Cristina G. Lucio Madrid
Madrid
Updated Sunday, March 31, 2024-00:53
Cancer The risks of imposed optimism when faced with a cancer diagnosis: "It makes it difficult to ask for help and can lead to greater isolation"
Colorectal cancer is the second most common cancer in Spain both in men - only behind prostate cancer - and in women - behind breast tumors. In addition, it holds second place in mortality from cancer: in 2023, 15,385 Spaniards died due to it.
On World Day against this disease, we spoke with
Josep Tabernero
, director of the Vall d'Hebron Institute of Oncology (VHIO) and head of the Medical Oncology Service at the Vall d'Hebron Hospital in Barcelona, who knows the disorder very well.
To know more
Children's oncology.
Alicia and Helios' baskets against leukemia: "When I train I am accelerating the treatment"
Editor: CRISTINA G. LUCIO Madrid
Alicia and Helios' baskets against leukemia: "When I train I am accelerating the treatment"
Cancer.
Spanish researchers reveal why cases like that of Marta, who suffered two different tumors in childhood, occur
Editor: CRISTINA G. LUCIO Madrid
Spanish researchers reveal why cases like that of Marta, who suffered two different tumors in childhood, occur
Estimates from the Spanish Society of Medical Oncology (SEOM) indicate that in 2024 the cancers that will be diagnosed most frequently in Spain will be those of the colon and rectum, with 44,294 new cases. Is the incidence increasing or is this type of tumor being diagnosed better? There is a combination of both. On the one hand, this is a disease that is increasingly better known and more and more emphasis is placed on its diagnosis. On the other hand, we know that colorectal cancer is mostly an age-related tumor. So the longer the population survives, the more likely it is to develop it. In any case, what is more alarming is that, when we correct the statistics for this age factor, we also see that colorectal cancer is increasing, especially in those under 50 years of age.
What is the reason for this increase? Because we do things wrong, because the lifestyles we lead are not good. Much effort is being devoted to investigating the contribution of each factor, but we know that it influences the fact that we have Westernized or Saxonized our diet, that we eat more and more ultra-processed food, that the population globally exercises little... We have made progress in many things in health and medicine but not in healthy habits. We have to spend time preparing food and eating seasonal fruits and vegetables because the easy way to go to the shelves and buy ultra-processed food takes a high toll on our health. At their center they investigate the role played by the microbiota. What have you found out so far? We have the Optimistic program, an international project in which different institutions collaborate to understand how the change in the microbiome contributes to the development of cancer and how it contributes to the disease having a longer prognosis or evolution. aggressive Bacteria have very important power. In our body we have around 4,000 different species of bacteria. This means that of the genome that we have in the body, only 0.01% is human. The remaining 99.9% of DNA and RNA that we have in the body is bacterial. Inside the intestine we have a reactor, called a reactome, which generates an enormous amount of metabolites and processes that are essential for life. And we know that when these bacteria are altered for different reasons, they can go from being essential to becoming harmful to life. Is this alteration of the microbiome key in people who develop colon cancer before the age of 50? We have not yet established the mechanisms involved, but we do know that early-onset colorectal cancer has a microbiome that is different from that of the normal population and that of colorectal cancer that occurs in older age. We have described the role of one particular bacteria,
Fusobacterium nucleatum
, but there are many more whose intervention we do not know. And we know that factors such as diet, obesity, breastfeeding or antibiotic consumption influence the composition of the microbiome. It is important that these drugs are taken only when necessary. Because its abuse has many consequences, not only when it comes to promoting bacterial resistance, but we also know that there are different diseases that are related to changes in the microbiota. There are different factors that influence changes in the microbiota and we cannot yet establish the risk attributable to each factor or the way to modify this risk, but the epidemiological association between young-onset colorectal cancer and a different microbiome has been demonstrated. Don't the population, especially the younger ones, think about the possibility of colon cancer and are slow to ask for help? There are two factors that come into play in this. On the one hand, it is true that many people, at 45 years old, do not think about the possibility of colon cancer and do not give importance to symptoms such as a change in the rhythm of bowel movements, weight loss or the presence of blood in the stool. , which are warning signs of the disease. But, on the other hand, we are also seeing in young people that the behavior of cancer is also more aggressive, probably because the microbiome that is related to that cancer is different. We believe that both things are happening, both a minimization of symptoms and the fact that in young people the disease progresses more rapidly. With these data in those under 50 years of age, should the starting age of colorectal cancer screening programs be reduced? This is being discussed a lot and I believe it will be lowered. Screening programs are established by cost-efficiency criteria. Until now, the norm was to carry them out from the age of 50, but there are already countries that have a higher incidence of colorectal cancer in young people, such as the US or Canada, which are lowering the start to age 45. I think this will end up happening here too. And probably, at the rate we are going, in 10 years we will have to lower it even more. But these changes always have to be determined by the certainty that you are going to have an impact, that lives are going to be saved. This year marks 10 years since the implementation of the screening program in Spain, but recently the Spanish Association against Cancer denounced that the objectives have not been achieved in a homogeneous manner throughout the territory and there is no transparent data on coverage or participation. a reality that not only happens in this area, but in other areas of health. When the ministry includes something in the services portfolio, this does not imply that all the autonomous communities immediately implement it.The screening program implies that if you test positive for blood in your stool you have to undergo a colonoscopy and the reality is that the necessary resources for this to be carried out are not always established. Without a doubt, a faster implementation of the program is a pending issue. But, on the other hand, it must also be noted that personal compliance, the compliance of the people who receive the letter for screening, is not as high as would be desirable. This also happened at the beginning with mammograms and gynecological examinations of women to detect cancer early. Therefore, it is very important to continue spreading the importance of the colorectal cancer screening program. We have to convince the population to carry out the
screening
when it corresponds to them because this saves lives. Of course, it would be easier to undergo a blood test than to send a jar of feces to test for blood, but for the moment it is the test we have and it is effective. At what point is liquid biopsy research? We have made a lot of progress because I want to remember that at the beginning, 10 or 15 years ago, it was used only to know the molecular profile of an already diagnosed tumor when tissue could not be accessed. Today we are already using it to detect microresidual disease after surgery or, in research programs, at the end of complementary chemotherapy treatment, to know if microresidual disease remains or not and with that data change the type of treatment. The goal is to increase the scope of application of liquid biopsy. And I believe that it will be a fundamental tool to change the prognosis, for example, of pancreatic cancer, which we diagnose late because it does not cause symptoms. When we manage to develop more sensitive techniques, which will be achieved, we will be able to start doing liquid biopsy in risk populations once a year or once every two years and know if a pancreatic microtumor is being generated. And in the future we will be able to operate on a pancreas without seeing it because we will know from the liquid biopsy that a pancreatic tumor is being generated when the disease is still millimetric. Only then will we change the prognosis of pancreatic cancer in a major way. It is true that new treatments are changing it, but in an incremental way. If we want to change it radically, it will be diagnosed very early. This will happen with the liquid biopsy. As for treatments, what is the difference between someone who is diagnosed today and another person who had the disease detected 30 years ago? Survival continues to increase. Survival 30 years ago was 35% and now in colorectal cancer the figures are very close to 60%. In 2030, if all goes well we will be at 70%. There are multiple factors that go into this. Of course, an earlier diagnosis has an influence but also the development of better treatments, which are not only pharmacological. There has also been great progress in surgical treatments or radiotherapy techniques, among others. Fundamentally, what has changed in recent years is that personalized treatment can now be offered. Before you were diagnosed with colorectal cancer and that's it and now there are at least five different subgroups defined with a clinical approach. And, in addition, there are at least 10 more subgroups in the research phase for which we are developing personalized treatments. Today we distinguish between colorectal cancer that does not have mutations in RAS, that which has mutations in BRAF, that which has overexpression of HER2, etc. And all these types of tumors have a different treatment.The panorama has changed radically and will continue to improve in the coming years without any doubt.