Progress has been made in Spain in the control of cancer during the last decades, as shown by the trend to decrease cancer mortality (Cabanes, Ann Oncol 2010) and increased survival from mid nineties (Eurocare).This change has been achieved by a combination of the increased impact of smoking prevention among males, better access to diagnostic and therapeutic strategies, early detection and improved application of what we know is effective, in general. + more...
However, data from EUROCARE and recent trends in cancer incidence of some tumour types, clearly shown room for improvement in prevention and control of cancer in Spain (Borras et al, Ann Oncol 2010). This improved effort should include as a cornerstone research on the key issues relevant in cancer epidemiology and prevention as well as in health services research. Priorities should be focused on five main research areas:
These areas of research and intervention have been selected according to the experience in research of the groups included in this program as well as the priorities that could be reasonably achieved in the framework of this RTICC time plan.
The global objectives of this program are fourfold:
Globally, the groups involved in this program have shown a relevant record in excellence of research as measured by publications in international journal of high impact, citations and competitive grants, as summarized in the previous section. Finally, this program represents an extension of the epidemiology program in the previous Network of the IS Carlos III which was very well evaluated by external reviewers, indicating the quality of the research carried out.
It is well known that the meaning and relevance of innovation and transfer of technology in the field of epidemiology and prevention of cancer is different of that of laboratory research. Even though, some groups in this program have been active in innovation as shown by different indicators such as the work done in designing innovative strategies for cancer prevention like the case of HPV vaccination, identification of new biomarkers which have allowed for patents approved or the public private partnership in several activities. The groups of C. Lazaro and G. Capellá have a long-time commitment to innovation in the field of molecular diagnosis of cancer where new advances in the analysis of the tumors are being streamed into the clinical routine. The use of screening techniques such as hypermethylation of MLH1 in tumor biopsies (Gausachs et al, 2012) or functional analysis of variants of unknown significance (VUS) (Borras et al, 2012) is recent examples. Currently, they are implementing the high-throughput next generation sequencing in the routine clinical setting with promising results.
The group of G Capellá filed a patent on a panel of methylation markers for early noninvasive diagnosis of colorectal cancer in stool DNA. The validation of this marker is just finished in the diagnostic setting and in the evaluation of risk of dysplasia in high-risk ulcerative colitis patients.
The "Genetic Susceptibility to Cancer" group is very active in setting up new workflows to improve genetic diagnosis. Currently the group is implementing different Next Generation Sequencing approaches with the aim of developing cost-effective algorithms for genetic testing in the context of hereditary cancer. Now two different strategies are being developed, one based in amplification by PCR of the gene/s of interest, and the other aimed to tackle all genes involved in hereditary cancer at the same time by using a liquid capture strategy. The implementation of these techniques is paramount both for diagnosis and research purposes and these approaches will be shared by the different groups of the programs.
Infections and cancer group: HPV tests for screening and research purposes. The group has 1) Done exercises on accreditation and validation of different HPV detection tests for use in the context of screening programs. 2) Created the Infections and cancer laboratory at ICO to train technicians in the HPV detection methods and opened a PhD research program and 3) Organized an international training program for PhD students to exchange training periods with major reference laboratories in the world.
Cancer is a group of complex diseases, associated with multiple life styles, environmental exposures, genetic and epigenetic factors. A better understanding of the etiological factors and the role of host susceptibility factors and the mechanisms of carcinogenesis will provide the clues for the identification of reliable biomarkers for early detection and methods of primary prevention. This endeavour will require an innovative approach and multidisciplinary teams. Groups included in the Program of Cancer Epidemiology and Prevention are integrated by physicians, epidemiologists, molecular and genetic biologists, nutritionists, statisticians, bioinformatics, psychologists, nurses, and public health specialist. This means that we are covering all the different backgrounds and skills needed for an integrative approach between groups for each of the main work packages, favouring and promoting positive synergies among them. Also, the fact that this program is covering a broad perspective of knowledge, from genetic epidemiology to cancer policy making, by focusing on epidemiological analytical skills, population based view of cancer prevention and control could result in a cross fertilization that will be able to produce a significant impact on cancer through the incorporation of scientific based knowledge in epidemiology. Finally, the past experience of cooperation between many of the researches included in this program, as shown in the previous RTICCC were several of the groups involved were cooperating successfully, could provide a further reassurance of the future prospect of the increased synergy would continue take place.
The coverage of most relevant and up to date research approaches in cancer epidemiology are covered in this program by the research groups, from genetic and molecular epidemiology, critical causal determinants of some cancer types such as infectious and environmental factors, as well as primary prevention, screening and health services related determinants of effective cancer care. The publications, research grants and involvement in different international collaborations show that the research experience of the groups is also a critical component of the epidemiological community in cancer.
MANAGEMENT STRUCTURE AND COORDINATION
Management of the program will be assured by the coordinator of the program, Dr. J.M. Borras. In addition, he will be member of the executive board of the RTICC. The leaders of each WP will support the management of the program assuring the internal organization of the different researchers involved in each WP from groups. The PI of each group involved in this program will be incorporated in the management structure, through an executive board, that will coordinate the different objectives, assessing compliance with deliverables. This Executive board will meet yearly taking advantage of the annual meeting of the RTICC. In summary, tasks and responsibilities of the coordinator are: To assure integration of the WP’s and to supervise the different activities of the WP’s, jointly with the executive board and WP’s leaders and communication with the RTICC coordinator and other programs.
The executive board should undertake an annual review of the activities of the WP’s and the compliance of the workplan.
Considering the number of groups, the past experience in cooperation among themselves as well as the workplan, this structure is considered sufficiently easy to manage.
Added value of the research groups from the cooperative structure:
IMPACT AND TRANSFER
The impact of this program is expected at five different levels:
Dissemination of this research will be made through the classical strategies based on papers published in the international literature, either in high impact general cancer or in cancer epidemiology and prevention journals. Also, researchers of this program will be very active with presentations of the results of the projects at scientific meetings, both international and national. However, all this knowledge in order to have an impact on the preventive and clinical practice requires close relationship with the relevant cancer policy makers as well as the advisory boards with influence on funding of research and innovation. The position of several researchers from the groups involved in this program would be very important in order to promote a rapid transfer of the knowledge to the key decision makers to set priorities both in research and in cancer prevention and control.
SCHEME OF EVALUATION OF THE PROGRAMME
As indicator for external evaluation, we suggest: Annual report on the activities of the program. Articles co-authored by components of two or more groups of the program. Evaluable articles should acknowledge specifically funding from the RTICC. Collaborative research proposals granted to two or groups of the program. Clinical trials with participation of components of two or more groups of the program. Patents co-invented by components of two or more groups of the program. As for the time-frame, we suggest evaluation in the second and fourth years.