It is possible to combat cancer without the health facilities and resources available in the global North. This is demonstrated by the work of Silvia Franceschi, who heads the Infections and Cancer Epidemiology Group at the International Agency for Research on Cancer (IARC) in Lyon, a center devoted to extending the benefit of advances made by research into the fight against cancer to poorer countries. Prevention efforts can serve as a useful starting point for meeting this challenge. Indeed, “vaccines offer a simple solution to preventing a certain proportion of tumors”, explained Franceschi to our Aspen Italia interviewer, “especially in poorer countries, where about a quarter of these conditions has an infectious origin.”
You have headed up the Infections and Cancer Epidemiology Group at the IARC since 2000. What does the Center do and what are its objectives?
The Center focuses on research into the causes of cancer, but it could be said that our broader aim is to promote fair access. In fact, we were established to ensure that advances in research on controlling cancer would not just benefit wealthier nations. We have a specific remit to study tumors in developing countries, and, for this reason too, our work is primarily concerned with prevention. In places where resources are limited, preventing cancers is a much cheaper approach than trying to bring in extremely expensive treatments. In particular, it is worth remembering that 16% of all cancers worldwide are caused by viruses and bacteria, a figure that rises to 33% for Africa.
Is there an effective method for preventing cancers caused by infections?
There are several methods. Checking blood transfusions and employing single-use syringes prevents the transmission of important carcinogenic viruses (for instance, hepatitis B and C, and HIV). The use of condoms and modern antiretroviral treatments reduces the chances of acquiring HIV through sexual contact, and screening for cervical cancer prevents infection by the human papillomavirus (HPV) developing into cancer of the cervix. For younger people though, we place a lot of store in vaccines that prevent infection with carcinogenic viruses. Currently, we have two very important vaccines, those for hepatitis B and the human papillomavirus, for the prevention of the majority of tumors of the liver and cervix respectively. Vaccination is feasible even in countries with limited health services. In our work, it is necessary for prevention efforts to be simple and inexpensive, and hence, available to all, in keeping with the principle of fair access.
What is Italy’s contribution to your work?
Italy was one of the five founding country members of the IARC. For this reason too, I don’t strictly consider myself as someone working abroad. I also head a group of around fifteen people, in which Italian researchers are well-represented. However, the situation is a little different in terms of Italy’s research contribution. There have undoubtedly been some pioneers in cancer epidemiology in Italy, but because it is still a relatively new field – straddling two disciplines, namely, so-called hygiene and bio-statistics – it continues to be fairly poorly represented in the way Italian universities are organized, and substantially underfunded.
Is it possible to cultivate research into this field in Italy? And how?
Yes it is, but in order to attract talent to epidemiology, primary material – in the form of reliable health statistics and information on the lifestyle of the population – must be available. The key is making such data available to researchers or providing funding to enable them to collect the required information themselves. These days, Italy’s healthcare system is of a good standard, but unfortunately, from the point of view of accessibility of health statistics – such as on mortality, the incidence of diseases, cancer registries, and hospital discharges – there is still much to be done. Lastly, there are also problems regarding bureaucracy and confidentiality, which need to be resolved as soon as possible.
