Dr Christopher Paul Wild, Director, International Agency for Research on Cancer
IARC Director Dr Christopher Paul Wild outlines the advantages of conducting cancer research with an international perspective; an approach adopted by the institution since its inception in 1965
Could you explain why the IARC was started?
IARC was the brainwave of a small group of French scientists who had the support of General Charles de Gaulle in proposing to the World Health Organization (WHO) that the richest nations of the world should join together and create an international effort to fight cancer. This collective initiative came to fruition following a resolution of the World Health Assembly in 1965 when five countries (France, Germany, Italy, UK and the U.S.), joined later that year by a sixth (Australia), became the first Participating States in IARC. Currently the Agency has 21 countries supporting it, the most recent new member being Austria.
What are IARC’s main goals, and how are you implementing them?
First and foremost, the Agency has a mission to conduct cancer research with an international perspective, particularly focusing on the low and medium-resource regions of the world where local cancer research capacity is limited. Research is primarily applied to studies of the causes and prevention of cancer.
A majority of our research is the result of excellent cooperation with scientists in countries across the world and is implemented through interdisciplinary studies involving laboratory scientists, epidemiologists, biostatisticians and others.
In addition to its primary research goals, the Agency also provides authoritative data to the wider cancer community and policy makers through, for example, the estimation of global burden of cancer and the evaluation of whether particular agents are human carcinogens (IARC Monographs), as well as numerous databases and publications relating to cancer research and control.
What are the current challenges facing IARC and how do you plan to combat them?
The major challenge is the one facing the world in general – namely the projected increase in cancer burden over the next two decades from an estimated 12.7 million new cases per year in 2008, to 20.3 million in 2030. This is primarily due to population increase and the ageing global population. Moreover, the growing recognition by developing countries that the major cancer burden will fall on them means that the Agency is increasingly being requested to collaborate with and support cancer research and control in these regions. This is happening at a time when the global financial crisis means the IARC Participating States find it difficult to provide increased funding. This mismatch between demand and resources must be met by attracting new States to the IARC cause, by international cooperation with other organisations sharing our goals, and by successful competition for new funding sources. We cannot afford to be passive in the face of the impending disaster of cancer in the poorest parts of our world.
By what means is IARC developing scientific strategies for cancer prevention and control?
The Agency seeks to provide, through its research, the evidence-base for public health interventions to reduce the burden of cancer. This information on causes and strategies for prevention can be used by international organisations, including the WHO, and national bodies to develop cancer control policies.
As mentioned above, IARC also provides high quality information on, for example, the scale of the cancer problem, expert evaluations of the causes of cancer etc. in order to further assist in cancer control. However, we should remain aware that for a majority of cancers we still do not know the cause. Thus while we implement the knowledge we have on prevention we must continue to study the causes of the disease.
To what extent does IARC conduct research itself?
The principal role of IARC is research. The authority which IARC has in the broader areas of cancer control stems from the quality and integrity of its research programmes. In fact, the Agency publishes its findings in the premier scientific journals, passing the most vigorous of peer-review processes. Agency scientists also apply competitively for funding from international and national agencies. These indicators of high standing are a part of what ensures the information coming from IARC is trusted and respected.
What role does dissemination play in the work of IARC?
Dissemination is a vital part of the IARC role. First, however, it is important to consider the people and organisations one is trying to reach with information. In our case it is primarily professionals in the cancer research community, policy and decision makers, cancer organisations and the media, rather than directly to the public.
As a publicly-funded international organisation we have a responsibility to communicate our findings in an accessible form. Increasingly, this is web-based, with free access wherever feasible. Through maintaining a reputation for high quality information we aim to be a provider of trusted content and opinion on cancer – an organisation of integrity.
How are you promoting international collaboration in cancer research as well as an interdisciplinary approach?
We have an enormous network of collaborators in countries throughout the world. It is a source of great credit to our staff and our history when one experiences the high esteem – but also I would say affection – expressed worldwide towards IARC.
Many of these contacts come through people who have held IARC Training Fellowships or have attended IARC Courses, or worked on joint projects with us. As a trusted ‘neutral’ international agency, IARC is frequently able to bring together and coordinate international teams of scientists from many countries who might find it more difficult to follow leadership from a single country. This role of international collaboration is therefore a guiding principle in developing our overall strategy.
What work does the Agency perform in conducting research in low and middle-income countries?
The Agency works with scientists in low and medium-resource countries in the design, implementation and analysis of research projects. Where possible there is an element of knowledge transfer and training that occurs as a natural part of this process. For example, conducting a screening trial in India involves training many collaborators who subsequently would be capable of training others and implementing the screening on a wider scale if proven successful.
In terms of the type of projects, these include the study of causes of cancer, particularly where there are specific and unusual risk factors. In addition we evaluate interventions through, for example, trials of vaccines against hepatitis B virus and human papilloma viruses and screening for breast, oral, colorectal and cervical cancers using approaches that are applicable in the resource-limited regions of the world.
Could you explain why emphasis is placed on elucidating the role of environmental and lifestyle risk factors?
From studies of rapid changes in the incidence of cancer over time; studies showing that migrants ‘adopt’ the cancer patterns of their new country of residence; and a wealth of experimental data, we know that the vast majority of cancers are related to environmental or lifestyle exposures. Therefore it is logical that in order to prevent cancer we first need to identify the specific causes. Given that for a majority of cancers we still do not know the causes and that, in any event, these will vary in different parts of the world, there is a vital need to devote efforts in this direction.
Furthermore, causes and prevention are the orphans of cancer research, with markedly fewer resources devoted to them than to basic and clinical science. The Agency can, in a modest way, try to redress some of that imbalance.
What is the Biobank and what benefits will this facility bring?
The IARC Biobank is a storage facility containing several million biological specimens gathered in epidemiological studies from around the world. The potential benefits of these materials, linked so well to information on exposures and clinical endpoints, are enormous. This is because advances in laboratory technology and understanding of mechanisms of cancer development are providing unprecedented advances in the development of biomarkers applicable to these specimens. This will lead to more refined measures of exposure, opportunities to demonstrate the plausibility of associations between exposure and disease, as well as clues as to how to intervene in those disease pathways to reduce the cancer risk.
I have never been more convinced of the potential offered by laboratory science to epidemiology and public health. It is here that we need a ‘two-way’ translational cancer research, from basic science to both the clinic and the population.
Is IARC having an impact on policies for cancer control, and if so how are you achieving this?
The activities of the Agency provide a vital foundation for cancer control. Examples of the type of data most directly relevant in the short term to cancer control are varied – including the estimates on global cancer burden, evaluation of the carcinogenicity of different agents (eg. IARC Monographs), data on the prevalence of risk factors worldwide (eg. human papilloma viruses), the classification of tumours (WHO ‘Blue Books’), results from intervention trials (eg. cervical cancer screening approaches) etc.
Education and training of cancer researchers worldwide is a core part of the Agency. How does IARC determine who is given priority and what has this activity facilitated?
The Agency focuses its education and training on its core competencies and these include cancer epidemiology, molecular epidemiology, cancer screening and cancer registration. We also place emphasis on interdisciplinary training in order to equip a new generation of ‘multilingual’ cancer researchers. The training is provided predominantly to scientists from low and medium-resource countries and indeed many of our courses are conducted in those regions in response to calls for assistance. However, I strongly believe that with an increasing recognition of the need to consider health on a global scale, we should use our training to inspire young scientists from the richer nations to dedicate their careers to the service of cancer control internationally. Personally I started out with an IARC Training fellowship 25 years ago and this was instrumental in my whole career direction. I am far from unique: of the 500 fellows that have been funded by IARC, some 80 per cent are still involved in cancer research.
Are there any specific targets that IARC has for the future, and what changes might this bring?
In the short term, the Agency is working with WHO and other international cancer organisations in order to prepare for the high-level UN Summit on Non-Communicable Diseases (NCD) to be held in New York in September 2011. This is a unique opportunity to raise the profile of cancer and other NCDs on the international development agenda. The global cancer burden projections from IARC will provide vital context to these discussions.
More generally the Agency needs to maintain its excellence in research whilst adapting to a changing world where national organisations have an increasing awareness of – and desire to address – cancer on an international scale. Here the Agency must show leadership, based on its excellent reputation and wealth of experience in the low and medium-resource countries, and work increasingly with partner organisations to achieve common goals.