Preventing cancer in all corners of the world

Text: Cecilia Odlind, first published in Swedish in Medicinsk Vetenskap, No 3/2018.

Elisabete Weiderpass is ready and alert when we meet. She has already finished parts of the interview in writing by answering the questions I sent out in advance. And the interview continues at a rapid pace. Soon I am able too look at the world from her zoomed out perspective. She is not only a professor of epidemiology at Karolinska Institutet, but also at the Arctic University of Norway in Tromsö.

In addition, she is also an adjunct professor at universities in Brazil, China and Iran and the head of the department of research at the Norwegian Cancer Registry. She is also a visiting professor in Kuwait. Due to her collaborations with research teams in different parts of the world she travels a great deal.

“We are all immigrants if you go back far enough in time. I feel at home in many different places,” she says.

In her research Elisabete Weiderpass focuses on identifying risk factors for cancer, with a particular focus on prevention and influence.

“For example, the incidence of stomach cancer and oral cancer. It varies a lot between different regions of the world. This is linked to the different ways of living and living environments in different countries,” she explains.

A unique overview

Her international cooperative research efforts have not only given her a unique overview of how different forms of cancer affect different countries, but also of how the conditions for providing health care and preventive measures varies globally. In developing countries, efforts have mainly focused on infectious diseases such as HIV and tuberculosis. But as the world’s population lives longer and longer, the incidence of different forms of cancer increases.

“It is an oncoming tsunami. Did you know that many sub-Saharan African countries lack the necessary infrastructure for diagnosing and treating even the most common forms of cancer? No screening, limited access to testing and medication, and lack of radiation therapy. There is a lot that has to be done in the years ahead to improve the situation,” says Elisabete Weiderpass.

The vast network of contacts that Elisabete Weiderpass had built up was also crucial for her landing her latest job: Director of the IARC, the Cancer Research Institute of the World Health Organization. Her new position at IARC will allow her to do more advocacy work to lower the risk of cancer and improve cancer treatment.

“Mapping cancer incidence and identifying risk factors is carried out at global level. But the efforts have to be adapted to local conditions. And they differ enormously from country to country,” says Elisabete Weiderpass.

She emphasises all the lost time, strength, quality of life and money that cancer leaves in its path.

“The suffering. I want to make sure that people never develop cancer.”

Prevented fairly easily

It might sound like an over-ambitious goal. But the fact is that as many as 20-50 per cent of all cases of cancer in the world could be prevented fairly easily, according to Elisabete Weiderpass’ research.

“Most people probably know that smoking causes about 20 per cent of all cancer. But it is less well known that the risk of breast cancer is linked to the intake of alcohol. Obesity, alcohol, physical inactivity and infections combined are responsible for a large share of all cancers,” she says. “It is important to spread this knowledge in order to allow people to take personal responsibility. Yet, a lot could also be improved through joint political decisions. Significant changes could be made by, for example, limiting intake of alcohol by imposing sales restrictions or by introducing 60 minutes of physical activity per day in schools so that all children can make exercise a habit,” she explains.

Another important preventive measure is screening of cell changes and vaccination against human papillomavirus infection (HPV) as protection against cervical cancer.

“The vaccination method has not been used for a sufficiently long period of time to scientifically prove its effects on cancer incidence, but we have been able to see that the vaccination decreases the presence of infections and thus we are anticipating fewer cases of cancer,” says Elisabete Weiderpass.

Another area where there is potential to reduce the risk of cancer is among those who receive hormone replacement therapy during menopause.

“In the 1990s, several research teams showed that these pharmaceuticals increased the risk of several forms of cancer, and today this information is widely spread. In Sweden, these pharmaceuticals are by and large prescribed in a serious manner, and they are not administered unnecessarily or for longer periods of time. But in many other countries the overuse is extensive,” she says. Another important issue at the international level is air and water pollution, which causes lung cancer, for example.

“The environment has no borders. There is a need for cooperation between countries,” says Elisabete Weiderpass.

A working class family

Elisabete Weiderpass was born in a working class family in São Paulo, Brazil. Thanks to a scholarship she was able to graduate with a degree in medicine.

“It was far from obvious that I would go on to higher education. Life is to some extent a series of coincidences and I had luck on my side,” she says.

To have a career as a scientist was also unimaginable for a woman in Brazil 25-30 years ago.

“Back then it was almost exclusively men who managed to do research full-time. Today, the situation has improved, but women still only make up a small minority of the academic sector,” says Elisabete Weiderpass who is now involved in a collaborative research effort with the University of São Paulo in Brazil, a country she visits once or twice a year. Instead, it was Karolinska Institutet that offered her the possibility of doctoral studies.

“This is where I was brought up to be an academic. For me, this was paradise. To feel that neither my background, my nationality nor me being a woman were obstacles for being able to do research or be challenged intellectually. I was welcomed with completely open arms”, says Elisabete Weiderpass.

Being part of gradually moving the frontiers of knowledge, that is the best part of doing research, she feels.

“The advancement of science is slow and it takes both patience and perseverance. But I am the type of person who welcomes challenges like these. As director and head of research, I also have an important role to play when it comes to inspiring other people to believe in their ability to perform above their own expectations. Together, we can achieve great things,” says Elisabete Weiderpass