On December 13, the US pharmaceutical company Moderna communicated the encouraging results obtained in the experimentation of an anticancer vaccine based on mRNA technology, the same one used successfully in vaccines against COVID-19. The news inaugurates a new therapeutic strategy against cancer but will require confirmation and further research before all patients can benefit from it. Meanwhile, epidemiologists warn, cancer patients will continue to increase at an ever-faster rate for at least another two decades.
The prediction is available to everyone on the website of the International Agency for Research on Cancer (IARC), the agency of the World Health Organization specializing in cancer research. If in 2020 there were about 20 million new cases of cancer in the world, the figure will rise to about 30 million in 2040, for 54 percent men. The number of deaths will also grow proportionally, going from 10 to 16 million in the same period.
If we limit ourselves to Italy, the IARC predicts that in twenty years the annual number of new diagnoses will grow from 400,000 to 500,000, and deaths from 180,000 to 230,000. The projection is analyzed in the recent report The numbers of cancer in Italy 2022 published by the Italian Association of Medical Oncology. “If on the one hand it represents the continuation of a growing trend in the number of new cases of cancer – write the epidemiologists Diego Serraino, Luigino Dal Maso, Carlo La Vecchia and Salvatore Vaccarella, who collaborated on the report – on the other hand it raises questions for which currently there are no comprehensive answers.”
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In fact, although they show a rather clear trend, even those of the IARC are estimates to be taken with caution because they are based on hypotheses that must be verified in the field. For example, they assume that between now and 2040, the incidence and mortality rates in various age groups will remain unchanged. In reality, in recent years both the incidence and mortality rates appear to have slightly decreased for many types of cancer and age groups. The credit goes to the improvement of therapies, awareness of risk factors and programmes screening which allow for earlier diagnoses.
The agency’s forecasts, however, take into account the progressive increase in the statistical weight of the older groups, in which the incidence of cancer is higher. This is the main reason why the number of cancer diagnoses and deaths in the general population is rising year on year and will continue to do so. Even if therapeutic advances continue, as Moderna’s announcement suggests, it is therefore highly likely that a global cancer epidemic is on the way.
The topic has been alarming oncologists for some years now. In 2016, the United States launched an ambitious program called “Cancer Moonshot”, with a clear reference to the extraordinary investment that brought astronauts to the moon in the 1960s. The program, confirmed by the Biden administration in early 2022, has the goal of halving cancer mortality in the United States over the next 25 years. Now also in Europe the scientific community is asking for a similar effort, made even more necessary by the worsening of social and health conditions in recent years.
In mid-November 2022, 47 oncologists from all over Europe published a substantial report in the journal “Lancet Oncology” in which they invited the European Commission to adopt a plan called the “European groundshot” aimed at the “70:35” goal, i.e. raising to 70 percent chance of 10-year survival after diagnosis for all cancer patients by 2035. The replacement of moon (moon) with ground (soil) in the denomination is significant. ‘A more patient- and citizen-centred and less techno-centric approach to cancer research is more appropriate to the challenges cancer poses to Europe,’ the researchers write. ‘Cancer research priorities need to reflect what is happening on the ground, and promote a person-based, holistic hit list.’ Very often, in fact, translational research has favored purely scientific and industrial objectives, which have had a limited positive impact on the quality of life of patients. In the current juncture, European oncologists highlight three critical issues that research must address immediately: the COVID-19 pandemic, the war in Ukraine and Brexit.
The COVID-19 pandemic has severely slowed down the activities of screening and oncological therapies. ‘An estimated one million cancer diagnoses were missed across Europe during the pandemic,’ write the report’s authors. “Scientific evidence shows that today a higher percentage of patients are diagnosed with cancer at a more advanced stage than pre-pandemic rates, due to delays in diagnosis and treatment. This advance in severity will put pressure on services European cancer healthcare providers in the years to come.”
The Italian data are in line with the European ones. The latest report National Outcomes Program. 2022drawn up by the National Agency for Regional Health Services and presented last December 6, shows that in 2021 the number of operations for breast cancer (leading cause of death from cancer in women) has returned to the pre-existing trend of the pandemic thanks to the resumption of activities screening. However, the surgeries missed in 2020 have not been recovered. “In the two-year period 2020-2021, the overall reduction compared to trend estimated at around 7,800 hospitalizations” (out of an annual volume of around 63,000 hospitalizations), estimates the report. The conclusions relating to colon cancer are similar, for which the operations missed in the two-year period 2020-2021 are around 4,900 out of the approximately 25,000 performed each Although it is not possible to estimate the extent, it is foreseeable that these data will affect cancer mortality in the coming years.
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Secondly, according to the authors of the report in “Lancet Oncology”, the war waged by Russia in Ukraine, which has led to a marked slowdown in the research activities of the two countries, hinders the fight against cancer in Europe. “Both countries are among the largest contributors to clinical cancer research in the world, especially to industry-sponsored research,” the study reads. In fact, among low-middle-income countries, only India has done more in oncology trial randomized trials – the most useful and relevant new therapy trials – of Ukraine. In the upper-middle income group, Russia is by far the top country for trials clinical trials (ahead of giants such as China and Brazil). Finally, the scientists highlight the problem represented by the United Kingdom’s exit from the European Union, which risks interrupting a very precious collaboration to the detriment of everyone, citizens first. Indeed, the United Kingdom is one of the main players in cancer research in Europe.
In addition to these contingent factors, oncologists emphasize the obvious importance of prevention. I study Global Burden of Disease As of 2019, an international collaboration that analyzed data from around 200 countries shows that around 4.5 million cancer deaths worldwide are due to preventable risk factors. In percentage terms, it is equivalent to 44 percent of total deaths (50 percent among men and 36 percent among women). Among the main causes are smoking, obesity and a sedentary lifestyle, abuse of alcohol and red meat, some viruses and environmental conditions. These risk factors too, due to the pandemic and its social consequences, have increased their impact in recent years. And they will very likely contribute to the cancer epidemic ahead.