Cancer, soon the number one killer in Hungary

01-08-2005 15:26
By Dr. József Tímár, translated by Tamás S. Kiss

Cancer is rapidly becoming the number one killer in Hungary. To overcome this serious "epidemic" cancer research requires several researchers and some earnest funding. Our recent studies on head and neck cancer (HNC) in Hungary will most probably be the focal point of interest for many years to come as middle aged men are the main target and not the older generation.

However, younger patients are also under threat with their so-called "self-destructive lifestyles", strongly abusing alcohol and tobacco.

While reviewing the data on Hungarian epidemiology, the biggest group of diseases is related to heart and multiple sclerosis. The second largest group is cancer related. Even so, cancer research has never been at the centre of medical research in Hungary. Instead, the emphasis has always been on neurobiology, the flagship of Hungarian medical science. However, if we understand and believe that socially cancer is such an important disease, while cancer research is so limited, then it is probably the government's duty to pursue or stimulate more activity in this field. In our latest research we found that in the lymphoid cells, which are also responsible for our immune system to help fight cancer, the so-called suppressing lymphoid cells (T-Cells) become predominant over the so-called helper T-Cells. This is identical to Acquired Immune Deficiency Syndrome (AIDS, caused by the HIV virus). In the case of collecting data from melanoma (a form of skin cancer) patients, we found that the ratio population of helper T-Cells versus Suppressor T-Cells is exactly the same as in those found occurring in AIDS patients.

Therefore, the result shows that the local acquired immune deficiency in this case can be induced by the tumor itself. This leads the patient's immune system to act like the immune system of AIDS patients. However, there are differences. Some tumors are not so immune suppressive, while others are highly immune suppressive. This leaves us with another question to research: We don't know which patients would benefit from immunisation therapy to stimulate their immune systems. But our findings can be a very important aspect in predicting the course of the disease and even tailoring specific immune therapies in the case of HNCs. It seems that this approach can be applied to other tumors also. To give an idea of the seriousness of HNCs we can see that [in adult males] there were about 3,000 new cases of oral cancer and 1,000 glottic (throat) cancer cases in 2001, compared to 1,400 new cases of oral cancer and about 500 glottic cases in 2000. These figures are registered at the National Cancer Registry. Hungary needs to take action and I hope that joining the EU will put cancer research to the fore. Hungary has a weak cancer lobby, unlike the West. This is not because the West is different, but rather it has recognised the importance of the issue. Having worked as a pathologist (the study of diseases and their control) for more than 20 years, while also researching cancer, mostly experimentally, I have always felt that the real test for any study in medicine is experimenting on human diseases and not on experimental models.

Since the start of my work, my prime interest was, and still remains, the tumor metastasis (implying that the cancer spreads to other parts of the body from where it originates), which is the ultimate killer of cancer patients. To broaden our studies for human tissue samples and patients we moved our lab to the institute of National Institute of Oncology (NIO). It is the only so-called comprehensive cancer centre in Hungary where a significant amount of cancer patients are available for "translational" research. Traditionally, our interest was more in the melanoma of the skin. The NIO's department of dermatology has a huge number of patients and a very well-tracked patient database on which we could build good international studies. However, with an alarming increase of HNC we soon turned our attention toward this type of tumor, which has now almost become a speciality at NIO. This kind of tumor in Hungary is unfortunately among the most frequent cancer types, especially amongst middle-aged men. Hungary is experiencing a kind of epidemic in HNC. In the past it was believed that the cause was the lifestyle of Hungarian men - heavy smoking habits and alcoholism. However, without reducing the significance of the above carcarcinogens (stimulants or causes of tumors), the story is not so simple. It is evident that there is also a genetic background for the hypersensitivity causing this cancer. It is also evident that Hungarian males, or probably a special group , the size of which is yet to be determined, have a genetic background causing sensitivity or vulnerability to carcinogens. It seems that Hungarians have inherited a weak enzyme from their ancestors.

Recently, with the help of the government's national research and development program starting in 2001, we focused our research on HNC. One of our colleagues tested Hungarian HNCs for the presence of viruses following reports appearing in international journals that the Human Papiloma Virus (HPV - the same virus that is responsible for cervical cancer among women) may be present or involved in HNCs. Surprisingly HPV was detected in about 40% of our HNC studies, indicating a significant involvement must be contributed to HPV.

Besides environmental factors such as tobacco, alcohol and genetic background, there is a significant contributing biological factor. Society may not realise that HNC is just as deadly as head and breast cancer (BC). The five-year survival rate of HNC is comparable to, if not worse than BC. However, BC has received decades of innovative combined chemotherapy approaches, which have been developed and clinically validated. This is why BC patients, even with advanced diseases, have a much better chance of survival than they had 10 years ago, while the situation for HNC patients has not changed significantly during the same period. This is partly because HNC was, and is still, not in the focus of research and development (R&D). However, the NIO is taking the problem very seriously and encourages everyone to join our initiative. R&D is also in desperate need of funding to use new molecular technologies - the so-called global gene expression profiling techniques.

In the past, one sample was taken from one patient and analysed for one gene. Nowadays, it is possible to take 100 samples from 100 patients and analyse 50 to 5,000 genes in 24 hours. But the equipment to do this costs significantly more than those used during the so-called "small shop" factory type experimental activities. Hungary is not a wealthy country and especially not too wealthy in supporting sciences. Not because it doesn't want to support science, but because the resources are limited. Recently the national R&D program has generously supported our activities. We are confident that if we continue to receive this support then we can produce significant data as our first reports indicated something that was unknown before. This will have a tremendous academic impact on Hungarian health policy. Patients are given therapy in Hungary just as good as in the West, yet still, it is not efficient enough to cure the majority of patients. The medical profession is still waiting for a breakthrough. However, unlike breast, melanoma and colon cancer, where a break through can be expected to be published any time, I am not so optimistic about HNC. This is because in the West this type of tumor is not so frequent. My colleagues [in the West] generally complain about not being able to carry out reasonable research, as they don't have enough clinical samples.

However, here in Hungary, at the NIO, we have hundreds of controlled cases plus a major tumor tissue bank ready for sophisticated clinical translation research. When I attend international cancer conferences I get the impression that international researchers would like to collaborate with us. Having the knowledge that Hungary has, such a well-controlled existing and reliable database is reassuring. The more scientific data we can come up with, the more international interest towards clinical centres in Hungary will be generated, especially HNC centres. Already, we are able to provide sophisticated treatments, as we have strong research teams for the projects. We have the requirements for significant successful international collaborations. Surprisingly in Hungary, there are only about 100 cancer researchers. This cannot be blamed on any brain drain but rather that medical researchers are more interested in other fields of medical science. The history books show that there has always been only a small group of researchers in this field. Fortunately, the few researchers that Hungary does have are internationally acclaimed. The real brains behind cancer research in Hungary are those experts who were "infected" by a devotion at a very young age and have refined and perfected their knowledge in this area. One aspect of raising awareness is that we must provide the hardcore, scientific proof of the involvement of these factors. Not only for the well-known risks caused by alcohol and smoking, but also the recent discovered risks such as genetic sensitivity and HPV.

Editor’s note:

MD PhD DSc József Tímár is Director Professor of Pathology at Semmelweis University of Medicine. He is also Scientific Editor of Pathology Oncology Research (POR), an English-language journal of the Arányi Lajos Foundation. Tímár and a group of medical experts are researching HNC at the Department of Tumor Progression of the National Institute of Oncology. He can be reached at jtimar@oncol.hu

The Arányi Lajos Foundation was established to commemorate the 150th anniversary of the first Pathology Department in Hungary which was privately initiated by professor Lajos Arányi (1812-1887). The founders wish to revive his ideas on complementary private funding for state-funded medical institutions, with the main goals being to attract public donations to help develop infrastructure and methodology in pathology and oncology while also supporting the publications of such activities. All support of the Foundation to POR is gratefully acknowledged.

Donations can be sent to:
Arányi Lajos Alapítvány/POR
OTP 11709002-20088868-00000000
OTP National Saving and Commercial Bank Ltd.
Budapest XI
Tinódi utca 9-11.
Hungary-1095