Cancer research that matters

q&a Cancer research that matters Elisabete Weiderpass is an expert in cancer epidemiology and cancer prevention. She has been the Director of the International Agency for Research on Cancer, the specialized cancer agency of the World Health Organization, since January 2019. She spoke with Nature Cancer about 2021 and the years ahead. ■■2021 has been another difficult year for the world, with the COVID-19 pandemic still not under control. What was the continuing impact of the pandemic on cancer research and patients with cancer? EW: In response to the pandemic, the International Agency for Research on Cancer (IARC) assessed the impact of COVID-19 on health systems at the national level and looked at the outcomes of current and future patients with cancer. IARC also participated in the COVID-19 and Cancer Global Taskforce and became a founding partner of the COVID-19 and Cancer Global Modelling Consortium, with a remit to co-develop tools and provide evidence to aid decision-making during and after the pandemic. In this manner, IARC was able to clearly assess the negative impact that the pandemic has had on cancer health systems and cancer outcomes. COVID-19 has interrupted registry operations, disrupted screening programs, and delayed patient diagnosis and initiation of treatment. The long-term, large-scale cancer aftershock will be strongly felt in the coming years. More precisely, IARC scientists found that two thirds of all population-based cancer registries surveyed reported disruptions to their operation during the early phases of the COVID-19 pandemic. In addition, inequalities in the cancer burden were exacerbated, with negative impacts reported more commonly in countries with a low human development index (HDI) than in countries with a high HDI. Furthermore, IARC assessed the impact of the COVID-19 outbreak on cancer screening programs in 17 low- and middle-income countries (LMICs) within different HDI categories. Lockdowns were imposed in all but one of these countries. Screening was suspended for at least 30 days in 13 of the countries, and diagnostic services for screen‐positive individuals were suspended in 9 of the countries. All but 5 of the countries continued cancer treatment. These results suggest an increase in the burden of cancer in the following years as a consequence of the COVID-19 pandemic, particularly in LMICs. In light of this estimated increase in the burden of cancer, IARC is developing and coordinating 1268 Credit: CC-BY-SA 3.0 IGO. IARC/M Stenmark a new strategy based on the Global Cancer taskforce, to find ways not only to mitigate these repercussions but also to improve cancer care and to develop evidence-based tools to guide health-system responses during pandemics. In a recent article, a team of public-health specialists led by scientists from IARC provided comprehensive guidance on best practices to maintain quality-assured cancer screening during the COVID-19 pandemic. Scientists from IARC estimated the impact of the COVID-19 pandemic on global cancer mortality related to delays to treatment caused by the COVID19 pandemic and proposed a model to minimize this excess mortality. They used published data on head-and-neck cancer, a known time-dependent disease, to develop an online tool that estimates the risk of cancer mortality and applied it to estimate the impact of the COVID-19 pandemic on data from 15 oncological services from around the world. This demonstrated that maintaining higher levels of cancer treatment during the COVID-19 outbreak and achieving more-rapid increases in treatment levels during the post-outbreak period can reduce the number of accumulated patients needing treatment and decrease the additional risk of dying due to longer time to treatment initiation. Finally, IARC and partner institutions comprehensively assessed the impact of the COVID-19 pandemic on pediatric oncology diagnoses and provision of healthcare, for the first time covering an entire country. The researchers compared the incidence of childhood cancer in Germany, which has 13.5 million people younger than 18 years, using nationwide high-quality cancer registry data, and found that the estimated age-standardized incidence rates were markedly higher, overall and across diagnostic groups, in 2020 than in 2015– 2019. The results from a qualitative survey indicate that diagnostic processes, timeliness of diagnosis, and delivery of treatment were hardly affected during the COVID-19 pandemic, so the underlying reasons for the increase in incidence rates seen in this study remain speculative. However, continued close monitoring of incidence patterns should shed light on the underlying reasons for the observed increase and contribute to understanding similar situations in other countries. ■■2021 has been the year of COVID-19 vaccination campaigns, with high-income countries taking the lead in vaccinating their populations, in contrast to many low-income countries, especially in Africa. How are the COVID-19 vaccination inequalities impacting cancer-related health services and existing cancer disparities? EW: We have evidence indicating that the COVID-19 vaccination inequalities will exacerbate cancer-related health services and inequalities in cancer burden. We have already discussed the negative impact of the COVID-19 pandemic on cancer-related health services, cancer registries, screening and treatment, more commonly reported in LMICs with a low HDI than in countries with a high HDI. It is a fact that the cancer burden is far from equitable. We know that LMICs — with 70% of all cancer deaths — bear Nature Cancer | VOL 2 | December 2021 | 1268–1270 | www.nature.com/natcancer q&a a larger burden of cancer mortality than do high-income countries. IARC global data on cancer burden indicate that there will be 30.2 million new cases of cancer and 16.3 million cancer-related deaths worldwide in 2040. The cancer burden will disproportionally affect LMICs that lack access to essential healthcare services, including essential information about cancer prevention, screening, treatment, and therapy. These inequalities will be even more emphasized in the future, and will be exacerbated by the pandemic and COVID19 vaccination inequalities. We have already witnessed how the pandemic has intensified existing challenges in health systems and hospitals and has affected services across the cancer continuum, from prevention to diagnosis, cancer screening, treatment, and palliative care. Inequalities in COVID-19 vaccination will further delay redressing these challenges. ■■How has the pandemic been affecting IARC’s mission of “cancer research for cancer prevention”? EW: The past two unprecedented years have brought IARC many challenges. There was an adaptation to remote working from March to May 2020. Our operations continued thanks to the outstanding commitment of IARC’s personnel and significant investment in the digitalization of activities. Subsequently, there was a (...truncated)