From my past global health experiences I have been struck by how difficult it can be to reliably diagnose cancer. Traditional pathologic diagnosis, the mainstay of cancer diagnostics in developed countries, is reliant upon having a sufficient number of well-trained pathologists and availability of adequate tissue specimens for review. Unfortunately, many already overburdened health centers in developing countries lack the resources to fill this need. One particular area of interest is HIV associated lymphoma which can easily go undiagnosed or even miss-diagnosed given the large differential diagnosis associated with lymphadenopathy and B symptoms in an HIV+ population.
Aside from traditional pathologic diagnosis, PET CT has shown promise to aid in the diagnosis in developed countries, but its utility in a resource limited setting is not practical. More recent advances in DNA technology using molecular techniques provide promise for the development of a diagnostic approach that could be done on blood specimens as opposed to tissue. The hope would be that with limited training a serum based diagnostic tool could be broadly implemented in a resource poor setting.
My goal for this elective would be to learn more about the diagnosis of HIV associated lymphoma in Johannesburg, South Africa. I hope to use the skill base that I have developed through Fellowship to better understand the diagnostic dilemma as outlined above. Additionally, I would like to use this opportunity to evaluate the feasibility of integrating a serum based diagnostic tool in a limited resource setting.