Cancer Epidemiology

Our research on the underlying causes of cancer in Uganda will be conducted within the context of our existing research platforms, in particular our General Population Cohort (GPC). The GPC was initiated in 1989, and comprises the population of 25 adjacent villages in rural Uganda; these individuals have been studied intensively for 30 years and a great deal of information about health and disease has been amassed. We have found that cancer is a major cause of death in this population and that the most important causes of cancer are underlying infections. The work of my Programme, is therefore focused on trying to understand the burden and transmission of these infections with a view to intervening to reduce the burden of associated disease.

We will build on our work showing that the malignant and non-malignant consequences of oncogenic infections (including HIV) are a major cause of morbidity and mortality in Uganda and that lifestyle risk-factors such as tobacco are currently relatively less important in this setting. We will i) examine the transmission dynamics of oncogenic infections, ii) initiate preventive interventions and, iii) conduct aetiological research on specific cancers. For example, the determinants and immune correlates of suppression and transmission of Kaposi’s sarcoma associated herpesvirus (which exists at higher prevalence in our rural cohort than has been reported anywhere else in the world) will be studied. Working within our population platforms, we will: i) examine the impact of a national HPV vaccination scheme on circulating subtypes of HPV; ii) assess the feasibility of H. pylori eradication in a population in which infection is ubiquitous; iii), conduct a feasibility study of Hepatitis C Virus cure and iv) develop further work on understanding liver disease and progression of chronic infection with Hepatitis B virus. We will also seek external funding to conduct a randomised-controlled trial of low-technology methods (a package of post-harvest measures) in combination with a bio-control approach to reduce aflatoxin levels, which we have previously shown to be an important exposure. Comparative research on the epidemiology and aetiology of haematological malignancies in Uganda and in the UK will be further developed, in conjunction with studies of the HIV-related cancers Kaposi’s sarcoma and conjunctival carcinoma.