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Lecture No.2
The North–South Asymmetry in the “Global Knowledge Structure” of Cancer Research and its Reorganization
SPEAKER
Malcom MOORE
Director, EurAsian Education – Intermal; Coordinator, Asian Pacific Organization for Cancer Prevention (APOCP)
- Profile -
Malcolm MOORE is a British scientist and international coordinator in cancer control. He graduated with a BSc in Zoology from Leeds University in 1973 and completed a PhD at Bristol University’s Graduate School of Medicine in 1979. His career spans over four decades, beginning with research fellowships in cytopathology and experimental pathology at institutions such as the German Cancer Research Centre and the Japanese Foundation for Cancer Research. He has held academic positions at Nagoya City University and the University of New South Wales, later serving as a guest scientist at the National Cancer Center in Tokyo. In 1999, Moore co-founded the Asian Pacific Organization for Cancer Prevention (APOCP), where he continues to serve as coordinator, and spent many years as Chief Editor of its journal, the Asian Pacific Journal of Cancer Prevention (APJCP), which has published over 12,300 articles. He has also led the UICC Asia Regional Office (UICC-ARO). More recently, he launched EurAsian Education – Intermal, an initiative expanding scientific outreach to encompass art, cuisine, history, and language, fostering cross-cultural collaboration and support.
Kazuo TAJIMA
Director, Misugi Clinic, Japan
- Profile -
Kazuo TAJIMA is a pioneering cancer epidemiologist whose research on HTLV-1 transformed global understanding of viral transmission and cancer prevention. Born in Hiroshima, Dr. Tajima graduated from Osaka University’s School of Medicine in 1972 and trained in surgery and pathology before joining the Aichi Cancer Center. He also has a master’s degree from Johns Hopkins University’s School of Public Health. His groundbreaking work on Adult T-cell Leukemia (ATL) led to the identification of HTLV-1 transmission routes, enabling preventive measures. He conducted global blood surveys, discovering HTLV-1 prevalence in Japan and the Andes, and extracted provirus DNA from Andean mummies, suggesting ancient migration links. He launched the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC), comparing cancer and non-cancer patient lifestyles. He previously served as Director of the Aichi Cancer Center Research Institute and Advisor to Mie University Hospital, and continues to champion community healthcare and inspire future medical researchers.
SUMMARY
SUMMARY
(1) Introduction to the lecture
Norie KAWAHARA began by reflecting on the first lecture of the autumn series that had taken place the previous week, and which had set the tone for the semester by providing the broad perspective that will anchor the entire series. She noted that the autumn lecture series is intentionally structured as a journey from cultivating a wide vision through to analyzing specific challenges to designing effective solutions. The first lecture was a crucial first step on that journey, providing a panoramic view of health that crosses national boundaries. The two speakers, Shinjiro NOZAKI and Rabindra ABEYASINGHE had asked students to consider one essential question, namely how can health and the systems that sustain it transcend national borders. Dr. Nozaki noted that the idea of “health for all” did not begin with the Sustainable Development Goals (SDGs), but rather it has a long lineage, from Japan’s early achievement of universal health coverage (UHC) to the Alma Ata Declaration, both of which predated the SDGs. He had also illustrated how leadership, such as Hashimoto Initiative, changed the global health agenda, turning infectious diseases into a shared global responsibility. He had noted how leadership thus matters because it connects vision with action.
Dr. ABEYASINGHE had then discussed contemporary and future issues, such as climate change, antimicrobial resistance (AMR) and non-communicable diseases (NCDs) like cancer. He made it clear that national borders mean little in the face of these forces. He asked students to imagine UHC not just as a national policy, but as a regional and even planetary commitment, and one that links human wellbeing to the wellbeing of earth itself. He noted that there is no UHC without shared responsibility. What resonated most was the call for shared ownership of health in Malaysia. As Dr. ABEYASINGHE observed, people often expect the government to take care of their health, but the future of UHC depends on a shift from a mindset of entitlement to one of co-responsibility where individuals, community and the government work together. That transformation, he noted, begins with health literacy, with helping people understanding that to live well is also to act well.
Finally, the lecture revealed that health systems are not only about treatment, but also about trust. UHC cannot be sustained by policy alone. It must be anchored in people's participation, in their willingness to talk together, to learn from each other and to care beyond their own borders.
Dr. Kawahara asked students to carry forward this spirit and lessons from lecture one, which had provided a broad global perspective, which is exactly what is required as students move to consider more specific cancer-related challenges in the coming lectures.
UHC is not just as acronym, it is a living bridge between wellbeing and equity, between science and humanity, and between nations, which choose to collaborate rather than compete. That ultimately is what this lecture series is about: learning to build those bridges.
Introducing the speakers for the lecture, Dr. Kawahara noted that the lecture series has been supported by the UICC Asian Regional Office (UICC-ARO) for the past 15 years, and Malcolm MOORE and Kazuo TAJIMA have been deeply involved in the activities of UICC-ARO over the years. Both speakers are leading persons in cancer epidemiology in Asia. Cancer research networks in Asia owe a great deal to their efforts.
(2) Lecture 1
Asia Pacific Organization for Cancer Prevention (APOCP) for the UICC Asia Regional Office (UICC-ARO)
Kazuo TAJIMA began by providing a brief self-introduction (see profile above). He explained that from 1977 to 2013 his main research focus has been patho-geographical/ethno-epidemiological studies on adult T-cell leukemia/lymphoma and human T-cell leukemia virus (HTLV-1) in Japan and the world. From 1987 to 2013 he established and operated the Hospital-based Epidemiological Research Program at Aichi Cancer Center (HERPACC), and from 2000 to 2009 engaged in a trilateral collaborative study with Korea and China, the KOJACH study.
In terms of research on global cancer control, from 1990 to 2005 Dr. Tajima served as Secretary General of the Asian Pacific Federation of Cancer Control (APFOCC) and from 2000 to 2015 as head of the Asia Pacific Organization for Cancer Prevention (APOCP). From 2006 to 2016 he spent 10 years as head of the Asian Cancer Prevention Program and Board Director for UICC.
With regard to Dr. Tajima’s work on the integration of epidemiological studies for lifestyle diseases prevention, the main means by which research is conducted are cohort studies and case-control studies, which focus on prevention (Figure 1).
Figure. 1 Scheme for Integration of Epidemiological Studies for Lifestyle Diseases Prevention
In terms of Dr. Tajima’s contribution to the main cohort studies in Japan, for a period of almost 30 years from 1980 to 2009, he engaged in the Japan Collaborative Cohort (JACC) Study. He also collaborated in the Three Prefecture Cohort Study on Air Pollution and Cancer (Aichi Prefecture) from 1990 to 2005. Another study that is ongoing is the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study.
Dr. Tajima previously served as the head of the study group of the Ministry of Education, Culture, Sports, Science and Technology (MEXT) to engage in an Epidemiological Study on Environmental and Host-specific Factors for Human Cancer, which covered a total of four fields. Of these, the third field was an ethnoepidemiological study on environmental and host factors for increasing cancer sin Korea, Japan and China (KOJACH Cooperative Study; Figure 2).
Figure. 2 Epidemiological Study on Environmental and Host-specific Factors for Human Cancer: Field A03 – Ethnoepidemiology of Cancer
The study group devised a pyramidal structure of recommended dietary and beverage habits for primary prevention of cancer.
With regard to the history of the Asia Pacific Organization for Cancer Prevention (APOCP), Dr. Tajima noted that since 2000 the organization has been engaged in educational and preventive actions with regard to cancer, and the organization’s journal, the Asian Pacific Journal of Cancer Prevention (APJCP) publishes a wide variety of papers and other reports. The APOCP was established ahead of the UICC-ARO, which itself came into being in 2007 as a body dedicated to cancer control activities in the Asian region, under the auspices of UICC. The funding meeting for APOCP took place in Thailand in November 2000, and the first APOCP General Assembly and International Conference took place in October 2002, on the topic of “Inflammation and Cancer.”
At the time of its inception, UICC-ARO engaged in a triple set of actions: 1) information transfer for knowledge, 2) Research coordination for evidence, and 2) Intervention efforts for prevention.
Another initiative was the Platform for Three Dimensional Strategic Directions for Practical Prevention Program (PPP) against Cancer, which incorporated site-specific strategies with broader regional and global strategies.
In recent years Dr. Tajima has been working in local communities, engaging in initiatives for the reinforcement of local community contribution for epidemiology and prevention studies. The role of local people and local governments is critical in order to attain data that is essential for cancer registries and epidemiological studies in the future.
Discussion
Dr. Kawahara asked what are the important elements for establishing similar activities to those engaged in by Dr. Tajima in Japan.
Dr. Tajima responded that the most important thing is collaboration among researchers and communities in the countries of Asia. As each country and region has its own specific lifestyles and disease patterns it is important to elucidate the various patterns of lifestyles and diseases in each country. UICC and APOCP can play a role in encouraging collaborative activities. It is very important to share knowledge about cancer and effective methods of cancer control.
Dr. Kawahara noted that Dr. Tajima has a strong network with colleagues in Asia, built up over the course of many years. She asked Dr. Tajima for a message to young researchers who are just starting their careers now.
Dr. Tajima responded that it is important for young researchers to take a holistic approach and look at a variety of factors when engaging in their research. There is a great deal of information available in this day and age, but it is important to be able to synthesize such information effectively.
Dr. Moore noted the importance of political support and funding for epidemiological studies in low and middle income countries.
Dr. Tajima noted the importance of gathering a broad range of information for epidemiological studies, including areas that extend to the arts and culture. It is important to take a holistic approach when looking to accumulate data, in order to gain a full picture of the situation in any given country or community.
A student asked about the relative high prevalence of colon and breast cancer in previous years in Japan, compared to China and Korea and what are the factors behind this difference.
Dr. Tajima responded that lifestyle factors are significant in determining incidence rates in different countries, and the same was found in the KOJACH studies. A study in the United States showed the rising incidence of cancer in immigrants as they adopt western lifestyles and diets.
(3) Lecture 2
Cancer Research Capacity in Low- and Middle-income Countries: An Attempt at a Comprehensive NGO Perspective
Malcolm MOORE opened by expressing his appreciation to his colleagues and hosts and reflected on his experiences leading the UICC Asia Regional Office (UICC-ARO), an organization which has been fully funded by UICC-Japan since its inception. He emphasized that his role at UICC-ARO had provided him with the necessary exposure to understand the challenges and opportunities in building cancer research capacity in low- and middle-income countries (LMICs). He introduced two colleagues from Central Asia—Elena Ten and Nurbek Igissin—highlighting their potential as future leaders in cancer control in LMICs, if given adequate support.
Dr. Moore noted that his presentation was originally inspired by a request from Simon Sutcliffe of the International Cancer Control Congress Association to address how to improve conditions for MSc and PhD students in LMICs. Dr. Moore contrasted his own experience as a PhD student in 1970s England—where he had access to funding, mentorship, and publication opportunities—with the current situation in many LMICs, where students often pay for their education, lack supervisory support, and face significant barriers to publishing.
He outlined four key elements that influence the success of postgraduate students and their research: academic authorities, granting bodies, the employment world, and the publication world. Among these, he noted that academic authorities bear the greatest responsibility, as they influence the other three elements. He stressed the importance of a supportive physical and research environment, including access to libraries, laboratories, office space, and high-speed internet. Structured academic routines are also of great value, such as daily journal clubs and pathology case discussions, which Dr. Moore himself had experienced in Japan and found to be highly effective in cultivating research skills among participants.
Dr. Moore also addressed the need for academic institutions to foster a culture of research by facilitating conference participation, cooperative research, and access to funding. Many supervisors in LMICs are trained in the field of infectious diseases and may lack the background or experience to guide research in non-communicable diseases (NCDs), which now account for the majority of premature mortality in Asia. He proposed strategies such as public health modules, course training, accelerated MSc/PhD programs, international training opportunities, and the involvement of foreign co-supervisors to address this gap.
On the topic of research training, Dr. Moore referenced a practical guide he had co-authored on scientific English writing and emphasized the importance of follow-up support to ensure that training leads to successful publication (Figure 3). He emphasized the importance of epidemiology courses targeting both academic and government bureaucratic staff to build shared understanding and capacity in cancer control.
Figure. 3 Key points to research training
Using WHO data, Dr. Moore illustrated that cardiovascular disease and cancer are the leading causes of early mortality in many Asian countries. He identified five cancers—lung, colorectal, stomach, breast, and cervical—as the most prevalent and proposed focusing research and training efforts on these areas, emphasizing the need for trained personnel in education, screening, early detection, epidemiological assessment, treatment, and rehabilitation.
In terms of how to go about research, Dr. Moore described the importance of hospital-based, site-specific clinical assessments and the creation of registries. He shared examples of successful registry development, noting that motivated and influential individuals are often the driving force behind sustainable cancer registries. He cited the example of a breast cancer registry initiated by a clinician in Malaysia and suggested that similar models could be expanded to other cancers and institutions.
He proposed a model for international hospital-based comprehensive case-control studies and cohort studies to assess screening, diagnosis, treatment, and outcomes, emphasizing the need for large datasets to evaluate clinical interventions and quality of life outcomes, and advocated for international collaboration to support such efforts (Figure 4).
Figure. 4 Important of multi-institutional cooperation in research
On the publication front, Dr. Moore discussed the challenges researchers from LMICs face in accessing high-impact journals, including cost barriers and editorial bias. He highlighted the role of the Asian Pacific Journal of Cancer Prevention (APJCP), which he had helped to establish in 1999, and which has been a leading publication in providing a platform for region-specific research. He presented data showing that APJCP has published more articles on key cancers than many other journals, underscoring its importance in the region. He called for standardized criteria for article quality and equitable review processes across journals.
Dr. Moore concluded by outlining a vision for a regional organization that would support MSc and PhD students through program design, funding access, publication support, and coordination with international bodies such as WHO, IARC, and UICC. He reflected on the legacy of the activities of the Asia Pacific Organization for Cancer Prevention (APOCP) and the Asia Pacific Federation of Organizations for Cancer Research and Control (APFOCC), and expressed a desire to revive and expand such collaborative efforts, including the activities of UICC-ARO.
Dr. Moore closed by encouraging the identification and support of future leaders in LMICs and invited participants to join his initiative, the EurAsian Education - Intermal organization, to continue building capacity for cancer research and control across the region.
Discussion
A student asked a question about the new initiative launched by Dr. Moore, EurAsian Education – Intermal, noting that it sounds like an inspiring idea, especially because it seeks to combine science with art, culture, and language. The student asked what inspired Dr. Moore to expand APOCP’s work into this more interdisciplinary space, and it will help people connect beyond the scientific community.
Dr. Moore responded that the pandemic was a big motivational factor in seeking to provide expertise free of charge to others because it is a responsibility of academics to do so and in so doing pay back to society. He seeks to get more involved in practical ways in NCDs control.
A student referred to cancer registries, noting that the creation of registries may be difficult in LMICs.
Dr. Moore responded that in China the quality of registries has increased dramatically in recent years, thanks to the Chinese government’s actions to enhance registries and collect the relevant data. However, in the countries of Central Asia there are still no registries of sufficient quality and countries in Southeast Asia also face challenges in compiling and maintaining registries. Registry data is essential for cancer control and it is extremely important that they continue to be developed.
Dr. Kawahara asked what is the most important thing that needs to change and what will be necessary to effect that change.
Dr. Moore responded that cancer control initiatives are a matter of national priorities. In East Asia the situation is very different from the situation in Central Asia, where financial support is not readily available. What is important is for countries that have been successful in bringing down cancer incidence, such as Korea and Japan, for example to share their experiences. It is important to work together to bring down the burden of cancer and other NCDs, because many risk factors are common to NCDs.
Dr. Kawahara noted that in the lecture students had learned about how cancer research and control have mainly developed from the perspectives of high-income countries, and how important it is to include the voices and viewpoints of LMICs.
Assignment
The assignment for students was set as follows:
Reflect on the importance of building research capacity for cancer researchers in LMICs and consider the main challenges they may face. Based on what you have learned in the lecture, think carefully about this topic and write your own thoughts and perspective.
Additionally, using the APOCP cancer epidemiology course or similar international training initiatives as an example, consider how effective such programs are, and suggest how they could be improved in the future.
Describe your own research background, and reflect on the “Four Worlds” model that shapes cancer research: academic authorities, granting bodies, publication world and employment world.
Compare this framework with your own research environment, and consider how each of these dimensions influences or differs from your experience.
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