In this installment of The ASCO Post’s Living a Full Life series, guest editor Jame Abraham, MD, FACP, spoke with Elisabete Weiderpass, MD, MSc, PhD, a Brazilian cancer researcher who is a naturalized Swedish and Finnish citizen. She is an expert in cancer epidemiology and cancer prevention. In January 2019, Dr. Weiderpass took office as elected Director of the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization (WHO), based in Lyon, France.
ELISABETE WEIDERPASS, MD, MSc, PhD
On the rising burden of global cancer: “We have to do more on the global level to decrease the unnecessary suffering due to preventable cancer. We must understand that between 30% and 50% of all cancer cases are preventable….”
On female leadership: “We should not take gender equality as a given. There are many challenges that stem from our training, because many women, at least in my generation, were not trained as leaders…. That needs to be addressed at the systemic level, beginning in the educational system.”
On the future of oncology: “Oncology is absolutely fundamental as a medical science, and it is imperative that we encourage more people to enter this noble field, not only clinical oncology, but also the areas of cancer prevention and cancer epidemiology, where there is a massive need for dedicated professionals.”
Family First: A College Degree
Dr. Weiderpass grew up in São Paulo, the most populous city in Brazil, where she completed her basic and secondary school years. Her family was decidedly lower-middle class, blue-collar working stock, so a future with a college degree didn’t appear plausible. However, given her drive to learn, Dr. Weiderpass’s parents encouraged her to continue her educational journey to attain a college degree. “It was truly wonderful to be part of a generation of working poor kids who were given the opportunity to attend universities and help change the future direction of their families through access to higher education,” said Dr. Weiderpass.
According to Dr. Weiderpass, her passion for medicine matured during her teen years in high school. Her first loves were music, languages, and literature. “I played several instruments when I was a child and adolescent. I was also very much interested in literature and languages and actually began serious studies in Latin American literature. But then, as often happens, my worldview changed, and I decided to move on to medicine. I think it was the right professional choice for many reasons, most notably an opportunity to make a difference in public health,” she said.
Hard Work Pays Off
Dr. Weiderpass’s hard academic work at the Federal University of Pelotas, in Rio Grande do Sul, Brazil’s southernmost state, paid off. Medical schools in Brazil follow the European model of a 6-year curriculum, divided into three cycles of 2 years each. The first 2 years are called the basic cycle, where students learn the basic sciences, such as anatomy, psychology, and immunology. The next 4 years encompass the clinical and internship cycles. The medical programs require a rigorous combination of classwork, research, and hands-on clinical practice.
Asked about her choice of Federal University of Pelotas, Dr. Weiderpass explained: “During my undergraduate work, I had developed a keen interest in public health, especially on the global scale. The Federal University of Pelotas was very prominent in Brazil in that area. This was all taking place during the heyday of the Brazilian Association of Collective Health, which was addressing the social determinants of diseases and established an additional line of research focused on health planning and management. Moreover, a research group in epidemiology, led by Prof. Cesar Victora and other pioneers at the University of Pelotas was making news in its efforts with community medicine, public health, and epidemiology. The professors leading these efforts were all bright and charismatic. I was 20 and very idealistic, so the idea of combining medicine with social work and social action, and basically, the aspiration to change not only the lives of individual patients but whole communities, was compelling to me,” said Dr. Weiderpass.
A Passion for Global Health
After attaining her medical degree, Dr. Weiderpass remained at the Federal University of Pelotas, where she completed a master’s degree in epidemiology. “My interest in public health and cancer epidemiology began to intensify, and I decided to go for a PhD, because I wanted to go into cancer epidemiology and cancer in public health instead of the usual clinical oncology path. I went first to France—to the IARC—to do a 1-year internship in cancer epidemiology. From there, I went to Sweden to do the PhD in cancer epidemiology,” said Dr. Weiderpass.
Asked about mentors who helped pave her path in cancer epidemiology, Dr. Weiderpass replied: “In Brazil, I had this tremendous privilege to work with three scientists who I admire profoundly. One was Prof. Kurt Kloetzel, a German-born physician who was the mastermind behind the training in community medicine and public health in the south of Brazil. He was a brilliant clinician-scientist and a great mentor. What I learned from him has remained with me throughout my career.”
She continued: “Then I had the privilege to work with the person who I believe is one of the most prominent epidemiologists in Brazil, Prof. Victora, who worked at UNICEF [United Nations International Children’s Emergency Fund] and was the creator of the postgraduate program in epidemiology in the south of Brazil, as well as with other outstanding scientists such as Prof. Fernando Barros and Prof. Luis Augusto Facchini. When I moved to Europe, I worked with Prof. Hans Olov Adami, who was at the Karolinska Institute in Sweden as well as Harvard University for many years. He founded the cancer epidemiology training program at Uppsala University and then at the Karolinska Institute. I worked with him for decades, and we still collaborate.”
GUEST EDITOR
Jame Abraham, MD, FACP
Dr. Weiderpass summed up: “So, I had the opportunity to be mentored by brilliant clinician-scientists who made a mark in their respective time periods by opening up new areas of education and training in Brazil and Sweden. The work they did marked an epoch in epidemiology and cancer epidemiology. My career was accelerated by a genuine curiosity about cancer problems affecting populations—and where these problems were occurring—combined with an interest in putting together resources in the different settings to conduct studies that would be relevant to those issues. I was fortunate to have fantastic mentors; without them, I wouldn’t be where I am today.”
The World Becomes Her Stage
While doing her doctoral studies at the Karolinska Institute, Dr. Weiderpass studied in depth the etiology of endometrial cancer. “After the PhD training period, I did postdoctoral work in Sweden, before moving back to France at the IARC/WHO, where I served as a senior scientist for 3½ years. I then returned to the Nordic countries and worked part-time academically, as well, at the Cancer Registry of Norway, Institute of Population-Based Cancer Research, whose main areas of research are screening, early detection, etiology, and prognostic factors. In that sense, it is more of a clinical epidemiology path, which stretches beyond academic research and seeks ways to improve the country’s public health. The Cancer Registry of Norway is a leading institution in performing studies answering questions about vaccination programs, early cancer detection, as well as cancer screening programs implementation that have an impact far beyond Norway,” said Dr. Weiderpass.
In the early 2000s, Dr. Weiderpass started to work in sub-Saharan Africa, a collaboration between the Karolinska Institute and IARC/WHO. According to Dr. Weiderpass, those experiences helped to inspire a career focused on reducing inequities in cancer diagnosis and treatment. She collaborated in the development and delivered training programs for Ugandan clinician-researchers in a joint PhD program between the Karolinska Institute and Makerere University, focused on infectious diseases and cancer. Her own research at the Karolinska Institute was focused on the epidemiology of cancer—in particular, women’s health, with a focus on identifying risk factors for certain forms of cancer.
In 2007, Dr. Weiderpass was made Head of the Genetic Epidemiology Group at the Folkhälsan Research Center in Helsinki, where she spent more than 10 years part-time, during a period that she was also active in research groups on cancer epidemiology at the Arctic Universiity of Norway in Tromsø, Norway.
Opportunity Knocks, Again
Dr. Weiderpass’s career in global health and cancer epidemiology took another turn in 2018. “I had the opportunity to return to the IARC, not as a scientist, but as Director. I thought this would give me the opportunity, in a way, to pay back all the gifts I received throughout my own training to the next generation of junior colleagues, as well as to mid-career colleagues, by serving them in the position of leadership at IARC,” said Dr. Weiderpass.
She continued: “I was honored to be chosen as the first female Director of IARC. I started in 2019, and my first mandate finished up this year. Then, in May 2023, I was elected again unanimously for a second mandate by the governing council—that is, our board, which is composed of 27 participating states or countries. That means I will start my second mandate in January 2024, and I will work there until the end of 2028. I’m very excited about the challenges and opportunities that lie ahead.”
Priorities as IARC Director
Asked to elucidate her central priorities as IARC Director, Dr. Weiderpass commented: “We divide our activities into four main priorities. The first would be what we call data for action, which means compiling data about cancer incidence, mortality, and survival, including differences across social status; inequalities in cancer; geographic distribution; time trends; and quantification of the burden of cancer as a global pandemic. The purpose is to combine all the intelligence about cancer in worldwide databases that we share as open assets with all stakeholders. And that can answer basic questions: Where are we today in terms of cancer incidence, mortality, prevalence, and survival? Where are we going in the future? And what can we do to hopefully reduce this cancer burden? That’s our first pillar.
The second pillar is built on cancer research, answering the big question, what causes cancer? What are the genetic, epigenetic, metabolic, and environmental susceptibilities to cancer? And then our third pillar is to understand those causes and put that understanding into prevention models, in terms of primary prevention, changing laws and regulations at the national level to decrease exposure to carcinogens in vulnerable populations, as related to lifestyle but also occupational exposures, environmental exposures, and so on.”
She continued: “And our fourth pillar, which we call knowledge mobilization, involves the compilation of knowledge in several series of books that we’ve published. One series is the Monographs on the Identification of Carcinogenic Hazards to Humans, which is a little bit like an encyclopedia of carcinogenicity exposures that are related to various populations. Other series are the WHO Classification of Tumours and the Handbooks of Cancer Prevention. We also offer educational courses, including online training particularly for lower middle–income countries and several intensive courses given annually—one in Lyon, a new one in China, and we probably will be starting yet another one in Brazil for our Brazilian and Latin American colleagues. So, we have quite a lot on our plate, but it is a very rewarding job because everything we do is geared for action against cancer.”
Lost Opportunities in Prevention Cause Frustration
During the conversation, Dr. Abraham noted that despite advances, there must be a degree of frustration, given the rising burden of global cancer. Although passionately optimistic, Dr. Weiderpass conceded that frustration was part of the job. “We have to do more on the global level to decrease the unnecessary suffering due to preventable cancer. We must understand that between 30% and 50% of all cancer cases are preventable, with that variation being the result of different exposures to carcinogenic substances in different countries and among different ages, different sexes, different ethnic groups, and so on. But that’s very good news that with this knowledge, now more than ever, we can implement prevention strategies properly and avoid greater incidence and mortality.”
She added: “We have major opportunities with some cancers. For example, we know for a fact that we have the opportunity to eliminate cervical cancer as a public health problem within this century with vaccination, screening, early detection, and, of course, proper treatment. We’ve seen similar rays of hope in certain pediatric cancers. The frustration is that despite all this knowledge, we are still lagging behind. Less than about 40% of the global population is protected by at least one effective measure of smoking control—the vast majority of the world’s population, largely in the developing world, is still exposed to deadly tobacco products and smoke. So, in a way, we have the knowledge to stop this killing pandemic, but we don’t yet have the political power or will to make a global concerted effort against the industries that are promoting these cancer-causing drugs and their byproducts.”
Personal Life: Achieving Balance
How does a super-busy leader in global oncology balance her work and personal life? “First off, I’m a very happy person, and I think I am such a lucky person because I’ve combined my dream scientific vocation with a wonderful family life. My husband, Prof. Harri Vainio, MD, PhD, is a toxicologist and has worked as a cancer researcher in earlier stages of his career. He has also worked in occupational health and public health for many years. So, we have a convergence of professional interests, and it has been a very rich life for us working in parallel—mostly in very different organizations—but we have been able to support and inspire each other throughout our common lives.”
Asked about attaining a work-life balance, Dr. Weiderpass said: “One thing I don’t compromise on is proper sleep, which for me is vital. When I fail to get the sleep I need, everything else collapses to some extent. And I try to have a very simple life, and try to have a clear focus and goals in mind, and then make time for the big stones in life: work, family, and health. Another principle is to try to be fully present—physically and mentally—in every moment, dedicating my full attention to every person that I meet and spend time with.”
She added: “Whenever I visit a city where I have not been before, I always try to listen to some local music. In the Nordic countries, where I usually spend the summers with my family, there are several music festivals, and we try to attend as many as possible. And in terms of literature, I’m always involved in a good book. So, it is a rich life, all around. And I make sure to find ways to keep centered.”
First Female Director
What advice would the first female Director of IARC give to young women pursuing a career in science? “In terms of female leadership, yesterday I had the opportunity to see a theater piece called A Doll’s House by Henrik Ibsen; it was written in 1879, but it reminds us of how the role of women has evolved in the past decades. The female gap is quite evident in leadership positions in oncologic hospitals and cancer research institutions all over the world.”
Dr. Weiderpass continued: “We should not take gender equality as a given. There are many challenges that stem from our training, because many women, at least in my generation, were not trained as leaders. We were trained to be followers, not leaders. That needs to be addressed at the systemic level, beginning in the educational system. All human beings have the capacity to do a great job if they are determined, motivated, and committed, regardless of sex or gender or any other physiologic or physical characteristics.”
Prolonging High-Quality Life
When the discussion turned to the vital area of survivorship, Dr. Weiderpass commented: “More and more the oncology community and the cancer prevention community are turning our eyes to the massive number of survivors. And that’s good, because people with cancer are living longer lives. But we still need a lot more progress in this very nuanced clinical area. I think there’s also an awareness that many of the new drugs, even when they do prolong life, are costly and have very unpleasant side effects. Balancing the risk-to-reward equation is tough but necessary.”
A Final Thought or Two
Dr. Weiderpass shared some closing thoughts: “There will be about 30 million new cancer cases per year by 2040. There’s so much work to do, and this is such an important area. Oncology is fundamental as a medical science, and it is imperative that we encourage more people to enter this noble field, not only clinical oncology, but also the areas of cancer prevention and cancer epidemiology, where there is a massive need for dedicated professionals. It’s a wonderful career for early scientists or early clinicians looking for something really meaningful to do. It’s a good path, and there’s going to be no shortage of jobs. The only thing we know for sure, unfortunately, is there is going to be an increased need for cancer professionals to handle the oncoming burden of disease in years to come.”
