Eric A. Engels, M.D., M.P.H.
|Organization:||National Cancer InstituteDivision of Cancer Epidemiology & Genetics, Infections and Immunoepidemiology Branch|
|Address:||NCI Shady GroveRoom 6E226|
Dr. Engels earned a B.A. in mathematics from the University of Virginia in 1987 and an M.D. from Harvard Medical School in 1991. From 1991 to 1994, he trained in internal medicine at Brigham and Women's Hospital. Subsequently, Dr. Engels received clinical training in infectious diseases and an M.P.H. at Tufts University School of Medicine. He joined the NCI Viral Epidemiology Branch (later the Infections and Immunoepidemiology Branch) in 1998 as a senior staff fellow, became an investigator in 2000, and was tenured in 2007. Dr. Engels holds an adjunct faculty appointment in the Department of Medicine at the Johns Hopkins Hospital. He received the 2006 Mentor of Merit award from the National Cancer Institute.
A major focus of investigation concerns the epidemiology of cancer in immunosuppressed individuals. My research on HIV-related cancers utilizes data from our HIV/AIDS Cancer Match (HACM) Study. This study links HIV/AIDS and cancer registry data from 15 U.S. regions to identify cancers arising in over 650,000 people registered with HIV/AIDS. The HACM Study allows my colleagues and me to address important research questions and examine patterns of cancer incidence that have direct public health relevance. We have used this resource to characterize trends in cancer risk among people with AIDS over the entire course of the AIDS epidemic. Our studies have documented substantial declines in Kaposi sarcoma and non-Hodgkin lymphoma over time, and a rise in the risk of Hodgkin lymphoma and anal cancer. We have also used this resource to examine cancer risk earlier in the course HIV infection and late cancer risk many years after an AIDS diagnosis. Additional studies are ongoing to characterize in more detail the overall burden of cancer in this population and risk factors for specific malignancies.
My coworkers and I also conduct research on cancer in solid organ transplant recipients, another immunosuppressed population. We performed the first epidemiologic studies of risk factors for transplant-associated Kaposi sarcoma and hepatocellular carcinoma, using U.S. transplant registry data. Our work has led us to initiate a major collaboration with the Health Resources and Services Administration (HRSA), which oversees the U.S. transplant network. Together with HRSA, we are conducting a computerized match of U.S. transplant and cancer registries. This Transplant Cancer Match Study includes population-based cancer data on approximately 40% of the U.S. transplant population.
My observation of a remarkably high risk for lung cancer among HIV-infected people caused me to question the common assumption that frequent tobacco use entirely explains the elevation. I have now conducted several retrospective cohort studies of lung cancer among HIV-infected persons. Utilizing various statistical methods to adjust for the effects of tobacco, each study demonstrated that lung cancer risk is higher in HIV-infected people than predicted from the effects of smoking alone. We are performing further studies to better understand the role of inflammation and infection in the etiology of lung cancer.
This work on HIV-related lung cancer has encouraged me to pursue other research projects to clarify the role of inflammation or infection in lung carcinogenesis in the general population. My colleagues and I showed that radiographic evidence of pulmonary scarring is associated with an elevated risk of lung cancer, and we have evaluated markers of pulmonary inflammation, such as C-reactive protein, as predictors of lung cancer. We have also studied chronic lung infections caused by Chlamydia pneumoniae or Mycobacterium tuberculosis in relation to lung cancer risk.
An additional research interest in non-Hodgkin lymphoma stems from the high risk seen in people with HIV/AIDS, as well as my belief that other infections and immune-related conditions are important. My collaborators and I conducted a large retrospective cohort study of hepatitis C virus and risk of lymphoproliferative malignancies in U.S. military veterans. This study showed an association with non-Hodgkin lymphoma and, for the first time, an association with the related malignancy, Waldenström macroglobulemia. We also demonstrated an association between chronic hepatitis B virus infection and an increased risk of non-Hodgkin lymphoma in a large Korean cohort.