“It’s not only about getting the treatment right; we also need personalised cancer care”

In our second virtual interview we sat down with Kamila Czene, Professor in Cancer Epidemiology at the Department of Medical Epidemiology and Biostatistics, to discuss her unusual and successful path within academia, her determination to become a researcher from a young age, as well as examples of being an active and engaged member of our institute.

Prof Kamila Czene

I always wanted to be a researcher”. A strong opinion statement from Kamila Czene as we start our conversation together. In fact, as a young girl living in the Czech Republic this was her life dream- not knowing however in what yet. Fast forward to right after the completion of her undergraduate studies in nuclear engineering (1992) in Prague, difficulties finding a sustainable funding stream within nuclear physics led to a move into medicine. As she explains, “I figured-out that research in medicine will always be needed”, which led to a PhD from KI on mechanisms of chemical carcinogenesis that cemented her path in cancer research. At the same time, as an early-career researcher another realisation came to mind; “I wanted to have better control over my working hours- for example picking-up samples from a freeze-dryer on a Saturday night was no longer appealing to me”. Many researchers reading this statement will of course smile in solidarity. Hence, with her passion for cancer research and newfound interest in large data analysis she embarked on a postdoc in cancer epidemiology. “In the early years of my postdoc I worked with family studies on cancer utilising large nation-wide data. This assisted my transition into breast cancer epidemiology; the field that I have been active in the past 15 years! In the present day I lead a research group focusing on the causes and consequences of breast cancer. One of the key factors to our success in this field has been as a result of combining clinical, genetic, molecular data and questionnaires with nation-wide registries as well as data from biobanks. We collaborate with several strong research groups in addition to leveraging our strong clinical networks- always with an underlying motivation to see our work in clinical praxis”.

What is your WHY? 

  1. “I always wanted to be a researcher, and a well appreciated researcher.”
  2.  “I like it when things make sense and are logical.”
  3. “I always try to do a good job no matter the importance of the task at hand.”

We laugh together when she describes her frustration when certain mechanisms that her group are investigating do not go exactly the way they hypothesized. This is however science, and cancer research is no exemption! Another valuable point from our discussion explains the process of getting into a position of trust, “remember that every task matters even those that might seem mundane. Putting effort in the work you are expected to deliver, even if you are not an expert, should be a priority”.

The focus of the group

The long-term goal of Kamila’s research group is to reduce the mortality of breast cancer in two fundamental ways. First by improving the early detection of the disease, followed by identifying the sub-group of women at increased risk of dying due to breast cancer. The research group investigates understudied areas, such as host factors of women - germline genetic variants and mammographic features.

Kamila goes into detail about two projects, out of numerous currently underway in her group, that she wanted to emphasise: “One example of our current projects is endocrine therapy in breast cancer patients. Tamoxifen is used for adjuvant therapy in patients diagnosed with hormone-receptor-positive breast cancer. Tamoxifen is a prodrug that must be metabolized to an active metabolite, endoxifen, to gain a therapeutic effect. The key gene for the conversion of tamoxifen to endoxifen is CYP2D6. We have recently shown that CYP2D6 genotype predicts side effects and tamoxifen discontinuation, hence the prognosis of breast cancer patients. We argue that CYP2D6 genotype should be taken into consideration in an effort to personalize endocrine breast cancer therapy(1). As Kamila explains,

“It is not only about getting the treatment right; we also need personalised cancer care. When it comes to the hormonal treatment strategy in breast cancer patients which is given for at least 5 years- we also need to care about the women’s side-effects and overall health. We need to check if she is able to adhere to the strict regimen, since up to 50 % of women (Link no. 2) currently discontinue the hormonal treatment within 5 years. My future goal would put emphasis on personalised medicine as well as personalised care and heath of cancer patients.”

Prof Kamila Czene

Another example from her group is the study of interval breast cancers - cancers diagnosed between two mammographic screening rounds. These cancers (about 30% of cases among mammographic screening attendees) are a combination of cancers missed at mammography, as well as fast-growing cancers arising between two screening rounds. The latter have worse prognosis than screen-detected cancers(3). Thus, what causes some cancers to become interval cancers rather than screen-detected? Kamila responds, “our previous findings point towards the importance of inherited and somatic genetic factors,(4,5) potentially associated with a faster growth rate or a dysregulation of the innate immune system. These studies support our hypothesis that interval breast cancers have a unique underlying biology- we are therefore further investigating molecular mechanisms leading to these cancers.” Kamila re-emphasizes that the objective is to minimize the number of interval cancers within the mammographic screening programme, resulting in reduced breast cancer mortality. Since screening resources are scarce, she recommends that future implementation should focus on accurately identifying healthy women at risk of interval cancer, as well as evaluate technologies for improved detection.

What cancer-related efforts are important to you right now?

As of today, one in three individuals is diagnosed with cancer during her/his lifetime. By 2030, it is estimated that the cancer frequency will increase to one in two. Therefore, I really appreciate the current efforts to increase the focus on prevention of cancer, both in a national and international setting. I believe that improved secondary prevention strategies, with high participation, aiming to decrease cancer mortality are of a high priority. With secondary prevention I mean improved cancer screening which may come through identification of high-risk sub-groups within the population. We should therefore try to improve the screening by individualising it. In addition, stronger efforts are needed in research on primary prevention. While we have several strong research groups at KI working successfully with cancer screening, primary prevention of cancer is overall not yet our strength.

Another issue that I am excited about, is our effort to increase collaborations between basic and clinical scientists to address important problems in the area of translational cancer research. Within the Cancer Research KI organisation, we very recently had a call for projects representing a genuine collaboration between basic and clinical researchers. We are further planning to have more translational research efforts including meetings and workshops to facilitate collaboration between researchers from different cancer fields. Hopefully we can start having these meetings and workshops after the COVID-19 times.”

The many ‘hats’ worn by Kamila

“My work as a research committee member for the Swedish Cancer Society, as well as additional experience from being an evaluator in national and international committees; for example the Swedish Research Council, Research Council of Norway, the European Commission, Research & Care Charity organization in the UK definitely helped me to become a better researcher and write better applications.” Based on her experience, research proposals of excellent quality are easily recognised, and evaluators reach a consensus easily. However, the fate of all the other good proposals competing against each other in an already highly competitive field such as cancer- is clarity. She has spent many years within her department (MEB) helping younger researchers by reading their proposals and providing advice. Kamila emphasises that it is important to learn to write with clarity, but by reading other people’s work you are also able to observe the things that you must not do yourself when writing a research proposal. A pro-tip from her would be, “do not be afraid to ask for help, ask someone who is not working close to you, but a little bit outside your field- they will understand if they understand-right?”

Kamila is also the co-director of Cancer Research KI, and describes her experience as follows; “since I am generally very interested in internal collaboration within KI, to work as a co-director of Cancer Research KI was an extremely suitable assignment for me. I can communicate with many interesting researchers that I would normally not encounter since their research does not cross paths with my own. As I already mentioned, during my career, I have acquired a broad competence base in various fields of cancer research from experimental research, epidemiology and biostatistics to clinically oriented research. These experiences helped form a personal interest of mine which is to facilitate effective communication between researchers from different disciplines.

What will we only know about you after we’ve worked together for a year? 

Kamila emphasises four things that a colleague, or a student will realise over time; 1) she has an exceptional memory when it comes to science-oriented information, however do not ask her to recall the name of that person you went for fika with yesterday at 10 am, 2) she is a unenthusiastic traveller (“perhaps the pandemic could help find new ways for us to stay connected- let’s see!”), 3) she loves discussions, and 4) she is not the optimistic one in a room as she is able to predict challenges with different projects and proposals. The last point she describes is more of a personality trait, but at the same time has been cultivated over many years of being a leader, manager, evaluator, mentor, recruiter and decision-maker. When you have worn as many ‘hats’ as Kamila has in her career and have taken the time to really understand the academic system from within, then this seems only natural. She did make a point to say that, “this does not mean that I am the NO person in the room, simply that I prefer to stay level-headed”.

Faculty Board of KI (Fakultetsnämden): the experience so far

Everything that Kamila engages with, whether at the Swedish Cancer Society or as a mentor for a junior researcher she does so because she is truly fascinated by it- with the primary aim to do a good job and be involved in all aspects of her environment. What she details in her interview reflect an active member of our community in KI:

“I also work in the Faculty Board of KI as strategic issues always interested me. The work I get to be involved in on the board of KI is very exciting. In fact, discussions amongst board members are very dynamic and never boring. In my previous leadership assignments as director of doctoral studies, vice-prefect and prefect at my department, I was mainly interested in research and doctoral education related issues. Within my current assignment as a Faculty representative on the board of KI I am learning more about undergraduate education, and collaboration with healthcare. It is really of great importance to obtain a comprehensive view of all parts of the university- and this for me is really fascinating!”

Prof Kamila Czene

Reflections: what would you advise your younger self about research?

In anticipation to this question Kamila worked hard to provide what she thought would be good answers that would benefit early-career researchers. This, in many ways, speaks to her love and interest towards her community once again. Her top three:

  1. “You do not need to know exactly what you will become in the future, don’t be afraid to change direction. There will always be opportunities to change direction.”
  2. “If you are not the person who is good in career planning (I was such a person), then focus on what you like now and do a good job!”
  3. “Listen and learn from those whose opinion you value- it is not good to discover all the mistakes by doing them yourself.”

What else?

The New England Journal of Medicine.This is the journal that I would love to publish our research in- I have tried a few times already and came close. One day it will happen, hopefully soon!”

 

Swedish. “When dealing with high-level leadership issues at KI, this is most often conducted in Swedish. For this reason, I need to improve my language skills. For example, at the Faculty Board of KI they are very nice and allow me to express myself in English- however I would like to make a bigger effort here.”

 

Driving License. “I uncovered an email from ten years ago from a dear colleague of mine saying that she purchased a pair of gloves for me as a gift that can be used once I managed to finally pass my driving license course. These gloves are made of a really nice leather and are very soft- unfortunately I have not been able to wear them as I have yet to officially pass the test! When we lack talent for something (i.e., driving) one has to work even harder, and potentially even longer to achieve it!