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Fighting the illness of the century

Perhaps a radical solution to the problem of tumours is closer than one might think. What is needed, however, is greater support for scientific research than what is seen today: for this reason, private associations are being created in many countries to support cancer research activities and must be encouraged

 

Contrary to what many may think, cancer is a very ancient disease: bone tumours have been identified in dinosaurs from the Mesozoic era, in remains from Etruscan tombs and in Peruvian mummies, whilst the vast historiography of the Assiro-Babylonians and Egyptian not only documents its existence, but also some diagnostic elements, possible remedies (cauterisation), and prognoses. Many well-known figures in ancient times have been struck down by this illness: Atossa – daughter of Cyrus and wife of Darius – was afflicted by a malignant breast tumour.

Nevertheless, there is little doubt that it is more widespread today and that cancer-related illnesses are increasing: annual mortality in Italy has grown from 66,000 cases in 1957 to 86,000 in 1965, and similar increases are seen in other countries. The most tragic aspect of this illness is the low ratio between morbidity and mortality; approximately 1.8 to 1, meaning that over half those suffering from cancer are destined to succumb to it.

What are the factors responsible for the progressive increase in frequency? Apart from a significantly ageing population, which exposes more people to the risk of cancer […], and factors related to improved diagnosis, other environmental factors certainly play a role […]. The epidemiological analysis of cancer against time and geographical distribution reveals some interesting data: 1) distribution of the various types of tumours is markedly differentiated in various parts of the globe: primitive cancer of the liver – almost inexistent in Europe – is frequent in African areas; stomach cancer is the most common in Japan, the sixth most common in the United States, but less frequent in Europe; pharynx cancer is very common in China and rarely found elsewhere, etc.; 2) some types of tumours are increasing rapidly (lung tumours), others are increasing too but less rapidly (leukaemia, breast tumours), and some are actually decreasing in many countries (tumour of the mouth, stomach, cervix); 3) circumscribed hotbeds with epidemic characteristics have been identified for some neoplasias (leukaemia, African lymphoma).

From these data we can deduce that carcinogenic environmental factors operate in different geographical areas, that each type of neoplasia recognises specific causal factors, and at least for some types of tumours, there is an apparent viral-born transmission process.

[…] Preventative strategies are inefficient for most types of tumours, for two main reasons. The first is the still incomplete understanding of their cause. […] The second obstacle is that, even when the carcinogenic factor has been identified, it is difficult to be eradicated. An effective example is the use of cigarettes: it is a well-known fact that smoking is the major cause of lung cancer, a rapidly-growing and perhaps the least-treatable illness. Statistical analyses have demonstrated that heavy-smokers are 40 times more susceptible to pulmonary neoplasias than non-smokers. Despite these figures, tobacco consumption is increasing and the average age when smokers start is decreasing. Why is this? Firstly, because the public is poorly informed by the press: most journalists are themselves smokers and in general prefer not to insist on the damage caused by a habit that they also have; secondly, many readers are also smokers and newspaper directors do not want to alienate themselves from a large portion of the public by disseminating the potential dangers of smoking. Finally, the economic might of the tobacco industry and the interests of government monopolies are so strong that they contrast any type of anti-smoking initiative launched by organisms or institutions. Furthermore, it is an arduous task to convince a heavy smoker to stop, for eventual harmful effects are distanced in time, and rarely will the smoker be worried about what might happen in 20 or 30 years. One of the objectives of the anti-tobacco campaign is to convince young people not to start smoking; again, we need some psychologically acceptable argument; proselytising about the dangers of lung cancer will not stop an adolescent from smoking, because by nature youngsters love risk and any potential harmful effects are projected far into the future. What is needed is indirect action to demonstrate the negative and immediate effects that smoke has on athletic prowess and physical development, perhaps also with the collaboration of people who do not smoke for professional reasons (sportspeople, musicians, singers); their role as idol for younger generations can represent a model to be followed and copied.

It is well-known that malignant tumours start with the illness of one or few cells, and for a certain period development is circumscribed within the primary site. If the morbidity is identified in this phase and the organ harbouring the primary tumour can be removed, recovery is possible; sadly, in many cases the neoplasia is only identified after it has grown considerably and often only after some cells have already left the primary site and colonised other distant organs. Given that in these cases there is little possibility of recovery, it is of paramount importance that therapy be started before the tumour starts to metastasise.

For this reason, many countries have introduced “mass screening” programmes, systematically examining the general population to identify and remove any initial tumor foci. […]

Satisfactory results have been obtained by the systematic examination of uterine tumours in women over 30 years old through colpo-cytological examination. […] The obstacles for this type of analysis in addition to any economic factor (each test costs from 500 to 1000 lire: screening the female population in Milan would cost approximately 300 million lire per year) are also psychological, due to the resistance of the female population to undergo a physical examination, exacerbated by the psychological paralysis caused by the word “cancer”, often leading to an evasive reaction. […]

It is misleading to say that there are no current therapies for malignant tumours: surgical and radiological techniques have now been perfected and are able to effectively counteract the illness. Notwithstanding, only 40% of patients with malignant tumours can be considered as having fully recovered. What are the reasons that impede the other 60% from benefiting from the efficacy of such therapies? Firstly, there is a biological reason: 25% of neoplasias are incurable, for they show very precocious metastasis and renderin ineffective any type of therapy. Secondly, 35% of cases would be treatable if: a) therapy started sooner; b) the applied therapy were goal-directed.

[…] Advanced surgical techniques permit the extensive demolition and anatomo-functional reconstruction of entire organs or apparatuses. […] Radiation therapy has advanced together with physics progress, and has now reached considerable levels of refinement. […]

Chemotherapy – the treatment of tumours with chemical substances, prevalently synthetic – has also made significant advances; if until recently it was available only as a palliative treatment and used as last resort in advanced cases, now this therapy is much more effective when used in conjunction with surgery or radiotherapy; even if still limited to some types of tumours such as choriocarcinoma of the uterus, it has been demonstrated to be clinically effective as a sole therapy in the treatment of this illness. The main limiting element of chemotherapeutic agents is their toxicity, very often proportional to their efficacy and highly compromising when elevated doses are administered, especially for highly reproductive tissues such as bone marrow, some intestinal cells and seminal cells.

[…] Although recovery with only chemotherapy is exceptional, this branch of oncology shows great promise: the incomplete understanding of drugs selectivity for specific types of tumours creates hope that effective chemotherapeutic treatments for specific neoplasias will be found in the future.

[…] Let us now examine the situation of anti-cancer institutions in Italy.
The current operative instruments are: a) three Institutes for the Study and Treatment of Tumours in Milan, Rome, and Naples, which apart from experimental and clinical studies function as training centres for medical and auxiliary personnel and as pilot centres in the application of new surgical, radiological, and chemotherapeutic treatments for tumours. b) Anti-tumour centres, which have diagnostic function and coordinate at a provincial level all anti-cancer activity, as well as statistical and epidemiological studies. c) The Italian League for the Fight against Cancer, that conducts propaganda and social support activities.

[…] The only source to identify radical solutions for cancer treatment is through scientific research. Recent progress in virology and immunology studies has demonstrated that this goal may be less distant than what considered previously. Notwithstanding this premise, financing for cancer research studies is limited and insufficient. In the United States and Soviet Union, state financing is generous but only a fraction of that allocated to space research; in the United Kingdom public financing is considered totally insufficient. In Italy too, funds allocated to scientific research have been very limited, and so cancer research relies principally on fragmentary endowments, often transitory, from several organisations without any programmatic and coordinated plan.

For this reason, many countries have seen the birth of private associations to support cancer research activities. In the United States, the American Cancer Society – a volunteer organisation – annually collects 20 billion lira and in Great Britain the British Empire Cancer Campaign and the Imperial Cancer Research Fund – both private – have an annual budget of over 2 billion lira each. The Italian Association for Cancer Research was founded in 1965 with the objective of sourcing funds and undertaking a wide range of activities to favour cancer research; it is coordinated by the Milan-based National Cancer Institute. In its first year of activity the Institute has amassed great consensus and many associates, showing that private citizens are both aware of the significance and importance of such initiatives aimed to all the people affected by the problems that this tragic illness poses for society.

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