Cancer Genomics: What We Can Learn from Africa

Cancer is a growing burden in Africa. By 2040, it is estimated that cancer incidence will more than double in Sub-Saharan Africa, and that more than twice as many cancer deaths will occur in low- and middle-income countries compared to upper-income countries. While the majority of cancer cases in the US and Europe are diagnosed at an early (treatable) stage, the majority of African cancer cases are and will likely continue to be diagnosed at late (often untreatable) stages. Therefore, cancer represents a significant and under-appreciated public health problem in Africa. We have developed the Men of African Descent and Carcinoma of the Prostate (MADCaP, www.madcapnetwork.org) to address this emerging public health issue. MADCaP is undertaking research to 1) evaluate African ancestral relationships among African populations, 2) understand the relationship of ancestry with cancer etiology, and 3) understand the role of genetic and non-genetic factors in cancer etiology and aggressiveness. We have established the laboratory, clinical, and epidemiological infrastructure to undertake these studies. We have demonstrated that ancestry and candidate genes are associated with genetic susceptibility to cancer. Therefore, optimal prediction of cancer risk and outcomes may require race-specific marker panels including polygenic risk scores. By expanding the research infrastructure and capabilities of these consortia, we will address an important and increasing cancer problem in Africa, and we will build capacity for research in an underserved continent. In addition, the increase in knowledge about genomic diversity will inform cancer risk, prevention, and treatment for all populations.