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Discovering the causes of cancer and the means of prevention

DCEG Hosts Visiting Scholar Silvia Franceschi

March 2012 - Linkage Newsletter

by Victoria A. Fisher, M.P.H., Linkage Editor

In September, DCEG welcomed as a Visiting Scholar Dr. Silvia Franceschi, head of the Section of Infections at the International Agency for Research on Cancer (IARC) in Lyon, France. She is recognized internationally for her research on the link between infectious agents and cancer.

Dr. Franceschi received an M.D. from Milan University in Italy and an M.Sc. in epidemiology from the University of Oxford in the United Kingdom. She also received postgraduate diplomas in obstetrics and gynecology and in medical statistics. Early in her career, she was a research fellow at the Mario Negri Institute for Pharmacological Research in Milan and a fellow at the Division of Epidemiology, Imperial Cancer Research Fund at Oxford. Dr. Franceschi served as Chief of the Epidemiology Unit of the Aviano Cancer Center in Italy for more than 15 years before joining IARC in 2000.

Louise Brinton, Joseph Fraumeni, Silviva Franceschi, and Allan Hildesheim

Throughout her distinguished career, Dr. Franceschi has conducted research involving infectious agents and cancer, most notably on the role of human papillomavirus (HPV) in the etiology of cervical and oral cancers, the associations of HIV and hepatitis C virus with lymphoma, and the relationship of Helicobacter pylori to stomach cancer. Her studies have involved broad international collaborations in Latin America, Asia, and Africa, and she has published more than 1,100 peer-reviewed articles. Her collaborations with DCEG date back to the 1980s and include several large pooling projects for cancers of the thyroid, cervix, and head and neck, as well as lymphoma.

Dr. Franceschi's two-day visit, hosted by Louise A. Brinton, Ph.D., Chief of the Hormonal and Reproductive Epidemiology Branch (HREB), and Allan Hildesheim, Ph.D., Chief of the Infections and Immunoepidemiology Branch (IIB), included a seminar titled "HPV infection in women with or without cervical cancer and HIV infection: Update from IARC studies."

Dr. Franceschi explained that more than 85 percent of the global burden of cervical cancer is borne by developing countries. The planning and evaluation of HPV vaccination and HPV DNA test-based screening require population-based data on age- and type-specific HPV prevalence among women with and without cancer. To this end, IARC has conducted approximately 30 surveys in representative samples of women worldwide, with priority given to countries that lack previous HPV studies or data on cervical cancer. The studies have not only confirmed a high prevalence of HPV in certain areas of sub-Saharan Africa, Latin America, and India but also identified countries where the incidence of cervical cancer was not previously known to be high, including China and Mongolia.

IARC also has investigated HPV prevalence by age group, observing substantial differences in age-specific curves of HPV prevalence between populations. "In some countries, young women do not show higher HPV prevalence than middle-aged women," said Dr. Franceschi. "Western age-specific curves of HPV prevalence should not be taken as the natural history of HPV infection. Women aged 40 years or older living in low-resource countries should not be left out from screening efforts," she said, "because they harbor a large number of precancerous lesions that might be easily treated."

Dr. Franceschi also described work on the distribution of HPV type in cervical cancer by HIV status. Studies from IARC have found no difference in the proportion of cervical cancers associated with HPV 16 and/or HPV 18 between HIV-positive and HIV-negative women. These findings provide reassurance as to the efficacy of current vaccines against HPV 16 and HPV 18, even among populations in which HIV infection is common.

During her visit, Dr. Franceschi participated in several meetings with DCEG scientists. Dr. Brinton led a discussion hosted by the DCEG Africa Working Group on "Research in low-resource countries, including Africa" that focused on the various opportunities and challenges of conducting epidemiologic studies in developing countries, and Dr. Franceschi emphasized the importance of hiring motivated and capable local staff. Aimée R. Kreimer, Ph.D. (IIB), moderated a session on "HPV infection in cancer of the head and neck," and Dr. Franceschi described her new Study of Human Papillomavirus and Precancerous Lesions in the Tonsil (SPLIT), which she is conducting in France.

Additional meetings focused on cervical cancer, including a session titled "Hormonal influences on cervical cancer" facilitated by Nicolas Wentzensen, M.D., Ph.D. (HREB). Dr. Franceschi presented data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study on invasive cervical cancer and sex hormone levels in premenopausal and postmenopausal women. Anil K. Chaturvedi, D.V.M., Ph.D. (IIB), and Vikrant Sahasrabuddhe, M.B.B.S., Dr.P.H. (HREB), led a session on "Cervical cancer among HIV-infected women: Other research ventures." A lively discussion ensued on the urgency of preventing cervical cancer in HIV-infected women now that antiretroviral treatment has become available and allows for longer life expectancy, especially in sub-Saharan Africa.

Dr. Franceschi also met with DCEG scientists during informal brown-bag luncheons. Maria Constanza Camargo, Ph.D. (IIB), and Michael B. Cook, Ph.D. (HREB), hosted a lunch for tenure-track investigators and fellows to discuss opportunities for high-risk innovative research during their early career years. Mary H. Ward, Ph.D., Occupational and Environmental Epidemiology Branch, and Katherine A. McGlynn, Ph.D., M.P.H., Deputy Chief of HREB, facilitated a lunch hosted by the Women Scientist Advisors to examine how women scientists can best position themselves to succeed in research careers.

"I am very touched by this honor, and I would like to thank Dr. Brinton, Dr. Hildesheim, Dr. Fraumeni, and the entire Division for allowing me to visit," Dr. Franceschi said. "A substantial portion of what I have done in my career has been conceived through collaborations here, and I greatly admire the creativity and resilience of the Division."