The era of silence about cancer is over, the word must be spoken without fear, the disease must be discussed without taboos. “I had to write this book because my gag dropped,” says Juan Fueyo, one of the world's great voices in cancer research. A specialist in neurology, he has been studying the genetic engineering of viruses designed to combat cancer for more than 25 years in the United States. He is a professor in the Department of Neurooncology at the MD Anderson Cancer Center in Houston - one of the most prestigious centers in the world - and a member of the American Academy of Neurology.
He has published books: Viral (2021) or The man who could destroy the world (2022), among others. He has now just presented When the World Stops. Cancer: from myth to hope (Ediciones B), his most desired book. In his new work he reviews causes, risk factors, treatments, aspects of cancer prevention and also historical, cultural and biological curiosities. Did anyone know that tall people have a higher risk of having cancer than shorter people? Fueyo tells La Vanguardia, from his home in Houston.
“When you are diagnosed with cancer, the world stops and then nothing will be the same again.” Never more?
It remains true that the patient's diagnosis of cancer stops the world. This is because the words “cancer” and “malignant” produce an instinctive, unstoppable and spontaneous emotional reaction. Many sufferers are overwhelmed by the emotional response, but that does not have to last forever. The time that this reaction lasts has an ideology: it depends on social status, what type of person you are, what education you have, what friends you have, where you live...
In effect, you speak of “ideology in cancer treatment.” In what sense?
The information they can give you after the cancer diagnosis should get the world moving again, so you can get on with your life. But in many cases this is not the case. A single migrant in a village in Galicia who receives a diagnosis of advanced breast cancer cannot be compared to a woman from Barcelona, married, with money, with a profession... The impact can even influence the prognosis. The second woman will immediately have the information about her cancer, another disease, she will know how to organize herself and will have a network to take care of her.
Patriarchy has a brutal effect on women with cancer, she explains. What are the consequences?
It is a devastating effect around the world. Perhaps only 10 or 15% of the world's cancer scientific journals have a female editor-in-chief. The number of premature deaths from cancer in women could be avoided much more than in men. When someone else has cancer in the family, she takes care of her, but… Who takes care of her, when she is the one who is sick? An article in The Lancet analyzing more than 180 countries demonstrates how patriarchy harms women. How many run oncology departments? How many have power in global cancer decision-making centers? This harms progress in treatments for women.
How does this affect breast cancer treatments, from which we suffer especially?
Breast cancer treatment is extraordinarily aggressive and has remained that way for hundreds of years. You have to wonder, if men had this type of cancer, whether the treatment would be so radical or not. I explain that we would have improved, if that were the case. The information we have from some cancer studies is only about the white man.
The subtitle says “from myth to hope.” Can we have it? As soon as we start reading, we find three quotes, and the first, from the Pan American Health Organization and the WHO, says that “the incidence of cancer will increase by approximately 60% in the next two decades”…
Despair lies as much as hope. But yes, the WHO predicts a tsunami in terms of the increase in cancer cases. One of the factors will be the acceleration of climate change, which will lead to an increase in the incidence of at least three groups of cancer: skin, intestine and lung. It's funny because 40 or 50% of cancers can be prevented, we know what to do... But no one stops sunbathing in summer!
“In the 21st century, cancer research is reaching a level that we could not predict even just a dozen years ago.” Can't we imagine the advances we will have in the next decade?
Advances happen spectacularly at an almost daily rate. The last two decades have been exceptional. 20 years ago no one could predict that two parts of cancer treatment, such as targeted medicine (drugs for a cancer in a specific patient) or the great revolution in immunotherapy. We had not managed to control the immune system in decades.
What advances await us, or where can they go?
More options have to appear because we now have technologies that allow us to delve deeper into the fundamental mechanisms of cancer. They are technologies such as genome sequencing, or how to understand the tumor microsystem. We have methods to make earlier diagnoses, with better, less invasive imaging techniques, and we are on the way to combining it with what could be seen in biopsies. In MRIs the resolution will continue to increase and we may be able to see microscopic aspects only with the image, thanks to artificial intelligence. If that comes, cancer control will improve a lot. My great hope is to be able to eliminate surgery, radiotherapy and conventional chemotherapy in brain tumors. All of this is extraordinarily aggressive and toxic and we have been doing it for several years now. The pace of progress now is so rapid, not a day goes by without a headline about cancer.
Interventions on the microbiome, he says, will be a constant in cancer treatments over the next 10 years. With what function?
The intestinal microbiome is very accessible, just by eating fiber you can modify it, you can take capsules to modify the intestinal flora, you can transplant flora from one patient to another... Now we know that the microbiota modifies inflammation. In immunotherapy, if we can make bacteria produce substances that benefit the patient's immunity, we could make the treatment synergistic with these strategies, combining it with immunotherapy.
“Cancer deaths will soon be things of the past,” we read in his book. When can it be “soon”?
It is now one of the three deadliest diseases in the world, causing many premature deaths. In the United States in the 1970s, we had 2.5 million cancer survivors a year. We now believe that by 2040 we will have 20 million survivors. That leads us to think that it will soon be in a few decades. By 2040, more people will die from cancer than from other diseases, we will have cancer under control.
Will the cancer vaccine arrive?
The Nobel Prize in Medicine has gone to the couple from the United States who discovered a way to keep messenger RNA stable, and this is what leads to the covid vaccine. They defend that the same technology could be used to develop vaccines against cancer. That would be great, but it's a play on words. Cancer vaccines are drugs that trigger the immune system to destroy cancer. Here vaccine is more like treatment than prevention. We here (in downtown Houston) are using viruses to infect tumors and trigger immunity, our treatments are based on this…
In our hands, and those of public health, is prevention, which would prevent almost half of cancer cases. Why not insist on this if it is the key? Are the administrations failing here?
Smoking has decreased, and with it tobacco-related cancers. Also uterine cancer, thanks to papillomavirus vaccines. In the case of tobacco we join forces with the greed of the tobacco companies and the greed of the government: tobacco continues to be sold, even though it can kill you. You buy it and the state benefits from this. In the case of beaches, we know that we should not expose ourselves to the sun, but everyone goes. Drinking causes cancer, but some console themselves with “a little glass is good”, and no, it is not good! The WHO has said that even when soft drinks use sweeteners, they can cause cancer. Oil refineries: those who live around them are known to develop more cancer. All this does not stop because there are economic interests.
Harvard University made a decalogue of habits to prevent cancer, and recommends checking vitamin D levels...
Vitamin D deficiencies may be accompanied by a higher risk of cancer. Some doctors maintain that taking vitamin D supplements could have a prophylactic effect. But be careful, none of the prevention factors act by themselves, we always talk about risk, not certainty.
How many cases of cancer are hereditary?
Cancer is neither inherited nor contagious. The vast majority of cancer, of all types of tumors, are not hereditary. When it is hereditary it is seen because there are families in which the vast majority of people have tumors, they have colon or lung cancer at very young ages... They are a very small and specific group of what the world of cancer is. In general, cancer is sporadic.
A tall person has a higher risk of having cancer than a short person. How is it explained?
Biologist Richard Peto investigated this and saw that rodents have more cancer than elephants and whales, which have developed mechanisms to protect themselves from cancer, causing them to live for many years. But when Peto went to the dogs, he saw that in the same species, small individuals have less cancer than large ones, because large ones have more cells and the incidence of mutation is higher. This has been proven in humans and yes, it has been seen that being taller than average makes you more predisposed to having cancer.
We must abandon euphemisms and stupidities, he says: a good attitude does not heal. Why is this message insisted on, then?
Attitude is nothing in cancer, attitude has nothing to do with recovery. We are influenced by the neoliberal and capitalist system that says: “even if you were born in a remote place, on a mountain, you can be whatever you want, a surgeon who will change the world.” If someone doesn't get it, it seems like they are a loser. This theory is false! If you are born in a ghetto or a small town your chances of doing something very important are small. This has carried over to cancer, and it seems that if you are diagnosed and you are a fighter and a warrior, you win. The bad thing about that, as in the neoliberal model of the economy, is that you are saying that the patient who cannot cope with the disease is a loser, a coward, a moral failure. There is no right. Talking about “beating cancer” is negative, because it is assumed that those who do not beat it do not have the right attitude.
What does lead to healing? What factors influence?
Cancer gets better when you have a group of specialists around you who are the best in the world, or when you have people around you who take care of you, and when the patient acquires very important information about cancer. But it's not because you wake up in the morning and say “I'm going to be fine.” It is important for the patient to have a positive attitude because what lies ahead is very serious: chemo can take away their strength, their hair and eyebrows can fall out, their nails can fall out, they can spend days vomiting... If you have the willpower to tell yourself “I'm going to keep going”, this will help you overcome the side effects of the drugs, but this does not mean that you will be cured, it does not mean a better prognosis. We must root out the idea that someone who is cured of cancer is because they have done everything possible; this leads us to think that those who do not overcome it are cowards or failures.
We must break the silence of cancer, you say, but many patients and even oncologists still do not pronounce those words, “cancer or tumor”…
Being silent is not going to protect you, not saying it or giving it a name is of no use to you. The more people know what you have, the more potential help you will receive. Furthermore, we must give more dignity to cancer, yes. We inherited the stigma of the word “cancer” from tuberculosis. Before, when the doctor told you “you have cancer”, there was nothing they could do to you, it was a death sentence. Now things have changed, there are many treatments, patients survive much longer, and that has not reached society. I want to return the conversation about cancer to society, remove the gag, we all know close patients with the disease, it is common, it is treatable and it does not mean that the patient will die. Cancer is now just another disease.
