Interview with Dr. Wild in Le Monde

On the occasion of the investigation published by Le Monde on Tuesday, October 25, regarding the figures concerning cancer in France, Christopher Wild, director of the International Agency for Research on Cancer [IARC, the cancer agency of the World Health Organization headquartered in Lyon] , explains the overall patterns of the evolution of malignant tumors in the world…

What are the overall tendencies in the global evolution of the incidence of cancer?

We do not currently have solid data on the long term evolution of the incidence of cancer for all countries. This information, obtained from nationally registered data, remains scarce in numerous developing countries. Starting from the database of the IARC, we observe changes linked to development: the level of occurrence of certain major cancers (lung, breast, colorectal) is increasing in many poor or emerging countries, while several others, more associated with poverty or infectious diseases (uterus, stomach, liver) seem, rather, to be on the decline.

Overall, an understanding of those incidences which are increasing in countries in transition has to do with changes in the risks undertaken, which are approaching those of the rich countries: tobacco consumption, overweight, sedentary, increase in the age of child bearing and breast feeding… For several cancers a divergence in global tendencies can be observed: among men, lung cancer tends to decline in wealthier countries but is stable or still increasing among women.

These tendencies reflect the “maturity” of the epidemic of tobacco use, and the fact that women have taken up cigarettes more recently than men. Globally, in lower income countries the smoking habit has arrived later and we may be able to observe in decades to come a rapid increase in cancer in certain countries, particularly among men. Other cancers are increasing as well: a sub-type of cancer of the esophagus strongly linked to obesity is increasing in several western countries.

How is the sharp increase in the incidence of thyroid cancer to be interpreted?

These increases are linked to the development of new diagnostic tools (tomography, magnetic resonance imaging, etc.) which have led to a considerable augmentation in the detection of small papillary tumors, which would not have been evident before.

In spite of a decline at the world wide level, cancer of the cervix is still increasing in certain countries of East Africa, Eastern Europe and in the former Soviet countries.

The incidence of a good number of cancer types is at the same time reasonably constant. The mortality rate of pancreatic cancer is relatively stable, for example. But because of the poor prognosis of these tumors and advances in the treatment of other major forms of cancer (breast, prostate, colorectal), this illness [pancreatic cancer] has become one of the leading causes of death in the EU countries.

Beyond the big, known causes – tobacco, alcohol – what are the major determining factors observed?

We now have considerable knowledge of certain risk factors, that can explain part of the developments under observation: First of all, the impact of chronic infections is often neglected as a risk factor, but accounts for perhaps 15% of cancer at a global level, especially for liver cancer (viral hepatitis), cervical cancer (papillomavirus) and stomach cancer (Helicobacter pilori).

However, this varies considerably country by country: in Africa more than 40% of cancers are linked to such infections, against 1% to 3% in North America or Australia, for example… Certain viral or bacterial infections decrease along with the level of development.

It is also interesting to see, in certain wealthy countries, the increase in the number of cancers in the oropharyngeal (mouth, lips, pharynx, etc.) and ano-genital areas associated with sexual transmission of human papillomavirus (HPV). This development is a supplementary argument for the introduction of the HPV vaccine, the benefits of which will extend beyond the prevention of cervical cancer.

What are the consequences of the increase in tobacco use?

Tobacco use continues to increase in numerous countries, which leads naturally to a rise in the incidence of lung and other cancers, including a pronounced increase among women as well as men, as well as other health effects (cardiovascular illness, chronic respiratory trouble, etc.)

Overweight, obesity and lack of physical activity are increasing in a dramatic manner in numerous regions of the world and these life style changes are associated with accumulated risk of several cancers, among which are breast, esophagus, colorectal, kidney…

To what are these life style changes connected?

They are often linked to urbanization, diet, sugary drinks and to the consumption of red meat and processed meats. At the same time, the tendency for women to have children later in life, to have fewer children and to breast feed only for short periods of time is associated with the increase in the incidence of breast cancer in numerous countries.

Has not classic oncology, founded before all else on the concept of mutation, been overtaken by the emergence of new toxicological paradigms?

I would certainly not say that the concept of mutation [of a cell – LeM] has been, one way or another, made obsolete by recent advances in the understanding of molecular mechanisms facilitating cancer. Cancers are to the contrary characterized by a large number of mutations.

I would further say that the discovery of new “events” at the molecular or cellular level which lead to the development of a cancer come with and complement the fundamental work undertaken on mutations and offer fantastic opportunities to study the prevention, the early detection and treatment of this illness.

It is very stimulating to witness the arrival of new tools for the investigation of different “events” – as for example epigenetic modifications [certain changes in DNA or in the genetic environment – LeM] which may be produced among populations.

One of the critical challenges with which we are confronted is to understand how, beyond the induction of mutations, environmental or behavioral factors have an impact on the risk of developing cancer. This information is fundamental for prevention and early detection and has been until the present time largely neglected, compared to other domains of cancer research.

Has not the epidemiology of cancer arrived at a limit, in fact, at the current time, on the effects of environmental factors – as, for example, exposure to toxic chemicals – during critical periods of development such as fetal, perinatal, adolescence – which may, in the majority of cases, be accounted for?

Take care: it would be a mistake to believe that exposure during adult life might be without importance or necessarily less important than exposure during the perinatal period. However, epidemiology must certainly consider life taken as a whole and must measure exposure during all periods of life, as accurately as possible, while using the most feasible instruments, such as questionnaires, environmental measurements or biological markers, for example.

I do not think that exposure during adolescence or in the period around birth cannot be measured, but I recognize that to obtain accurate measurements is certainly a challenge to the extent that the exposure occurred in the past. The encouraging news is that new scientific developments will permit meeting this challenge.

What are they?

I will cite two: The first is that certain environmental exposures leave a molecular “tattoo” in DNA – in the blood cells, or in the tumor itself, for example – that can be detected many years after expression. This allows the beginning of an opening of a window into the past.

The second is that there are in the world a large number of recruited individuals from mother-father-children cohorts, who provide biological samples. In these studies it is possible to link exposures in the perinatal period with changes in the biology of the child.

One might then interpret these observations in connection with abnormalities of cellular or molecular function observed later in life. There again, this will allow the establishment of a bridge between an event that occurred early in life and its consequences much later.

This is Bill Spurlin’s translation of an interview given by Dr Christopher Wild to Le Monde, published here without objection from the IARC.


I Punched Holden Caulfield

I punched Holden Caulfield in the face, and he fell heavily
On the ground, ideology oozing out of him
But that did not save Jack.

I went on my way for years and came back to that spot.
Holden was gone, having climbed back into his book,
Where he lives on, dead like Jack.

When in a hotel room near San Marcos in 2010
I heard about Salinger’s death, I cried.
(Not Jack’s Salinger; J. D.)

Wept a lot, broke down actually
for several hours. They were all really dead now,
Franny, Zooey, Holden and Jack.

Near Meriden, CT

It wasn’t that the people I met in my brief visit to Radio Mountain were
Uninterested in sex; they seemed to consider it more of a distraction –
Something unnecessarily complicated, like stereophonic sound.

Full of joy, they showed me the radio console they had built themselves:
Monaural, with built in limiting and several sides so that colleagues
Could sit down together and broadcast programs at the same time.

We took a run through the heavenly fields outside the studio, with the dogs.
My arthritis vanished, and the dogs enjoyed the run as much as I did.
Reversing direction suddenly one of them, a large furry bowling ball,
Came in collision with me and we all ended up in a laughing heap.

Over there the transmitting towers pointed, not skywards
Because we were already there, but everywhere, exciting the ether
With celestial bop. So fast. Can you imagine dancing to that?

There is sadness aplenty there too, remembering friends lost.
I actually cried when I saw snow, not knowing it snows
In every month there, a little bit, not like the tragic winter
That sometimes occurs in other parts of New England.

But, being near Connecticut, Heaven could hardly be without snow.
The road to it is easy, about nineteen miles west by south of Hartford.
There is a brook called Sodom near a medical center off I-691.
Take the first exit and follow the brook north to Rte. 71.
Go right, and you will soon see the entrance to Hubbard Park and the Peaks.

C. Thomas Daniels obit. 11 June, 1997

Needing some warmth; a break from Northborough
(Wherever that is: north of Westborough
and east of Southborough – a wide spot in
Route 20 with 4 gas stations and houses in the woods)
I went to visit Tom Daniels in Hell.

He met me naked, having given away
the shirt on his back and everything else.
“How are things up there?” he asked. “Cold,”
I said, “and too many trees reaching out
to kill each other, those I love, and me.”

“We don’t have trees here. Too hot,” he said.
“Have a beer.” I declined. He reached
behind him to grab one from a refrigerator.
“How do you rate that?” “They seem to like me here,”
he said, “I get a lot of perks. Just no clothes.”

I twisted a little inside, remembering
The clothes he sent my way when he worked at Sears
Sports jackets, pants, sweaters, underwear.
I never paid a dime. When they caught up
with him, he asked me for money, but I hadn’t any.

Still he stayed my friend. Why? Because
I drank like him. Because when I wasn’t looking
he chased my girl friends, and I was after his
(particularly Carol Kiloski). Because we were
both spoiled kids who used to have money.

1967. Too old to be kids now; no excuse.
Get a job; dodge the draft; get out of town;
drink the scotch and get on the motorcycle, dammit.
Skull fracture in uniform on the way to Fort Dix.
Dilantin and beer for the rest of Tom’s unnatural life.

“How do you like Hell?” I asked engagingly.
“Not too bad,” he said. “You don’t get
older. Some well known people are here.
It is not like being alive. There is certainty.
Nobody cares if I lie. There will be beer.”

“I will have no clothes. I will have nothing
to give away, and so no friends. No internal organs.”
“Why no organs? Do you not need them?”
“No, they got destroyed before I died.
Although it is also true that I do not need them.”

“The last thing I remember is falling
down a flight of stairs. First my spleen,
liver and pancreas, then heart, stomach,
lungs and intestines were ruptured, liquefied.
All weakened by alcohol, and all dissolved.”

“Did you fall or were you pushed, by chance?”
“I don’t know and I don’t care,” he said,
and reached behind him for another beer.
Wherever Tom was in Hell always was
a refrigerator full of beer behind him.

I owe him much. The clothes; the damage to
his van the night I sideswiped that Mercury
on Duncan Road in it. He was generous and had
a jet of brown hair that fell from his forehead
between his smiling blue eyes. A true friend.

“Why did you come here?” he asked, seriously.
“And how? Was it expensive? Did you fly?”
“Expedia,” I said. “Quite cheap. No hotel.
No auto. The earth just opens and you go.
And I hadn’t seen you before you died.”

“I didn’t get a chance. You were drinking,
every day, a lot, and had been for years,
and I avoided you for that reason, having
my own problem. But I need to tell you, Tom,
how much you mean to me, dear dead friend.”

And then I saw the old, slow grin break out.
This, in the red flickering light on the expanse
of his naked, curiously baby-like body
turned him young again for a second. I
remembered his former looks: handsome; well dressed.

“Where do we sleep tonight, old friend?” I asked.
And the grin vanished. He reached for a beer.
“Let’s get this straight,” he said in a tired voice.
“There is no sleep here. Sleep is about change,
waking in the morning with something to live for.”

“There is no hope here. No change. Just beer.”
And I realized that Tom had finally got
what he wanted for himself in life: nothing.
For a place to sleep, I left Hell a day early,
through the same fissures whence I came.