Each year in France, 160,000 people die from cancer. This disease is the first cause of death in men and the second in women. Research for the fight against the different cancers continue to advance but the health crisis has had a strong impact on cancer services. The WHO estimates that in Europe, one in three countries closed them during the epidemic.
Is screening no longer as systematic because of Covid-19? Are treatment research advancing? Some answers with Jean-Yves Blay, general manager of the Center Léon Bérard, in Lyon, guest of Elodie Poyade and Pascal Auclair in the program Your Health (BFM Lyon) this Thursday, February 4.
A delay in diagnosis due to the pandemic
On this world day in the fight against cancer, it is important not to forget the other diseases while the Covid has taken pride of place for almost a year in our news …
Jean-Yves Blay: Yes absolutely, especially since the impact of the Covid on the care of patients with cancer has been multiple. On the one hand, these are people who are more fragile and who will have more notable or more frequent complications than the general population. On the other hand, there is a problem with the use of the health system mainly for the services of patients treated for Covid. Patients sometimes found it difficult to come for a consultation. There were therefore diagnostic delays in our country as in all European countries.
Some patients no longer come so easily to be screened, thinking that hospitals are overwhelmed. So they’re falling behind in finding cancer that could save lives?
So yes, there is a delay in the detection of cancers especially during the first confinement. People who knew they had a problem but had not yet been diagnosed did not dare to come because the health system was in a jam. They were also afraid of catching Covid-19. Delays in diagnoses but also in surgical interventions. It is also difficult to measure these delays. However, it is something that we have observed and that we continue to observe in part, but now people dare to come to hospitals to be diagnosed.
Since the start of the pandemic, have you observed a stronger lethality among cancer patients? Are there any special precautions to take?
Precautions are the ones we all need to take. We must vaccinate cancer patients as soon as possible, but for the moment it remains a little difficult. Indeed, we must be very vigilant about the risk of contamination because they are more at risk of developing serious complications and of being hospitalized in intensive care.
“A very personalized oncology”
Today, what are the most frequent pathologies and are there new types of people affected by these cancers? Especially with women who are more impacted than in the past?
Cancer, in our country and in Western countries, represents four major pathologies: the breast, the prostate, colorectal and you lung. These four pathologies represent a large fraction of cancer patients. These four groups are very different diseases, there are subgroups within each of them. This fragmentation characterizes the current moment in which we find ourselves in oncology. That of a very personalized oncology. Many cancers are quite rare diseases that were thought to be relatively homogeneous such as lung cancer which in reality represents about ten or even thirty different diseases.
Does changing mores, such as the fact that women smoke a lot more, have a direct impact on the cancer rate among women?
It is clear that the female smoking has increased over the years therefore mechanically the number of lung cancers observed in women as well. It has also become in some countries the leading cause of cancer lethality. It is a sociological phenomenon which tends rather to diminish in our country even if, as the President of the Republic said this morning, we must work on reducing smoking among young people in particular.
A ten-year strategy to reduce cancer
The Head of State has asked for a tobacco-free generation for those who will be 20 years old in 2030. Warnings also against excess alcohol to pass according to him from 150,000 to 100,000 cancers per year, so-called “preventable” cancers. In your opinion, do these communication strategies that we have seen in particular on cigarette packs work?
Unfortunately not enough. There is still an increase in people who stop smoking and who come for help from tobacco specialists. This method of communication works, but not enough. We must go even further. I think that the principle of the ten-year strategy to reduce cancer, announced by Emmanuel Macron, will go further.
We have seen that the classical methods have obtained significant effects but that we have reached a ceiling. It is not enough to know that the tobacco causes cancer to stop. We have to put in place other things, especially among young people. Thereupon, it is a completely innovative strategy that will have to be implemented. This is one of the projects, both achievable and quite exciting, which will take place over the next ten years.
How do you convince young people not to start smoking?
I believe there is no answer. This will be the work of our next few years. Find the way to eradicate and truly have a tobacco-free generation.
Progress in the fight against cancer
Research is progressing, a lot of effort but also money. Do you feel that these efforts are paying off? Do some cancers heal faster and are the chances of remissions much higher?
We are going through a complete revolution. What we understood about cancer 10 years ago has nothing to do with what we understand now. We have very specific treatments for certain subgroups of these diseases that work in a remarkable way. They make patients who were incurable a few years ago curable. The examples are multiplying. It’s just not going to be a big group like lung cancer, but rather a small group within each pathology. We are progressing a lot, but step by step.
For example, especially with immunotherapy but not exclusively. Immunotherapy is a major revolution for a large number of cancers.
The Lyon Civil Hospices Cancer Institute works on immunotherapy on a daily basis. Are there several research projects that are still underway for this year 2021?
There are several types of projects that are set up. Overall, immunotherapy projects are in different dimensions. The current immunotherapy approach is the earliest possible treatment of patients, particularly in the first-line situation in the metastatic phase but also in an adjuvant situation.
Both at the Hospices Civils de Lyon and at the Center Léon Bérard, we have protocols, generally common, which are being developed and which make it possible to give these treatments very early to patients not only to treat in the long term but also to prevent the appearance relapse. Immunotherapy works in virtually all types of cancer, but only in a fraction of the patients that we are understanding.
Cancers: “All reasons to keep hope”
Today, we are able to heal from cancer diagnosed early. We must keep hope, we do not necessarily die of cancer?
The vast majority of patients who are treated for cancer will be cured. The numbers improve over time. So I think there’s every reason to keep hope.
The Léon Bérard Center is an establishment specializing in the fight against cancer. Located in Lyon, this private establishment has three main objectives: to treat, research and teach. The Léon Bérard Center is part of the Unicancer group, which brings together all the centers 100% dedicated to the fight against cancer in France and the National Federation of Cancer Centers.