Tribute to Pelayo Correa
PELAYO CORREA
1927-2025
Photo taken in June 2016 when Dr. Pelayo Correa received the Doctor Honoris Causa from the Universidad del Valle (Cali, Colombia).
1927-2025
Photo taken in June 2016 when Dr. Pelayo Correa received the Doctor Honoris Causa from the Universidad del Valle (Cali, Colombia).
| Pelayo Correa was a pioneer of an etiologic approach to cancer, demonstrating that understanding causes can lead directly to prevention. Although he is best known for his work on gastric cancer, his vision helped shape the framework within which other researchers later established HPV as a necessary cause of cervical cancer and developed effective prevention strategies worldwide. The scientific trajectory of Pelayo Correa, a Colombian researcher born in Sonsón, Antioquia, in 1927, spanned more than half a century, from the 1960s to 2015, through sustained work across Colombian and North American universities. His work exemplarily integrated epidemiology, pathology, and public health, leaving a profound imprint on the epidemiology of cancer at regional and global levels, as well as on the training of generations of researchers in Latin America and beyond. Although Pelayo Correa is widely recognized for his fundamental contributions to gastric cancer, his legacy extends well beyond this specific field. From early in his career, he developed an etiologic way of thinking, centered on understanding the natural history of disease and identifying preventable causes. This approach—linking cause, natural history, and prevention—has become a cornerstone of modern public health and is particularly relevant for the control of infection-related cancers, including cervical cancer. Etiology as the basis for prevention In the early 1960s, when Pelayo Correa began his career, the cancer profile in much of Latin America reflected a complex interplay of social, environmental, nutritional, infectious, and biological determinants, characteristic of populations undergoing demographic and epidemiologic transition. In that context, gastric cancer in men and cervical cancer in women ranked among the leading causes of cancer incidence and mortality. These patterns were documented in a pioneering manner by the Cali Population-Based Cancer Registry, founded by Correa, whose earliest data preceded the first volume of Cancer Incidence in Five Continents and contributed early evidence from middle-income settings to the global understanding of cancer patterns1. Within this historical context, Correa’s scientific work took shape through population-based observational studies, integrating epidemiology with pathology from the outset. From this work emerged the model of sequential histopathological changes, known as the Correa cascade, describing progression from chronic gastritis to gastric atrophy, intestinal metaplasia, dysplasia, and ultimately gastric cancer2. This model provided one of the clearest demonstrations of cancer as a multistep and multifactorial process. Building on the identification of modifiable determinants, these insights later led to the design and implementation of a clinical trial providing evidence of chemoprevention, showing that eradication of Helicobacter pylori can alter the natural history of precursor lesions and constitutes a strategy for primary prevention of gastric cancer3. This long-term program of population-based and clinical research was supported by competitive grants from the National Institutes of Health (NIH), particularly the National Cancer Institute (NCI). From etiology to prevention: cervical cancer and HPV This way of understanding cancer—from cause to prevention—proved foundational for subsequent advances in other fields. In Cali, Colombia, this approach translated directly from population-based research into public health action, illustrating how epidemiologic insight can guide cancer control. In the area of cervical cancer, the documentation of the disease as the leading cause of cancer morbidity and mortality among women led to the citywide implementation of cervical cytology, supported by a centralized cytology laboratory with rigorous quality control, under the supervision of Dr. Nubia Aristizábal, Professor of Pathology at the Universidad del Valle. Two decades later, this experience made it possible to demonstrate that the absence of prior cytology was associated with an approximately tenfold increased risk of invasive cervical cancer, providing clear population-based evidence of preventability4. This body of evidence created the conditions for a decisive shift from observation to causal understanding. Building on the experience of population surveillance and prevention in Cali, Nubia Muñoz, together with Xavier Bosch, conducted at the International Agency for Research on Cancer (IARC) a population-based case–control study in Colombia and Spain, using cases from the Cali Cancer Registry5. This study provided the first unequivocal epidemiologic evidence that infection with HPV is a necessary cause of cervical cancer. The strength and consistency of these findings led to their confirmation in multiple regions worldwide, establishing the definitive evidence of causality and laying the foundation for contemporary strategies aimed at the prevention and eventual elimination of HPV-related cancers5. A global legacy Correa’s legacy has been recognized across disciplines and regions, reflecting the breadth of his influence on cancer epidemiology, public health, and prevention. This European perspective now joins those tributes, initially shaped through work at IARC by Nubia Muñoz and Xavier Bosch and subsequently continued from Europe, where this etiologic framework has been translated into contemporary cancer prevention strategies with global reach. Beyond his scientific production, Pelayo Correa exercised international editorial and scientific leadership. During the 1990s, he served on U.S. presidential advisory committees on cancer and was the founder of an international journal in cancer epidemiology, contributing to the definition of scientific priorities and to strengthening the links between research, public policy, and prevention. From a European perspective, Pelayo Correa’s legacy reminds us that understanding the causes of disease is the indispensable foundation of cancer prevention. His work remains a central reference for global efforts to reduce the burden of cancer, including those aimed at the control and eventual elimination of HPV-related cancers. REFERENCES: 1. Correa P, Llanos G. Morbidity and mortality from cancer in Cali, Colombia. J Natl Cancer Inst. 1966;36(4):717-45. Available from: https://academic.oup.com/jnci/article-abstract/36/4/717/919132?redirectedFrom=fulltext 2. Correa P, Haenszel W, Cuello C, et al. A model for gastric cancer epidemiology. Lancet. 1975 Jul 12;2(7924):58-60. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(75)90498-5/fulltext 3. Correa P, Fontham ET, Bravo JC, et al. Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-helicobacter pylori therapy. J Natl Cancer Inst 2000;92(23):1881-8. Available from: https://academic.oup.com/jnci/article-abstract/92/23/1881/2906034?redirectedFrom=fulltext&login=false 4. Aristizabal N, Cuello C, Correa P, et al. The impact of vaginal cytology on cervical cancer risks in Cali, Colombia. Int J Cancer. 1984 Jul 15;34(1):5-9. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.2910340103?sid=nlm%3Apubmed 5. Muñoz N, Bosch FX, de Sanjosé S, et al. The causal link between human papillomavirus and invasive cervical cancer: a population-based case-control study in Colombia and Spain. Int J Cancer. 199211;52(5):743-9. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/ijc.2910520513 Download pdf Written by Luis Eduardo Bravo, Professor, Department of Pathology, Universidad del Valle (Cali, Colombia). Nubia Muñoz, Emeritus Professor at the National Cancer Institute of Colombia (Bogota, Colombia). Xavier Bosch, Editor-in-chief at HPV World (Barcelona, Spain). |
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