"Cancer is not going to disappear, but there are more and more cures and chronification"

The life expectancy of the Spanish population It is one of the highest in the world, especially in the women. “In the lead are Japan and Switzerland, but Spain is well placed. That is because we continue to have the Mediterranean diet, a good health system, mild climate, universal screening programs … ”, explains dr. Josep Tabernero, a oncology expert In addition, he accumulates positions: he is the director of the Vall d’Hebron Institut de Oncología (VHIO), head of the Oncology Service of the Vall d’Hebron University Hospital and medical director of the IOB Oncology Institute.

Despite the optimism of his first statement, this expert warns that the Cancer prevention It's failing because we skip the recommendations of the specialists. “The Decalogue of Oncology Prevention must be followed, and this is not the case. If we comply, our risk would be reduced by 40%, ”he explains.

M.H. What does this prevention decalogue propose?

Josep Tabernero No smoking, reduce alcohol consumption, do not drink trans fats and minimize saturated fat, increase the consumption of vegetable fiber, and minimize the consumption of ultraprocessed. Also exercise several times a week, avoid excessive exposure to the sun's ultraviolet rays, avoid pollution and ionizing radiation. And control obesity.

M.H. There are also proactive measures.

J.T. They are, for example, getting vaccinated against hepatitis B or treating hepatitis C infection (to prevent liver cancers), getting vaccinated against papillomavirus (to prevent cervical cancer), getting well established screening tests (gynecological examinations and breast, blood tests for the colon …).

M.H. What cancers are more related to lifestyle?

J.T. Above all, the intestinal and hormone dependent, such as most of the breast, prostate and endometrium. All of them are linked to excess body fat, because it increases the levels of hormones that favor the development of these tumors.

M.H. The Vall d’Hebron hospital, and you as a principal investigator, participates in a large international project to study the relationship between the microbiome and colon cancer. How important is that job going to be?

J.T. We know that the composition of the intestinal microbial population influences the risk of developing tumors. Our goal is to find out how far that relationship goes in colon cancer. The study is called OPTIMISTIC and it involves 11 centers and 14 researchers from around the world. We want to see the effect of the microbiome in all phases of cancer, from its inception to metastatic disease.

M.H. How have the latest oncological advances changed the landscape?

J.T. They have been revolutionary and are improving cure rates. We try to use more personalized treatments, aimed at specific cellular alterations and with few side effects.

M.H. Do you think that chemotherapy will eventually disappear?

J.T. Not at the moment, but it will be combined more often with biological treatments. There will also be more prevention, early diagnosis, chronicity … Nor will the cancer disappear. In fact, the older we turn, the greater our risk of suffering. On the positive side, thanks to new advances, the rates of healing and chronicity continue to increase.

M.H. A Swiss study found that some older women die from causes other than cancer, even if they have untreated cancers. If they had treated them, would they have lived less?

J.T. The important thing in Oncology is to see how the disease evolves before treating it. There are many cases that we do not treat. For example, there are chronic lymphatic leukemias that are not treated until the patient does not develop clear symptoms or the disease progresses. In addition, cancer cells have an enormous capacity to develop resistance to treatments. That is the cause of most deaths. That is why it is important to investigate, to anticipate how cancer cells will evolve and prevent them from becoming resistant.

M.H. What fields are you working on right now?

J.T. Basically in three fields. The first is to develop drugs that reduce cancer's ability to evolve. The second is to take cancer to a state that makes it vulnerable to medications and, finally, to use a combination of treatments that act together as a barrier that it is not able to overcome. The experiments are giving promising results, but they will all take at least a decade to become real.

A threat in numbers

According to Spanish Society of Medical Oncology (SEOM), this year they will be diagnosed near 280,000 cases of cancer in our country, 12% more than in 2015. This increase responds to factors such as population increase, aging, exposure to risk factors such as tobacco, alcohol, obesity and sedentary lifestyle, and the establishment of programs for early detection of disease, which increase the number of localized cases while favoring cures. Globally, the number of new cancer cases is also expected to increase in the next two decades, from the 18.1 million that were detected in 2018 to some 29.5 million in 2040. Despite the high numbers of mortality, survival increases continuously. In Spain it is 53% at five years, similar to that of other countries in our environment. + Info: www.vhio.net/en, IOB-onco.com and seom.org