requests for training in cancer pathology, two virtual training courses were organized: one in English for participants in Nigeria and another in French for participants in Francophone Africa. Each course had weekly 90-minute sessions covering essential topics in cancer pathology led by global experts. Methods Two research questions were investigated for both courses: (1) did the participants improve their knowledge of the topics covered during the course, and (2) did the course participants appreciate the virtual training format? Results The Nigeria course enrolled 85 participants from 26 Nigerian states; the Francophone Africa course enrolled 425 participants from 18 African countries. In the pre-post technical assessment, participants increased their scores on average by 3.4% (P > .05) in the Nigeria course and by 13.1% (P < .001) in the Francophone Africa course. On the postcourse survey, 95.8% of Nigerian respondents and 96.1% of Francophone African respondents reported being satisfied or very satisfied with the virtual format. Conclusions Virtual training is a promising tool to improve cancer diagnosis in Africa, as the experience of the courses illustrates that participants appreciate the virtual format. Continued training is required to reinforce skills and enable participants to appropriately apply new knowledge to their daily practice.

(P > .05) in the Nigeria course and by 13.1% (P < .001) in the Francophone Africa course. On the postcourse survey, 95.8% of Nigerian respondents and 96.1% of Francophone African respondents reported being satisfied or very satisfied with the virtual format.

The rising cancer incidence and mortality in sub-Saharan Africa (SSA) warrants an increased focus on adopting or developing approaches that can significantly increase access to treatment in the region. One such approach recommended by the recent Lancet Oncology Commission for sub-Saharan Africa is hypofractionated radiotherapy (HFRT), which can substantially increase access to radiotherapy by reducing the overall duration of time (in days) each person spends being treated. Here we highlight challenges in adopting such an approach identified during the implementation of the HypoAfrica clinical trial. The HypoAfrica clinical trial is a longitudinal, multicentre study exploring the feasibility of applying HFRT for prostate cancer in SSA. This study has presented an opportunity for a pragmatic assessment of potential barriers and facilitators to adopting HFRT. Our results highlight three key challenges: quality assurance, study harmonisation and machine maintenance. We describe solutions employed to resolve these challenges and opportunities for longer term solutions that can facilitate scaling-up use of HFRT in SSA in clinical care and multicentre clinical trials. This report provides a valuable reference for the utilisation of radiotherapy approaches that increase access to treatment and the conduct of high-quality large-scale/multi-centre clinical trials involving radiotherapy. Not available yet.

In sub-Saharan Africa (SSA), urgent action is needed to curb a growing crisis in cancer incidence and mortality. Without rapid interventions, data estimates show a major increase in cancer mortality from 520 348 in 2020 to about 1 million deaths per year by 2030. Here, we detail the state of cancer in SSA, recommend key actions on the basis of analysis, and highlight case studies and successful models that can be emulated, adapted, or improved across the region to reduce the growing cancer crises. Recommended actions begin with the need to develop or update national cancer control plans in each country. Plans must include childhood cancer plans, managing comorbidities such as HIV and malnutrition, a reliable and predictable supply of medication, and the provision of psychosocial, supportive, and palliative care. Plans should also engage traditional, complementary, and alternative medical practices employed by more than 80% of SSA populations and pathways to reduce missed diagnoses and late referrals. More substantial investment is needed in developing cancer registries and cancer diagnostics for core cancer tests. We show that investments in, and increased adoption of, some approaches used during the COVID-19 pandemic, such as hypofractionated radiotherapy and telehealth, can substantially increase access to cancer care in Africa, accelerate cancer prevention and control efforts, increase survival, and save billions of US dollars over the next decade. The involvement of African First Ladies in cancer prevention efforts represents one practical approach that should be amplified across SSA. Moreover, investments in workforce training are crucial to prevent millions of avoidable deaths by 2030. We present a framework that can be used to strategically plan cancer research enhancement in SSA, with investments in research that can produce a return on investment and help drive policy and effective collaborations. Expansion of universal health coverage to incorporate cancer into essential benefits packages is also vital. Implementation of the recommended actions in this Commission will be crucial for reducing the growing cancer crises in SSA and achieving political commitments to the UN Sustainable Development Goals to reduce premature mortality from non-communicable diseases by a third by 2030.

Correspondence to Dr Katy Graef, BIO Ventures for Global Health, Seattle, Washington, USA; kgraef@bvgh.org Rwanda, a landlocked country in sub-Saharan Africa with a population of 12.3 million, is investing in cancer control and prioritizing the response to its highest-incidence cancers.1 2 Over 1500 Rwandan women develop gynecologic cancers each year, with 71% of those women dying from their disease.3 4 The Rwanda Biomedical Centre (RBC)—the implementation arm of the Ministry of Health—has prioritized the expansion of quality gynecologic cancer prevention, screening, diagnostic, and treatment services nationwide. In response to Rwandan OB-GYNs’ need for improved in-service oncology management training and continuing education during the COVID-19 pandemic, BVGH, RBC, and Rwandan and international academic partners designed and held an innovative, multi-week gynecologic cancer management training program targeting Rwanda’s OB-GYNs. Human papillomavirus vaccine coverage in Rwanda: a population-level analysis by birth cohort.

Genetic improvement toward optimized and stable agronomic performance of soybean genotypes is desirable for food security. Understanding how genotypes perform in different environmental conditions helps breeders develop sustainable cultivars adapted to target regions. Complex traits of importance are known to be controlled by a large number of genomic regions with small effects whose magnitude and direction are modulated by environmental factors. Knowledge of the constraints and undesirable effects resulting from genotype by environmental interactions is a key objective in improving selection procedures in soybean breeding programs. In this study, the genetic basis of soybean grain yield responsiveness to environmental factors was examined in a large soybean nested association population. For this, a genome-wide association to performance stability estimates generated from a Finlay-Wilkinson analysis and the inclusion of the interaction between marker genotypes and environmental factors was implemented. Genomic footprints were investigated by analysis and meta-analysis using a recently published multiparent model. Results indicated that specific soybean genomic regions were associated with stability, and that multiplicative interactions were present between environments and genetic background. Seven genomic regions in six chromosomes were identified as being associated with genotype-by-environment interactions. This study provides insight into genomic assisted breeding aimed at achieving a more stable agronomic performance of soybean, and documented opportunities to exploit genomic regions that were specifically associated with interactions involving environments and subpopulations.

Soybean is the world’s leading source of vegetable protein and demand for its seed continues to grow. Breeders have successfully increased soybean yield, but the genetic architecture of yield and key agronomic traits is poorly understood. We developed a 40-mating soybean nested association mapping (NAM) population of 5,600 inbred lines that were characterized by single nucleotide polymorphism (SNP) markers and six agronomic traits in field trials in 22 environments. Analysis of the yield, agronomic, and SNP data revealed 23 significant marker-trait associations for yield, 19 for maturity, 15 for plant height, 17 for plant lodging, and 29 for seed mass. A higher frequency of estimated positive yield alleles was evident from elite founder parents than from exotic founders, although unique desirable alleles from the exotic group were identified, demonstrating the value of expanding the genetic base of US soybean breeding.