"If we do things well, 30% of tumors can be avoided"

Dr. Josep Tabernero is one of those people everyone stops to listen to when he speaks. Because he knows what he's talking about, no matter how hard it is, because he deeply understands a disease that affects many people closely. He is the head of the Medical Oncology Service at Vall d'Hebron Hospital, director of the Vall d'Hebron Institute of Oncology (VHIO), and head of the Cancer Molecular Therapy Research Unit at Vall d'Hebron, a pioneer in Spain in the development of clinical trials. Recently, he has been involved in the future CaixaResearch Institute as director of the scientific committee that is bringing it forward.

Born in Barcelona in 1963, he graduated and obtained his doctorate in Medicine and Surgery from the Autonomous University of Barcelona (UAB). He completed his residency at Vall d'Hebron, where he met Dr. Josep Baselga, who years later became his boss and colleague. He has dedicated his entire career to cancer and has become one of the world's leading oncologists, even though he once considered specializing in neurosurgery. Also trained at Esade and Iese, Tabernero uses any question to remind us that cancer can be prevented, that we could save many deaths, while also focusing on all the research that still needs to be done and the resources that need to be allocated.

--- How would you define cancer?

--- Cancer is a disproportionate growth of cells that become anomalous, accompanied by a series of alterations that our own body makes to help them. They are not just malignant cells: tumors, when they grow more than two millimeters in diameter, need blood vessels to feed themselves. Our body is so foolish that it gives them blood vessels, which are not cancerous cells. But malignant cells also cause inflammation, and this favors their progression and spread to other places. In addition, malignant cells create substances to deceive the immune system so that it does not attack them. That's why cancer is also all the barbarities our body does to help it grow.

--- How can it be so intelligent?

--- All eukaryotic cells, among which bacteria are also found, are intelligent. Why are they so intelligent to grow, but not so much to stop and not end up destroying an organism and dying? If they were extremely intelligent, they would reach an equilibrium. If in the end they kill the patient, all cancer cells also die. Cancer cells are still normal cells in which a series of genetic errors have appeared that cause them to start growing. But they are like the rest of the cells, they are prepared to live and self-perpetuate, but in a disorganized way and without any control or brake.

--- What can we do?

--- Disease prevention is extremely important. 30% of tumors can be avoided if we do things well. First, eliminate tobacco, it is the most important factor that causes cancer. But, if you put together everything that is linked to diet and lifestyle habits, the effect is greater than that of tobacco. This means an excess consumption of fats, red meat or ultra-processed foods, low fiber consumption, obesity and lack of exercise. When all this is put together, the effect is greater than that of tobacco alone. Then, there is pollution. Whether we like it or not, engines must be removed from cities. But not only from cars and trucks, but also from diesel and gas boilers. In 10 or 15 years they will be banned.

--- If it is already known, why is it not done?

--- To be able to avoid these tumors, you have to be very clear about why they happen. Otherwise, you cannot regulate it. We cannot ban ultra-processed foods, even though we know that if you eat a lot, you have more cancer. But we don't know why. We suspect it, yes, but it has to be verified. We have to do it because, to end up regulating and prohibiting something, you have to be very clear about it. Otherwise, the lobbies go against it. More so in this country, which is a great exporter of food. But also the market. Stores have ultra-processed foods because, otherwise, they lose customers. In the end, it's the individual's fault. What can be done? We can educate better and give more information, but people have to make more decisions.

--- Understood.

--- The question you don't ask me, but that sometimes I am asked is: Will cancer disappear? The answer is no, because the disease is linked, mostly, to getting older. It is true that, each time, we detect more cancers, we also do it at earlier ages, under 50 years old. But, mostly, cancer is linked to aging. When I started working, 35% of patients were cured, now we are at 65% in women and 56% in men. By 2030, we will reach 70% survival and, by 2040, more. If, in addition, we avoid tumors that can be avoided, even better. Each time, the figures are better, but, it will not disappear completely. If we died at 40, there would be no cancer. The older we get, the more chances we have for the cells in our body to degenerate. If, on top of that, we add fuel, by smoking, drinking and eating badly, all this causes it even more.

"The more you talk about cancer, the more it is done, the more aware we are that we can have it, the earlier it is diagnosed and the more chances there are of being cured"

--- We were afraid of it, but today it is openly discussed. Charity races are held and the Marathon is organized. In the 60s, when cancer was mentioned, everyone looked at the ceiling.

--- What has made us change?

--- Many things. First, the prognosis has improved a lot, with cases like breast cancer having a survival rate above 90%. Second, we have realized that, no matter how you look at it, 1 out of 2 men and 1 out of 3 women, throughout their lives, will have cancer. Therefore, it is a problem that needs to be talked about openly and, if it is a disease in which much progress has been made in knowledge, research, diagnosis, and treatment, it is worth talking about. The more you talk, the more is done, the more aware we are that we can have it, the earlier it is diagnosed, and the more possibilities there are of being cured.

--- How is Barcelona doing in terms of healthcare?

--- The city is always well-positioned. Many factors have contributed to this. Firstly, there is a good medical academy. Medical schools are good, compared to the rest of the country. Then, in the field of research, there have always been research institutes linked to hospitals. There is a magma of centers, among which there is a lot of collaboration, which has put Barcelona in a privileged situation. There are also ERC funding grants from the European Commission or the ICREA program, promoted by Minister Andreu Mas-Colell. Finally, we have a very good healthcare network, with connection throughout the territory, which ensures geographical equity with cutting-edge technologies for the diagnosis and treatment of diseases. There is no single message. Many things have coincided and have favored a lot of research, especially in the biomedical area. Of course, there is also the attractiveness of Barcelona as a city to live in, with good climate, good lifestyle habits, not just the diet... which means that researchers from all over the world want to come here.

"Research saves us from diseases. For those that cannot be avoided, research allows for better diagnoses and better treatment"

--- Political and administrative stability. To develop research plans and attract partners, strategic stability is needed, and to say: "We are betting on this because, in addition to being a driver of knowledge and health, it is an economic driver." For this, you need continuous plans and not to get distracted, because there is a lot of competition worldwide. More funding is also needed, both public and private. It has increased a lot, but we are still not in the situation of other leading countries. Research is expensive, but it can also save a lot of money. If you have sick people, first, they enjoy life less, but, from a cost-efficiency point of view, being sick is a very excessive consumption of resources, even more so in some diseases. Research, especially in the field of prevention, saves us from diseases. For those diseases that cannot be avoided, research allows for better and earlier diagnoses, and, once detected, to treat them better, increase survival, and make them chronic. There are many angles to show that investing in research will give us better health.

--- Throughout your career, how do you think the sector has changed?

--- There is much more collaboration between centers. Not everyone has to do the same thing again; instead, it is much faster to collaborate, and also to share infrastructures, which are expensive. Before, everyone had their proteomics laboratory, and it was decided that two centers would have them and that we would all go there. It is a good decision to be more efficient. In addition, there has been a knowledge boom. When I started, human genome programs did not yet exist, and they have brought about a revolutionary change in the understanding of disease, in understanding its particularities and the different types that exist. Since I started until now, in just 35 years, survival has doubled. This has not happened in any other area of medicine in such a short time.