World Oncology Forum 2015

Preventing the preventable

Dr Franco Cavalli - European School of Oncology, Bellinzona, Switzerland

We started four years ago, in 2012, when the European School of Oncology celebrated its 30th anniversary. At that time we decided that in order to do that we would put together a high level meeting of one hundred experts in the different fields of cancer research and cancer treatment, including fifteen scientific journalists, both from the lay press and from the scientific press. These one hundred experts were convened in Lugano and they had to answer one sole question – are we winning the war against cancer, yes or no? Well, after very long discussions, they came up with kind of mixed answers, saying yes, from a pure scientific point of view we might be on the right track to solve the problem. But if we look at the number of patients dying every year because of cancer worldwide where we expect an increase by almost 100% within the next 20 years, we might be about to lose the war against cancer.

So we decided, well, we might try to do something about that and we put together an appeal called Stop Cancer Now which was intended to be for the public opinion and for the policy makers. We published that in full page advertisements in the five leading newspapers worldwide and we started some activities in order to try to realise these ten points of our appeal which go from prevention, early diagnosis, essential treatment package, education of the patient and mainly asking governments to deal with the cancer problem since our impression is that many of the international political organisations like G8, G20, World Bank and so on, they do not like very much to discuss cancer because it’s much too complex an issue for them.

The theme of this year’s World Oncology Forum is ‘Prevent the Preventable’ – could you tell us about that?

After this first meeting we decided to have two smaller meetings, one last year where we discussed the points of the appeal relating to ‘Treat the Treatable’ and this time we are meeting here in Milan to discuss ‘Prevent the Preventable’, whereby we decided to concentrate mainly on obesity and alimentation. The first time in Lugano we put a lot of weight on tobacco so our declaration about tobacco was very strong, calling for a war against tobacco. One of the points of our appeal is also concentrating on preventing infections, so calling for much more widespread use of available vaccines, mainly thinking of HPV and cervical cancer. So there was one point in our appeal which was related to eating disorders, to obesity, to physical activities which we didn’t discuss in depth. So we thought that since we are in Milan, since we have now the world experts in Milan, which is devoted to feeding the world so, again, to this whole problem on how to feed the population, including all the eating disorders we decided to concentrate on that aspect and that’s what we are just discussing now.

With obesity on the rise globally, do you think this will impact the cancer landscape?

There are a lot of data, some we have already discussed today and yesterday night. On the one side we have still to remember that the role of obesity and of eating is there but is, for sure, much less important than, for instance, tobacco. Tobacco remains much more important so we should not forget that and concentrate just on eating vegan or vegetarian but continuing to smoke. This should be remembered. On the other side, there is no doubt that eating habits, obesity, lack of physical activities are important factors, not so much in creating the beginning of the first cell which will then develop to a cancer but in keeping the cancer cells alive. So we know that during our live there will be very often a cell which will be mutated and this mutated cell could then be the beginning of a process leading to a cancer but most of these cells will not survive. The effect of obesity and of eating habits and what we can consider the microbiota, or the microenvironment, in our body, the role of all of that is that this microenvironment can either kill or keep the tumour cell alive and allow the tumour cell to grow and to develop a cancer. So all the epidemiological data that we have points to the fact that obesity, lack of physical activity, high consumption of fat, of red meat, of processed meat, increases the occurrence of various types of tumours. Of course the increase is not, let’s say, 150% like comparing non-smokers to smokers, it’s perhaps in the order of 10-15%. So it’s much less and this creates also the problem, the difficulties in pinpointing exactly which is the role, mathematically expressed, of this complex of microenvironment factors. But there is no doubt that it is important, what we have to understand is how important that is in relation to all the possible factors which are favouring the development of cancer.