November 21, 2024 • 48 mins
In this episode of Inside Cancer Careers, we explore international efforts to combat cancer, featuring Dr. Lisa Stevens from the International Atomic Energy Agency (IAEA) and Dr. Andre Carvalho from the International Agency for Research on Cancer (IARC), World Health Organization (WHO). They discuss integrating radiotherapy and nuclear medicine into cancer control, the importance of national cancer control plans, and IARC's focus on cancer prevention research. They emphasize international partnerships, improving access to radiotherapy and screening, and empowering low-and middle-income countries. Both speakers reflect on their personal journeys into the field of medicine and public health, sharing insights on the challenges and opportunities they have encountered. They also provide advice for aspiring professionals in global health.
SHOW NOTES:
Dr. Lisa Stevens
Dr. Andre Carvahlo
Programme of Action for Cancer Therapy (PACT)
Technical Cooperation Programme
International Atomic Energy Agency (IAEA)
Early Detection, Prevention and Infections Branch
International Agency for Research on Cancer (IARC)
World Health Organization (WHO)
GLOBOCAN
International Cancer Control Partnership
UICC World Cancer Congress
CanScreen5 project
Rays of Hope
Islamic Development Bank
WHO Global Initiatives
AD: 13th Annual Symposium on Global Cancer Research
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
OLIVER BOGLER (00:03):
Hello and welcome to Inside Cancer Careers, a podcast from the National
Cancer Institute where we explore all the different ways people fight cancer
and hear their stories. I'm your host, Oliver Bogler from NCI Center for Cancer Training.
In a recent episode, we talked to Dr. Satish Gopal from the NCI and Dr. Peter Kingham from
(00:24):
Memorial Sloan Kettering Cancer Center about the global cancer work of US-based organizations.
Today, we're talking to two leaders who work at
international organizations engaged in fighting cancer across the globe.
Listen through to the end of the show to hear our guests make some interesting
recommendations and where we invite you to take your turn. And of course,
(00:44):
we're always glad to get your feedback on what you hear and suggestions on what
you might like us to cover. The show's email is NCIICC@nih.gov.
It's a pleasure to welcome Dr. Lisa Stevens, Director of the Programme of
Action for Cancer Therapy, PACT, in the Department of Technical Cooperation at
(01:05):
the International Atomic Energy Agency, or IAEA. Welcome, Lisa.
LISA STEVENS (01:11):
Thank you so much, Oliver.
OLIVER BOGLER (01:12):
It's also a pleasure to welcome Dr. Andre Lopez Carvahlo,
Deputy Head of the Early Detection, Prevention and Infections Branch at the International
Agency for Research on Cancer, part of the World Health Organization. Welcome, Andre.
ANDRE CARVALHO (01:28):
Thank you, Oliver, pleasure to be here.
OLIVER BOGLER (01:30):
So of course there are institutions that fight cancer in every
country, right? Cancer centers, research institutions, hospitals, universities.
But then there are organizations that have a transnational mission. Let's start with you,
Lisa. Please tell us about the IAEA and its work in relation to cancer.
LISA STEVENS (01:50):
Sure, thanks Oliver. I'm delighted to tell you and all the listeners
because I think oftentimes when people hear about the International Atomic Energy Agency,
they don't naturally think about cancer and global health. But the division that I lead
within the technical cooperation program actually looks at cancer very broadly
and how we can integrate the technical mandate of IAEA, which is radiotherapy,
(02:16):
nuclear medicine, diagnostic imaging, into comprehensive cancer control.
So through the PACT program, we partner with WHO and with IARC that Andre is representing today to
conduct comprehensive cancer assessments of the surveillance, prevention, screening, diagnostics,
(02:38):
all forms of treatments, palliative care, survivorship care, with a team of both
international experts that are nominated by the three leading UN agencies for the IMPACT mission
that work closely with a team of local cancer experts. And they visit facilities, they collect
data, they develop a review report that has expert recommendations that are evidence-based that we
(03:05):
encourage the country to use to develop a national cancer control plan, strategic funding documents.
And in the case of IAEA, we have a technical cooperation program. So the countries can
utilize recommendations, again, within our technical mandate area to develop
programs for a two or four year cycle. So that's really what the Programme of Action
(03:27):
for Cancer Therapy does. We collaborate not only with experts outside of the IAEA, also
with our internal technical experts from nuclear applications, but also from safety and security.
OLIVER BOGLER (03:42):
Thank you. Andre, you work at IARC, which is part of the WHO. Can
you tell us about IARC's mission and the mission of the team that you are part of?
ANDRE CARVALHO (03:51):
Okay, sure. So, IARC is a specialized WHO,
the World Health Organization specializing in cancer research. So, and the way that works
with WHO is that we provide the evidence or gather the evidence and then WHO will do recommendations.
(04:12):
The main focus of IARC is on cancer prevention. And on that, we do many aspects of cancer
prevention. We have some pillars and some branches that will study what can prevent cancer,
why it occurs and how you can prevent. So we have the monographs that study substances or exposures,
(04:38):
risk factors and whatever that risk factors is carcinogenesis in different levels.
The other part of that that is a little bit new because this is coming from the seventies
is the handbooks. And the handbooks see the other way around. What we can do,
(04:59):
you know, to prevent cancer. So screening, right,
eating better, physical activities. So it's the other way that, you know, to prevent.
The third companion that we have is the blue books. That's about,
you know, the pathology and how you should describe and do a better diagnosis of cancer.
(05:20):
We have some groups or branches that study the mechanisms for cancer to occur. And then
we have also the branch that I am part of that we try to understand interventions
that can either do primary prevention or secondary prevention or cancer
(05:41):
screening. How that can be implemented you know, and what is the evidence that
that intervention would prevent or decrease the incidence and the mortality of cancer.
We still have a group that works in environment. They are the ones that write the word codes
(06:04):
against cancer. We have the European code, those original codes. We have the European code,
the Latin American code that is already up and running. And we're about to start the Asian code
and the idea is that to have the codes that are specific for the region so we can prevent cancer.
And one more aspect that we do is the GloboCan. It's the database that most
(06:31):
people use for cancer surveillance in the cancer burdening countries
is to see the incidence and mortality of cancer worldwide.
And in actual that's what we do.
OLIVER BOGLER (06:39):
That's a lot of things. Andre, you mentioned primary and secondary prevention. just
for those who are not prevention experts, primary prevention is when you are trying to prevent the
cancer from appearing in the first place. And then secondary is recurrence. Is that correct?
ANDRE CARVALHO (06:55):
No, secondary is kind of the cancer screening,
right? That you are preventing, you are trying to do early detection of cancer,
right? Or detect the pre-cancer lesions that you can treat. And this is really,
it's kind of, this is more evident for cervical cancer, for colorectal cancer,
that the screening tests can identify the potential presence of pre-malignant lesions that
(07:22):
if you treat it, the cancer will not occur because you're treating before, it becomes invasive.
OLIVER BOGLER (07:27):
So for example, if we think about smoking and lung cancer,
not smoking is primary prevention and getting a lung CT would be a secondary prevention.
ANDRE CARVALHO (07:36):
That's correct.
OLIVER BOGLER (07:37):
Okay, great. Thanks for those overviews. So Lisa,
I know that you've been involved in a lot of work over much of your career helping
countries develop cancer control plans. You co-founded the International Cancer
Control Partnership. Tell us a little bit about these cancer control plans that you
(07:59):
help countries stand up and how that connects to the work that we were just talking about.
LISA STEVENS (08:04):
Sure. So a national cancer control plan is really meant to be a
strategic document that all stakeholders within the cancer community, academicians, clinicians,
ministries of health, ministries of education, ministries of finance, can contribute to and
understand what are the priorities, often linked to what Andre was talking about, what are the
(08:29):
higher burden cancers in a specific country.What are the gap areas that need to be
addressed? I think in every cancer plan I've ever supported, cancer registries are always
in there as something to be strengthened, even if there's something that's existing, you know, it's
moving it to population-based or continuing to strengthen it. So it's really the strategic look.
(08:50):
And I think in the 2011 high-level meeting at the UN where NCDs were put on the stage,
there was a call for countries to have cancer plans. And this was really what inspired the
work that resulted in the International Cancer Control Partnership. We met on the margins of
(09:12):
the 2012 UICC World Cancer Congress in Canada and brought together interested stakeholders.
And the initial idea was that it would be for sharing information because we knew that there
were organizations like IARC and WHO and IAEA and American Cancer Society and the National
Cancer Institute and a whole host of others that were often, UICC, I can't forget them,
(09:38):
because they were in the co-founding of the ICCP.We were getting approached independently by one
country. And so there were three organizations working in a silo on a cancer plan. You know,
maybe with one person in the Ministry of Health, another group was approached by
someone in a civil society organization. And it was not an efficient use of anyone's resources at
(10:01):
the national level or in the global community. And so we created the partnership initially to
start sharing information. Who was doing what? Who was having missions, you know, in which country?
What cancer plans were publicly available?So the ICCP portal was born at that point
and is really an international resource, not only for published cancer and NCD plans, but also for
(10:27):
toolkits that planners can utilize in focusing on a specific area of the cancer control continuum or
a specific type of cancer. And so that's the work that we've been doing since 2012 to really bring
the community together. And its amazing to see how the partnership has grown, how we've brought
(10:48):
in either regional specific organizations or specific to a part of the cancer care continuum.
OLIVER BOGLER (10:57):
And just for the audience, UICC, that's the Union
for International Cancer Control. It's like a convener of experts in that field, right?
LISA STEVENS (11:06):
So yeah, UICC is an umbrella organization
for civil society entities around the globe.
OLIVER BOGLER (11:14):
Yeah. So Lisa at these plans, obviously, or maybe it isn't obvious,
each country needs its own plan because the situation about or the way cancer
presents and the cancer challenges are different in different countries, right?
LISA STEVENS (11:28):
Correct. And yeah, the situation on the ground is very
different in terms of what's available, what types of screenings are available,
what type of prevention is in place, the adherence to the Framework Convention on
Tobacco Control or taxation of cigarettes or alcohol. So it is very contextual.
(11:52):
And especially I know one of the things that we've been talking about with IARC over the years
is how do we incorporate cancer research into a national cancer control plan? Because that varies,
as you mentioned at the beginning, Oliver, each country has its own set of research institutions,
cancer centers, and how do they work together to not only implement the cancer plan,
(12:15):
but do research to advance the field. So yes, each country should have its own.
OLIVER BOGLER (12:22):
Because we've learned that what you learn about cancer in one country
may not be applicable to the way cancer is in other countries, right? And of course,
at this point in time, the science is very heavily based towards developed
Western countries like the United States, where much of the research has happened.
Andre, Lisa mentioned screening is an important part of these national cancer plans. And I
(12:45):
know that you're a part of the CanScreen5 project. Can you tell us about what that is?
ANDRE CARVALHO (12:52):
Okay, so IARC have been for a long time this platform that's the GloboCan for
incidence and mortality, right? And then in 2019, you know, as I was arriving at IARC, you know,
this platform was about to be launched, you know, by the branch that's led by Partha Basu. And,
(13:13):
you know, we, that's the idea is to collect information about cancer screening activities
around the globe, right? And also try to understand how countries are preparing themselves
in terms of the protocols, in terms of the performance indicators of those cancer screenings.
It's mainly at this stage based on the three cancer screening sites,
(13:37):
cancer sites that WHO recommends, that's cervical cancer, breast cancer, and colorectal cancer. But
the platform is built in a way that eventually the food tube can start collecting information
for lung cancer screening, prostate cancer screening, and so on. But it's a data repository
(13:57):
and it's interactive like the GloboCan about cancer screening activities around the globe.
OLIVER BOGLER (14:02):
Lisa, IAEA was founded to bring out the benefits of splitting the atom,
right? That was the original cause. And of course, one of the ways that atomic physics interfaces
with cancer is through radiotherapy. I wonder whether you could tell us a little bit about how
(14:24):
IAEA works to improve access to radiotherapy. Because it's an important component of the
therapy for many cancers. And it's not easily accessible in all parts of the world, right?
LISA STEVENS (14:37):
Right, so the agency has been supporting cancer technology for more than
six decades. In 2022, our director general really wanted to look at that equity and accessibility
that you mentioned, Oliver, and said, you know, I keep mentioning that there are 20 countries
(14:59):
in Africa with no public radiotherapy center, and we can't just keep quoting these numbers,
we really need to do something. And so he launched Rays of Hope, which is a coordinated effort and
very coordinated on the IAEA side between nuclear safety, the technical officers in the human health
(15:22):
division, the technical cooperation department that has that relationship with the country,
the PACT division and our procurement team as well to make sure that countries were prioritizing what
they needed in terms of education and training so that they had radiation oncologists, medical
(15:44):
physicists, radiologists, all of the specialists in country to be able to operate the machines that
we can support the procurement of. So we can support linear accelerators, PET scans, x-rays
in order to ensure that there's that link between diagnosis and in 50 to 60 percent of cancer cases,
(16:05):
they are indicated for radiotherapy at some point in the course of treatment and palliation.
So yes, there is a very concerted effort to make sure that we're linking our efforts,
we're working closely with the member state, understanding what their priorities are,
what they can absorb in terms of that capacity building and do they have the
(16:29):
infrastructure in place in a hospital to have radiotherapy or the diagnostic
imaging? Do they have the regulations in place to support, to ensure that it's safe,
that there's quality assurance and it can be delivered in a timely fashion?
OLIVER BOGLER (16:47):
Andre, access is also critical for screening, right? It's one thing to have a
hospital in a city where people can come to get screened, but many people can't access that. I
wonder if you could comment on this. And I wonder if you could also talk a little bit
about your prior work before you went to IARC. You and I had a chance to meet when you were leading
(17:08):
a really phenomenal prevention program at the Hospital De Cancer in Barretos in the state of
Sao Paulo in Brazil. What's your perspective on access to screening and how it can be improved?
ANDRE CARVALHO (17:22):
This is very interesting and important question, Because, you know,
this is one of the major barriers, right? It's kind of, you know, access in two senses,
right? Was that available and was that affordable, right? And those are, you know,
(17:44):
sometimes you have countries that have those two things, you know, just the big centers,
the big cities who have it and then it's difficult to access and expensive,
so it's not affordable. Sometimes you have that is affordable, but it's not close to
home. And those are the two things that are kind of more difficult when you have that.
(18:07):
As we have been noticed that, you know, and this come without surprise,
that when a country has universal health care, right, this is much easier to cover
because the affordability part of access is gone and then create availability is something with
mobile units is eventually, and some incentives for transportation, you can cut that barrier.
(18:34):
But when you don't have that in a low or low middle income countries, the part of affordability
is very important to be considered as well. We're just finalized to work in a tool that you're
to become public available, called Intervener.This tool, right, would we hope, many stakeholders
(19:01):
in a country or region use that to prioritize what their barriers to improve the screening. And this
tool links those barriers with proven evidence by interventions that you can use to overcome
the barriers that you prioritize. And we hope that that will help not only regarding availability and
(19:26):
affordability, but also other processes that need to be considered when is done, cancer screening.
And as you comment, I guess it's time for me to talk a little bit how I got
to IARC. I have a little bit of a different career on how I got here. As you comment,
(19:51):
I am originally from Brazil. And by training, I am a head and neck surgeon. And I have been a
head and neck surgeon back in Brazil for almost 18 years before I decided to go officially to public
health in terms of doing my master in public health in the University of Washington, Seattle
and be hired to IARC. It's been a little bit over five years now that I am part of the IARC team.
(20:19):
As I mentioned, I work in two cancer hospitals back in Brazil. The one that I did my medical
residency on I was a staff at for eight, nine years and then I moved to the Barretos Cancer
Hospital, that's where we become known, contacts, right Oliver, and eventually that hostel become
(20:41):
a city institution with MD Anderson, thank you to you. That when I went there to start the teaching
and research activities, one strategic decision was trying to see what would be the niches that
was quite unique for that hospital. And then that hospital in particular invest a lot in prevention,
(21:07):
in screening, and in palliative care. And those are the areas that you begin to explore
in terms of research and innovation and for the Master and PhD programs.
So that's where I begin to get linked to screening, to public health, and eventually
(21:29):
here I am at IARC in the global level, trying to promote cancer prevention.
OLIVER BOGLER (21:37):
Thanks, Andre. And I remember at Barretos, you had these big trucks that would
travel all around the rural areas. You were in the state of Sao Paulo,
but far from the city and in a quite rural area. And these trucks would provide services
to the populations, right? Cancer screening, particularly in women's cancer, correct?
ANDRE CARVALHO (21:55):
That's correct. So we would be the first big cancer center if you come from
the Amazon region, going to the big cities in the East coast in Brazil. And those trucks for
doing screening and they would do for mammography, Pap smear and for skin cancers, early detection,
(22:22):
they would go up to the Amazon region and come back and those trips usually would
take 60 days or so stopping in cities and try to promote early detection of cancers.
And one interesting way that that work is that every city that they stop, there was a commitment
(22:47):
from that city to send the patient to be treated in the cancer center, and that treatment would be
covered by the universal healthcare in Brazil. So nobody would be with a diagnosed but without
a timely treatment. And that was also something interesting to understand, how important it is to
(23:11):
think about all this pathway when we talk about early detection. As Lisa comment,
how important is given timely and standard cancer treatment mode to a better survival.
OLIVER BOGLER (23:25):
Right, screening without care makes no sense.
ANDRE CARVALHO (23:28):
That's it.
OLIVER BOGLER (23:30):
Lisa, the IAEA also has a Women's Cancer Partnership Initiative that focuses on
addressing the unique challenges of women's cancer globally. Could you tell us about that, please?
LISA STEVENS (23:42):
Sure, we launched that back in 2019 in partnership with the Islamic Development Bank.
And at that time, I had just joined the agency and we were really looking to again, raise the profile
of what the agency does in cancer diagnosis and treatment. And we found a very interested partner
(24:03):
in the Islamic Development Bank. They wanted to focus on women's cancers for their member
countries. And so we launched this back then.I will say with the advent of Rays of Hope,
there's the radiotherapy machines, even back in 2019 when we had the Women's Cancer Initiative,
(24:23):
the machines can treat any type of cancer. They weren't colored pink for breast cancer
or not allowed to be used for others. It was really about advocacy and awareness
raising that this form of treatment is really important for many of these cancers in women.
And so we've incorporated the coverage of breast and cervical cancer also with
(24:47):
the launch of the WHO Global Initiatives on cervix breast and childhood cancer to ensure
that Rays of Hope comprehensively looks at all of these cancers that need radiotherapy.
OLIVER BOGLER (25:00):
You’ve both mentioned partnerships in your discussions, and I wonder if you could
make a general comment. The organizations that you work for are inherently involved in forming global
partnerships, right? What is the significance of that work and how do you accomplish it?
LISA STEVENS (25:18):
Well, again, I think partnerships are essential in order to move anything forward.
And I think the PACT program is a great example because each of those UN entities,
if we just look at the UN, cover a different part of the cancer control spectrum. So alone,
(25:39):
IAEA sticking to its technical mandate can only do a certain part of it. But when
all three of us come together, it's really, it's a perfect partnership.
And I will say partnerships also do need some care and attention. And the three UN agencies
meet regularly, not only in person annually, but we have work plans and we get together
(26:04):
on specific topics to advance and make sure that our work is synergistic and not siloed.
Then we have partnerships with civil society. We are branching out more and more into the
private sector because we know that they are key partners. I mentioned Islamic Development Bank.
We're looking at other international financial institutions. And we have our strong partners
(26:29):
with member states who can contribute resources, expertise to our cancer work.
ANDRE CARVALHO (26:37):
And I guess if I might just compliment, think what Lisa brought,
we are the three UN agencies that has some activities in cancer. And we are complementing
each other. So I think this is a good example how we at that level interact. But also
(26:58):
being in this platform allow us to also interact not only with other organizations, but also
with governments. In a sense that, if you think about doing implementation research, most of our
research, even though it's still research, we have a lot of many times the government involved and it
(27:25):
can use the health system. So once the results are positive from those studies, the chance
of that to get implemented in the field is way higher because the major stakeholder that's the
policymaker can be part of that. And this is quite unique when we are in these global organizations.
OLIVER BOGLER (27:50):
So you've both been in your current positions approximately five years, and I wonder
if I might entice you to reflect back over those five years and also to project forward maybe five
years in terms of the work that you're doing. What have you seen, what have you accomplished,
and where do you think you'll be in five years in terms of your work? Lisa, let's start with you.
LISA STEVENS (28:12):
So gosh, coming into it was quite a shock to join a UN agency. thought after having
worked in US government, there are lots of structures and infrastructures and bureaucracy
here, but really just building a team and again, strengthening the partnerships both
(28:35):
within IAEA and making sure that the technical inputs that we needed to do
the impact reviews and also the NCCPs, the work because we had recently moved
locations within the agency to technical cooperation. So really aligning ourselves
with the work of the other divisions in the technical cooperation department
(28:58):
was important to me over these first few years as I was getting integrated into the work.
Where I'll be in the next five years, again, I think the focus on cancer as a global epidemic is,
I mean, it's time really for countries to focus, make sure that they understand
(29:22):
what their gap areas are, develop a national cancer control plan, a strategy for addressing,
looking at common risk factors so that all NCDs can be reduced in countries. So I think
that they'll continue to be these requests for the plans, the assessments, and hopefully as
(29:43):
programs like Rays of Hope and the WHO Global Initiatives really again shine the spotlight,
but also raise expectations and raise the level of requests that we can support through bigger
partnerships and with the support through these strategic funding documents so that a country
(30:03):
really can mobilize either national resources or international resources to address the challenge.
OLIVER BOGLER (30:10):
Thanks, Andre.
ANDRE CARVALHO (30:11):
Yes. So for me, it was my first exposure to the global health scenario,
if you will. I have been doing international collaborations for quite a long time back in
Brazil, but it's different when you got into an institution that's global per se. So I think
(30:31):
the first years was trying to understand the same thing that Lisa experienced in her agency. Is that
how the agency works, what is the mandate of the agency, how is the interaction between the three
UN agencies and how can we interact globally in terms of who can we partner with and how. So there
(30:55):
is a lot of understanding of the navigation, but once you understand that, you begin to take the
whole advantage of being in this global platform.I'm in a stage now that what I want for the next
five years is do more of what I'm heading to, is trying to see how evidence-based interventions can
(31:21):
be truly implemented, taking in consideration the local context. Because we see more and more, when
this has been happening, results from research that's a controlled environment. usually don't
have the same benefit when we try to implement in the health system or in the real world. And try
(31:46):
to understand what needs to be adapted, taking to consideration the context of the region or
the country that we're trying to do that, or what are the new gaps that was not evident
in the research and how to overcome that. This is kind of, for me, is a very exciting place
to do research. So we can bring to the real world interventions that can benefit cancer prevention.
OLIVER BOGLER (32:15):
Great, we're gonna take a break. And when we return,
we're gonna learn how our guests got into the work that they're doing now.
[music]Calling all global cancer researchers!
Now is the time to share your original research designed to reduce the burden of cancer in low-
and middle-income countries. Submit your scientific session and abstract proposals
(32:39):
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Know an outstanding professional who embodies virtue and eminence in cancer research,
(33:01):
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The deadline to submit proposals for abstracts, sessions, and Pearline
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(33:23):
Keep up with new and innovative research in global oncology at the
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(33:48):
new funding opportunities, cancer control resources, and more on the NCI Center for Global
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[music ends]
All right, we're back. I'm always curious about what first attracts
people to the field of biology, medicine, and biomedical sciences. Let's start with you,
(34:13):
Andre. When did you know that you wanted to do medicine and science?
ANDRE CARVALHO (34:18):
Okay, I guess that came early on in my case,
right? My dad was a pediatrician. So you know, even though he was the second of his family,
he had a brother that was also a doctor. You know, that's not kind of many generations, if you say,
but in my mind, you know, I would be a doctor when I grow up and that's eventually happened.
(34:45):
But I like it that, you know, it's kind of it was not something that I was pushed to.
And I left home to go to med school and I really enjoyed my time at med school and
trying to understand how the body works and things like that and diseases and how to treat.
Finally, I make my decision to go for surgery and eventually for head and neck surgery, specifically
(35:12):
in oncology. And I got lucky to get a family that support all my trajectory, but also to have a
mentor, you know, when I started in the field that, you know, from the beginning, you know,
he institution, he said, you know, the importance of being part of institution, the importance of
(35:33):
doing research and the importance of implementing the findings of research, learn from research,
and so on. So that's when, you know, I begin to go for the field of research in the medical field.
OLIVER BOGLER (35:47):
I've got to ask, why surgery?
ANDRE CARVALHO (35:51):
It's a funny, you know, that's one influence that came from my dad actually,
right? Because it was very interesting. was having coffee with him and I say,
I'm not sure if I will do cardiology or surgery. And then he told me, you know,
I saw surgeons that become cardiologists, but I never saw cardiologists that become a surgeon. So
(36:14):
can always go back if you go to one track, but not to the other. And then I made my decision,
but know, first year into the surgical residence, I was over about thinking of being a cardiologist.
OLIVER BOGLER (36:27):
Okay, you were committed. Interesting. Lisa,
how did you first know that you wanted to go into science?
LISA STEVENS (36:34):
Yeah, I was as Andre was talking, I was trying to think back to when I knew,
but I mean, probably even before high school, but definitely in high school,
I just gravitated towards the sciences. And I went to a small liberal arts school. So even though I
had the liberal arts training, I was a biology major with a Spanish minor and then worked for a
(37:00):
couple of years before I went back to grad school.I went to University of Maryland and was able
to connect with a lab at the National Cancer Institute. So actually did my PhD research at NCI.
And then after I defended my thesis, I decided that I wanted to leave the lab and it wasn't
(37:24):
for lack of love of science. actually, still love science. I like the thought process. But for me,
the lab was a very solitary endeavor. You did a lot of work alone and it didn't meet
my personality. And so what I felt as I moved into the office of the director of NCI in three
(37:48):
different offices there, that I was able to support science in a different way. And I'm
very comfortable with that decision. And the last center that I was in at NCI was the Center for
Global Health. And I didn't pursue that. That was more of there was an opportunity. And I thought,
(38:13):
well, everyone's talking about global health. This was in 2012. And I thought
it sounds really interesting. Yeah, it's been a whirlwind since then.
OLIVER BOGLER (38:24):
I mean, it's quite a distance from molecular and cell biology where you started with
your PhD, the same kind of science that I did when I was still active. What skills that you had in
that early part of your research career have you been able to take into this new arena with you?
LISA STEVENS (38:41):
I mean, I think it's really just understanding the science. I don't follow it
as closely as I did when I was doing my research, but I can read papers and understand what's going
on in that inquiry. I think is one of the skills you learn as a scientist in the lab
(39:01):
that if you continue it, your questions might be slightly different. But if you still have that,
if you approach things with that curiosity, then I think it's helpful no matter what field you're in.
OLIVER BOGLER (39:16):
Andre, you described how you started in medicine and surgery and then you
started getting interested in research. Tell us a little bit more about that journey and
how that informs your current role. I understand you're not actively practicing surgery right now,
right? You're focusing on your public health work, your cancer prevention work.
ANDRE CARVALHO (39:35):
That's correct, right. When I moved to IARC, IARC is a research institution.
so I gave the part of the practicing medicine part of my career. So as I comment right,
I had, you know, this mentor that was the head of the head of the surgery department
(39:58):
at AC Camargo Cancer Hospital back in Brazil. And, you know, I started research kind of late,
not as a medical student, but, you know, into my medical residency, you know,
and I got, you know, very passionate about try to understand when you put evidence together,
(40:21):
when you put numbers together, how you get this bigger picture of what's going on with
the patients. And if you do treatment A or B, how different are their survival?
And then I begin to learn actually more and more from results of the research that I was doing,
(40:42):
looking at the medical records from head and neck cancer patients in the hospital. And that
just began to grow in terms of, I ended up, you know, doing my PhD supervised by him, Dr. Paulo
Kowalski. And then eventually I went to my postdoc and my postdoc was very interested in it. I did
(41:05):
a postdoctoral fellow at Johns Hopkins. And that was in molecular biology trying to find, you know,
methylation markers in saliva to do early detection for head and neck cancers. Because
at that point in Brazil, 80 % of the cancers, head and neck cancers were in advanced stage.
And I think also that triggered, the whole idea is that, that came along and how can we
(41:30):
have a different patient that is diagnosed in early stage that you can provide less
treatment with less morbidity, but with higher chances of cure just because you
identify that cancer in the early stage. And that's kind of what become to be involved in
(41:53):
my experience at Barretos Cancer Hospital with screening. And my move to do a Masters
in Public Health outside Brazil to try to work more in global health.
OLIVER BOGLER (42:10):
Fascinating pathways you both had. I wonder as my final question,
what advice you might give to someone who's listening, who's perhaps both interested
in the work that you do today, but also the career paths you took and who might
also be interested in working at a global agency. What would you say to them, Lisa?
LISA STEVENS (42:29):
I think I would say be open to opportunity. So the opportunity to work at
the Center for Global Health was not something that I had envisioned. And even opportunities
when you're an undergrad or in graduate school or medical school. I think it's just recognize and
(42:51):
sometimes decisions that might not go your way might provide other avenues for you to pursue.
OLIVER BOGLER (42:57):
Thank you, Andre.
ANDRE CARVALHO (42:59):
I agree, it's kind of being open-minded. And sometimes opportunities come
to you and you just take advantage of that. Be curious, know, want to learn more. You need to
be out of the comfort zone, right? You need to understand that when you go for global health,
(43:22):
there are things that you need to understand about culture and that's going to be my comment later
on, because we are going to work and collaborate with people from all around the globe. And that
is fascinating, but also a challenge. So we can start with international collaborations
(43:43):
and get a small taste of it. And as soon as you get, even in your country, a chance to be
in a global organization, this can be also a path for you to go in the direction of global health.
(44:04):
[music]
OLIVER BOGLER (44:04):
Now it's time for a segment we call Your Turn, because it's a chance for
our listeners to send in a recommendation that they would like to share. If you're listening,
then you're invited to take your turn. Send us an audio recording with a tip for a book,
a video, or a podcast, something that you found inspirational or amusing or interesting. You
can send these to us at NCIICC@gov, and we'll play it on an upcoming episode.
(44:29):
But now I'd like to invite our guests to take their turn. Let's start with you, Lisa.
LISA STEVENS (44:35):
So my turn, I'm going to recommend a podcast called The Lazy
Genius. And it was recommended to me by a woman I work with here. It's … I don't
even know if I want to call it advice, but practical ways of managing, making decisions,
organizing. And some things are relevant and some things aren't, but they're short,
(44:55):
you know, maybe 20 or 30 minute podcasts. And I often send them to friends of mine,
if there's a particular topic I think they might be interested in.
OLIVER BOGLER (45:04):
That's a great recommendation, Andre.
ANDRE CARVALHO (45:06):
Yeah, I'd like to suggest a book, The Culture Map by Erin Meyer. And it
talks a little bit on how people think, lead and get things done across country and try
to see differences, cultural difference in communication, leadership, decision-making
and giving feedback. This is a book that was suggested for me when I was starting at IARC and
(45:32):
it's fascinating because when you go for global health and you have international collaborators,
you kind of need to understand the culture. Otherwise, you might not accomplish what you need.
And even though, you know, of course, you know, the book has a little bit of a stereotype,
you know, trying to, to, to, you know, say a country would act like that, and you know,
(45:55):
that's not true, but also give, you know, very much this cultural awareness, you know, even if
This is not exactly how all the country that you're visiting would behave. You know, opens
your mind to try to understand that they will not behave the way you think they would based on your
own culture. It's about, you know, cultural awareness and try to understand difference
(46:20):
and how to collaborate and bring together different cultures to accomplish something.
OLIVER BOGLER (46:25):
That's a great recommendation. I we live in a flat world and we meet people
from all over and that is our strength in science and medicine. So fantastic.
I'd like to make a recommendation as well. It's for a website. It's called thestorygraph.com.
It's a great place for people who love books and love data. And I love both. With StoryGraph
(46:46):
and a bit of effort, you can track your reading. You can set annual goals and
get great recommendations for the next book.Also, it's really cool. It's AI powered and,
regular listeners will know that I am AI obsessed. But the AI here gives you
a personal recommendation based on what you've read. So it will take a book and it will give you
a paragraph on why it thinks it's a really good read for you or maybe why it's not. And that is,
(47:10):
has been very helpful to me in, sorting through the many, many books that one could read. And,
it lifts the veil a little bit on why you're being recommended things, right? lot of recommendation
sites just say this is recommended to you, but you don't really understand why. I think that's really
fabulous. Anyway, check it out and you can import your data from other similar services as well.
(47:32):
Well, I want to thank both of you, Lisa, Andre. Thank you so much for your time
and for your insights and for sharing your work and your careers with us.
LISA STEVENS (47:40):
It was a pleasure.
ANDRE CARVALHO (47:42):
Thank you so much for having me.
OLIVER BOGLER (47:45):
That’s all we have time for on today’s episode of Inside Cancer Careers! Thank
you for joining us and thank you to our guests.We want to hear from you – your stories,
your ideas and your feedback are welcome. And you are invited to take your turn
and make a recommendation to share with our listeners. You can reach us at NCIICC@nih.gov.
(48:05):
Inside Cancer Careers is a collaboration between NCI’s Office of Communications and Public Liaison
and the Center for Cancer Training. It is produced by Angela Jones and Astrid Masfar.
Join us every first and third Thursday of the month wherever you listen – subscribe
so you won’t miss an episode.If you have questions about
(48:26):
cancer or comments about this podcast, you can email us at NCIinfo@nih.gov or
call us at 800-422-6237. And please be sure to mention Inside Cancer Careers in your query.
We are a production of the U.S. Department of Health and Human Services,
(48:47):
National Institutes of Health, National Cancer Institute. Thanks for listening.
Hello and welcome to Inside Cancer Careers, a podcast from the National
Cancer Institute where we explore all the different ways people fight cancer
and hear their stories. I'm your host, Oliver Bogler from NCI Center for Cancer Training.
In a recent episode, we talked to Dr. Satish Gopal from the NCI and Dr. Peter Kingham from
(00:24):
Memorial Sloan Kettering Cancer Center about the global cancer work of US-based organizations.
Today, we're talking to two leaders who work at
international organizations engaged in fighting cancer across the globe.
Listen through to the end of the show to hear our guests make some interesting
recommendations and where we invite you to take your turn. And of course,
(00:44):
we're always glad to get your feedback on what you hear and suggestions on what
you might like us to cover. The show's email is NCIICC@nih.gov.
It's a pleasure to welcome Dr. Lisa Stevens, Director of the Programme of
Action for Cancer Therapy, PACT, in the Department of Technical Cooperation at
(01:05):
the International Atomic Energy Agency, or IAEA. Welcome, Lisa.
LISA STEVENS (01:11):
Thank you so much, Oliver.
OLIVER BOGLER (01:12):
It's also a pleasure to welcome Dr. Andre Lopez Carvahlo,
Deputy Head of the Early Detection, Prevention and Infections Branch at the International
Agency for Research on Cancer, part of the World Health Organization. Welcome, Andre.
ANDRE CARVALHO (01:28):
Thank you, Oliver, pleasure to be here.
OLIVER BOGLER (01:30):
So of course there are institutions that fight cancer in every
country, right? Cancer centers, research institutions, hospitals, universities.
But then there are organizations that have a transnational mission. Let's start with you,
Lisa. Please tell us about the IAEA and its work in relation to cancer.
LISA STEVENS (01:50):
Sure, thanks Oliver. I'm delighted to tell you and all the listeners
because I think oftentimes when people hear about the International Atomic Energy Agency,
they don't naturally think about cancer and global health. But the division that I lead
within the technical cooperation program actually looks at cancer very broadly
and how we can integrate the technical mandate of IAEA, which is radiotherapy,
(02:16):
nuclear medicine, diagnostic imaging, into comprehensive cancer control.
So through the PACT program, we partner with WHO and with IARC that Andre is representing today to
conduct comprehensive cancer assessments of the surveillance, prevention, screening, diagnostics,
(02:38):
all forms of treatments, palliative care, survivorship care, with a team of both
international experts that are nominated by the three leading UN agencies for the IMPACT mission
that work closely with a team of local cancer experts. And they visit facilities, they collect
data, they develop a review report that has expert recommendations that are evidence-based that we
(03:05):
encourage the country to use to develop a national cancer control plan, strategic funding documents.
And in the case of IAEA, we have a technical cooperation program. So the countries can
utilize recommendations, again, within our technical mandate area to develop
programs for a two or four year cycle. So that's really what the Programme of Action
(03:27):
for Cancer Therapy does. We collaborate not only with experts outside of the IAEA, also
with our internal technical experts from nuclear applications, but also from safety and security.
OLIVER BOGLER (03:42):
Thank you. Andre, you work at IARC, which is part of the WHO. Can
you tell us about IARC's mission and the mission of the team that you are part of?
ANDRE CARVALHO (03:51):
Okay, sure. So, IARC is a specialized WHO,
the World Health Organization specializing in cancer research. So, and the way that works
with WHO is that we provide the evidence or gather the evidence and then WHO will do recommendations.
(04:12):
The main focus of IARC is on cancer prevention. And on that, we do many aspects of cancer
prevention. We have some pillars and some branches that will study what can prevent cancer,
why it occurs and how you can prevent. So we have the monographs that study substances or exposures,
(04:38):
risk factors and whatever that risk factors is carcinogenesis in different levels.
The other part of that that is a little bit new because this is coming from the seventies
is the handbooks. And the handbooks see the other way around. What we can do,
(04:59):
you know, to prevent cancer. So screening, right,
eating better, physical activities. So it's the other way that, you know, to prevent.
The third companion that we have is the blue books. That's about,
you know, the pathology and how you should describe and do a better diagnosis of cancer.
(05:20):
We have some groups or branches that study the mechanisms for cancer to occur. And then
we have also the branch that I am part of that we try to understand interventions
that can either do primary prevention or secondary prevention or cancer
(05:41):
screening. How that can be implemented you know, and what is the evidence that
that intervention would prevent or decrease the incidence and the mortality of cancer.
We still have a group that works in environment. They are the ones that write the word codes
(06:04):
against cancer. We have the European code, those original codes. We have the European code,
the Latin American code that is already up and running. And we're about to start the Asian code
and the idea is that to have the codes that are specific for the region so we can prevent cancer.
And one more aspect that we do is the GloboCan. It's the database that most
(06:31):
people use for cancer surveillance in the cancer burdening countries
is to see the incidence and mortality of cancer worldwide.
And in actual that's what we do.
OLIVER BOGLER (06:39):
That's a lot of things. Andre, you mentioned primary and secondary prevention. just
for those who are not prevention experts, primary prevention is when you are trying to prevent the
cancer from appearing in the first place. And then secondary is recurrence. Is that correct?
ANDRE CARVALHO (06:55):
No, secondary is kind of the cancer screening,
right? That you are preventing, you are trying to do early detection of cancer,
right? Or detect the pre-cancer lesions that you can treat. And this is really,
it's kind of, this is more evident for cervical cancer, for colorectal cancer,
that the screening tests can identify the potential presence of pre-malignant lesions that
(07:22):
if you treat it, the cancer will not occur because you're treating before, it becomes invasive.
OLIVER BOGLER (07:27):
So for example, if we think about smoking and lung cancer,
not smoking is primary prevention and getting a lung CT would be a secondary prevention.
ANDRE CARVALHO (07:36):
That's correct.
OLIVER BOGLER (07:37):
Okay, great. Thanks for those overviews. So Lisa,
I know that you've been involved in a lot of work over much of your career helping
countries develop cancer control plans. You co-founded the International Cancer
Control Partnership. Tell us a little bit about these cancer control plans that you
(07:59):
help countries stand up and how that connects to the work that we were just talking about.
LISA STEVENS (08:04):
Sure. So a national cancer control plan is really meant to be a
strategic document that all stakeholders within the cancer community, academicians, clinicians,
ministries of health, ministries of education, ministries of finance, can contribute to and
understand what are the priorities, often linked to what Andre was talking about, what are the
(08:29):
higher burden cancers in a specific country.What are the gap areas that need to be
addressed? I think in every cancer plan I've ever supported, cancer registries are always
in there as something to be strengthened, even if there's something that's existing, you know, it's
moving it to population-based or continuing to strengthen it. So it's really the strategic look.
(08:50):
And I think in the 2011 high-level meeting at the UN where NCDs were put on the stage,
there was a call for countries to have cancer plans. And this was really what inspired the
work that resulted in the International Cancer Control Partnership. We met on the margins of
(09:12):
the 2012 UICC World Cancer Congress in Canada and brought together interested stakeholders.
And the initial idea was that it would be for sharing information because we knew that there
were organizations like IARC and WHO and IAEA and American Cancer Society and the National
Cancer Institute and a whole host of others that were often, UICC, I can't forget them,
(09:38):
because they were in the co-founding of the ICCP.We were getting approached independently by one
country. And so there were three organizations working in a silo on a cancer plan. You know,
maybe with one person in the Ministry of Health, another group was approached by
someone in a civil society organization. And it was not an efficient use of anyone's resources at
(10:01):
the national level or in the global community. And so we created the partnership initially to
start sharing information. Who was doing what? Who was having missions, you know, in which country?
What cancer plans were publicly available?So the ICCP portal was born at that point
and is really an international resource, not only for published cancer and NCD plans, but also for
(10:27):
toolkits that planners can utilize in focusing on a specific area of the cancer control continuum or
a specific type of cancer. And so that's the work that we've been doing since 2012 to really bring
the community together. And its amazing to see how the partnership has grown, how we've brought
(10:48):
in either regional specific organizations or specific to a part of the cancer care continuum.
OLIVER BOGLER (10:57):
And just for the audience, UICC, that's the Union
for International Cancer Control. It's like a convener of experts in that field, right?
LISA STEVENS (11:06):
So yeah, UICC is an umbrella organization
for civil society entities around the globe.
OLIVER BOGLER (11:14):
Yeah. So Lisa at these plans, obviously, or maybe it isn't obvious,
each country needs its own plan because the situation about or the way cancer
presents and the cancer challenges are different in different countries, right?
LISA STEVENS (11:28):
Correct. And yeah, the situation on the ground is very
different in terms of what's available, what types of screenings are available,
what type of prevention is in place, the adherence to the Framework Convention on
Tobacco Control or taxation of cigarettes or alcohol. So it is very contextual.
(11:52):
And especially I know one of the things that we've been talking about with IARC over the years
is how do we incorporate cancer research into a national cancer control plan? Because that varies,
as you mentioned at the beginning, Oliver, each country has its own set of research institutions,
cancer centers, and how do they work together to not only implement the cancer plan,
(12:15):
but do research to advance the field. So yes, each country should have its own.
OLIVER BOGLER (12:22):
Because we've learned that what you learn about cancer in one country
may not be applicable to the way cancer is in other countries, right? And of course,
at this point in time, the science is very heavily based towards developed
Western countries like the United States, where much of the research has happened.
Andre, Lisa mentioned screening is an important part of these national cancer plans. And I
(12:45):
know that you're a part of the CanScreen5 project. Can you tell us about what that is?
ANDRE CARVALHO (12:52):
Okay, so IARC have been for a long time this platform that's the GloboCan for
incidence and mortality, right? And then in 2019, you know, as I was arriving at IARC, you know,
this platform was about to be launched, you know, by the branch that's led by Partha Basu. And,
(13:13):
you know, we, that's the idea is to collect information about cancer screening activities
around the globe, right? And also try to understand how countries are preparing themselves
in terms of the protocols, in terms of the performance indicators of those cancer screenings.
It's mainly at this stage based on the three cancer screening sites,
(13:37):
cancer sites that WHO recommends, that's cervical cancer, breast cancer, and colorectal cancer. But
the platform is built in a way that eventually the food tube can start collecting information
for lung cancer screening, prostate cancer screening, and so on. But it's a data repository
(13:57):
and it's interactive like the GloboCan about cancer screening activities around the globe.
OLIVER BOGLER (14:02):
Lisa, IAEA was founded to bring out the benefits of splitting the atom,
right? That was the original cause. And of course, one of the ways that atomic physics interfaces
with cancer is through radiotherapy. I wonder whether you could tell us a little bit about how
(14:24):
IAEA works to improve access to radiotherapy. Because it's an important component of the
therapy for many cancers. And it's not easily accessible in all parts of the world, right?
LISA STEVENS (14:37):
Right, so the agency has been supporting cancer technology for more than
six decades. In 2022, our director general really wanted to look at that equity and accessibility
that you mentioned, Oliver, and said, you know, I keep mentioning that there are 20 countries
(14:59):
in Africa with no public radiotherapy center, and we can't just keep quoting these numbers,
we really need to do something. And so he launched Rays of Hope, which is a coordinated effort and
very coordinated on the IAEA side between nuclear safety, the technical officers in the human health
(15:22):
division, the technical cooperation department that has that relationship with the country,
the PACT division and our procurement team as well to make sure that countries were prioritizing what
they needed in terms of education and training so that they had radiation oncologists, medical
(15:44):
physicists, radiologists, all of the specialists in country to be able to operate the machines that
we can support the procurement of. So we can support linear accelerators, PET scans, x-rays
in order to ensure that there's that link between diagnosis and in 50 to 60 percent of cancer cases,
(16:05):
they are indicated for radiotherapy at some point in the course of treatment and palliation.
So yes, there is a very concerted effort to make sure that we're linking our efforts,
we're working closely with the member state, understanding what their priorities are,
what they can absorb in terms of that capacity building and do they have the
(16:29):
infrastructure in place in a hospital to have radiotherapy or the diagnostic
imaging? Do they have the regulations in place to support, to ensure that it's safe,
that there's quality assurance and it can be delivered in a timely fashion?
OLIVER BOGLER (16:47):
Andre, access is also critical for screening, right? It's one thing to have a
hospital in a city where people can come to get screened, but many people can't access that. I
wonder if you could comment on this. And I wonder if you could also talk a little bit
about your prior work before you went to IARC. You and I had a chance to meet when you were leading
(17:08):
a really phenomenal prevention program at the Hospital De Cancer in Barretos in the state of
Sao Paulo in Brazil. What's your perspective on access to screening and how it can be improved?
ANDRE CARVALHO (17:22):
This is very interesting and important question, Because, you know,
this is one of the major barriers, right? It's kind of, you know, access in two senses,
right? Was that available and was that affordable, right? And those are, you know,
(17:44):
sometimes you have countries that have those two things, you know, just the big centers,
the big cities who have it and then it's difficult to access and expensive,
so it's not affordable. Sometimes you have that is affordable, but it's not close to
home. And those are the two things that are kind of more difficult when you have that.
(18:07):
As we have been noticed that, you know, and this come without surprise,
that when a country has universal health care, right, this is much easier to cover
because the affordability part of access is gone and then create availability is something with
mobile units is eventually, and some incentives for transportation, you can cut that barrier.
(18:34):
But when you don't have that in a low or low middle income countries, the part of affordability
is very important to be considered as well. We're just finalized to work in a tool that you're
to become public available, called Intervener.This tool, right, would we hope, many stakeholders
(19:01):
in a country or region use that to prioritize what their barriers to improve the screening. And this
tool links those barriers with proven evidence by interventions that you can use to overcome
the barriers that you prioritize. And we hope that that will help not only regarding availability and
(19:26):
affordability, but also other processes that need to be considered when is done, cancer screening.
And as you comment, I guess it's time for me to talk a little bit how I got
to IARC. I have a little bit of a different career on how I got here. As you comment,
(19:51):
I am originally from Brazil. And by training, I am a head and neck surgeon. And I have been a
head and neck surgeon back in Brazil for almost 18 years before I decided to go officially to public
health in terms of doing my master in public health in the University of Washington, Seattle
and be hired to IARC. It's been a little bit over five years now that I am part of the IARC team.
(20:19):
As I mentioned, I work in two cancer hospitals back in Brazil. The one that I did my medical
residency on I was a staff at for eight, nine years and then I moved to the Barretos Cancer
Hospital, that's where we become known, contacts, right Oliver, and eventually that hostel become
(20:41):
a city institution with MD Anderson, thank you to you. That when I went there to start the teaching
and research activities, one strategic decision was trying to see what would be the niches that
was quite unique for that hospital. And then that hospital in particular invest a lot in prevention,
(21:07):
in screening, and in palliative care. And those are the areas that you begin to explore
in terms of research and innovation and for the Master and PhD programs.
So that's where I begin to get linked to screening, to public health, and eventually
(21:29):
here I am at IARC in the global level, trying to promote cancer prevention.
OLIVER BOGLER (21:37):
Thanks, Andre. And I remember at Barretos, you had these big trucks that would
travel all around the rural areas. You were in the state of Sao Paulo,
but far from the city and in a quite rural area. And these trucks would provide services
to the populations, right? Cancer screening, particularly in women's cancer, correct?
ANDRE CARVALHO (21:55):
That's correct. So we would be the first big cancer center if you come from
the Amazon region, going to the big cities in the East coast in Brazil. And those trucks for
doing screening and they would do for mammography, Pap smear and for skin cancers, early detection,
(22:22):
they would go up to the Amazon region and come back and those trips usually would
take 60 days or so stopping in cities and try to promote early detection of cancers.
And one interesting way that that work is that every city that they stop, there was a commitment
(22:47):
from that city to send the patient to be treated in the cancer center, and that treatment would be
covered by the universal healthcare in Brazil. So nobody would be with a diagnosed but without
a timely treatment. And that was also something interesting to understand, how important it is to
(23:11):
think about all this pathway when we talk about early detection. As Lisa comment,
how important is given timely and standard cancer treatment mode to a better survival.
OLIVER BOGLER (23:25):
Right, screening without care makes no sense.
ANDRE CARVALHO (23:28):
That's it.
OLIVER BOGLER (23:30):
Lisa, the IAEA also has a Women's Cancer Partnership Initiative that focuses on
addressing the unique challenges of women's cancer globally. Could you tell us about that, please?
LISA STEVENS (23:42):
Sure, we launched that back in 2019 in partnership with the Islamic Development Bank.
And at that time, I had just joined the agency and we were really looking to again, raise the profile
of what the agency does in cancer diagnosis and treatment. And we found a very interested partner
(24:03):
in the Islamic Development Bank. They wanted to focus on women's cancers for their member
countries. And so we launched this back then.I will say with the advent of Rays of Hope,
there's the radiotherapy machines, even back in 2019 when we had the Women's Cancer Initiative,
(24:23):
the machines can treat any type of cancer. They weren't colored pink for breast cancer
or not allowed to be used for others. It was really about advocacy and awareness
raising that this form of treatment is really important for many of these cancers in women.
And so we've incorporated the coverage of breast and cervical cancer also with
(24:47):
the launch of the WHO Global Initiatives on cervix breast and childhood cancer to ensure
that Rays of Hope comprehensively looks at all of these cancers that need radiotherapy.
OLIVER BOGLER (25:00):
You’ve both mentioned partnerships in your discussions, and I wonder if you could
make a general comment. The organizations that you work for are inherently involved in forming global
partnerships, right? What is the significance of that work and how do you accomplish it?
LISA STEVENS (25:18):
Well, again, I think partnerships are essential in order to move anything forward.
And I think the PACT program is a great example because each of those UN entities,
if we just look at the UN, cover a different part of the cancer control spectrum. So alone,
(25:39):
IAEA sticking to its technical mandate can only do a certain part of it. But when
all three of us come together, it's really, it's a perfect partnership.
And I will say partnerships also do need some care and attention. And the three UN agencies
meet regularly, not only in person annually, but we have work plans and we get together
(26:04):
on specific topics to advance and make sure that our work is synergistic and not siloed.
Then we have partnerships with civil society. We are branching out more and more into the
private sector because we know that they are key partners. I mentioned Islamic Development Bank.
We're looking at other international financial institutions. And we have our strong partners
(26:29):
with member states who can contribute resources, expertise to our cancer work.
ANDRE CARVALHO (26:37):
And I guess if I might just compliment, think what Lisa brought,
we are the three UN agencies that has some activities in cancer. And we are complementing
each other. So I think this is a good example how we at that level interact. But also
(26:58):
being in this platform allow us to also interact not only with other organizations, but also
with governments. In a sense that, if you think about doing implementation research, most of our
research, even though it's still research, we have a lot of many times the government involved and it
(27:25):
can use the health system. So once the results are positive from those studies, the chance
of that to get implemented in the field is way higher because the major stakeholder that's the
policymaker can be part of that. And this is quite unique when we are in these global organizations.
OLIVER BOGLER (27:50):
So you've both been in your current positions approximately five years, and I wonder
if I might entice you to reflect back over those five years and also to project forward maybe five
years in terms of the work that you're doing. What have you seen, what have you accomplished,
and where do you think you'll be in five years in terms of your work? Lisa, let's start with you.
LISA STEVENS (28:12):
So gosh, coming into it was quite a shock to join a UN agency. thought after having
worked in US government, there are lots of structures and infrastructures and bureaucracy
here, but really just building a team and again, strengthening the partnerships both
(28:35):
within IAEA and making sure that the technical inputs that we needed to do
the impact reviews and also the NCCPs, the work because we had recently moved
locations within the agency to technical cooperation. So really aligning ourselves
with the work of the other divisions in the technical cooperation department
(28:58):
was important to me over these first few years as I was getting integrated into the work.
Where I'll be in the next five years, again, I think the focus on cancer as a global epidemic is,
I mean, it's time really for countries to focus, make sure that they understand
(29:22):
what their gap areas are, develop a national cancer control plan, a strategy for addressing,
looking at common risk factors so that all NCDs can be reduced in countries. So I think
that they'll continue to be these requests for the plans, the assessments, and hopefully as
(29:43):
programs like Rays of Hope and the WHO Global Initiatives really again shine the spotlight,
but also raise expectations and raise the level of requests that we can support through bigger
partnerships and with the support through these strategic funding documents so that a country
(30:03):
really can mobilize either national resources or international resources to address the challenge.
OLIVER BOGLER (30:10):
Thanks, Andre.
ANDRE CARVALHO (30:11):
Yes. So for me, it was my first exposure to the global health scenario,
if you will. I have been doing international collaborations for quite a long time back in
Brazil, but it's different when you got into an institution that's global per se. So I think
(30:31):
the first years was trying to understand the same thing that Lisa experienced in her agency. Is that
how the agency works, what is the mandate of the agency, how is the interaction between the three
UN agencies and how can we interact globally in terms of who can we partner with and how. So there
(30:55):
is a lot of understanding of the navigation, but once you understand that, you begin to take the
whole advantage of being in this global platform.I'm in a stage now that what I want for the next
five years is do more of what I'm heading to, is trying to see how evidence-based interventions can
(31:21):
be truly implemented, taking in consideration the local context. Because we see more and more, when
this has been happening, results from research that's a controlled environment. usually don't
have the same benefit when we try to implement in the health system or in the real world. And try
(31:46):
to understand what needs to be adapted, taking to consideration the context of the region or
the country that we're trying to do that, or what are the new gaps that was not evident
in the research and how to overcome that. This is kind of, for me, is a very exciting place
to do research. So we can bring to the real world interventions that can benefit cancer prevention.
OLIVER BOGLER (32:15):
Great, we're gonna take a break. And when we return,
we're gonna learn how our guests got into the work that they're doing now.
[music]Calling all global cancer researchers!
Now is the time to share your original research designed to reduce the burden of cancer in low-
and middle-income countries. Submit your scientific session and abstract proposals
(32:39):
for the 13th Annual Symposium on Global Cancer Research today. From exploring cancer health
disparities to implementing and evaluating evidence-based cancer control interventions,
ASGCR provides a forum for investigators to share science-based initiatives for cancer control.
Know an outstanding professional who embodies virtue and eminence in cancer research,
(33:01):
training, or practice? Nominate them for the Rachel Pearline
Award and recognize their notable contributions to global oncology.
The deadline to submit proposals for abstracts, sessions, and Pearline
Award nominations is January 17, 2025. Visit events.cancer.gov/cgh/asgcr to learn more.
(33:23):
Keep up with new and innovative research in global oncology at the
bi-monthly Global Cancer Research and Control Seminar Series – returning in
2025! Learn from investigators and cancer control experts working around the world
and engage in conversations on approaches to addressing cancer morbidity and mortality.
Find more information about the Global Cancer Research and Control Seminar Series,
(33:48):
new funding opportunities, cancer control resources, and more on the NCI Center for Global
Health website cancer.gov/globalhealth. That is cancer.gov/globalhealth.
[music ends]
All right, we're back. I'm always curious about what first attracts
people to the field of biology, medicine, and biomedical sciences. Let's start with you,
(34:13):
Andre. When did you know that you wanted to do medicine and science?
ANDRE CARVALHO (34:18):
Okay, I guess that came early on in my case,
right? My dad was a pediatrician. So you know, even though he was the second of his family,
he had a brother that was also a doctor. You know, that's not kind of many generations, if you say,
but in my mind, you know, I would be a doctor when I grow up and that's eventually happened.
(34:45):
But I like it that, you know, it's kind of it was not something that I was pushed to.
And I left home to go to med school and I really enjoyed my time at med school and
trying to understand how the body works and things like that and diseases and how to treat.
Finally, I make my decision to go for surgery and eventually for head and neck surgery, specifically
(35:12):
in oncology. And I got lucky to get a family that support all my trajectory, but also to have a
mentor, you know, when I started in the field that, you know, from the beginning, you know,
he institution, he said, you know, the importance of being part of institution, the importance of
(35:33):
doing research and the importance of implementing the findings of research, learn from research,
and so on. So that's when, you know, I begin to go for the field of research in the medical field.
OLIVER BOGLER (35:47):
I've got to ask, why surgery?
ANDRE CARVALHO (35:51):
It's a funny, you know, that's one influence that came from my dad actually,
right? Because it was very interesting. was having coffee with him and I say,
I'm not sure if I will do cardiology or surgery. And then he told me, you know,
I saw surgeons that become cardiologists, but I never saw cardiologists that become a surgeon. So
(36:14):
can always go back if you go to one track, but not to the other. And then I made my decision,
but know, first year into the surgical residence, I was over about thinking of being a cardiologist.
OLIVER BOGLER (36:27):
Okay, you were committed. Interesting. Lisa,
how did you first know that you wanted to go into science?
LISA STEVENS (36:34):
Yeah, I was as Andre was talking, I was trying to think back to when I knew,
but I mean, probably even before high school, but definitely in high school,
I just gravitated towards the sciences. And I went to a small liberal arts school. So even though I
had the liberal arts training, I was a biology major with a Spanish minor and then worked for a
(37:00):
couple of years before I went back to grad school.I went to University of Maryland and was able
to connect with a lab at the National Cancer Institute. So actually did my PhD research at NCI.
And then after I defended my thesis, I decided that I wanted to leave the lab and it wasn't
(37:24):
for lack of love of science. actually, still love science. I like the thought process. But for me,
the lab was a very solitary endeavor. You did a lot of work alone and it didn't meet
my personality. And so what I felt as I moved into the office of the director of NCI in three
(37:48):
different offices there, that I was able to support science in a different way. And I'm
very comfortable with that decision. And the last center that I was in at NCI was the Center for
Global Health. And I didn't pursue that. That was more of there was an opportunity. And I thought,
(38:13):
well, everyone's talking about global health. This was in 2012. And I thought
it sounds really interesting. Yeah, it's been a whirlwind since then.
OLIVER BOGLER (38:24):
I mean, it's quite a distance from molecular and cell biology where you started with
your PhD, the same kind of science that I did when I was still active. What skills that you had in
that early part of your research career have you been able to take into this new arena with you?
LISA STEVENS (38:41):
I mean, I think it's really just understanding the science. I don't follow it
as closely as I did when I was doing my research, but I can read papers and understand what's going
on in that inquiry. I think is one of the skills you learn as a scientist in the lab
(39:01):
that if you continue it, your questions might be slightly different. But if you still have that,
if you approach things with that curiosity, then I think it's helpful no matter what field you're in.
OLIVER BOGLER (39:16):
Andre, you described how you started in medicine and surgery and then you
started getting interested in research. Tell us a little bit more about that journey and
how that informs your current role. I understand you're not actively practicing surgery right now,
right? You're focusing on your public health work, your cancer prevention work.
ANDRE CARVALHO (39:35):
That's correct, right. When I moved to IARC, IARC is a research institution.
so I gave the part of the practicing medicine part of my career. So as I comment right,
I had, you know, this mentor that was the head of the head of the surgery department
(39:58):
at AC Camargo Cancer Hospital back in Brazil. And, you know, I started research kind of late,
not as a medical student, but, you know, into my medical residency, you know,
and I got, you know, very passionate about try to understand when you put evidence together,
(40:21):
when you put numbers together, how you get this bigger picture of what's going on with
the patients. And if you do treatment A or B, how different are their survival?
And then I begin to learn actually more and more from results of the research that I was doing,
(40:42):
looking at the medical records from head and neck cancer patients in the hospital. And that
just began to grow in terms of, I ended up, you know, doing my PhD supervised by him, Dr. Paulo
Kowalski. And then eventually I went to my postdoc and my postdoc was very interested in it. I did
(41:05):
a postdoctoral fellow at Johns Hopkins. And that was in molecular biology trying to find, you know,
methylation markers in saliva to do early detection for head and neck cancers. Because
at that point in Brazil, 80 % of the cancers, head and neck cancers were in advanced stage.
And I think also that triggered, the whole idea is that, that came along and how can we
(41:30):
have a different patient that is diagnosed in early stage that you can provide less
treatment with less morbidity, but with higher chances of cure just because you
identify that cancer in the early stage. And that's kind of what become to be involved in
(41:53):
my experience at Barretos Cancer Hospital with screening. And my move to do a Masters
in Public Health outside Brazil to try to work more in global health.
OLIVER BOGLER (42:10):
Fascinating pathways you both had. I wonder as my final question,
what advice you might give to someone who's listening, who's perhaps both interested
in the work that you do today, but also the career paths you took and who might
also be interested in working at a global agency. What would you say to them, Lisa?
LISA STEVENS (42:29):
I think I would say be open to opportunity. So the opportunity to work at
the Center for Global Health was not something that I had envisioned. And even opportunities
when you're an undergrad or in graduate school or medical school. I think it's just recognize and
(42:51):
sometimes decisions that might not go your way might provide other avenues for you to pursue.
OLIVER BOGLER (42:57):
Thank you, Andre.
ANDRE CARVALHO (42:59):
I agree, it's kind of being open-minded. And sometimes opportunities come
to you and you just take advantage of that. Be curious, know, want to learn more. You need to
be out of the comfort zone, right? You need to understand that when you go for global health,
(43:22):
there are things that you need to understand about culture and that's going to be my comment later
on, because we are going to work and collaborate with people from all around the globe. And that
is fascinating, but also a challenge. So we can start with international collaborations
(43:43):
and get a small taste of it. And as soon as you get, even in your country, a chance to be
in a global organization, this can be also a path for you to go in the direction of global health.
(44:04):
[music]
OLIVER BOGLER (44:04):
Now it's time for a segment we call Your Turn, because it's a chance for
our listeners to send in a recommendation that they would like to share. If you're listening,
then you're invited to take your turn. Send us an audio recording with a tip for a book,
a video, or a podcast, something that you found inspirational or amusing or interesting. You
can send these to us at NCIICC@gov, and we'll play it on an upcoming episode.
(44:29):
But now I'd like to invite our guests to take their turn. Let's start with you, Lisa.
LISA STEVENS (44:35):
So my turn, I'm going to recommend a podcast called The Lazy
Genius. And it was recommended to me by a woman I work with here. It's … I don't
even know if I want to call it advice, but practical ways of managing, making decisions,
organizing. And some things are relevant and some things aren't, but they're short,
(44:55):
you know, maybe 20 or 30 minute podcasts. And I often send them to friends of mine,
if there's a particular topic I think they might be interested in.
OLIVER BOGLER (45:04):
That's a great recommendation, Andre.
ANDRE CARVALHO (45:06):
Yeah, I'd like to suggest a book, The Culture Map by Erin Meyer. And it
talks a little bit on how people think, lead and get things done across country and try
to see differences, cultural difference in communication, leadership, decision-making
and giving feedback. This is a book that was suggested for me when I was starting at IARC and
(45:32):
it's fascinating because when you go for global health and you have international collaborators,
you kind of need to understand the culture. Otherwise, you might not accomplish what you need.
And even though, you know, of course, you know, the book has a little bit of a stereotype,
you know, trying to, to, to, you know, say a country would act like that, and you know,
(45:55):
that's not true, but also give, you know, very much this cultural awareness, you know, even if
This is not exactly how all the country that you're visiting would behave. You know, opens
your mind to try to understand that they will not behave the way you think they would based on your
own culture. It's about, you know, cultural awareness and try to understand difference
(46:20):
and how to collaborate and bring together different cultures to accomplish something.
OLIVER BOGLER (46:25):
That's a great recommendation. I we live in a flat world and we meet people
from all over and that is our strength in science and medicine. So fantastic.
I'd like to make a recommendation as well. It's for a website. It's called thestorygraph.com.
It's a great place for people who love books and love data. And I love both. With StoryGraph
(46:46):
and a bit of effort, you can track your reading. You can set annual goals and
get great recommendations for the next book.Also, it's really cool. It's AI powered and,
regular listeners will know that I am AI obsessed. But the AI here gives you
a personal recommendation based on what you've read. So it will take a book and it will give you
a paragraph on why it thinks it's a really good read for you or maybe why it's not. And that is,
(47:10):
has been very helpful to me in, sorting through the many, many books that one could read. And,
it lifts the veil a little bit on why you're being recommended things, right? lot of recommendation
sites just say this is recommended to you, but you don't really understand why. I think that's really
fabulous. Anyway, check it out and you can import your data from other similar services as well.
(47:32):
Well, I want to thank both of you, Lisa, Andre. Thank you so much for your time
and for your insights and for sharing your work and your careers with us.
LISA STEVENS (47:40):
It was a pleasure.
ANDRE CARVALHO (47:42):
Thank you so much for having me.
OLIVER BOGLER (47:45):
That’s all we have time for on today’s episode of Inside Cancer Careers! Thank
you for joining us and thank you to our guests.We want to hear from you – your stories,
your ideas and your feedback are welcome. And you are invited to take your turn
and make a recommendation to share with our listeners. You can reach us at NCIICC@nih.gov.
(48:05):
Inside Cancer Careers is a collaboration between NCI’s Office of Communications and Public Liaison
and the Center for Cancer Training. It is produced by Angela Jones and Astrid Masfar.
Join us every first and third Thursday of the month wherever you listen – subscribe
so you won’t miss an episode.If you have questions about
(48:26):
cancer or comments about this podcast, you can email us at NCIinfo@nih.gov or
call us at 800-422-6237. And please be sure to mention Inside Cancer Careers in your query.
We are a production of the U.S. Department of Health and Human Services,
(48:47):
National Institutes of Health, National Cancer Institute. Thanks for listening.
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