Biography

Dr. Engels earned a B.A. in mathematics from the University of Virginia in 1987 and an M.D. from Harvard Medical School in 1991. From 1991 to 1994, he trained in internal medicine at Brigham and Women's Hospital. Subsequently, Dr. Engels received clinical training in infectious diseases and an M.P.H. at Tufts University School of Medicine. He joined the NCI Viral Epidemiology Branch (later the Infections and Immunoepidemiology Branch) in 1998 as a senior staff fellow, became an investigator in 2000, and was tenured in 2007. Dr. Engels holds an adjunct faculty appointment in the Department of Medicine at the Johns Hopkins Hospital. He received the 2006 Mentor of Merit award from the National Cancer Institute.

Research Interests

Immunosuppression, infection, and inflammation in cancer

A major focus of investigation concerns the epidemiology of cancer in immunosuppressed individuals. My research on HIV-related cancers utilizes data from our HIV/AIDS Cancer Match (HACM) Study. This study links HIV/AIDS and cancer registry data from 13 U.S. regions to identify cancers arising in over 650,000 people registered with HIV/AIDS. The HACM Study allows my colleagues and me to address important research questions and examine patterns of cancer incidence that have direct public health relevance. We used this resource to characterize trends in cancer risk among people with AIDS over the entire course of the AIDS epidemic. Our study documented substantial declines in Kaposi sarcoma and non-Hodgkin lymphoma over time, and a steep rise in Hodgkin lymphoma risk. We have also used this resource to examine cancer risk earlier in the course HIV infection, and are currently extending this work to look at late cancer risk many years after an AIDS diagnosis. Additional studies are ongoing to characterize in more detail the risk factors for specific malignancies.

My coworkers and I also conduct research on cancer in solid organ transplant recipients, another immunosuppressed population. We performed the first epidemiologic studies of risk factors for transplant-associated Kaposi sarcoma and hepatocellular carcinoma, using U.S. transplant registry data. Our work has led us to initiate a major collaboration with the Health Resources and Services Administration (HRSA), which oversees the U.S. transplant network. Together with HRSA, we are undertaking a computerized match of U.S. transplant and cancer registries. This Transplant Cancer Match Study will obtain population-based cancer data on approximately half of the U.S. transplant population.

My observation of a remarkably high risk for lung cancer among HIV-infected people caused me to question the common assumption that frequent tobacco use entirely explains the elevation. I have now conducted several retrospective cohort studies of lung cancer among HIV-infected persons. Utilizing various statistical methods to adjust for the effects of tobacco, each study has demonstrated that lung cancer risk is higher in HIV-infected people than predicted from the effects of smoking alone. We are performing additional studies to better understand the role of smoking and other factors in the etiology of lung cancer in this setting.

This work on HIV-related lung cancer has encouraged me to pursue other research projects to clarify the role of inflammation or infection in lung carcinogenesis in the general population. My colleagues and I performed a systematic analysis of polymorphisms in 37 inflammation genes in relation to lung cancer risk in a large U.S. case-control study. Our study identified significant associations of lung cancer risk with variants in interleukin 1A and 1B, key cytokines in initiating inflammation. In other studies, we have demonstrated an increased risk of lung cancer in people with tuberculosis or chest x-ray evidence of pulmonary scarring. My colleagues and I are presently evaluating chronic Chlamydia pneumoniae infection as a risk factor for lung cancer.

My interest in non-Hodgkin lymphoma stems from the high risk seen in people with HIV/AIDS, as well as my belief that other infections and immune-related conditions are important. Building on our prior work on the epidemiology of human herpesvirus 8 (HHV8), we described the first case of an HHV8-positive non-Hodgkin lymphoma in Africa. My collaborators and I also conducted a large retrospective cohort study of hepatitis C virus and risk of lymphoproliferative malignancies in U.S. military veterans. This study showed an association with non-Hodgkin lymphoma and, for the first time, an association with the related malignancy, Waldenström macroglobulemia. Ongoing work utilizes population-based data from the SEER-Medicare linkage to examine risk factors for diverse hematologic malignancies in the elderly U.S. population.

Keywords

Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS), Hepatitis C virus, Solid Organ Transplantation, Kaposi sarcoma, Non-Hodgkin lymphoma, lung cancer

Selected Publications

• T.P. Giordano, L. Henderson, O. Landgren, E.Y. Chiao, J.R. Kramer, H. El-Serag, E.A. Engels. Increased risk of non-Hodgkin lymphoma and lymphoproliferative precursor diseases among 146,394 hepatitis C virus infected U.S. veterans. JAMA. 2007; 297:2010-2017.
• E.A. Engels, R.M. Pfeiffer, J.J. Goedert, P. Virgo, T.S. McNeel, S.M. Scoppa, R.J. Biggar. Trends in cancer risk among people with AIDS in the United States 1980-2002. AIDS. 2006;20:1645-1654.
• E.A. Engels, X. Wu, J. Gu, Q. Dong, J. Liu, M.R. Spitz. Systematic evaluation of genetic variants in the inflammation pathway and risk of lung cancer. Cancer Research. 2007; 67:6520-6527.
• S.M. Mbulaiteye, E.A. Engels. Kaposi sarcoma risk among transplant recipients in the United States (1993-2003). International Journal of Cancer. 2006; 119:2685-2691.
• Y.Y. Yu, P.F. Pinsky, N.E. Caporaso, N. Chatterjee, M. Baumgarten, P. Langenberg, J. Furuno, Q. Lan, E.A. Engels. Lung cancer risk following detection of pulmonary scarring on chest x-ray in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening TrialArchives of Internal Medicine 2008; 168:2326-32.

Collaborators

DCEG Collaborators

• Anil Chaturvedi
• James Goedert
• Ruth Pfeiffer