Science

Cancer: how scientists hope to save us from disease

Large bay windows with soft light, comfortable sofas, unlimited coffee. Sylvia, Marc, Nadine and Ichan* wait in the lobby of the Interception building behind Gustave-Roussy, the first European cancer center located in Villejuif (Val-de-Marne). They are not sick, but they have a high risk of developing a tumor. The goal of the program they agreed to participate in was to prevent them one day from having to cross the doors of a huge building made from neighboring organ pipes where cancer patients are treated.

“The idea behind the concept of Interception is to prevent the onset of the disease or, if that is not possible, to detect it at such an early stage that the patient is cured without consequences. It is about preventing the future: we are not yet, but we are building everything necessary to achieve this,” explains Dr. Suzette Delaloge, oncologist in Gustav-Roussy and project leader. In the end, all you have to do is fill out an online questionnaire to find out your risk and receive advice or even medication to reduce it, as well as personal screening. The stakes are huge. Despite advances in treatment, which should once again be illustrated by the congress of the European Society for Medical Oncology, taking place this weekend in Paris, cancer remains the leading cause of death in France, with about 160,000 deaths each year. However, scientists estimate that 75% of people who developed a tumor in previous years were identified as people at high risk of getting sick.

Paradoxically, prevention is not very successful: “Participation in organized screening is collapsing, papillomavirus vaccination is not attractive, it is quite disastrous,” Dr. Delalog regrets. Hence the idea to tailor these measures to each person’s real risk to make them more acceptable. “In the case of breast cancer, the women most at risk will have a mammogram every year, and the rest can postpone this screening for several years,” illustrates geneticist Olivier Caron, a member of the Interception team.

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Sylvia, Mark, Nadine and Ichan were referred here by their doctor because they are heavy smokers – at least one pack a day for over thirty years. Their day promises to be busy. Mark, 45, a nightclub manager, tries out an elliptical trainer that mimics the motion of running. He should stop in a few minutes… “We’re evaluating their cardiovascular and muscle capacity so that we can then see how to increase their physical activity on a daily basis,” explains Elodie, an athletic trainer. While waiting for their turn, Sylvia, Nadine, and Yichang answer a questionnaire about their diet. An opportunity to demystify some of the fake news: no, royal jelly or essential oils don’t protect against cancer… Everyone will get screened and attend a conference on the risks of tobacco. At the end of the day, they leave with personalized advice – diet, exercise, an appointment with a tobacco specialist, and a calendar of next exams.

New verification tools

Similar programs exist for breast, colon, and mouth cancers. A questionnaire provided to general practitioners in the region allows them to identify among their patients those who are most at risk of developing one of these tumors, often because of their family history, weight or medical history. 800 residents of Ile-de-France have already taken part in it. Soon some tumors of the blood and pancreas will be added. “We only consider cancers for which we can offer interventions: prevention, screening, or a research program,” says Suzette Delaloge. His team is teeming with projects. For pancreatic cancer, which is often detected too late, participants will wear a blood glucose patch several times a year for several days. The appearance of type 2 diabetes would indeed be a sign that the pancreas is suffering, which could be due to a tumor.

In the coming months, other cancer centers, hospitals and clinics will offer a similar service. “We are pioneers, but we need equal access to this type of program throughout the territory. In addition, we need to have a wide range of actors whose future we can follow in order to continue to refine our risk assessment,” emphasizes Professor Fabrice Barlesi, Managing Director of Gustave-Roussy. Because, of course, it will be necessary to measure the impact of the proposed measures, even if they are already all based on verified data.

Scientists are also working to develop new screening tools, such as biomarkers in blood and stool, to identify smokers who are most at risk of getting sick. Significant inflammation, decreased immunity, microbiota dysregulation may be precursor signals. If this is confirmed, the researchers are already planning to block the tumor process with short-term immunotherapy to restore immunity or drugs to modify the intestinal flora. “People at high risk present both a favorable context for the appearance of deleterious mutations in their cells, and a weakened immune system that does not destroy these mutated cells. Therefore, we can play at several tables. In the long term, we will see which one will be most effective depending on the profile of each,” explains Suzette Delalog. After precision medicine, perhaps the era of precision prevention is coming.

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* Names have been changed.

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