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Jan. 10, 2012

Forming a global cancer network for research, clinical care, education and prevention.

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The Development of Mexico's First Tumor Bank

Tumor banks are critical for basic, translational and clinical research. However, creating a tumor bank is a complex project involving patients, physicians and researchers, and avenues for collection, storage, documentation and data analysis. Most major cancer centers either have, or have access to a network of tumor banks, and The Instituto Nacional de Cancerología (INCan), Mexico’s National Cancer Institute, knew developing one was important for their ability to contribute to cancer research. Leadership at INCan made a commitment to invest and support a tumor registry and on Feb. 20, 2009, the INCan Tumor Bank began operating with samples collected in surgery. In the intervening two years, the tumor bank has marked a number of successes and continues to improve and contribute to Mexico’s ability to carry out cancer research – but it has not been easy.

“The first year was difficult,” Luz Ruíz-Godoy, M.D., INCan’s tumor bank coordinator says. “There was a lack of information about how to bank tissue. But as everyone becomes better informed, the whole process gets easier.”

The tumor bank’s staff and leadership have worked steadfastly to educate and inform everyone from the upper levels of INCan leadership to the housekeeping staff on the structure and organization of the tumor bank. This education has included presentation to different departments at INCan to inform them about the tumor bank and starting rotations through the tumor bank for pathology residents. The tumor bank's biggest challenge, however, has been the education of patients who must provide informed consent for their tissues to be collected. While the bioethics committee and others strived to implement an informative and ethical consent strategy, the tumor bank’s management has refined and improved the process. In October 2011 the bioethics committee approved an updated consent letter and began providing the letter to all first time patients as well as capturing the letter in the patient’s record.

The effort has paid off and by the end of 2011 the tumor bank had collected more than 4,000 samples. As with many tumor banks, INCan is concentrating on collecting samples from Mexico’s most prevalent cancer types, including, breast, cervical, ovarian, lung, colorectal, renal, prostate and head and neck. By December of 2009, the tumor bank had begun taking biopsies in addition to surgery samples. The tumor banks was able to start delivering samples to protocols approved by the scientific, tumor bank and bioethics committees in early 2011 and by November were collecting bloods samples and cryo-preserving the plasma. One of the final sampling and collection achievements of 2011 was when, in December, the bank began collecting lung biopsies and standardized their procedure for making cell blocks from pleural effusions.

With their successes in sample collection as a foundation, the tumor bank was able to create a database of the four most common malignancies: breast cancer, colon adenocarcinoma, renal cell carcinoma and ovarian adenocarcinoma. The database is housed electronically on INCaNet, and provides information with regard to age, gender, topography, histopathologic diagnosis, clinical stage, treatment and monitoring. INCaNet continuously updates the patient’s clinical information and allows researchers and physicians to see the scanned and signed letter of informed consent. The tumor bank is not keeping its achievements to itself, however, and recognizes that creating a network of tissue banks will allow Mexico’s cancer research to further increase its contributions.

Steps to enable a network within Mexico and regionally requires sharing information. Specialists in various fields from the Instituto Nacional de Medicina Genómica (INMEGEN), Mexico’s National Institute of Health, visited INCan’s tumor bank recently. Their aim was to learn the legal and structural requirements of creating a tissue bank in order to assist them in starting a biobank at INMEGEN. In June 2012, INCan will host course on biobanking with an open call to any institution throughout Mexico that is interested in starting a tumor or biobank.  INCan’s tumor bank has also been a leader regionally, helping to found The Tumor Bank Network of Latin America and the Caribbean also known as Red de Bancos de Tumores de la Alianza Latinoamericana y del Caribe (ReBTALyC). INCan represented the founding 11 member countries of ReBTALyC at the Second National Congress of the Biobanking Network in Tarragona, Spain and will soon publish an article on the history and future plans of the group.

None of this happens in isolation. The tumor bank required the support of the leadership of INCan as well as a dedicated and capable team headed by Alejandro Mohar Betancourt, M.D., Ph.D. general director. In addition to Ruíz-Godoy, the tumor bank coordinator, the team in includes: Abelardo Meneses García, M.D., Ph.D., adjunct director general; Hector Maldonado, M.D., Ph.D., coordinator of pathology; Maria de Lourdes Suarez, M.D., pathologist; Virginia Enriquez Carcamo, chemist; Evelyn Estrada, social worker; David Aguilar, nurse; and Silvia García, secretary. Betancourt, Meneses, Ruiz-Godoy, Maldonado and Suarez began keeping samples in the INCan pathology department more than ten years ago. Now, this small group continues to advance the importance of tissue collection for the benefit of cancer research in Mexico and beyond. 

"The INCan tumor bank is important to develop research protocols and provide a platform for translational and personalized medicine," says Ruiz-Godoy. "Our objective is to expand into bio-banking other types of samples and enhance cancer research in Mexico."

Calendar of Events

Global Oncology Lecture - Phil Castle, Ph.D.
MD Anderson
Mays Clinic - ACB 1.2325
Jan. 19, 2012

Excellence in Oncology
Istanbul, Turkey
Feb. 23-25, 2012

GAP Annual Conference
Oslo, Norway
May 14-16, 2012


Second Sister Institution Added to Study

Physicians from The University of Texas MD Anderson Cancer Center have been working collaboratively with the Instituto de Cancerología (IDC) Las Américas in Medellin, Colombia on a study entitled Conservative Surgery for Women with Low-Risk, Early-Stage, Cervical Cancer. The study is led by Kathleen Schmeler, M.D., assistant professor in the Department of Gynecologic Oncology & Reproductive Medicine but managed by local principal investigators. At IDC Rene Pareja, M.D. directs the effort. Now, the Instituto Nacional de Cancerología (INCan) in Mexico City, Mexico will also contribute to the study under the leadership of David Cantú de Leon, M.D. in the Department of Gynecologic Oncology. Several sites in South America are in the process of submitting paperwork to enable additional institutions to join the study including fellow Sister Institutions Clínica Alemana in Santiago, Chile and The National Institute of Neoplastic Diseases (INEN) in Lima, Peru.

Network News

January is Cervical Cancer Awareness Month

Cervical cancer, and indeed all HPV related cancers, are preventable with the advent of the HPV vaccine. For those who did not have the benefit of vaccination, cervical cancer and HPV can be screened for by a variety of methods. Appropriate screening can catch precancerous and early stage cancers, allowing health care providers to treat early cervical cancer, and would be cervical cancer, relatively easily. The fact that cervical cancer is one of the few cancers for which health care providers have the tools to prevent and successfully treat, makes it even more profound that cervical cancer is the leading cause of cancer deaths in women in many low–income and developing countries.

In the U.S., the American Cancer Society recommends women begin cervical cancer screening with the Pap test about three years after they begin having intercourse but no later than 21 years old. Pap tests should be repeated every two years and beginning at age 30, those with three normal Pap tests may screen every 2-3 years with Pap tests or with HPV tests. In contrast to the United States, countries like Mexico have implemented at home collection of samples for HPV testing in order to reach underserved populations. In 2008 the Mexican government also started a school-based HPV vaccination program and in two years provided all three vaccines in the series to more than 130,000 girls between the ages of 9-12. In the United States, where there are multiple avenues of access for girl’s to receive the vaccine, only about half of girls 13-17 have had one dose and far fewer complete the series.

Next week, Phil Castle, Ph.D., executive director of The American Society for Clinical Pathologists Institute, will be here at MD Anderson to talk specifically about eliminating cervical cancer as a problem in the developing world and what it will take to reach that goal. Then, at the end of the month, on January 31st, Houston will host the 2012 Cervical Cancer Summit, the focus of which is underserved populations here in the United States. Keep reading GAP Connect for more on these events and the ongoing discussions surrounding HPV prevention and screening and cervical cancer treatment.