Fátima Carneiro, named the world’s most influential pathologist in 2018, talked to FULLCOVER about a lifetime of challenges and achievements, clearly showing a passion for work that has not diminished over the years.
ProfessorFátima Carneiro was named the world’s most influential pathologist in 2018 by The Pathologistmagazine. Born and raised in Angola, then a Portuguese colony, she was studyingmedicine at university when civil war broke out and like many other citizens,she and her family were forced to leave the country. She came to Porto to finish herstudies and although she dreamt of being a pediatrician, she ended up as apathologist - a decision she has never regretted. Professor Carneiro neverchooses the easiest way; even today when she has to look at a patient’s tissueon a glass slide, she will, just for the sake of a challenge, do it beforegetting additional clinical information.
She is astrong believer that no one knows everything and is passionate about theimportance of getting a second opinion, which she does in her role.
Extremelydemanding and a perfectionist, but never more with others than herself,Professor Carneiro wanted to have it all – clinical activity, teaching and research – and she achieved this with a career inpathology (even though it’s been difficult to balance her professional andpersonal life and she’s lost many hours’ sleep).
During herlong-standing and brilliant career, she has always strived to share herknowledge and FULLCOVER is privileged to have spent time with her.
What droveyou to a career in medicine?
My dreamwas to become a pediatrician as I loved children and the clinical activity.
I decidedto become a pathologist after I graduated in medicine. It was 1978 and I’d justfinished medical school (at Porto University). Manuel Miranda Magalhães,professor of cell biology whom I’d met at the University of Luanda, invited me,at the end of the academic year, to join his team. It was an unexpected invitationand, after some hesitation, I told him cell biology was too quiet a field for myexpectations.
It was thenhis turn to be taken by surprise (as such an invitation should have beenconsidered a compliment), and he asked about my expectations. These were clearin my mind: to be clinically active, to participate in teaching (I loved to dothis while still a medical student in my third year) and to have theopportunity to undertake research (quite ambitious, I have to admit). He thenjust said: "That is pathology.” I’d never thought about this (my experience inthis area had not been particularly good, it was at the time of civil war thatforced me to move from the School of Medicine, Luanda, Angola, to theUniversity of Porto). All of a sudden, this field sounded attractive and,refusing his offer to introduce me to the pathology department director, Idecided to go and see him on my own. There I was, in front of Professors DanielSerrão and Manuel Sobrinho Simões. The latter, well -known for his affabilityand with some curiosity (I guess), advised I could start work with him the nextday. This was the first day of a lifelong experience that I have neverregretted. Pathology has allowed me to cover all the areas I was interested in– clinical multidisciplinary work, teaching and research - and it is alsoclinical activity at a crucial moment – that of diagnosis. Because I don´t havea queue of patients lined up waiting, it gives me some freedom to work in allthe areas I enjoy, without time restrictions.
You werenamed by "The Pathologist” magazine as the ‘world’s most influentialpathologist’ in 2018. What research work/activities led to you being given thisprestigious title?
Besides mymajor involvement in pre and post -graduate teaching (nationally and abroad)and diagnostic activity in histopathology and molecular pathology, I think mywork with international organisations played a role. This includes many yearssupporting international institutions such as the European Society of Pathology(I progressed from member of the Executive Committee, to president, chair ofthe Working Groups and chair of the Advisory Board) and the World HealthOrganization (WHO), writing and co -editing editions of its ‘blue book’ ondigestive diseases.
You’vecontributed to multiple discoveries in the field of gastric cancer; what are theselatest discoveries and how did you achieve them?
I wouldselect my contribution in the field of hereditary cancer(s) affecting thestomach. It was fascinating to be involved with the International GastricCancer Linkage Consortium and study and characterize the pathological featuresof Hereditary Diffuse Gastric Cancer (HDGC). More recently, I completed similarwork to characterise the histological profile of the GAPPS (Gastric Adenocarcinomaand Proximal Polyposis of the Stomach) syndrome. Countless hours of work wereneeded to study the whole length of gastric mucosa in stomachs - removed fromcarriers of germline mutations of the CDH1 gene (in HDGC) - and hundreds of digital images of GAPPS. The help of DrXiaogang Wen, a Chinese pathologist who has been working with us for severalyears now, was invaluable in these projects.
Are youusing any new research and treatment methods, what are they and will theyevolve in the future?
As I am ananatomic surgical pathologist, I do not clinically practice in the sense ofobserving and treating patients. Currently, my research focuses oncharacterising the immunological environment of gastric cancer, aiming tobetter identify patients with gastric cancer who may benefit from immunotherapy.This type of treatment aims at stimulating the patient’s immune cells, enablingthem to kill, or at least help to kill, the neoplasic (tumour) cells.
What’s therationale behind personalised medicine and what impact is this having in theprevention, diagnosis and treatment of cancer? Is there a new paradigm withinthis area?
In itsbroadest context, since clinicians have been working to provide care tailoredto people’s individual health needs, all types of therapy are personalised.Within our area, personalised medicine is a move away from a ‘one size fits all’approach to the treatment and care of patients with a particular condition,using new strategies to better manage patients’ health (prevention, earlydiagnosis) and to achieve the best outcomes in the treatment of patients(precision therapy targeted to molecular biomarkers).
Arepathologists progressing in understanding the cause and effect of cancerand other life‑threateningdiseases? Are we nearing the breakthrough stage for cancer?
There is abetter understanding of cancer development and a deeper knowledge aboutpredisposing factors that increase the risk of developing diseases, morespecifically, cancer. It is now clear cancer is much more than a disease causedby alterations of the genome (mutations in the broad sense). Regulation of thegene expression, by epigenetic mechanisms, is increasingly important. Furthermore,the tumour’s environment is a key factor, mediated by inflammatory and immunecells, as well as the external environment, such as lifestyles, obesity anddiet.
Istechnology changing the delivery model of medicine? Is virtual medicinebeing increasingly used to provide patients with a more personalised approachand bespoke treatment?
The socalled ‘virtual medicine’ will increase, hopefully supporting a morepersonalised approach and a move towards individual clinical treatment (whilewe continue to show compassion for every patient). The role of biobanks, withclinical annotations, is crucial to analyse genetic and molecular features ofthe patients and their tumours and to correlate with patient outcomes, enablingus to study the outliers (specifically positive, rather than negative ones).
How wouldyou like to see medical services delivered in the future?
Instead offocusing on treating advanced diseases, we should focus more on promotinghealthy living, prevention and early diagnosis.
What do youfeel are the great advances in medicine over the last decade?
Understandingthe influence of lifestyles in the development of diseases and improvement ofgeneral health education, getting people more involved in prevention and earlydiagnoses. Greater use of high-throughput "omics” technology (genomics,transcriptomic, proteomics, metabolomics, etc), that may be applied to theindividuals, theirtumours and the microbioma, for the better understanding of biologicalprocesses and diseases. One of the challenges now is how we deal with ‘bigdata’ generated by "omics” methodologies and to make sense out of it.
You’reinvolved in many societies and committees in Portugal and across Europe, howdoes this greater collaborative approach benefit participant countries?
All the countries have access to sharedknowledge through our meetings, benefiting over the years, hundreds ofstudents, residents and pathologists. Publications (scientific articles andbooks) are also distributed worldwide.
What areyour greatest accomplishments and biggest challenges?
There aremore than a few, but I’m proud of my seniority in my main field of interest - gastriccancer. This has resulted in many collaborations with several scientificsocieties, (co)authorship of around 200 papers on gastric cancer (and over 350peer‑ ‑reviewedpublications on h factor ‑64) and authorship of chapters in renowned books bythe WHO and the Union for International Cancer Control (UICC)1. I’m also veryproud of my international networking activities. My professional (in thestrictest sense) teaching and research initiatives have lead to collaborationson four continents: North and South America, North and Sub ‑SaharanAfrica, Asia (China, Japan and Singapore), Australia and New Zealand, andEurope (the latter mainly related to work with the European Society ofPathology).
As forchallenges, the pathologist of the future must be able to understand themechanisms of disease and to translate new knowledge to patient care.
What advicewould you give to anyone considering a career in pathology?
Pathologyoffers opportunities for research, clinical work, and teaching – so for thosewho want all three, there’s no need to compromise. Pathology is an amazingdiscipline, and one that plays a pivotal role in clinical medicine and in allof our efforts to better understand disease. It’s a profession and integrativediscipline and now is an excellent time to join this field.
As auniversity professor, I believe there are many talented young people joiningthe profession, but they have a very different mindset. They want toaccommodate all the different facets of their life: personal, professional andsocial – something my generation was not very good at doing. This will mean aclearer definition of their contract roles, as exists in other countries likethe Netherlands.
Do you haveany hobbies/interests?
I do notcurrently have much free time, so I spend it with my family and travelling (bringingmy children whenever possible). We have spent great times in Africa, Brazil,US, China and Japan, and many places in Europe(from southern to central and northern). I`m now a devoted grandmother to ababy boy and we are soon to have another addition to the family. I stronglysuspect my son and daughter agreed between themselves to have children at thesame time, but I’m thrilled at the prospect of having two babies in the family.
FátimaCarneiro has a medical degree from Porto’s Faculty of Medicine and a doctoraldegree from the University of Porto. She is a professor of anatomic pathologyat the Medical Faculty of Porto, head of anatomic pathology at São JoãoHospital and senior investigator at the Institute of Molecular Pathology andImmunology at the University of Porto
(IPATIMUP).She was president of the European Society of Pathology, she is coordinator ofthe Portuguese Network of Tumour Banks and council member of the InternationalGastric Cancer Linkage Consortium (IGCLC) and the International Gastric CancerAssociation (IGGA).
She isrenowned for her contributions to gastrointestinalpathology, including research on the molecular pathology of sporadic gastriccancer and hereditary gastric cancer syndromes.
