Thierry Philip: “If Europeans under the age of 20 quit smoking tomorrow, cancer mortality would be halved in 50 years”

It has been a busy June for Professor Thierry Philip (Paris, 72 years old).

The oncologist, head of the Curie Institute, in the French capital, and president of the Organization of European Cancer Institutes (OECI, for its acronym in English), traveled more than 13,000 kilometers and a couple of Atlantic crossings in a few days to reach everywhere: a few weeks ago he flew to the congress of the American Society of Medical Oncology (ASCO) in Chicago and in the middle of the month, he landed in Valencia to attend the annual meeting of the OECI, which this year was organized as host by the Fundación Instituto Valenciano de Oncology.

He already told his readers on his blog: it was time to take a "pause" because, with so many citations, he would not even have time to feed that diary of life where he reflects on the convulsive politics of his country, the latest findings in oncology and the adventures —and misadventures— of his football team, AS Saint-Étienne, which, much to his chagrin, has just been relegated to the second division.

At the end of this interview, the most important trip was still missing: crossing the African continent to Reunion Island, in the middle of the Indian Ocean, to meet his ninth granddaughter, Emilie.

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Despite the frenetic pace of work, Philip was on time for the telematic appointment from Valencia, in the middle of the OECI congress.

He had a slight cold and a few sneezes escaped him.

“I think I caught it gardening, so I guess it's more allergy than virus.

But it is better that the interview be by videoconference ”, he laughed.

He had a few days ahead of meetings and conferences on advances in oncology and the leitmotif of the European congress: the role of artificial intelligence and

in the fight against cancer.

Ask.

The OECI congress puts the focus on artificial intelligence.

How has this tool contributed to the fight against cancer?

Response.

It is better to talk about

than artificial intelligence because, in fact, it is about leading the machine to learn what the doctor and other researchers know and to accumulate that experience so that it learns to do it more quickly and sometimes better.

Machine

is already used in practice, especially in diagnosis and pathology, which is when you look under a microscope to define what type of tumor it is.

But this will not replace the doctor, but you will learn what he knows to do it faster.

Q.

And what is the future of these tools?

A.

The future is that in each cancer center, the use of artificial intelligence and

is at the heart of the organization.

It will be a process that will increase the quality of the centers.

P.

Is there a lot of inequality in the approach to cancer in Europe?

A.

The quality is not exactly the same.

We see that in Eastern countries, for example, the quality is different due to the lack of economic resources, drugs or organizational problems.

We must focus on these countries where that quality is not enough.

We believe that for every five million people there should be a comprehensive cancer center and then a network of centers around it so that patients, whatever door they knock on, receive the same type of treatment.

In the future, probably with a blood test we will be able to know who is at risk of cancer and who is not”

Thierry Philip, President of the Organization of European Cancer Institutes

Q.

Where are the inequalities?

R.

The first is in prevention, since 40% of tumors could be avoided if you fight tobacco, alcohol and poor nutrition.

The second is in access to screening and, particularly, breast, colon or uterus screening.

The third inequality is in early diagnosis: you need to be diagnosed as soon as possible because if it is a small tumor, it can be treated and have more chances of being cured.

And after this, another inequality is treatment: if you look at the map of Europe and see, for example, the number of radiotherapy units, you realize that in some there are not enough and not all of them can offer everyone rapid access to radiotherapy and treatments such as surgery, chemotherapy or immunotherapy.

P.

More than 18% of those over 15 in Europe smoke daily.

Is Europe, in general, failing in cancer prevention?

A.

Yes. If every young person under the age of 20 quit smoking tomorrow, cancer mortality would be cut in half in 50 years.

Tobacco is the biggest problem.

We have made progress since the 1950s: the number of lung cancer tumors is falling in almost all of Europe among men, but, paradoxically, it is increasing in women because tobacco use is still increasing among them.

Although

with a CT, detect cancer early and, in those cases, take the patient to surgery and probably cure 50% of them, most lung tumors arrive at the hospital in a metastatic state and, at five years, survival is of 5%.

With immunotherapy this has risen to 23%, but around 80% still die.

We have to make a lot more effort to combine radiotherapy and immunotherapy and maybe we can get to 25% or 30%.

But the best thing is to stop smoking.

P.

You have said that there are also inequities in access to screening and treatment.

How can artificial intelligence help reduce them?

Can we predict who will develop cancer in the future?

A.

I don't know yet.

What I do know is that probably in the future we will transform the screening process because we will be able to follow cancer, after diagnosis, using a blood test, looking at the cells in the blood.

In the future, with a blood test, we will probably be able to know who is at risk of cancer and who is not.

And whoever is at risk will undergo mammograms, endoscopies, etc.

We will be able to do it very easily because it will be a very simple test.

This will be the future to fight inequality.

Thierry Philip, before attending EL PAÍS by videoconference from ValenciaAna Escobar

P.

Cancer care has suffered greatly from the impact of the pandemic throughout Europe.

When will it recover?

R.

There are several problems after the pandemic.

The first is that, in 2020 and 2021, there were no screenings, no early diagnoses, and no hospital accessibility.

And we are sure that, because of this, mortality will increase for the first time in 10 years.

The second problem is that the way people see work has changed and they don't want to work like they used to.

For example, in Paris, 20% of hospital beds are closed because there is a lack of nurses, especially at night.

We need to find a way to attract nurses and have them stay.

The only positive impact of the pandemic is that, for the first time during the pandemic, all countries decided to buy vaccines together, which means that they can also tackle cancer care jointly.

P.

Cancer treatments, precisely, are becoming more expensive.

Can the health system stop being sustainable?

A.

This is an important issue.

If you look at France, for example, in 2008, the total cost of cancer drugs, especially chemotherapy because immunotherapy had not yet arrived, was one billion euros.

Now, a trillion euros is what increases spending every year and this is unsustainable.

And what do we do to solve it?

First, transparency to be able to understand drug prices because pharmaceutical companies sell drugs at different prices in France, Italy, Spain, Poland or Romania, for example.

We have to understand the price, why it is lower in one country than in another, go to the pharmaceutical companies and say: I cannot afford this.

Many of these drugs are very expensive compared to what it costs to bring them to market, because in many of these drugs, the beginning of the research began in an academic laboratory, that is, it was paid for with public money.

So they cannot say that the price is explained by the long research time that this drug took because that long time was in a public laboratory.

We have to understand the price of medicines, why it is lower in one country than in another, go to the pharmaceutical companies and say: 'I can't afford this'

Thierry Philip, President of the Organization of European Cancer Institutes

Q.

During the pandemic, there was a joint purchase of vaccines.

Would this example be reproducible with a joint purchase of cancer immunotherapies?

R.

Yes. What happened with the vaccines opened a door and we see that this is part of the solution.

One part is transparency and the other is the relationship network between rich and less rich countries to combat inequality.

Because the problem for Europe is not to go from a childhood cancer survival rate of 80% to 85% in France – which is also important – but to ensure that any child in Europe has an 80% chance of being cured of their cancer.

And that's not the case yet.

P.

It is not the same to have cancer in Spain than in an Eastern European country, for example.

R.

_

No. What we can do is put the whole world in the same bag by buying drugs at a European level and then distributing them to all countries, including, if necessary, some help from Europe in the less rich countries to fight against inequality. .

We want more money from Europe for those who have less.

If we want to fight inequality, we don't need to give more money to France, Germany, Italy or Spain;

we need to give money to Poland, Romania and other Eastern countries.

Fighting inequality means being unequal in the distribution of European money as far as the country is concerned.

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