Tackling the Global Cancer Burden: A Conversation with NCI’s Dr. Ted Trimble
, by NCI Staff
NCI’s Center for Global Health (CGH) was established in 2011 to foster research and collaboration aimed at better addressing the global burden of cancer, particularly in countries where the incidence of and deaths from cancer have been rising. In honor of World Cancer Day, CGH Director Ted Trimble, M.D., M.P.H., discusses CGH’s efforts to pursue key opportunities in global cancer research.
How is the global cancer burden different from that in the United States?
The global burden of cancer varies from country to country. In some countries, the population pyramid is different; for example, in countries with younger populations, pediatric cancer is relatively common because there are proportionately more children and adolescents in those countries compared to the population in the United States.
Risk factors for cancer also vary among countries. In India, many people chew tobacco, sometimes in combination with areca nut, which increases the risk of oral cancer, one of the most common cancers in that country. And Mongolia has the highest rates of hepatitis B and C infections in the world and, subsequently, has the highest rates of liver cancer and liver failure.
Some countries have high rates of certain cancers for reasons that we don’t understand. For example, rates of esophageal cancer are very high along the east coast of Africa, from South Africa up to Somalia. In Chile, there are high rates of gallbladder cancer. In both of these cases, we aren’t sure why this is, so it’s important to expand our research efforts so we can better understand and explain what’s going on.
What do you see as the biggest challenges in global cancer prevention and control?
We know that prevention is exceptionally important. Vaccination against hepatitis and human papillomavirus (HPV) is critical, and tobacco control is also vital. We must continue to raise awareness surrounding the importance of cancer prevention and control.
We are working closely with other NIH institutes and the Centers for Disease Control and Prevention to improve air quality and help prevent heart disease, chronic lung disease, and cancer. Through investments in dissemination and implementation, we are able to identify research that will address both indoor and outdoor air pollution, bringing improvements to indoor cook stoves and heating options.
In some poor neighborhoods in Mongolia, for example, people burn tires to heat their tents and cook their food. Obviously, burning tires creates a lot of toxic chemicals, but that’s all they have. So it’s really a question of identifying alternative, healthier ways to heat their houses and cook their food.
What is NCI’s role in addressing some of these burdens?
NCI conducts and funds cancer research. We also work to make sure that the important findings from our research get implemented in public health and routine clinical practice.
CGH often works in partnership with other NCI divisions, offices, and centers because many of them are involved in research affecting global health and cancer. We also work very closely with NCI-Designated Cancer Centers to strengthen their global health efforts and ensure that they are working as effectively as possible with each other. So our job is to coordinate with the extramural research community, as well.
The International Cancer Control Partnership—which involves NCI, the Union for International Cancer Control, the World Health Organization, the American Cancer Society, the International Atomic Energy Agency, and a number of other agencies—is heavily involved in helping countries develop national cancer control plans, as well as providing technical assistance for the implementation of those plans.
Can you provide an example of where NCI has contributed directly to global cancer control?
One of our biggest contributions has been in cervical cancer prevention. NCI has been a leader in efforts to understand the causes of cervical cancer. While the burden of cervical cancer in the U.S. has been greatly reduced thanks in large part to Pap screening, in many less-developed countries cervical cancer is a leading cause of death.
NCI’s Doug Lowy, M.D., John Schiller, Ph.D., and researchers in NCI’s Division of Cancer Epidemiology and Genetics (DCEG) have been instrumental in this area, as well. Due to research done around the world, much of it conducted in the U.S. and sponsored by NCI, we now know that cervical cancer and several other cancers are caused by specific HPV types. Drs. Lowy and Schiller’s work was critical in the development of a vaccine to prevent infection with this virus.
The cost of the HPV vaccine, however, remains a barrier to access; a single dose usually costs several hundred dollars, and the current recommendation is for three doses delivered over 6 months. But NCI’s partners, such as the Bill and Melinda Gates Foundation, have arranged to make the vaccine available for as little as $4 per dose to people in the lowest-income countries.
In addition, research being done by DCEG and others has suggested that two doses, or even a single dose, may be sufficient to provide protection against HPV infection. This could greatly expand the number of people who can receive the vaccine and potentially save many lives as a result. NCI’s DCEG and Division of Cancer Prevention have also worked to develop HPV diagnostics, which can complement and, in some cases, replace traditional Pap smears.
With World Cancer Day on the forefront of our minds today, it’s important to think about the unique challenges and opportunities that arise when addressing cancer research, control, prevention, diagnosis, and treatment in low- and middle-income countries. It is through coordinated, collaborative work that we will successfully tackle cancer on a global level.