Next up, everyone is Dr Tom. You'll drink from the Fred Hutchinson Cancer Center and less cancer board member and Dr Vick Suhas Reboot, who's from the National Cancer Institute, and we welcome them both today. Hi, thank you to less cancer for coordinating the virtual gathering for National Cancer Prevention Day. As we enter the second year of the global sars-cov-2 pandemic, it's important to reflect upon the importance of science and public health as partners in prevention of infectious diseases. And it's an honor to join you today to talk about the implications for cancer prevention. My name is Thomas Aldrick. I am a medical oncologist and researcher at the Fred Hutchinson Cancer Research Center who focuses on the prevention and treatment of infection related cancers. Including cancers that occur in the setting of HIV both in the US and through a unique collaboration between the Front Hutch Cancer Research Center and the Uganda Cancer Institute, where we focus on the prevention of infectious related cancers in low resource settings. On cancer prevention day it's important to commit to efforts to prevent cancers caused by viruses and have their infectious agents. Worldwide, 35% of all cancers are caused by infections. Importantly, these include cervical cancer, anal cancer and some forms of head and neck cancer, which are caused by a virus called human papilloma virus, or perhaps better known as HPV. It includes a variety of lymphomas, some of which are caused by viruses or bacterial. Infection includes Kaposi's sarcoma, a tumor that is most commonly seen in skin but can also involve lungs and other organs. That is caused by a virus called Kaposi's sarcoma herpes virus. That is quite common in people living with HIV, especially in sub Saharan Africa, where it is one of the communists cancers. Overall, it includes several forms of liver cancer, which can be caused by viruses such as hepatitis B or hepatitis C, which are preventable or treatable. And it includes stomach cancer that can be caused by a virus or a bacteria H Pylori. Additionally, among the greater than one million people in the United States and 38 million people globally that are living with HIV cancer, has become the leading cause of preventable suffering and death. HIV infection itself substantially increases the risk of several cancers caused by other cancer viruses, especially Kaposi's sarcoma lymphoma, and the HPV associated cancers, cervical cancer and anal cancer. As well as some other common cancers that are not caused by infectious agents such as lung cancer. It remains important for the US and global health community to commit to both HIV prevention efforts as well as 90 90 90 goals, which are efforts underway for early detection and universal treatment of HIV that are required for an HIV free generation. Through years of research, several important interventions have been proven to prevent infection related cancers. It's important to double down our efforts to make these available globally. First, prevention and treatment of HIV is a critically important form of cancer prevention and would decrease the burden of at least eight common cancers in populations at high risk for HIV. This is particularly important for sub Saharan Africa were currently greater than 26 million people are living with HIV. Second, vaccines against hepatitis B virus and human papilloma virus are effective at preventing liver cancer, cervical cancer and some head and neck cancers. And increased use of these vaccines are imperative. Third cervical cancer screening, which includes identification and treatment of pre cancers, is a highly effective way to prevent cervical cancer. And maybe a model for prevention of other HPV associated cancers as well for people living with HIV. Other established cancer prevention efforts, such as smoking cessation, are critically important in general. I recommend that people living with HIV have general cancer screening and prevention efforts. But there may be some need to tailor specific cancer prevention early detection, such as lung cancer screening for people living with HIV. And these cancer preventive education efforts can be integrated into HIV care. Besides the established ways to prevent infection related cancers, doctors and scientists are researching ways to further improve early detection and prevention of cancer caused by infections. For example, through novel approaches to anal cancer screening or improve treatments for pre cancers. As the US and global health community continue at work speed to develop and implement vaccines for sars-cov-2. It will remain important to build on this momentum and the scientific advances of the past year to accelerate efforts to prevent cancers caused by other forms of infection. Yeah, such as viruses. I could not be more optimistic about the opportunities and efforts for prevention of infection related cancers again. I want to thank less cancer for your continued efforts to raise awareness about infection related cancers and bring to the table a discussion about prevention of these important cancers. I now want to turn over the discussion to my friend and colleague Vic, somebody who is a researcher at the National Cancer Institute's Division of Cancer Prevention, who will talk more specifically about exciting research aimed at prevention of HPV associated cancers. >> Than you Tom, I appreciate the opportunity to join you and our colleagues at the less cancer national Cancer Prevention Workshop. As you mentioned, a significant proportion of cancers globally are caused due to infections, and one of the cancers that I focus on within that sphere is the human papillomavirus, or HPV related cancers, particularly cervical cancer. Happy to talk a little bit of what we're doing here at the National Cancer Institute to our efforts and cancer prevention on expanding some of the work related to HPV related cancers. As you know, this cancer a particularly cancer of the uterine cervix, cervical cancer is a major cause of morbidity and mortality. Globally, about 600,000 of women are diagnosed every year you do this cancer and more than 200,000 women died into this cancer. Including in the US, where it has, although the problem is declined over the past several years as a result of include access to prevention services does not completely vanished. And we do see more than 13,000 women annually diagnosed with cervical cancer in the US. And more than 5000 them entirely to this cancer. And so there's something to be said about. The ability of us to do something for cancer, for which we know a lot about the cause of the vision, the human papilloma virus. As well as the availability of various prevention tools such as the human papilloma virus HPV vaccines, which have been available now for almost 15 years, and have been the mainstay of prevention of cervical and other HPV related cancers. The vaccines are available globally, but the US despite several years of pushed through the public health and the clinical communities, the vaccine uptake rates are still struggling at around 70%, and the serious completion rates are even lower. And there are several reasons why, this has been the case. But certainly, one of the causes is related to vaccine hesitancy. And along with the push towards increasing COVID vaccination now, we hope that in the near future, HPV vaccine rates will also go up as the general public, and the population understands the bottoms of vaccination. But it really for bottoms of a vaccine that has shown to prevent cancer, that is eminently preventable through this morality. We also have seen a significant effect as you mentioned, screening and treatment efforts related to cervical cancer. These are grouped Pap smears, which have been the mainstay of self cancer prevention in the United States, and more recently, through the testing for the virus HPV to cervical Pap smear, related provider collected samples. What we are researching now, is try to see how we can expand on reaching the women, who do not get perhaps minutes regularly in the United States. We're trying to focus on about 20 to 30% of women, who are either under screened, or never been screened. You do a variety of reasons, including lack of availability or geographic and accessibility to a civilian, or the hesitance in terms of these other situations for getting update to screening. And so, we're trying to pilot a matter called a self sampling, which will allow women to collect a sample for HPV testing, at a time and place of their choosing. And we're going to work with the broad stakeholder community to implement something called the Last Mile project, that we're going to try to show the equivalency of this approach, to the perhaps near base cervical cancer screening. We hope to expansion of efforts for cervical cancer screening, as well as increased efforts in HPV vaccination. We can make cervical cancer, potentially eliminated. We can eliminate that as a public health problem in the United States, and also globally. I'm very optimistic, as you are about the efforts that we can collectively do to address some of peace. Incredibly important cancer preventative efforts to collaborative efforts, both in research as well as community advocacy, and implementation. So I was hearing your work Tom, and I was just wondering, maybe you want to talk a little bit. I just wanted to hear your thoughts on, how is COVID affected care for people with cancer? And how do people with cancer, including people with HIV associated cancers, how are they affected? And what sort of concentrations are going on for the past year related to care of the cancer, along with their risk for COVID? >> Great, thank you for the question. I think that the past year has been quite challenging for my colleagues, who have been treating cancer for their entire career, and really adapting and pivoting to new technologies, and new methods for managing people with cancer. We are doing this here in Seattle, and we are doing this internationally, and our global work in Uganda. I think one of the important take home messages that I've come away with over the past year, is that for certain cancers it remains critically important to maintain a level of care for patients, so that we don't fall behind on progress that's been made in prevention and treatment of cancer, and associated decreases in depth from cancer. And so, I think coming up with ways to manage cancer in the COVID pandemic, has required innovation. A lot of that innovation has been in the forms of mobile technology, and as as well as distant care health visits over Zoom, for example, management of patients and interdisciplinary bounds through conference calls and to a certain extent, we're able to do. And we've learned quite quickly that we're able to do quite a bit via videoconferencing, and direct contact with patients through video, which protects the patients from the need to be an increased risk for COVID, or in hospitals where there is increased risk for COVID. And so, I think leaning on technology especially information technology, will be quite important when I think about this from the research perspective. I do also think that there will be important room for mobile technology for interventions such a smoking cessation adherence, antiretroviral therapy that's implemented not only in the U S, but around the world. And so, those are the areas that I think we will see advances in the next year or two, in areas that will allow for continued improvements in cancer prevention and care. >> Sure. Now, that's very interesting to hear because I think this is a great sort of paradigm shift in our care is being delivered, as you said through telemedicine that might open up avenues which nobody had thought of before, at least thought out for such as large scale before the COVID dynamicate us. But I'm also glad to hear that you think smoking secession is a key intervention, particularly for lung cancer and prevention, and for generally for a whole range of current diseases. Do you see lung cancer, you mentioned something about lung cancer and HIV, I wonder if you want to speak a little more about that, yeah. >> Yes, Absolutely. One of the interesting from the scientific perspective observations, has been that people with HIV are at increased risk of developing lung cancer, even after you take into account differences in the proportion of people smoking. And there was initially, an effort to see if there was an infectious agent in lung cancer. In people with HIV, many of the other cancers occurring in HIV are caused by infections. And to take an infectious agent, has not been identified. That specifically leads to lung cancer in people with HIV but nonetheless, the increased risk exists. Additionally, people with HIV developed lung cancer about a decade younger than people without HIV, and so it calls into question. Things like CT scans for early detection of lung cancer in people with HIV. And whether that should be done at a different age than the general population. And so that is a specific cancer early detection intervention, that may need to be specifically tailored for people with HIV. Maybe I can take an opportunity to follow up on to me, what was one of the more exciting events on the global health state over the past year. Which was that in November of 2020, the WHO launched a strategy to eliminate cervical cancer as a global health problem, I wanted to hear your thoughts. Since the largest burden of cervical cancer occurs in low resource settings. What are some of the priorities for making sure that cervical cancer has prevented both in the US, but also around the globe. >> So, absolutely, as you said, this is such an important cancer and then eminently preventable cancer that we can focus our efforts on. And so the WHO relatively took on this as a goal for elimination as a public health problem and the strategy, as you mentioned that was inaugurated in November. This is a very long term strategy, but at least in the intermediate term, there is a setting of a target of 90, 17, 90 as they call it. For the year 2030 that the goal will be to vaccinate the HPV vaccine 90% of all Asia logical girls that is built by up to the age of 15 years. Globally, 70% of all women should be screened with high performance screening tests by the age of 25 then again by the age of 45. And then 90% of those who are identified with cervical disease more pre cancer, invasive cancer, should receive treatment, that's a lofty goal. But it's something that the WHO has, along with the member states, signed on as something including the United States has signed on as well. That's worth achieving, with an expectation that its efforts are made towards achieving that goal. A mathematical model has suggested that 70 kinds of rates, incidence rates might start declining. Starting in about 10 to 15 years, and we go down almost 80 or 90% in the next 70 or 80 years, so it's supposed to be a very long term strategy. Obviously, a lot of these are modelling exercises to project out what might be the impact of these targets. But it at least sets the stage for efforts to increase awareness of the importance of screening and the importance of vaccination for governments. For public health professionals as well as for the general public, so that this gets on the radar and people don't skip vaccinations. Don't skip screenings, don't de emphasize, including in pandemic situations like COVID. The importance of regular cancer preventative interventions, so I think it will be something that we are all committed to working towards in the United States. As you mentioned, we are working with a whole range of partners to improve. On some of the most challenging situations where we do see the last few 1000 cases of cervical cancer. Those typically happen in women who do not the same screening or are under schemes. Were trying to improve access to those populations to serve something and other methods. But I think this will be something that we do want to redouble our efforts in the US to achieve that last mile of so the cancer screening, but also globally. >> Maybe it is one last question and thinking about where our fields overlap. Is that the issue of preventing cervical cancer and anal cancer in people living with HIV. And it's interested in what you think the most exciting advance areas of research are in this field from your perspective. >> I think some things which you are very involved with, I think this is at the cutting edge of things. Which is some of these efforts around finding non invasive treatments for treating pre cancer both for anal and cervical cancer. We do have a current methods that are adequate, I would say, but not without their resulting possibilities, including exceptional treatments and surgical treatments. And we do need some more, preventative methods that are non invasive. So therapeutic vaccines or topical methods for treatment that are patient driven. Rather than injected or require a surgical excision would be terrific advances to make for improving prevention. But as you said, including everything, the whole spectrum from vaccines to straining to some of these innovations and treatment are really important. And I think researchers such as you with pretty much and globally are working towards that goal. Which is usually important research agenda for the public or in Seattle for taxpayer. Puts on this on this topic are really key to make some real advances on going preventative metrics. But I'd love to hear some of what your thoughts are on this topic as obvious and, well, the cutting edge politically and research wise as well. >> Yeah, thank you and perhaps it was a planted question but certainly I do agree with you. That I think that there are areas for improvement in the way the pre cancers are treated. And that people living with HIV, often need more frequent surgeries or more toxic management of anal lesions or cervical lesions. And so moving towards vaccines and other topical immune module Torrey approaches. Is an exciting area of research, and I think is one of the areas that I'd like to see grow. Over the next 5 to 10 years, as a novel approach to prevention of cervical and anal cancer. >> Let's start with Tom and really, actually continue to work together to address these issues. Along the whole range of partners and really great opportunity to talk to you today on this workshop. And thanks to the LessCancer or and Andrea and Bill and everybody to making this happen. >> Yes, it's always great, thank you, Andrea, thank you, Bill.
