W. Charles Penley, MD FASCO
Chair, Conquer Cancer Foundation Board of Directors
Myanmar, a country of approximately 51 million people, is home to a rich cultural heritage and vast natural resources. A former British colony, it has been independent since 1948, but was ruled by a military junta from 1962 to 2011, and during that time was largely closed to outside visitors and influence. Health care in general, and oncology care in particular, has been negatively impacted by an ageing infrastructure and lack of health care spending by the government. Since 2011, the country has become more open to outside information and investment, and there has been significant improvement in many health care facilities, though many very basic medical needs are still unmet. There are currently approximately 30 medical oncologists serving the needs of the entire country, most based in the two largest cities. Many screening procedures long considered routine in developed nations, such as Pap testing and mammography, are not widely available.
With this background, ASCO International was invited to provide a Multidisciplinary Cancer Management Course (MCMC) in Yangon, the country’s largest city. The course was jointly sponsored by the Oncology Society of the Myanmar Medical Association (MMA) and the Pinlon Group of Hospitals. Dr. HtayHtay Kyi, of the Pinlon Group, was our very gracious host. Dr. Myo Thant, Clinical Assistant Professor of Medicine at the University of Maryland’s Greenebaum Cancer Center, served as the conference coordinator in the United States. Professor Soe Aung, an ASCO member and President of the Oncology Society of the MMA, was the conference leader in Yangon. Faculty from the United States, Singapore, and Myanmar were featured. The course took place at the Sedona Hotel in Yangon on February 21-22, 2015. I was pleased to attend the conference as a representative of the Conquer Cancer Foundation (CCF) Board of Directors, and as a member of the faculty. Doug Pyle, ASCO’s Senior Director of International Affairs, was the course organizer and logistician, and aided us all greatly by providing technical support during the audience response sessions. (Thanks, Doug!)
Attendance at the MCMC exceeded all expectations, and the 200 registered attendees filled the room to capacity. Attendees included practicing physicians, medical officers, medical students, nurses, and other health care workers. Specialties represented included medical oncology, radiation oncology, surgery, diagnostic radiology, OB/GYN, and pathology. Content was focused on commonly occurring malignancies such as colon, breast, and lung carcinoma, with an emphasis on the team approach to cancer management. While some discussion focused on the unavoidable “work-arounds” required in a system with limited resources, the bulk of the conversation related to current state-of-the-art care being provided in developed nations. The attendees were engaged, and discussion during the Tumor Board sessions was lively.
My personal impression is that one of the greatest effects of the conference will prove to be increased utilization of a team approach to cancer care. The medical culture in Myanmar simply had not, to date, robustly embraced that concept. Through the exchange of personal contact information between faculty and conference attendees, I believe that international collaboration will continue well into the future. One final testament to the success of the meeting is that prior to the MCMC there were 9 ASCO members in all of Myanmar, but by the conclusion of the meeting 35 membership applications had been submitted!
During the third day of my whirlwind trip to Yangon, I had the pleasure of visiting with Dr. Mya Thida, who was one of the inaugural recipients of the Conquer Cancer Foundation’s International Innovation Grant. Dr. Thida is Professor and Head of the Department of Obstetrics and Gynecology at the University of Medicine 1 in Yangon. Her project, “Effectiveness of a visual inspection with acetic acid (VIA) and cryotherapy-based single-visit approach to cervical cancer prevention in Taikkyi Township,” aims to increase the number of women who receive screening and treatment for cervical cancer in Myanmar. Currently, only approximately 0.9% of women in Myanmar undergo Pap screening for cervical cancer. Factors that contribute to this very low rate include limited access to routine health care and the very limited pathology support available. Dr. Thida described the current state of screening as “opportunistic,” which she defined as providing Pap screening to women who were hospitalized or accessing the health care system for other reasons. As a result, cervical cancer is the second leading cause of cancer mortality in women between age 15 and 44 in Myanmar, according to World Health Organization data from 2012.
VIA has been reported by many authors to be an effective screening tool which can be used by non-physician health care workers in underserved populations. Dr. Thida’s approach is to train both local and “mobile” teams of primary care physicians and nurses/midwives to provide the screening. In addition, Dr. Thida’s group takes the screening one step further—women who have a positive VIA screen are offered cryotherapy at the time of the screening visit. Women who have successfully undergone the single visit “screen and treat” procedure are seen in follow-up in six months. With emphasis on community outreach and public education, Dr. Thida’s team is making progress. With six visits to Taikkyi Township over 6 months in 2014, the screening rate for eligible women has risen to 17.2% in that community. The VIA positivity rate has been 3%, with two women diagnosed with invasive cervical cancer and referred for specialist care. Other communities are in earlier stages of development of the screening program. Dr. Thida’s work is ongoing.
Our visit with Dr. Mya Thida included a morning presentation of the results of the study to date, as well as an overview of cancer care provided by the faculty at the Central Women’s Hospital in Yangon. In the afternoon, we were given a tour of the Central Women’s Hospital, including outpatient clinic areas and inpatient wards. I was very favorably impressed by the volume of high-quality work that is being provided to the women of Yangon despite an ageing facility and limited resources. Dr. Thida and her staff are deserving of high praise for their efforts.
For additional information regarding this topic, please see The ASCO Post article: “Non-communicable Diseases Are The Leading Cause of Death in Low- and Middle-Income Countries”
In conclusion, I would like to thank our hosts and colleagues in Myanmar for a very warm welcome and their enthusiastic participation during our brief visit to Yangon. The MCMC was a huge success, and I was very pleased to see the progress that is being made in cervical cancer screening as a direct result of one of the CCF’s inaugural International Innovation Grants. Through the efforts of our members and donors, ASCO and the CCF are truly “making a world of difference in cancer care.”
W. Charles Penley, MD, FASCO, is Chair of the Conquer Cancer Foundation of ASCO Board of Directors. Dr. Penley is a partner with Tennessee Oncology, PLLC, in Nashville, Tennessee, and has been treating patients in community practice for more than 25 years.