Sometimes numbers speak. And when it comes to oncology, clearly state that in recent decades medical discoveries have made it possible to significantly modify the prognosis of many forms of tumors. Promoting healing in some cases and reaching the point of “chronicizing” the situation, keeping it under control over time, in others. So, let's let the numbers show the reality of the mathematics.
In Europe, from 1988 to today, progress against cancer they saved more than 6 million lives (6,183,000). In the United States, in 30 years (1991-2021), cancer mortality has decreased by 33% and over 4 million cancer deaths have been avoided. In Europe there are 23.7 million citizens (12.8 million women and 10.9 million men), with an increase of 41% in 10 years (2010-2020). And our country makes records in the Old Continent the highest number of women alive after diagnosis in relation to the population (6,338 cases per 100 thousand inhabitants, equal to approximately 1,939,000 citizens). Be careful though. There is no shortage of problems. If overall cancer mortality continues to decline, the incidence increases globally and in individual countries. In the world, in 2022, there were 20 million new cases of cancer. In Italy, in 2023, they have been estimated 395,000 new diagnoses, with an increase, in three years, of 18,400 cases. In 2024, in the United States, it is expected to exceed two million for the first time.
The situation in Italy
Let's say it. Considering these results solely as the result of scientific progress is reductive and inappropriate. Because the improvements obtained depend on the combination of several factors: reduction of cigarette smoking and greater attention to healthy lifestylesmore early diagnoses thanks to screening, increasingly effective therapies and multidisciplinarity. But above all, the global attention to the sick also counts, which leads the prevalence of cases, i.e. the number of people alive after diagnosis in our country, to constantly grow.
“It is the demonstration of theexcellent level of our healthcare systemwhich guarantees the best therapies for everyone – recalls Francesco Perrone, President of the Italian Association of Medical Oncology (AIOM), on the occasion of the Congress of the American Society of Clinical Oncology (ASCO) in Chicago”.
Obviously, this does not mean that there is no room for improvement. The prevalence includes people in therapy, those who are under surveillance for the prevention of possible relapses and those who have recovered, who do not require further treatment or checks. The Italian figure is significant, to which must be added the over 268 thousand lives saved in our country between 2007 and 2019. But, as mentioned, there is still more to be done.
“Organizational aspects must be addressed – Perrone points out – starting from too long times to access innovation. In Italy, citizens affected by cancer they still wait 14 months in order to be treated with innovative therapies already approved at European level. We are ready to collaborate with the Italian Medicines Agency to define new models for early access, immediately after European approval, to truly innovative therapies in terms of improving survival and quality of life. These are those treatments that the FDA, the American regulatory body, defines as 'breakthrough' and which represent an important added value compared to the available therapeutic alternatives”.
The importance of the multidisciplinary approach
Massimo Di Maio, AIOM President-elect, also focuses on the importance of have the drugs available soon which can really change the lives of patients.
“In Italy various provisions regulate early access to drugs already approved by the European regulatory body, before reimbursement by the National Health Service – he explains. But they must be integrated with rules that allow for returns innovative therapies available in much shorter terms compared to the current ones, at most within three months of European approval. Immediate access to treatment must be part of a unitary strategy against cancer that includes decreasing incidence and mortality, improving patients' quality of life and establishing regional oncology networks.”
Let's be clear. Talking only about drugs and innovation is reductive if they are not also considered advances in care modelsachieved thanks to the integration of different skills.
“The comparison between different skills allows the choice of the best therapies for the patient and the management of innovative technologies such as liquid biopsy, a blood test that allows us to analyze some characteristics of tumor cells, for example the presence of mutations in their DNA – continues Di Maio. To date, the uses of liquid biopsy, validated in clinical practice, are still limited. The first use concerned advanced stage non-small cell lung cancer, for the evaluation of the mutational status of the EGFR gene, therefore as predictive factor of response to targeted therapies, but an increase is foreseeable in the near future. The emerging clinical applications of this procedure mainly concern colorectal, breast and prostate cancers and advanced melanoma.”
The value of early diagnosis
There is a third, further term that explains how much and how the paths of those who discover they have cancer are changing: screening. Going to “look” for the disease in the healthy population, obviously respecting the relationships between costs and benefits, means be able to detect tumors in their early stages. And therefore have a better chance of healing or at least of being treated as best as possible. For this reason, experts are calling to strengthen screening in our country. Saverio Cinieri, President of the AIOM Foundation, reminds us of this by numbers.
“In 2024 the mortality rate for colorectal cancer among young people (25-49 years) in Italy will increase by 1.5% among men and 2.6% among women compared to the period 2015-2019 . Instead in the age group between 50 and 69 years, included in the current program colorectal screening, a decrease in deaths of 15% in men and 16% in women is expected in 2024 – the expert says. Bringing forward the age of screening for this neoplasm, therefore no longer starting from 50 years but from 45, would allow more lives to be saved”.
Even in the United States, colorectal cancer is becoming increasingly common in people under 50. At the end of the 1990s it was the fourth cause of death from cancer in both men and younger women. Today it is the first in men and the second. in women.
“The new recommendations of the US Preventive Services Task Force (USPSTF), in fact, they lowered the starting age of screening for colorectal cancer at the age of 45 – underlines Saverio Cinieri -. This secondary prevention program is able to identify, in addition to the presence of a tumor in asymptomatic people, also adenomas, i.e. polyps, potentially capable of transforming into cancer”.
