Education and training of cancer researchers have been recognized as a paramount need and a key component of IARC’s mandate since the very first formulations of its programme in 1965. At that time, training opportunities were available only at a limited number of leading research institutions in economically developed countries. In the field of epidemiology, formal courses and on-the-job training possibilities were even fewer, essentially restricted to the USA and the United Kingdom. IARC’s international dimension prompted four main types of initiatives: international training fellowships, Senior Visiting Scientist Awards, international courses, and the development of educational materials. These have become continuing IARC activities aimed at providing the professional knowledge and skills considered necessary for “what comes next” in cancer research.
John Higginson welcomes the members of one of the first IARC Fellowship Selection Committees, in the meeting room made available by the City of Lyon.
The Fellowship Programme was developed as one of IARC’s very first activities. It was initiated in 1966, offering one-year training fellowships to young scientists with no previous postdoctoral experience, and has continued uninterrupted until the present day. Applications are reviewed and evaluated by an ad hoc IARC Fellowship Selection Committee composed of scientists, most of whom are from institutions other than IARC.
Stipends have kept pace with the cost of living and compare well with those provided by other granting organizations. IARC’s core budget funds the programme; additional support has been provided in the past by the Italian Association for Cancer Research and in recent years by the European Union EC-FP7 Marie Curie Actions-People-COFUND programme (IARC Postdoctoral Fellowships) and by Cancer Council Australia (IARC-Australia Fellowships) and the Irish Cancer Society (IARC-Ireland Postdoctoral Fellowships).
Until 2004, fellowship recipients were selected regardless of their country of origin, and the host institution could be anywhere in the world. About 98% of fellows chose institutions in North America and Europe; the USA ranked first (about 50%) and the United Kingdom second (about 20%), followed by France, Sweden, Germany, and Canada. The desire to provide a unique training experience and the increasing public health relevance of cancer in low- and middle-income countries have informed some major changes in the IARC Fellowship Programme in more recent times. First, since 2004, fellowships have been tenable solely within one of IARC’s research sections, with an extension for a second year possible, subject to satisfactory performance as evaluated by the Fellowship Selection Committee. Second, selection of fellowship recipients is driven by scientific excellence, but among equally meritorious applicants priority is given to candidates from low- and middle-income countries and to research projects relevant to such countries. This training format means that fellows are integrated into IARC research projects, often resulting in longer-term collaborations that extend well beyond the period of the fellowship.
Over the decades the number of candidates has varied around an average of 50 applicants per year, with peaks of more than 100. A total of 602 fellowships were awarded over the 49-year period 1966–2014, an average of 10–15 per year. In the early years (1966–1976), female fellows were a minority (about 10% of the total); their proportion has increased markedly, reaching 60% in the most recent period (2003–2014). The great majority of fellows (80–85%) return to their home country after the postdoctoral training. Most continue to work in cancer research, and it is significant that the three most recent IARC Directors – Paul Kleihues (1994–2003), Peter Boyle (2004–2008), and Christopher Wild (2009–present) – had been IARC postdoctoral fellows early in their careers – in 1970, 1981, and 1984, respectively – before progressing to prominent positions outside IARC.
Countries of origin of IARC research training fellows (1966–2013). Over the years, the IARC Fellowship Programme has attracted postdoctoral scientists from an increasingly wide range of countries.
The distribution of fellowships by research area has reflected the evolution of disciplines within cancer research. Overall, two thirds of the fellowships have been allocated to the fields of epidemiology and biostatistics (24%), cell biology (18%), chemical carcinogenesis (12%), and viral carcinogenesis (11%), with the proportion for chemical carcinogenesis decreasing over time. The other third of fellowships have been in biochemistry and the growing sectors of genetics, molecular biology, and molecular pathology.
Further training opportunities at IARC arise through the recruitment of postdoctoral scientists, outside the Fellowship Programme, who are supported directly by extrabudgetary funds obtained mostly from competitive grants awarded to specific IARC projects. The selection of these postdoctoral scientists (currently about 30 per year) is also approved by the IARC Fellowship Selection Committee, to maintain a uniform standard. In 2011, IARC introduced the Postdoctoral Fellowship Charter, an agreement that lays out what is expected of IARC, the supervisor, and the postdoctoral trainee, including participation in training courses in different core research skills such as grant writing, making presentations, bioethics, and biostatistics. In addition, an Early Career Scientists Association has been created by postdoctoral trainees and PhD students, bringing together students, fellows, and other postdoctoral scientists to promote social activities, to facilitate dialogue with IARC management, and to improve opportunities for career development.
Postdoctoral scientists coming to IARC enter an environment where people of some 50 different nationalities work together towards common goals through research projects conducted across the world. As a result of the collaborative nature of its work, IARC provides opportunities for interactions with scientists from all over the world, and every year IARC welcomes several hundred researchers who attend conferences, workshops, and research meetings. All of these networks offer postdoctoral scientists a remarkable introduction to world cancer leaders and a rich experience that helps equip and inspire them for their future careers. As a postdoctoral fellow from Mexico said recently, upon leaving IARC and returning home as the head of a new research group on molecular mechanisms of carcinogenesis, “It has been a very positive experience. The laboratory facilities are appropriate and up-to-date. The foremost value is the atmosphere at IARC, which favours exchanges between staff, fellows, and external scientists visiting the Agency; fruitful interactions take place easily and pave the way for future collaborations.”
Postdoctoral fellows don’t spend all their time working. These members of the Early Career Scientists Association enjoyed a summer picnic in 2014.
A prominent feature of IARC’s earliest years was the awarding of Travel Fellowships to senior cancer researchers, enabling international scientific exchanges during relatively short visits. In 1983, the Senior Visiting Scientist Award was established, offering scientists with a distinguished record in cancer research the opportunity to spend a longer period of 6–12 months at IARC with the aim of developing a collaborative project. Applications are evaluated by the same selection committee that assesses candidates for postdoctoral fellowships. To date, 44 awards have been made to scientists from 18 countries, more than half of them conducting research in a variety of areas within epidemiology and biostatistics. The presence and contributions of highly qualified external scientists have proven most valuable to strengthen the methodological approaches and widen the thematic perspectives of IARC’s research teams. These awards have also been instrumental in reinforcing collaborative links with the visiting scientists’ institutions.
Three recipients of the Senior Visiting Scientist Award (left to right): Neil Pearce from New Zealand, currently a professor at the London School of Hygiene & Tropical Medicine, received one of the first awards, in 1982; Jack Siemiatycki, now a professor of epidemiology at the University of Montreal, Canada, was an awardee in 1996; Leticia Fernández Garrote, a professor at the National School of Public Health, Havana, Cuba, was a recipient in 2013.
In a related development, the Expertise Transfer Fellowship was instituted in 2006 to enable established investigators to spend 6–12 months in an appropriate centre in a low- or middle-income country to transfer their knowledge and expertise in areas relevant to the host country and related to IARC’s activities. To date, fellowships have been awarded to investigators from France, the Netherlands, Sweden, and the USA to visit Colombia, India, Uganda, and Uruguay to train PhD students in cancer epidemiology, to foster projects on cancer registration, and to investigate the relationships between viruses and cancer.
An annex to the very first IARC Annual Report (for 1966) stated: “In the short time since the establishment of IARC, its professionals came to recognize the dearth of competent epidemiologists and biostatisticians in the domain of cancer research. It would therefore be useful if the first of the international courses is devoted to ‘Concepts and methods of cancer epidemiology’. It is hoped that the course can be organized in July 1968.” The course took place in Lyon on 24 June–5 July 1968, with 30 participants, 23 of whom had all their expenses covered by IARC. Among the invited faculty members were Richard Doll and Donald Reid, who was a professor of epidemiology at the London School of Hygiene & Tropical Medicine.
Participants in the first course on cancer epidemiology in Lyon, in 1968. In the centre of the front row is Louis Pradel, then mayor of Lyon. To his right is Walter Davis, the IARC course organizer. Third from the right in the back row is the course’s scientific director, Albert Tuyns, wearing dark glasses. At the extreme left of the photograph is Calum Muir, then head of the Unit of Epidemiology at IARC.
That first course set the tone for what became one of IARC’s most popular educational activities. Courses were organized by the IARC education and training professionals, with a faculty that was usually composed primarily of external scientists, joined by some IARC scientists. Participants were selected on the basis of qualifications and involvement in research, with attention paid to the resulting distribution by institutions and countries. Attendance was free. Whenever feasible, total or partial support to meet travel and accommodation expenses was provided by IARC.
These characteristics of IARC courses have remained fundamentally the same over the decades. From those early beginnings with one annual course, the programme developed and stabilized at the level of two to five courses per year, at least one of which took place elsewhere, often in a developing country (see “IARC courses in developing countries”). In the 40 or so years until 2004, 134 courses were organized, 77 of them away from Lyon, in countries spread over the continents. The number of participants has varied from an occasional low of 20 people to a high of about 80, with an average of 30–50 students, most of whom are qualified at postgraduate level. The most frequently covered topics have been epidemiology and biostatistics, with an emphasis on methodology. Other subjects taught have been chemical carcinogenesis, virology and cancer, and mutagenesis. A successful series on the detection of environmental health hazards was presented in the 1980s and 1990s at venues in countries including China, Thailand, and Zimbabwe.
In its 50 years of activity, IARC has witnessed, and participated in, the revolution in biology, initially stemming from advances in molecular genetics. In the early 1980s, genes, whose presence could be inferred only indirectly through their influence on physical traits such as eye colour, blood group, or certain heritable diseases, became directly “measurable”. This was a huge change: for the first time, epidemiologists were able to investigate the effects not only of exposure to measurable environmental agents, like tobacco smoke, and of physiological traits, like weight or blood cholesterol, but also of inherited genes. To acquaint epidemiologists with the novel concepts and techniques of molecular biology, IARC organized a two-week course on “Molecular biology for epidemiologists” in Lyon in July 1986. Fifty epidemiologists attended the course, which was led by John Cairns, with a faculty composed of cellular and molecular biologists, geneticists, and virologists. The lectures were complemented by practical demonstrations of molecular biology techniques. The course was offered again two years later, at the Institute for Cancer Research in Oslo, and ushered in subsequent short courses in molecular epidemiology.
John Cairns, an outstanding molecular biologist who made influential contributions to microbiology and cancer biology, took a keen interest in the societal and public health aspects of cancer. The most remarkable aspects of his lectures and conversations were the seeds of reflection that they invariably planted in the listeners.
A restriction fragment length polymorphism (RFLP) pattern from a 2001 IARC laboratory notebook. RFLP was the first widely used technique to determine variations (polymorphisms) in the DNA sequence between individuals. These variations show up as different bar patterns when a DNA sample is broken into pieces (digested) by enzymes and the resulting fragments are separated according to their lengths.
In 2005, the first IARC Summer School in Cancer Epidemiology was held in Lyon (see “The IARC Summer School in Cancer Epidemiology”). At the same time, there was a reorientation of the IARC courses; most of them became specialized (particularly in cancer registration and cancer screening), while some were upgraded to an advanced level (e.g. in statistics). From 2008 to 2014, more than 70 courses were held, two thirds of them in low- and middle-income countries, with a total of more than 2500 attendees.
For half a century, the wide geographical distribution of IARC courses has made training available locally in a substantial number of countries, providing valuable technical support for cancer research, particularly in epidemiology. The courses have also promoted the image of IARC as a key organization for international collaborative studies in the cancer field. As with the postdoctoral training, the “benefit beyond measure” is the number of new collaborations, projects, and long-term friendships that result from sharing a learning environment with other similarly motivated colleagues from as far apart as Chile and China, or South Africa and Sweden. One should not underestimate the encouragement and impetus that springs from such relationships formed during time spent together at a course.
Locations of IARC international courses (2008–2013). Since the first Summer School was held in Lyon, the IARC courses have been reoriented and are centred particularly in East Asia and Latin America.
Among the materials produced by IARC, the so-called “Blue Books” series (from the colour of the cover), on the histological and molecular classification of tumours, occupies a prominent position. The books are of value for education, research, and clinical pathology practice. Well-defined histological and clinical diagnostic criteria are indispensable for clinical and epidemiological cancer studies, and in 1956–1957 the World Health Organization (WHO) initiated a programme aimed at producing an international classification and grading of tumours that would be accepted and used worldwide. Indeed, classification of tumours was one of the topics considered for the new cancer agency in the early 1960s, before its creation at the World Health Assembly in 1965 (see the chapter “The birth of IARC”). There was also an obvious need for the histological classification of tumours in laboratory animals to be standardized, particularly for use in long-term carcinogenicity experiments (see the chapter “Carcinogens in the human environment”). In 1973, IARC published the first of a series of reference books, Pathology of Tumours in Laboratory Animals, coordinated by Vladimir Turusov. Successive volumes dealt with tumours of the rat, mouse, and hamster. Demand was high; the books were reprinted, and a second edition followed in the 1990s.
Paul Kleihues (left) at IARC with Jean-François Mattei, then French Minister of Health, Family, and the Disabled. Kleihues was the IARC Director from 1994 to 2003. His tenure coincided with a cancer research environment undergoing revolutionary changes, culminating in the Human Genome Project. He adapted IARC’s laboratory activities to this new environment, encouraging connections to IARC’s major epidemiology projects. A distinguished neuropathologist, he continued his personal involvement in research on the molecular genetics of brain tumours.
The WHO classification of human tumours began with the first edition (1967–1981), which was essentially based on histological typing. The second edition was led by WHO (1982–2002), until fresh impetus was energetically provided by Paul Kleihues during the 1990s. IARC took responsibility for the third edition (2000–2005), and Kleihues collaborated with Leslie Sobin, editor of the first two editions. It was Kleihues who introduced the transformative information coming from the molecular characterization of human tumours. Each volume of the series is prepared by a group of often more than 100 internationally recognized experts convened by IARC. The “Blue Books” incorporate histology, immunohistochemistry, and genetic tumour profiles as features for diagnostic definition and malignancy grading. They also contain concise sections on epidemiology, clinical signs and symptoms, imaging, prognosis, and predictive factors, making each volume, 250–500 pages long, a compact and comprehensive reference, wonderfully illustrated (see “The WHO Classification of Tumours of the Central Nervous System”).
The complete WHO Classification of Tumours series, of which IARC is now producing the fourth edition, currently includes 11 volumes, covering tumours of the central nervous system; the skin; haematopoietic and lymphoid tissues; endocrine organs; soft tissue and bone; the head and neck; the digestive system; the lung, pleura, thymus, and heart; the breast; female reproductive organs; and the urinary system and male genital organs (see whobluebooks.iarc.fr). Rare is the pathology department anywhere in the world that does not contain one or more volumes of the “Blue Books”. The quantity distributed – about 15 000 copies per year – is a testament to their widely acknowledged value. The books are at the heart of IARC’s broader publishing activities, underpinning other areas of research, including cancer registration (see the chapter “Cancer registries: a worldwide endeavour”), biostatistics (see the chapter “Innovation in statistical methods”), and epidemiology (with the comprehensive volume Molecular Epidemiology: Principles and Practices, published in 2011 and led at IARC by Paolo Boffetta and Pierre Hainaut, and the preparation of a new edition of the textbook Cancer Epidemiology: Principles and Methods by Isabel dos Santos Silva, first published in 1999). The Education and Training Programme website (training.iarc.fr) offers an overview of recorded presentations, reference books, and practical manuals produced by IARC.