WILL EUROPE BEAT CANCER?

It is clearly the goal of the Europe’s Beating Cancer Plan, in which the European Commission is investing a lot of resources. Is this investment directed towards the key weak points that will beat cancer? This is what I would like to discuss with you today.   

Prevention 

It was only a few months ago that I was discussing with some friends how impressed we were by the low number of young active smokers around us. Even most of the active smokers of our generation have quit. It seems that Europe’s anti-tobacco campaign has worked so far, and therefore, it seems logical to continue with the outlined tobacco-free Europe plan. Hopefully, we will also see the magic with vaping…  

But am I the only one surprised by how the main roles of the current TV series handle a quite normal life salted with intermittent touches of cocaine or other strong drugs? 

I also still remember the moment, quite some years ago already, in which I finally found my vaccination book and realised that I had received my 8th boost of the diphtheria vaccine. We were perhaps a bit off with our estimation, my doctor and I, when some weeks before we had calculated that it would probably be my 6th boost. Thus, she had decided that, even if only five were necessary, a 6th boost would not kill me. Better to be sure that I was enough immunised before starting working at the lab. 

Thus, I expect European vaccination programs to be more efficient once electronic vaccination registries will be in place in all Member States. Better late than never. 

And since we talk about vaccination, me growing up during a time where human papillomavirus (HPV) vaccine was only given to girls under 12, I can only praise the incorporation of HPV vaccination to the vaccination program for both, girls and boys starting at an earlier age now and being given up to 27 years old. This simple measure will already considerably decrease the cases of cervical cancer and other HPV-related cancers in the future.  

And regarding infection-attributable cancers, which account for nearly one in four cancers. It seems to me that more could be done than just promoting the HPV and Hepatitis B vaccination along with treatment of Hepatitis C and Helicobacter pylori (H.Pylori). For example, along with the EU4Health program supporting the Eurohelican project, in which the health of young adults in Slovenia treated for H. pylori with cocktails of antibiotics is being assessed, Europe’s Beating Cancer Plan could envisage the support to the investigation of mucosal adjuvants and other strategies to boost H. pylori vaccination. Vaccination would be a safer method to remove H. pylori from the stomach than the current H.Pylori treatment, which produces antibiotic resistances and microbiota dysbiosis. Methods to eradicate this type of infection would have a great impact preventing liver and gastric cancers. 

Other preventative measures considered by this [Europe’s Beating Cancer Plan] plan are mainly focused on unveiling unknown risks and reducing the risks of developing cancer by promoting a healthy nourishment and lifestyle or reducing pollution and exposure to hazardous substances. 

EU seems to stand behind the saying that ‘prevention is better than cure’. 

Screening 

We have all been told that cancer screenings of the population are costly for healthcare systems. But is it so? Leaving aside the ethical reasons as to why we shouldn’t prevent people from suffering from the outcome of an advanced cancer diagnosis, and only focusing on the economic reasons, could an efficient screening of the population turn into an economical advantage?  

Studies show that the cost of treatment and care of later stage diagnosed cancer is higher than the one of early stage diagnosed ones. If EU would create a very automatised screening system, with groups of specialised trained health workers helped by informatic programs to speed up the screening of the most abundant types of cancer, would we reduce the screening costs and turn them into economically advantageous? 

I would like to have the answer to this question in the near future, but this seems to not be a priority for the Europe’s Beating Cancer Plan. The EU’s priority will be to push for the current screening methods to become available to a higher number of people, and even though it mentions that it will promote the development of novel approaches for screening and early detection, the plan lacks concrete measures.  

Having three persons close to me diagnosed with cancer before turning 35, I find breast cancer screening in Europe very limited, as most EU countries start it with women over 50. But who would like to go through screenings before that age knowing that mammography uses X-ray, and that repeated radiation can trigger cancer? Breast cancer screening with MRI, a painless non-invasive imaging exam that uses harmless radio waves passed through the breast to form exceptionally detailed images, should be considered one of the goals of this European commission’s plan. It is known to be the best detection method, although currently the most expensive too. Research, as the one performed at the University of Chicago, which has developed the high spectral and spatial resolution imaging (HiSS) that detects invasive breast cancer as reliably as conventional methods (but in shorter times and without the need of contrast), should be the way to go for Europe, developing the best screening methods for a bigger targeted population while keeping them affordable.  

A good surprise, though, that I had during my first years living in Sweden, was the self-collection HPV screening test that I found in my post. This is really a terrific idea for people like me, who had experienced the reluctance of a family doctor when asking for a screening test while not experiencing any symptoms, and had, therefore, internalize the idea that there is no point on going to the doctor if you do not feel really sick. This test consists of a swab that you introduce in the vagina, rotate, and then put inside the tube that comes with it. Then you just need to post it and wait for the results. I really think this must reduce the costs of screening for HPV, as no health care professionals are necessary in the process, and surely it must increase the number of participants, as you do not need to make an appointment at the hospital. It would be great to have this “mailed” option in all Europe, and that cytology of the cervix would also be done the same way. However, due to the fact that you need to be able to reach the cervix in that case and that requires a special brush and spatula to collect the cells, you will need to visit your gynaecologist or health care professional for the cervix cancer screenings.  

Other self-sample tests are the guaiac faecal occult blood test (gFOBT) or the faecal immunochemical test (FIT), which detects blood in the stool. These are great options to detect colorectal cancer, and as they are cheaper than colonoscopies, they can reach a higher number of people. They are already used in Europe and will hopefully arrive in many European mailboxes in the next coming years, and hopefully to increasingly younger people too.  

EU’s plan is to extend targeted cancer-screenings beyond breast, colorectal and cervical cancer to include additional cancers, such as prostate, lung and gastric cancer. After finding out that a cheap saliva test allows the screening of some genomic marks associated with a higher risk of prostate cancer, and that 40% of the 55–69-year-old men who screened positive for these marks were diagnosed with prostate cancer, I think this is an achievable objective in the near future. A new era in which artificial intelligence (AI) will analyse your genome and epigenome after a blood test to let you know if you are at high risk of developing cancer has already started, and the EU will be part of it.  

In fact, this personalised cancer risk prediction, when hopefully extended to young people, will be an amazing screening tool to help with the current problem of 80% of paediatric cancers already being spread to other parts of the body when diagnosed (compared to about 20% of adult cancers). But for a start, the Commission will launch the ‘Helping Children with Cancer Initiative’ to ensure that children have access to rapid and optimal detection, diagnosis, treatment and care. 

Screening is a privilege we should all take advantage of. 

Diagnosis 

Because not all doctors and pathologists have access to the same number of patients and samples, they do not all have the same knowledge when diagnosing cancer after a mammogram, sonogram, x-ray, MRI, or tissue slide from a biopsy. For those with no possibility to ask to a senior colleague, the option of using AI to compare their patients’ images with a library of anonymised European images and to get a diagnosis from it will be of great help. 

Personalised treatment choice 

Now that the costs of sequencing DNA from biopsies have decreased considerably, it seems possible to do a personalised treatment selection for each individual patient based on the response of previous patients with similar genetic and epigenetic profiles to the available treatments. This is what the ‘Cancer Diagnostic and Treatment for All’ initiative wants to achieve by sharing combined genomic and Electronic Health Records’ information between Cancer Centres. In such manner, the European Union will jump into personalised medicine, which is of extreme importance in oncology, as each cancer is different. 

As knowledge is power, the plans’ ambitions are not only to offer cancer training programs to healthcare professionals, but to also create EU Networks linking EU cancer centers.  

Cured 

Surviving cancer does not necessarily mean going back to where you would have been if you had never been diagnosed with it in the first place. Although healthy, you will now carry a clinical history that those hospitals that may treat you in the future will need to know. It is a great and necessary advance in this dynamic moving EU, that all hospitals, with your consent, will be able to access your information from any Member State’s Hospital record, thanks to the ‘Europe Health Data Space’ Regulation. However, if traveling outside of Europe, the ‘Cancer Survivor Smart-Card’, which is a mobile application to track your medical history and to connect with healthcare professionals, could show very handy. 

Carrying a clinical history can be mentally burdensome, but it is necessary to monitor our health. However, carrying the additional burden of unemployment after a sick leave is something none should experience, and I am glad to see that the Europe’s Beating Cancer Plan not only envisages to solve this situation by funding re-skilling and up-skilling programmes, but it also contemplates the need to offer leaves and flexible working-time arrangements to the carers, who very frequently bear an important burden too. 

It is worth mentioning that the plan also raises the injustices of insurance requirements regarding cancer survivors in long term remission.  

The European Union should no longer focus on ‘how long’ people live after diagnosis, but rather on ‘how well and how long’ they live. 

These are some of the key points of the ‘Europe’s Beating Cancer Plan’, along with the creation of a European Knowledge Centre on Cancer. This centre will be responsible of the coordination of scientific and technical cancer-related initiatives at EU level. Among other things, it will support best practices, supply guidelines and contribute to the development of the European Cancer Imaging Initiative and the European Health Data Space.  

To summarise, I find the targets of the Plan extremely well chosen. I only have some doubts about the ‘Cancer Survivor Smart-Card’, which could be expensive to develop and not very efficient depending on its design. I would have liked to have access to more concise details about it. 

We would also like to see an assessment of the development of the Europe’s Beating Cancer Plan, as 2025 will be its half-time. How far have we come now that we are halfway? 

We hope that the aims of this plan will be achieved in the next coming years as we think that, while not completely, it will have an important impact on the fight against cancer.