2024-02-01 09:09:00
This anniversary year is also the time to launch a call for a new National Cancer Plan, for the FCC which “intends to put pressure on public authorities so that in 2024, the fight against cancer is once again placed at the heart of their priorities ”.
The opportunity to take stock of the situation with Dr. Véronique Le Ray, medical director and spokesperson for the Foundation.
Dr Véronique Le Ray, spokesperson and medical director of the Cancer Foundation ©DR/FCC
In 100 years, what are the biggest changes we can see in cancer?
If we have to highlight the main advances that have appeared in a century, I would say that today we undeniably have better knowledge of the mechanisms and risk factors that cause cancer. We also have a much wider range of complementary treatments which, together, can better combat the disease. In addition to surgery, radiology, chemotherapy, immunotherapy and hadrontherapy, which includes phototherapy (X-rays), proton therapy and carbon ion therapy, have been added. Clearly, treatments have evolved quickly and well. Another advance to be welcomed is more comprehensive care which offers the patient paramedical care (psychosocial well-being, dietetics, aesthetic advice, etc.). Additionally, the idea that moving during and after treatment is beneficial is a relatively recent notion. Likewise for investment in research and knowledge in terms of prevention, this dimension was absent 100 years ago. But when we know that certain preventive measures can prevent up to 40% of cancers…
Currently, nearly 75,000 new cases of cancer are diagnosed each year. In 2030, according to the Belgian Cancer Registry, this number could rise to 83,500. What can we say about this increase in incidence?
More active screening for certain cancers (skin, uterus, colon, etc.) may have played a role in the apparent increase in incidence, but this probably does not explain the entire change. In men, the most common cancer is prostate, followed by lung and then colon. In women, the order of the top three has changed since, since 2018, behind breast cancer, we find lung cancer, ahead of colorectal cancer. Due to an increase in female smoking over the last two decades, lung cancer is increasing in women (+86% between 2006 and 2020) while it is declining in men (-19% between 2006 and 2020). ).
Which cancers are experiencing strong progression?
The cancers recording the greatest increase are those of the skin (5 to 10% more per year, depending on the type of skin cancer). The incidence of melanoma is increasing for both sexes. In men, age-adjusted incidence increased by 130% between 2006 and 2020, while it increased by 89% in women, placing melanoma as the 4th most frequently diagnosed cancer in women. since 2010, facing cervical cancer. Another cancer on the rise is that of the testicle. Each year in Belgium, around 130 cases of testicular cancer are diagnosed among 15-29 year olds. It is the most common cancer in this age group among men, although it remains rare. We do not yet have an explanation for this increase in incidence. Colorectal cancer diagnoses remained stable between 2006 and 2020 in both men and women, and showed a peak in 2014, when a colorectal cancer screening program was introduced in Flanders.
Suffering from testicular cancer, this Belgian athlete must give up the Paris Olympic Games
To what extent can we say that we can already see the effects of environmental pollution in the figures?
Outdoor and indoor air pollution, which is indeed a risk factor for cancer, varies depending on location, housing, season, temperature, proximity to sources of pollution, humidity, etc. The proportion of cancers generated by outdoor air pollution is estimated between 2 and 4%. Indoor air pollution also has an impact on our health, especially since we spend on average 80% of our time in enclosed or semi-enclosed spaces. It is estimated that indoor air is 5 to 7 times more polluted than outdoor air. It is contaminated by volatile organic compounds, gases, vapors coming from numerous products that make up our habitat (candles, incense, cleaning products, cigarette smoke, paints, glues, heating appliances, plant fertilizers, air fresheners, radon in certain regions of the country, etc.). Some are carcinogenic. Carcinogenic pollutants alter DNA and lead to mutations that can lead to the development of cancers, mainly in the lung. Air pollution could also have an influence on bladder cancer.
Belgium ranks 6th out of 27 EU countries in terms of cancer incidence. How do we explain this bad position?
Let’s not forget that in 2020 we were in fourth position. In Belgium, we have relatively high exposure to risk factors, with regard to tobacco and alcohol. There is in fact still 1 in 5 Belgians who smoke in our country and marketing is aimed at young people. We therefore replace old smokers with new ones. And the same goes for alcohol: young people are targeted by marketing. However, tobacco is linked to 20% of all cancers and alcohol to 8%. To this must be added junk food and a sedentary lifestyle and lack of physical activity. And these are the four most important risk factors in the incidence of cancer.
“In 2030, the number of skin cancers in Belgium will be approximately equivalent to that of all cancers combined”
What do new targeted therapies consist of specifically and what are their benefits?
Targeted therapies are a set of treatments designed to block the growth or spread of cancer cells. These treatments interfere with molecular modifications or with mechanisms which are at the origin of the development and/or dissemination of these tumor cells. Their advantage is that they are “personalized”, that is to say adapted to the patient, the type and subtypes of the tumor. They increase the chances of remission. Hadrontherapy is a radiotherapy technique which allows cancer cells to be irradiated very precisely, either with protons (proton therapy) or with other charged particles such as carbon ions (carbon therapy). This is very important for brain tumors in children for example, because proton therapy can precisely irradiate cancerous brain tissue and much less healthy brain tissue. This helps reduce the intensity of the after-effects and better preserve the child’s (cognitive) development. Additionally, particles such as carbon ions can also be used to treat tumors resistant to traditional conventional photon (X-ray) radiotherapy.
How much has the cancer survival rate improved?
Today, for all cancers combined, the survival rate is around 70% at 5 years after diagnosis compared to around 40% only 30 years ago. However, there are large disparities by type of cancer. For some, the 5-year survival rate is more than 90%, for others it is only 12%. For example, the survival rate for breast cancer is now 92% (except triple negative cancer). That said, each year, 5-year survival improves. Moreover, the ambition of the Cancer Foundation is to promote an increase in the survival rate. If, between 2004 and 2019, for all cancers combined, the 5-year survival rate increased by 5%, the FCC aims to accelerate this growth to no longer increase by 5%, but by 10%. by 2040. But this will depend on many factors, the most determining of which remains early diagnosis. Then, faster support with better treatments should make it possible to achieve this objective. Whether it concerns diagnostic or treatment tools, this inevitably involves fundamental research. Also the FCC has decided to grant, in 2024, 35 million euros for research.
Concretely, what measures should be taken to achieve this objective?
We certainly need to improve screening in our country where we only reach 50% participation at best. There are also big regional differences. The systematic screening rate for cervical cancer, for example, is 64% in Flanders, 48% in Wallonia and 46% in Brussels. The systems are different: for colon cancer, for example, in Flanders, we send a screening kit to the home, whereas in Brussels, you have to go to the pharmacist and in Wallonia, order it online. If the FCC is not going to organize the testing campaigns, we will certainly support them in order to increase participation.
Why is it customary to take the 5-year survival rate?
In oncology, doctors tend to talk about “5-year survival”. For what ? Because recurrences most often occur during the first years of the disease. This indicator therefore reflects a very high probability of recovery (remission). Generally, survival at 1, 5 and 10 years is taken into account, but the Belgian Cancer Registry records and publishes the figures at 5 years.
In Belgium, cancer is doing well: “We are recording more new cases than the European average but our cancer plan dates from 2009”
What do you think are the biggest challenges to face in the years to come in terms of cancer?
It would be the centralization of care while working in a network, especially for complex cancers. Then, we should be able to immediately reduce the cost of personalized targeted therapy because today, it remains expensive. But in the long run, if we treat cancers more easily with a greater remission rate, we will reduce costs in the long term. And finally, prevention, prevention, prevention…
1706783443
#Belgium #high #exposure #cancer #risk #factors