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Member Research & Reports

UNC Faculty Member’s NEJM Perspective Calls for “Cancer Moonshot” to Include Low-Resource Countries

The “Cancer Moonshot” initiative has energized the cancer research community in The United States, but not sharing the results of the findings with the rest of the world will be a missed opportunity.

cancer moonshot malawi_karl mueller
[Photo: Women and children wait at the Matanda Service near Lilongwe, Malawi. UNC’s Dr. Satish Gopal hopes the President’s Cancer Moonshot initiative will benefit all people around the world. (Photo by Mr. Karl Mueller.)]

Those are the sentiments of Dr. Satish Gopal, adjunct assistant professor of epidemiology at the UNC Gillings School of Global Public Health. Dr. Gopal, who is also a clinical assistant professor of oncology at UNC’s School of Medicine and a clinician and scientist at the UNC Lineberger Comprehensive Cancer Center, expressed his views in a recent “Perspective” article in the New England Journal of Medicine titled “Moonshot to Malawi.” In the article, Gopal calls for a commitment to contribute resources and energy to control cancer in less-resourced countries where there are significant gaps in cancer awareness, prevention, diagnosis and treatment.

“With the ‘Cancer Moonshot,’ there’s a huge amount of enthusiasm and serious commitment to take the fight against cancer even further,” said Dr. Gopal. “What I see is very little of the energy, funding, enthusiasm and outrage getting channeled to parts of the world where there’s a huge amount of unaddressed need. The science community needs to help address this issue.”

Dr. Gopal is the only board-certified medical oncologist practicing in Malawi, a southern African country of about 17 million people. He also is the cancer program director for UNC Project-Malawi, a research and care collaboration between UNC-Chapel Hill and the Malawi Ministry of Health.

Few, if any, of the significant advances made in cancer care during the past several decades have reached Malawi, said Dr. Gopal, who has lived and worked in the country with his family since 2012. Even basic services are sometimes lacking. There are no radiation oncology services anywhere in Malawi, and generic chemotherapy medicines that were licensed 40 to 50 years ago are sometimes not available.

Further illustrating disparities in care and prevention, the vaccine against human papillomavirus, a virus linked to cervical, oropharyngeal and other cancers, is not available to girls and women in Malawi, despite overwhelming disease burden. Surveys also have shown extremely low awareness about breast cancer among women in Malawi, which contributes to late diagnosis and reduced opportunities for cure and highlights an urgent need for greater awareness.

“The pace of cancer advances has been quite rapid over the past decade,” Dr. Gopal said. “We treat and diagnose many cancers totally differently from when I entered my oncology fellowship six years ago. Now with the ‘Moonshot,’ we have a remarkable opportunity to accelerate that even further. This is going to change cancer domestically. What I’m trying to highlight is that we also could have the opportunity to change cancer worldwide, and that is not being done.”

Dr. Gopal said that while organizations, including the National Cancer Institute, are making greater investments in global cancer programs, the response should extend beyond research grants and papers. At UNC Project-Malawi, he said, researchers and physicians are working on groundbreaking science and are using proven strategies to more effectively treat, prevent and diagnose cancer in a low-resource country. Broadly, he believes the cancer initiative needs to mirror the global response to human immunodeficiency virus (HIV), which included tremendous social activism and political will even outside the research community.

“What happened in the HIV world is that the research community in some ways led the way and was a catalyst,” said Dr. Gopal. “But they also were able to catalyze a movement that was bigger than universities and science, and that’s what ultimately was required to completely change the face of that disease worldwide.”

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