Lecture Series in Global Oncology
Phil Castle, Ph.D., Striving to End Cervical Cancer Worldwide
On Jan. 19, 2012, Phil Castle, Ph.D., the executive director of the American Society for Clinical Pathology (ASCP) Institute, visited MD Anderson to provide GAP's second Global Oncology Lecture. The event was a success, with nearly 100 visitors from several institutions including Rice University, Baylor College of Medicine, UTMB, UT Health Science Center Houston and the UT School of Public Health. Castle presented "Talking the Talk, Walking the Walk: How Do We Make Global Cervical Cancer Prevention a Reality?" in Mays Clinic, ACB 1.2325 and candidly discussed the research behind feasible solutions to the world's cervical cancer problem. His lecture can be heard on MD Anderson's iTunes University and his GAP Connect profile is included below.
It is popular to attribute being a life-long learner to professionally successful people. The term is bandied about by educators from elementary school to the university, by human resource recruiters, by managers in performance reviews and by investigators at every level of training. In part, they are correct, it is imperative that an innovator and problem-solver is a life-long learner. The frequency with which the term is used, however, belies the actual number of individuals actively engaged in synaptic development. And while you might expect such a person to inhabit scientific disciplines more often, discovering an academic who delves into outside disciplines and readily admits their own shortcomings and gaps in information is rare. Phil Castle just happens to be one of those people.
Castle has a Ph.D. in biophysics from Johns Hopkins University, but he carries the designation, and all that it implies, as comfortably and unassumingly as wearing a perfectly broken in pair of blue jeans. The letters provide credibility for his work, but his mind would have functioned similarly had he chosen a different path. Sometimes, a person’s path chooses them, however, and for Castle a major first step was taking a human physiology course from Richard Cone, Ph.D.
“My mind was reeling with thoughts after class,” explains Castle. “I thought if someone could provoke that much thought I should probably work with him/her.”
Having built a career in membrane biophysics and eye physiology, Cone took his own turn in the road and began working on preventing sexually transmitted infections (STIs). His Mucosal Protection Laboratory continues to labor on research aimed at protecting women from infections that can lead to disease. While in Cone’s lab, Castle contributed to contraceptive and sexually transmitted infection (STI) prevention research.
“Before my work in Cone’s lab, I had not considered the possibility of research focused on improving health,” says Castle. “That changed the course of my career towards reproductive health and helping populations.”
Following his graduate work, Castle moved on to a post-doctoral fellowship at the National Institute of Health in the molecular biology of mammalian fertilization. He carried out his work on the zona pellucida, or the glycoprotein matrix that envelops that mammalian egg and mediates the initial sperm binding to the egg, in the Laboratory of Cellular and Developmental Biology at the National Institute of Diabetes and Digestive and Kidney Diseases. But his heart was in study reproductive heath and prevention of STIs. A subsequent opportunity with the National Cancer Institute’s (NCI) Cancer Prevention Fellowship gave him the opportunity to earn a M.P.H. from Johns Hopkins Bloomberg School of Public Health and took him to the Hormonal and Reproductive Epidemiology Branch (HREB) in NCI’s Division of Cancer Epidemiology and Genetics (DCEG), where he could work on HPV, an STI that is the necessary cause of cervical cancer.
When Castle started his research in HREB in 2000, he worked under the mentorship of Mark Schiffman, M.D. and Diane Solomon, M.D. Schiffman was chief of the HPV Research Group at HREB and Castle was able to contribute to several large cohort studies, including: The Portland Kaiser Cohort; the Guanacaste Natural History Study; the ASCUS-LSIL Triage Study (ALTS). He later started the Persistence and Progression (PaP) Study, the Mississippi Delta Project, and The Low-Cost Molecular Cervical Cancer Screening Study and participated in numerous others. At HREB, Castle went on to become a principal investigator, in 2003, and received scientific tenure in 2010.
“Schiffman and Solomon nurtured me and gave me tremendous opportunities for growth and education,” explains Castle. “Mark Schiffman taught me practically everything I know in epidemiology and guided my early career. I am forever indebted to them and they are lifelong friends. They continue to be my mentors.”
Through Schiffman and Solomon, Castle met and engaged in research and discussions with the thought-leaders in HPV and counts them all as mentors, including: Walter Kinney, M.D., an obstetrician and gynecologist with Kaiser Permanente Medical Group; Mark Stoler, M.D., a professor in Pathology, Cytology and Gynecology at the University of Virginia School of Medicine; Cosette Wheeler, M.D., a professor in the Departments of Molecular Genetics and Microbiology and Obstetrics and Gynecology at the University of New Mexico Health Sciences Center; Francisco Garcia, M.D., professor in Obstetrics and Gynecology at The University of Arizona Cancer Center; Robert Burk, M.D., Ph.D., professor in several departments at Albert Einstein School of Medicine, and head of a lab investigating HPV infection and cervical carcinoma; Howard Strickler, M.D., also a professor at Albert Einstein, in the Department of Epidemiology and Public Health; Isabel Scarinci, Ph.D., professor in the Division of Preventive Medicine at The University of Alabama School of Medicine; Jose Jeronimo, M.D. of the Program for Appropriate Technology (PATH); Tom Cox, M.D., director of Women’s Health at the University of California, Santa Barbara; and You-lin Qiao, M.D., professor at the Chinese Academy of Medical Sciences.
In addition to these luminaries, Castle singles out Sholom Wacholder, Ph.D., a senior investigator in the Biostatistics Branch, Division of Cancer Epidemiology and Genetics. Wacholder works on several DCEG projects, and contributed significantly to the research programs in HPV.
“Wacholder has a wonderful appreciation of both epidemiology and statistics. I wish that I had a year just to go train with him,” says Castle.
Having spent more than a decade at NIH, Castle had learned from the best and brightest, but it had strengthened his resolve to contribute to solutions to the problems and their underlying mechanisms their research was elucidating. While discussing ideas with colleagues at the American Society for Clinical Pathology (ASCP) to use laboratories in Africa that the ASCP was assisting to provide testing for HPV and cervical cancer screening, he learned of a position to lead the ASCP’s Institute and establish a health services research program. Castle had spent years researching the natural history of HPV infection and cervical cancer. He had worked on projects to evaluate screening and diagnostic technologies for HPV infection, pre-cervical cancer and cervical cancer. He had investigated and validated low-cost strategies for low-resource setting countries and was intent on the results of that work leading to reducing cervical cancer and improving the livelihood of those affected by it. Cervical cancer prevention was a paradigm for health services research on evidence-based medicine. Castle’s work had allowed him to delve into research surrounding appropriate testing in different settings and feasible and sustainable health care services for the cancer with the greatest health disparities globally.
Castle left his tenured position at NIH and took on the role of executive director of ASCP’s Institute with the directive of improving pathology and laboratory medicine capabilities in low income countries paired with cervical cancer prevention programs and breast cancer control programs. To be clear, Castle’s objective in taking the role is to assist in the coalition building and cooperative efforts of multiple agencies he sees as necessary to make cervical cancer a non-issue in developing countries.
“My goal is to put myself out of business,” says Castle.
While the final objective may be clear, the path to arrive at the end result is not. Integration of HPV vaccination and screening will be key to provide immediate and long-term impacts. A significant advance is the advent of HPV vaccination, and the recent research illustrating that two and even one vaccine in the series provides protection when given to the right population; women who receive the vaccine prior to sexual activity. HPV vaccination, however, will not help generations of women who are at risk of cervical cancer. Screening remains an integral service to protect these women and reduce cervical cancer in populations with a high incidence. There are several options for screening and prevention, including self-collection and HPV testing, which has demonstrated promising results and can be employed for screening coverage everywhere women are willing to participate - from Africa to China to the United States’ Mississippi Delta. But, who will participate in a collaborative working group, how the efforts will be organized and most importantly, how any program will be funded, are nebulous sketches at best.
“I have no idea how we are going to do this – how’s that for honest? But I am certain it is going to take large coalitions working in concert,” explains Castle. “We know so much about cervical cancer prevention. We have such great tools. We have great evidence-based guidelines. If we cannot reduce global burden of this cancer, we are unlikely to be successful against other cancers.”
To Castle, the focus at present is much more about deciding the problem can and will be solved. Like so many obstacles in human history, it is going to take innovative solutions. When asked if eliminating HPV associated cancers as a problem in the developing world is possible, Castle’s optimism remains.
“I wouldn’t be doing this if I didn’t believe it was possible,” Castle explains. “We have proven there are solutions – now we just have to make sure those solutions are provided worldwide.”