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Cancer sleuths span the globe tracking down a prolific killer

May 30, 2017 | Dagny Stuart

Photo by Joe Howell


Cancer is a peripatetic world traveler that doesn’t recognize geographic barriers or halt at national borders. It is among the leading causes of death worldwide. There were 14 million new cancer cases in 2012 and 8.2 million deaths, and the number of new cancer cases is expected to surge to 22 million within the next two decades.

Nearly two-thirds of new cancer cases and deaths now occur in developing regions, especially low- and middle-income countries. These countries face the double burden of poverty and infection-associated cancers (cervix, stomach, nasal cavity), as well as the ‘Western cancers’ as more individuals adopt unhealthy Western lifestyles such as tobacco use, overeating and physical inactivity. Most of these regions also lack resources and expertise for cancer research, control and prevention.

Investigators at Vanderbilt-Ingram Cancer Center (VICC) and Vanderbilt University Medical Center (VUMC) have become leaders in global health initiatives to discover the causes of cancer, including dietary and environmental factors as well as genetic and biological mechanisms. VICC scientists and clinicians are leading or involved in global cancer research activities in more than two dozen countries, across five continents.

In late 2016, scientists in the Vanderbilt Epidemiology Center and VICC received a grant to plan and develop a Regional Center of Research Excellence in non-communicable diseases in Vietnam. Xiao Ou Shu, M.D., Ph.D., MPH, associate director for Global Health and co-leader of the Cancer Epidemiology Research Program at VICC, and Thuan Van Tran, M.D., director of the National Institute for Cancer Control in Vietnam, are co-principal investigators for the project.

The National Cancer Institute’s (NCI) Center for Global Health is funding the global collaboration grants to create Regional Centers of Research Excellence (RCREs) for non-communicable diseases (NCD) including cancer in low- and middle-income countries or regions.

Non-communicable diseases, such as cancer, cardiovascular disease and diabetes account for more than 72 percent of premature deaths globally and low-and middle-income countries carry a disproportionate burden of those diseases. The NCI planning grants for RCREs support partnerships between high-income countries and less affluent countries for the development of regional hubs to coordinate scientific research in low- and middle-income countries.

“I am pleased that we have been selected to help lead this important initiative to create a foundation of cancer and other NCDs research excellence in Vietnam,” said Shu, an Ingram Professor of Cancer Research. “Vanderbilt is well-regarded for our record of excellence in population-based science, research training and program building. We also have longstanding collaborations with leading investigators in the Asia region.”

Shu noted that she and her Vanderbilt colleagues are forging closer ties with Vietnam’s National Institute for Cancer Control.

According to Shu and Van Tran, rapid economic growth, industrialization, and widespread adoption of a Western lifestyle in Vietnam have been accompanied by an emerging epidemic of NCDs. However, NCD research in that country is limited. There is no population-based epidemiological research program for cancer, diabetes, or other NCDs in Vietnam due to the lack of a population-based cancer registry, a dearth of well-trained investigators and the absence of research infrastructure.

The new U.S.-Vietnam-China partnership aims to create a self-sustaining NCD research and training center in Vietnam and establish a large population-based cohort study for NCD research there.

The Shanghai Municipal Center for Disease Control and Prevention in China is providing regional expertise in NCD research and control programs relevant to Vietnam. Additional partners, Hanoi Medical University and Hanoi School of Public Health, are leaders in prevention research in Vietnam.

The group will launch a breast cancer study and a community survey for type 2 diabetes, two NCDs of particular public health concern in Vietnam, and collect biospecimens that will lay a foundation for future research.

In other Asia regions, Vanderbilt’s Wei Zheng, M.D., Ph.D., MPH, Anne Potter Wilson Professor of Medicine and director of the Vanderbilt Epidemiology Center, is leading several health initiatives, including genome-wide association studies of breast and colorectal cancers. He also is spearheading multiple projects in the Asia Cohort Consortium which involves more than 1 million individuals.

The group has already identified more than 30 new genetic markers for breast and colorectal cancer susceptibility and quantified the relationship between body mass index and mortality risks, as well as the impact of tobacco smoking on mortality.

In the Western Hemisphere, VICC investigators have longstanding investigations in cancer epidemiology and prevention, with a focus on stomach cancer, the No. 3 cause of global cancer mortality. For more than 25 years the NCI has funded VICC gastric cancer studies, led by Pelayo Correa, M.D., in Colombia, which is considered a “population laboratory.”

Over the past decade, the NCI has funded gastric cancer molecular epidemiology and prevention initiatives in the Central America (CA-4) region, led by Douglas Morgan, M.D., MPH, associate professor of Medicine in the Division of Gastroenterology and VIGH director of Latin America sites. The CA-4 (Honduras, Guatemala, El Salvador, Nicaragua) is the core impoverished low/middle income region in the Western hemisphere, with a population of 36 million people and accounting for more than 4 million immigrants in the U.S. Scientific discoveries have implications for infection-associated cancers among patients in the U.S. and globally.

This research platform in Central America has spawned the development of broad cancer control and capacity-building programs, with funding from the NCI Center for Global Health awarded to Morgan and Jennifer Pietenpol, Ph.D., Executive Vice President for Research at VUMC and director of VICC. Efforts have focused on the development of cancer registries and national cancer control plans in the CA-4, as well as scientific investigations such as the CA-4 gastric cancer HER2 study, and the El Salvador national gastric cancer epidemiology study.