Anna Lluch (73 years old) makes an appointment at the Hospital Clínico de Valencia at 9.30.
“It gives you time to arrive from Madrid, I also arrive then.
In the Ave you rest”.
In the waiting room, a young woman exclaims: "Anna!"
She leaves and the smiling and deep voice of the oncologist is heard.
I peek out to check that it's her and I see that they embrace her.
When we start talking, she warns that she sometimes has a hard time finding the words: “It's age.
I go around and in the end it comes out”.
She also assures that she has not felt sexism.
"Although my boss came to tell me: 'I don't count you as a woman,' she says.
Do you want to rest a bit?
No. Then my husband will take me to catch the plane to Oviedo.
And he will cook.
Cook very well.
You know how to cook?
A lot: lentils, baked rice, stew and nougat, with a recipe from my mother-in-law.
But I do not have time.
Aren't you tired of traveling so much?
On the contrary, the trips help me to study, especially the long ones.
This week I'm going to Argentina.
They spend enough sending me the ticket.
Is your husband with you?
In 1978 he did move in with you in a caravan, next to Lake Como, in Italy.
I went to Milan to learn how to biopsy tumors.
If your tumor cells have estrogen receptors, the hormones block them and do not stimulate tumor growth.
My children remember it as an adventure.
Is anyone a doctor?
No. Vicent makes documentaries.
Joan has been in NGOs in Colombia, Lebanon and Nicaragua.
My grandchildren were born there.
And how did he take it?
I about the mother who cries because she doesn't have her son near her…, no.
I care that they are happy.
Anna is an assistant director.
She is making a film in Galicia.
In other words, they see each other at Christmas.
She is a showgirl.
She likes the beer and going out, and look, her partner is a researcher.
They get along great.
Are you worried about the beers?
In the documentary
he remembers when his college classmates drank one and thought: "Everyone in town is working now."
Don't you ever take one?
It's hard for me to take time for myself.
I don't think of any other form of enjoyment than my work.
Sometimes I'm lazy: if in the afternoon I don't have emergencies or anything to download from the internet, I keep thinking.
What is downloaded from the internet?
I no longer go to all the congresses, but I need to find out how this world is going.
Have you felt that you were bothered by continuing to work without getting paid?
Nobody has told me.
But I have stopped getting into organizational issues.
I see patients and follow the research projects with Juanmi Cejalvo.
For this to work, she is as basic the lady that she cleans as I am.
That's why she made dinners for everyone.
It is essential to know how to care.
Where did you learn it?
It doesn't seem like his mother was careful.
It was not.
I am the daughter of Valencian and Madrid.
They were laborers.
My mother said that studying medicine was for people with money.
And I turned off the light.
She had to put towels under the door so he wouldn't see that she had it on.
Have you ever applauded?
When she told him that she was getting good grades, she would say: "I'd miss it, with what you study."
I am not so.
I need to care.
Anna Lluch, pictured at the Hospital Clínico de Valencia, where she was head of hematology and medical oncology.Raúl Belinchón
Have you not had the need to do something beyond your profession?
Yes. I went to Mozambique for two summers, with Lola Sala, director of Public Health.
We thought to educate in prevention and we realized that breast cancer was not the priority, but infectious diseases.
So we took buckets of water and bleach to the day hospital, full of flies, to teach how to disinfect it.
I ask him if he is not interested in anything else and he tells this.
Perhaps I have inherited my obsession with work from my parents.
My kids called me a Calvinist because I wouldn't let them watch TV.
Have you felt that you neglected them?
They have never told me.
I have had a husband-mother, devoted to them.
And the holidays were untouchable.
Untouchable, but he learned to biopsy in the summer.
And as pragmatic as he is, he had children before finishing Medicine.
I always think that I will be able to.
But, of course, what happens happens.
I am not serene.
My husband, yes.
Is stress not a cause of cancer?
It has been studied that it produces hormonal alteration.
But I think it gives me life.
Although I have had depression and headaches.
Do you have a personal relationship with cancer?
My husband has had prostate cancer.
What do you work on?
He is an agricultural engineer.
He has always been in La Unió de Llauradors i Ramaders.
Did you learn social involvement from him?
No. My father was in jail for three years for red.
He never spoke about it.
But he was afraid that I would get into politics.
My colleagues and I fought for all hospitals to be university hospitals.
That means that it is investigated where it is cured.
What did you do to make your husband support you so much?
He is a very secure person, a man with values.
Why don't men with prostate cancer wear blue bows?
Because they have not overcome the modesty of expressing it to warn that the revisions are made.
Are you in favor of bows?
I am in favor of visibility.
The little pink bows or balloons seem silly to me.
And the bottles, one more business.
But communicating it is essential.
I say that I'm not very talkative.
She doesn't seem quiet.
I count the good and silence the bad.
I think: why worry anyone?
Does he help a lot and doesn't let himself be helped?
I am clear that this is a type of pathology.
I don't count the problems or the prizes.
My husband scolds me.
Three or four times I have asked the psychiatrist for help, who advises me to talk.
But he costs me.
I think it's time that I take away from someone else.
When do you disconnect?
Until two in the morning I study on the internet.
The luck is that my husband falls asleep early.
If I watch a movie, I feel bad.
I only justify the ones that teach me things.
Anna Lluch, at the Clinical Hospital of Valencia. Raúl Belinchón
He was a family doctor in Loriguilla.
Have you missed that tranquility?
Yes. I was pregnant with my second child.
I would love to be a village doctor.
Today in the elevator I noticed an older woman and I thought that I would like to be a symptom control doctor: you don't need to come here and stand in line.
You need something else.
Have you maintained the closeness of a rural doctor with his patients?
I have claimed it.
It is worth taking all this home.
She makes you feel alive.
You don't have to think about what your patients have, you have to think about how you can help them.
That motivates you.
Perhaps I consider myself too helpful, but accompanying the process of focusing on the positive is motivating.
Before a patient who is not well, I look at her hands.
I think that in a few days she will not be there.
And I take them, I touch them.
I keep all the memories that they give me and from time to time I take them out and look at them: this cross-stitch embroidery was made for me by so-and-so, this handkerchief… They have given me barbaric gifts because people are very grateful.
I have a box in a bank with the things that are worth money.
We pay 1,200 euros a year for it.
My husband scolds me, he says let's auction it off and give the money for research.
But I can not.
I link to that.
Do you remember the 10,000 patients you have?
On my mobile I have almost all of them with a Z in front.
They know that I answer according to the urgency that I give to what they explain.
Don't hard cases take away your happiness?
I refuse to say how much time is left because I don't know.
Today we can try up to 10 different chemos.
There are new treatments every year.
When a patient with HER2 appears, I congratulate her.
In the breast, tumors of hormonal origin were previously considered the easiest.
You just have to take a pill.
But it is a pill that destroys your sex life.
Compared to dying it is nothing.
But it happens.
Claims the nurse manager.
A professional to whom patients entering clinical trials have direct access.
They communicate the changes and the nurse warns, helps and, if necessary, acts as a bridge with the oncologist so that the doctor can cover more.
"Diagnosing breast cancer without specifying the composition of the tumors is like saying nothing."
For the treatments it is necessary to know the tumors biologically.
Equity should not be sought in treatment, but in diagnosis.
In Milan I learned the technique to biopsy hormone receptors and I preached it in Alcoi, Vinaròs… The surgeons sent me a small glass of ice and the tumor inside the plastic glove they had used during the operation to the blood bank.
That's how I started.
And I also preached in private because if the patients did not come to me when they were already ill.
Collecting from a patient and when it becomes difficult to redirect it to public health, shouldn't it be punishable?
Private hospitals always win.
With the new drugs they send us patients because they can't pay for them.
Vote for the parties that allocate more money to public health.
In Spain, 37,000 breast cancers are diagnosed each year.
Increasingly, but mortality has decreased.
Even so, 15%, about 6,500, die.
But now the average survival in metastases is 56-60 months.
Three years ago I was at 18-20 months.
What do the results depend on?
We have gone from the most important thing being the size to the fact that what is fundamental is the biological type that is detected with molecular studies and when it is detected.
When I was studying it seemed that cells only had a nucleus, cytoplasm, ribosomes and a wall-membrane.
Today they are a crossroads of signs.
You cannot say that a tumor is good or bad.
We need to know the attributes of the cells for healing to progress.
That is why I defend that diagnosis is more important than treatment.
Not all small hospitals need to do molecular testing.
It should focus on the big ones and the small ones should refer them tumors, not patients.
Do they put the reputation of the hospital ahead of the healing of the patients?
I'm afraid so.
We are trying to get governments to network technology, the problem is that everyone wants to be the Mayo Clinic.
Small hospitals, the one in Benicarló or the one in Vinaroz, find it difficult to trust pathologists with more resources.
He talks about the empowerment of patients to ask for their tumors.
I do not allow anyone diagnosed elsewhere to come if they do not bring me a sample of their tumor.
To be able to analyze in depth its nature.
A patient has the right by law to request it.
The BOE explains it: the laboratories are guardians.
She is in favor of registering these tumors.
There is only in Navarra, Castellón and Tarragona.
If we professionals do not upload the data to a national registry, we do not know what tumors we have or where they occur.
Without this epidemiological information we cannot plan health correctly.
In Japan there are almost no breast cancers.
Not even in Chinatown, inside Manhattan.
That indicates a relationship between diet and tumors.
Why do so many doctors trained here leave Spain?
If there are few doctors and many shifts, they burn out.
That is not solved with voluntarism, but with political will.
The public health system is decided at the polls.
That being said, we are failing technological training.
You have to mix laboratory and patients.
Do all patients have the right to a second opinion?
Yes. Even outside of your community.
Although it is more difficult in some than in others.
Have you had political problems?
Not even when he won the PP.
I have had to fight for some new medications, but the same with some as with others.
It should be possible to put health above politics at the national level.
Anna Lluch.Raúl Belinchón
Calls for a national registry of tumors and defends health as a regional competence.
Policies must be national.
The decision on vaccines was made like this.
But we need closeness to talk.
I have defended that the oncologists of the hospitals that depend on it come to the tumor committees and that together we diagnose.
The committees are the fruit of interdisciplinarity.
New technologies should help share information.
Don't you have to go to Houston to try to get cured?
Treatments from there can exist here.
I don't like to perpetuate false cancer myths.
Nor use war terms.
You don't fight cancer, you try to stop it.
The new drugs are not missiles, they are accurate cures, the result of research.
Today in Europe 50,000 breast cancers are diagnosed each year in people under 40 years of age.
Would you advance the reviews?
We do not have a reliable screening method for young women.
Their mammary glands are very dense and do not allow to see the tumors.
We would have to do mammography, ultrasound and MRI, and the MRI detects false positives.
We would be biopsied all day.
It is better to check self-exploring.
Technology should be used when it is needed.
The number of mastectomies that are done because of MRI when surgeons see specks near where the tumor is is enormous because there is still no effective method for MRI biopsy.
Is it something similar to excess C-sections?
Are more mastectomies performed than necessary?
What appears in the resonance is sometimes not found.
When in doubt, some surgeons opt for mastectomy and prosthesis replacement.
And what happens with prosthetics happens.
Behind the prostheses we find breast cancers.
What do you advise then?
Analyze the tumors.
Starting from the information.
And for a mastectomy, reconstruction with the patient's own tissue of the fat of the abdomen or back.
A scar remains that takes years to be aesthetic.
But there would have to be a deadline for the reconstructions.
There isn't because they depend on plastic surgeons.
In oncology, plastics have become a problem.
Was it diagnosed late during covid?
Many people were afraid to come to the hospital.
Checkups were neglected, but the hospital was prepared.
What is your challenge today?
The liquid biopsy informs before the tumor appears in the CT.
It checks if there are tumor cells in the blood.
Advance the diagnosis.
It is the future.
her among the 100 best doctors in the world.
Oncology should not be measured with economic indices.
What has been your relationship with money?
I come from a family with little and, when I have had it, I have tried to share it.
But never much, because I have never had a private consultation.
Are you optimistic?
We have to discard that cancer is equal to death.
It is not.
There is a seed of goodness in the world, but we rarely let it grow.
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