Interview with Silvia de Sanjosé: “We Have Succeeded in Making Spain a Leader in the Elimination of Cervical Cancer”

Silvia de Sanjosé Llongueras, associate researcher at ISGlobal, will receive the Jaume I Award for Clinical Research and Public Health this fall.

Silvia de Sanjosé grew up among the sewing machines of her parents’ textile business, but soon realized she was not interested in production lines, but in getting closer to people and understanding their needs. This led her to study Medicine, a choice she celebrates today: although over time she has steered her career towards the study of populations, she continues to be guided by the same will to value each individual.

Recognized as one of the leading international experts on the human papillomavirus (HPV), her career has been marked by research, vaccine promotion, and the implementation of screening programs. She has worked for the International Agency for Research on Cancer (IARC), the Catalan Institute of Oncology (ICO), and the international organization PATH, and she chaired the International Papillomavirus Society (IPVS). She currently advises the U.S. National Cancer Institute (NCI/NIH), the World Health Organization (WHO), and Médecins Sans Frontières, in addition to being an associate researcher at ISGlobal, affiliate professor at the University of Washington, and chair of the Multidisciplinary Collaborative Group for Scientific Monitoring of COVID-19. This fall, she will receive the Rey Jaume I Award for Clinical Research and Public Health.

-In Spain, women today are much more protected against cervical cancer.

-We have fought a lot, it has taken us many years to get where we are, but I like to acknowledge that, in this cancer, we are on the front line. We are doing things right and just need to remain vigilant.

-Do you feel part of this success?

-Very much so. Together with Xavier Bosch and Xavi Castellsagué we were pioneers. I dedicated myself a lot to the Catalan community, and I am proud that now researchers who did their PhD with me continue the work. Catalonia is very much at the forefront of cervical cancer screening. Scientifically, it is a huge leap to go from publishing the first study that said HPV is the cause of cervical cancer to being concerned about whether to give a single vaccine dose or how we will implement self-sampling screening. Moreover, I am very satisfied to have been part of teams where, besides colleagues, we are friends. The good professional relationship within the papillomavirus community is very rewarding.

-What remains to be done?

-The great achievement has been vaccines. Sweden, Norway, Denmark, England, and Scotland have already published how, in less than twenty years, the incidence of cervical cancer is decreasing in the vaccinated population. It is spectacular. This cancer is the fourth most common in women worldwide and the one that kills the most before the age of 50. In Spain, a very significant decrease in genital warts has been observed when the quadrivalent vaccine was used. But the total reduction of cervical cancer attributable to vaccines will be seen around 2070. Meanwhile, gynecology clinics still see unvaccinated women, in whom it is not unusual to detect a cervical lesion related to an HPV infection, and such a lesion can lead to cancer.

-In Africa this happens often.

-It happens in 90% of women there. The incidence of cervical cancer is a great social indicator. Where rates are very high, there is much poverty or lack of infrastructure.

35 years dedicated to HPV and its impact on health

-Have you always been linked to cervical cancer?

-In 1989 I started working at IARC in Lyon. There I participated in the first studies that demonstrated the relationship between HPV and cervical cancer. Since then, I have been studying how to prevent this cancer!

-And haven’t you grown tired?

-No! Not at all! I was a family doctor. But at a conference, Dr. Armando Martín Zurro told us that what we saw in the consultation was just the tip of the iceberg, and that those who did not go might have more problems than those who did. It was like seeing the light! In 1984 I joined the Municipal Institute of Public Health of Barcelona, to work with Josep Maria Antó. Later I went to the London School of Hygiene and Tropical Medicine to do a Master’s in Epidemiology, and I stayed to complete my PhD.

-So you actually practiced as a family doctor.

-Two years at the General Hospital of Alicante (1981-82) and the third at a primary care center in Cornellà (1983). I have always missed clinical practice, because I really liked contact with people. During my residency at the Emergency Department of the Clínic Hospital in Barcelona, I also did many in-house call shifts. I was happy there, but I found the way patients were treated rather harsh and not very respectful. I always thought that each of them could be my father or mother. That is why I moved towards family medicine, to relate to people in the way I liked. When you do community health, you gain another vision, sometimes a bit too distant from the population. But little by little, I have transformed my way of working and now I do it increasingly closer to the teams and the real needs of people.

Never lose sight of people

-How do you manage to connect with people? For example, you were recently in the Amazon.

-Yes. In the project we are carrying out in nine countries, we work closely with groups that conduct cervical cancer screening. I try to travel whenever I can, although it tires me now, to visit places and have close contact with nurses, field coordinators, gynecologists... It is often difficult to communicate with the local population because of the language barrier, but sitting with them and observing how they interact during visits helps me feel closer to them. I always learn a lot.

-You have come very far professionally while keeping your feet on the ground.

-Look, I was once president of the International Papillomavirus Society. The experience helped me understand that I had to get closer to the problem of health inequality. I needed a personal change. For two years I became involved in a cervical cancer screening project with the NGO PATH, focused on Honduras, El Salvador, Nicaragua, and Guatemala. And as a result of this work, I was contacted by the U.S. National Cancer Institute (NCI) to co-lead the multinational project PaVE, which seeks to validate innovative, low-cost methods for cervical cancer prevention in places with little infrastructure or difficult access to medical services. Since then, I have been working on this project, which did not stop even during the COVID-19 pandemic.

The icing on the cake

-What do you think about receiving the Jaume I Award?

-I see it as recognition of a line of work with both an important international and national dimension. I am proud to have devoted many years to addressing a major public health issue. Approaching it within a public health framework, studying the community as a whole, provides much deeper insights than if we only relied on the clinical perspective of individual symptomatic demand. Being able to predict who might develop the disease and act before it happens—effectively—is both essential and highly motivating. I have been fortunate to meet people along the way who shared this vision of medicine. They supported me greatly, we supported each other, and together we have achieved truly remarkable results. This award is a celebration of all that collective effort. And I like to remember that my mentor Xavier Bosch also received it many years ago, and that it is the second time it goes to ISGlobal, because the award last year went to Jordi Sunyer.

-Should we emphasize that it also awards a woman?

-The visibility of women in research has improved, although parity is not the best goal. I have no doubt that the Jaume I Awards have prioritized science and not the sex of the researcher, but I am glad that four women have been awarded. In medicine and research there are more women than men, so it is to be expected that there is corresponding visibility.

-Do you feel that you have had to put family somewhat aside to dedicate yourself to research?

-Manolis Kogevinas and I have two children, and we did our best to make work compatible with family life. For example, we had a very detailed schedule so that our work trips did not overlap. The first night we left them alone, I think my eldest son was already 16. They complain that we worked too much! It is true that we have lived our work with passion, and it may be that part of our leisure time we also devoted to work more than they would have liked.