OTHER-01 INTERNATIONAL CLASSIFICATION, BRAIN TUMOURS AND CARE: ACCOUNTING FOR THE DIAGNOSTIC POTENTIAL OF SUB-SAHARAN AFRICA

Abstract

Abstract International cancer classification is fundamental to oncology. It structures diagnostic routines, research programmes, treatment pathways, and grounds for correspondence and comparison across settings. It is vital to cancer epidemiology, which influences national and global health investment and policy. However, the process of classification is not straightforward and often poorly understood. Importantly, classification is not simply a matter of discerning biological difference. It also demands ethical and political choices, which have major social consequences around the world. These choices are made largely by classification experts in elite settings in high-income countries and overseen by the WHO's International Agency for Research on Cancer. Decision-making is therefore rooted in particular frameworks and assumptions about technical capabilities for diagnosis, which might not be appropriate to the situations of practitioners (and patients) in low- and middle-income countries, who often face the challenges of severely limited resources and compromised healthcare infrastructures. These issues have been made starkly apparent in the field of neuro-oncology in recent years. A key concern is the progressive integration of new molecular genetic and epigenetic biomarkers in brain and CNS tumour diagnosis. Although such markers have been welcomed by many as a powerful way to distinguish between brain tumour subtypes, others caution that parts of the world without access to molecular pathology—including many parts of Africa—will be “left behind”. This presentation will introduce a new 5-year social science research project about brain tumour classification and care in Sub-Saharan Africa. The project aims to: 1) document the various “on-the-ground realities” of brain tumour diagnosis and care in Sub-Saharan Africa, and 2) examine how the diagnostic contexts of low- and middle-income countries are considered by brain tumour classifiers. The presentation will reflect on the role that the social sciences might play in the process of cancer classification, which is, arguably, thoroughly social.