Cancer prevention : an interdisciplinary approach across gender and cultural divides

 Cancer incidence is on the rise worldwide, posing a rapidly increasing humanitarian and economic challenge. Men and women have different cancer susceptibility and survival across different parts of the world, and respond differently to therapy.  How environmental, hormonal and nutritional factors act in concert with genetic and epigenetic determinants of cancer development is poorly explored.

The International Cancer Prevention Institute (ICPI) is a unique educational and research platform for addressing these issues through interdisciplinary efforts and strong personal relationships among participating laboratories and institutions.

Changes in known and unknown determinants of cancer risk modify the sex- and age-specific incidences of cancers. At the same time, improved methods of early detection and increased survival of cancer patients boost the number of cases, with an urgent need of improved efforts in cancer prevention, in its three main forms:

I. primary cancer prevention, at the level of various human populations, aimed at reducing overall incidence of various cancer types;

II. secondary cancer prevention, at the level of individuals, aimed at early detection of premalignant and confined malignant lesions and identification of high risk lesions in need of more radical treatment;

III. tertiary cancer prevention, at the level of cancer patients, aimed at preventing cancer recurrence and appearance of “secondary primary tumors” after removal of the primary cancer.

From its base in Lausanne, Switzerland, ICPI strives to pioneer innovative international efforts in primary, secondary and tertiary cancer prevention. ICPI activities are structured along three main axes : (i) education and training, (ii) research; (iii) public outreach.

 Currently, most cancer research focusses on mechanisms of tumorigenesis to identify molecular targets for therapy rather than to prevent the disease. Measuring success in cancer prevention is difficult and funding agencies provide relatively limited support because the growing economic impact of preventing the disease is still poorly appreciated. To overcome these issues and to shift the research paradigm, it is essential to train a new generation of scientists aware of challenges and opportunities in cancer prevention and endowed with an interdisciplinary view on how to address them.

            Cross-disciplinary educational efforts for doctoral and advanced master studies in cancer prevention are rare. To link research efforts in basic molecular and cellular biology with epidemiological and environmental studies, is key for decreasing risk of various cancer types and minimizing clinical problems resulting from under- or over-treatment of patients. Equally important is dissecting the role of epigenetic and genetic determinants of biological responses, such as sex hormones and chromosomes, for personalized efforts to detect and prevent malignant conversion of premalignant lesions and potentially cause their complete resolution.

            In depth training and education are intimately linked with participation in cutting-edge research efforts. Research programs at ICPI are focusing on breast and skin cancer, as benchmarks of major clinical significance for primary, secondary and tertiary cancer prevention in organs with reproductive and non-reproductive functions, respectively. Other cancer types will be considered as ICPI further develops, such as colon, liver and prostate cancer.

            Research results can take decades to translate into effective public health measures. In a rapidly developing world, it is essential to close the gap between basic and clinical researchers and operators in the public health and policy making sectors. Another activity of ICPI is hence to foster communication skills and outreach activity of participating members and their students with people with different backgrounds and the general public. This will be achieved through informational meetings, local workshops and discussions.

The following topics will be addressed as part of ICPI teaching, research and/or outreach activities, including, in addition, a personalized service for sex hormones measurements :

1) environmental pollutants and food products as endocrine disruptors

2) individual differences in levels and metabolism of endogenous steroid sex hormones (estrogens, progestogens, androgens)

3) exogenous modulation of sex hormones levels and activity (hormonal contraception, hormone replacement therapy and hormone ablation therapies, induction and maintenance of gender dysphorias)

4) interplay between sex hormone signaling and cancer stem cells, the tumor microenvironment and systemic factors such as the immune system and metabolism

5) modulation of sex hormones signalling plus/minus epigenome- and immune-targeting drugs as novel modalities of secondary and tertiary cancer prevention.

Gender and Sex : time to bridge the gap ?

The incidence of many cancer types arising in organs with non-reproductive functions is significantly higher in male than female populations, with associated differences in survival (Clocchiatti et al., 2016). Equally important, for secondary and tertiary cancer prevention, are the substantial differences in drug toxicity and response between the two sexes.

Together with occupational and/or behavioural factors, molecular differences between the two sexes, at cellular and organ/systemic levels, are likely to play a determining role. The focus of this program is on the combined impact that sexual hormones and sex chromosomes can have in this context on susceptibility to various cancer types and drug response.

The aim is to establish a multi-disciplinary forum for the generation of novel conceptual frameworks and approaches to these complex issues. Experts in human development and genetics, cancer cell biology, metabolism and immune system are being brought together with epidemiologists and clinical investigators to address the following topics:

  1. Genetics and epigenetics of sex determination
  2. Environmental impact
  3. Drug toxicology and pharmacological approaches (immunotherapy)
  4. Societal challenges and opportunities

Initiatives :

Master Program of Advanced Studies in Gender Medicine and Cancer Prevention;

Meetings and Workshops;

Analytical Services