WILD GEESE: Ralph DeVere White, Director UC Davis Comprehensive Cancer Center, CaliforniaEven after 40 years of treating cancer, Ralph de Vere White believes more can be done

Ralph DeVere White heads up a team at one of the world’s leading universities, where he is putting together a plan to reduce the number of deaths by cancer.

From the early days of treatment, when most patients were too far gone by the time they were diagnosed, he has witnessed many improvements in how the disease is tackled. However, after almost 40 years of treating the disease, White believes there is still much that can be done to reduce the number of people it kills every year.

Having graduated in medicine from UCD, White headed to America to study urology in 1974. It was not meant to be a permanent move but, almost four decades later, he has learned to call the US home.

“At that time there was no training in Ireland for urology, so I came here. It was my expectation to go back to St Vincent’s in Dublin as a urologist once I had finished.”

Shortly before he was due to return to Ireland, he got word that the job had fallen through, so he travelled to Boston.

He did the American medical exams, got a job at Boston University Hospital and spent three years there concentrating on urological cancers and research. A stint working in New York was followed by a move in 1984 to the University of California, Davis, where he was offered the position of chair of urology.

He was instrumental in having the then fledgling cancer centre designated as a National Cancer Institute and, in 1996, he was asked to take charge.

Under his guidance, the institute’s funding has grown from $17 million (€13.6) when he started, to $112 million last year. This year Davis was named a comprehensive cancer centre, allowing it to expand its work in developing new treatments in the ongoing worldwide battle against the disease.

“We have done a good job at picking up cancers earlier. Clearly when you look at the drop in the death rate from prostate, colon and breast cancer, treating them early has reduced deaths. There is no doubt about it.

“When I started, people being treated for testis cancer would undergo chemotherapy and they were in hospital for six to nine days and were very sick. People now do chemotherapy as an outpatient. We have made huge improvements in lowering toxicity.”

Cancer treatment remains largely ineffective in cases where early detection methods have failed or not been used. That, White says, is where cancer research must improve. While new treatments are being developed all the time, he believes it is also important to focus on how existing treatments can be put to better use. One area identified has been how different ethnicities are affected by the disease.

“Different ethnic groups do not get tested for certain cancers. For instance, we know that Hispanics do not get screened for colon cancer. Native American women tend not to get mammograms.”

By identifying those trends, White’s team is coming up with ways to target those groups and improve the chances of catching cancer before it is too late.

“The great thing about this is you don’t have to have a new drug or develop a new treatment. It’s merely trying to bring to patients existing treatments in a way that is sensitive so that they will avail of these things.”

Davis researchers are also excited about a new technique in testing tumours in mice that promises vast improvements in late-stage cancer treatment. Scientists have recently bred a mouse that has no immune system. Previously, tumours would have to be manipulated to ensure they survived a mouse’s natural defences. With these mice, White’s team can test the effectiveness of drugs on the exact tumour that is attacking the patient.

White’s work is well known around the world and, in 2006, the Irish government came looking for his help to plan for a single comprehensive cancer treatment centre in Ireland. He suggested using a system similar to the US, where hospitals and research centres are given a set of criteria that, if they can meet, will allow them to be designated as national cancer institutes.

“Unfortunately the plan died with the economy,” he says, “but there is huge talent in Ireland. You have a number of excellent places and, if you could unify it into one, you would have a powerhouse.”

He points to the established links between industry and research in Ireland as a major boon to future success and, having worked with health professionals from all over the world, he believes Ireland’s doctors are among the elite.

For the current generation, he expects there will be opportunities for those who wish to follow the worn path to America in search of employment.

“America is an extraordinarily generous place and it rewards excellence and effort,” he says. “We are going to experience a doctor shortage in the coming years and I would imagine the issue of doctors emigrating from Ireland to the States will open up again.”