IARC 50th Anniversary Conference

Tackling cancer in the developing world

Dr Christopher Wild - Director of IARC, Lyon, France

We wanted something to mark this 50th anniversary of the agency and because we rely on so many people around the world to conduct our research it seemed that it was fitting to bring a lot of those people together for this anniversary. So that’s the basis of the conference but then we wanted, ideally, something to go beyond the duration of these three days and so one of the features we are really pleased about is something we’ve called the IARC 50 for 50. We have managed to invite fifty emerging cancer research leaders from the developing world to come to the conference. They had a couple of days leadership training prior to this conference, they’re now mixing with all these leading researchers and we’re now looking at ways we could keep that network together beyond this week and really leave a legacy for the future in the developing world from this IARC 50th anniversary.

IARC has always been the leader in reaching out to developing countries, do you feel that this reflection back fifty years gives you a good feeling? Obviously you will see lots of stuff still to be done and that’s 50 for 50 but what do you think you’ve achieved in the last fifty?

I think one thing we’ve achieved is really the original vision of IARC which was to catalyse international cooperation in research. It’s interesting, the initial vision for IARC was of quite a large budget supporting this international agency taken away from military budgets so there’s a very interesting history there. We didn’t get the funding that was proposed but we got the model which was that this centre in Lyon should really be the centre of international cooperation, should bring people together to conduct research. In some ways having that limited budget really emphasised that as the only way to proceed.

The agency has been the hub and now you’re strengthening the spokes, fifty spokes.

In a sense what we’re trying to do is in some areas, and cancer registration is a good example where for many years there were bilateral relationships between IARC and registries in country. What we’re doing now is taking this approach of establishing six regional hubs, six regional centres of excellence, supported, coordinated by IARC but who are really taking on themselves the responsibility to develop registry capacity in their region. I think this is really another way of working by the agency.

You’ve got a lot to do in the developing countries and there’s not much money traditionally gone into cancer prevention research in the low and middle income countries and the challenges are enormous and you’ve reflected these. Where would your batting order be - viruses, carcinogens or chemicals? What do you think in the next ten years, let’s say ten years?

Yes, I think there are some big opportunities actually. If we think about what the priorities would be in cancer control, and particularly from the perspective of cancer prevention, we always have to start with tobacco control. We know there are enormous efforts by the tobacco industry to spread this habit into new markets, I think we need to resist that. Infections cause such a high proportion of cancers in the developing world, we know in Africa, sub-Saharan Africa, one in three cancers are associated with infection. So we’ve got the vaccines there against hepatitis B virus, human papilloma virus. Then also with cervical cancer, not just the vaccine for the women of tomorrow but the screening for the women of today; we have some very effective approaches to screening based on HPV DNA detection. I think that’s another intervention which will give us some quite quick returns.

Let’s concentrate on the high income world. Why is there no money going into prevention research? The Wellcome Trust is 3% of their entire budget and other agencies get up to 5% and boast about it. This is serious short-termism is it not?

I think there’s a clear imbalance between the investment that’s being made in research into new treatments and the clinical context and I think that’s understandable because, as we know from our own experience, when people come across cancer it’s often when a loved one, a friend, is touched by the disease and the first question is, ‘Is there a cure?’ So I understand why there’s that emphasis but we have to somehow bring in the benefits, illustrate the benefits that can come from prevention and promote that, show what the benefits would be, not only to health but the economic benefits. Then there’s another challenge and opportunity is to bring some of the advances that we’ve made in understanding the biology of cancer and this can give us actually fresh clues about the causes of the disease and new avenues to prevention. So really bringing that connection between the lab science, the understanding of mechanisms and getting this double benefit, both in the clinic but also in the population, is something that we should tackle.

And on your back doorstep is Europe and it would be really nice if Europe could get its act together as we have the privilege of having Lyon in our family. What do you see of the prospects of a cancer network in Europe for prevention?

We’ve got a very nice example in Europe of an initiative to try and bring the clinical centres together and we’ll see how that plays out in the coming years. We’re just starting through European funded projects to try to identify who are the key partners in Europe that could similarly coalesce around a vision for cancer prevention. What does cancer prevention comprise? For me it starts with the description of the cancer burden, what are the prevalent risk factors and what are the interventions we have available and how would we implement those? It’s a diverse set of players that need to come to the table but there’s an imperative to do it because, as we know, not even the rich countries of Europe can afford to treat their way out of the cancer problem, it simply will not work given the projections in the coming two decades. So we have to tackle this in a coordinated way and complement the advances in the cancer treatment that are certainly also needed.

The agency has got fifty years of experience of bringing multidisciplinary teams together and I’m sure everything will go brilliantly and well done. Thank you.

Thank you.