Montserrat García-Closas (Barcelona, 56 years old) is one of the most renowned researchers in cancer epidemiology.
This Spanish researcher, who has never worked in our country, studies the causes of breast cancer.
She graduated in Medicine from the University of Barcelona and received a PhD in Epidemiology and Public Health from Harvard University in the United States.
After finishing her doctorate, in 1996 she began research at the National Cancer Institute of the United States (NCI) in the area of cancer epidemiology and genetics.
She then began her work on breast cancer.
"I don't know what led me to study this type of tumor: that it affects many women, that it has various causes... All of this, from the point of view of epidemiology, is very relevant," says García-Closas.
In 2010 she returned to Europe,
at the Institute for Cancer Research (ICR) of the University of London, until 2015 when she returned to the United States, again to the NCI, where she was appointed deputy director.
But after eight years, and in this succession of comings and goings between the United States and Europe, García-Closas is about to return to the ICR of the University of London: “I am going back to Europe.
I am going to lead a new center dedicated to the epidemiology and prevention of cancer in which the ICR and Imperial College are participating, ”she explains.
García-Closas is about to return to the ICR of the University of London: “I am going back to Europe.
I am going to lead a new center dedicated to the epidemiology and prevention of cancer in which the ICR and Imperial College are participating, ”he explains.
García-Closas is about to return to the ICR of the University of London: “I am going back to Europe.
I am going to lead a new center dedicated to the epidemiology and prevention of cancer in which the ICR and Imperial College are participating, ”he explains.
The interview with Montserrat García-Closas takes place at the National Cancer Research Center (CNIO) in Madrid before a seminar on the very precise detection of the possibility of developing breast cancer and how to transfer this information to those affected who have It was his most recent job.
The researcher explains about her new work: "It is about applying what we have been researching in recent years."
Ask.
What he investigates are the causes of breast cancer...
Answer.
Yes. They are complex causes because it involves a combination of genetic and environmental issues.
And when I say environmental, I mean not only the impact of the environment, but everything that is not a genetic factor.
Among these causes, we have known for many years that there is a relationship between susceptibility to cancer and reproductive life.
Q.
And how does the reproductive life of women affect their susceptibility to breast cancer?
A.
There is less risk in women who have children and who breastfeed.
What appears to be affected is the length of time a woman's ovaries are producing hormones.
That is why it influences that menarche, the moment in which a young woman has her first menstruation, is early or late.
The same goes for menopause.
And that is why the number of pregnancies also counts, if the children are given to breastfeed and how many months they are given.
That is, the shorter the period of hormone production by the ovaries, the more protected a woman is against breast cancer.
There is another issue regarding the relationship between susceptibility to breast cancer and reproductive life that makes it complicated.
At the beginning and during the first five years after a pregnancy there is an increased risk.
This is when an explosion of hormones occurs.
But then, in the long term, pregnancies protect.
All these factors have to do with hormones.
Not only with those produced by women, but also with those that contain some drugs such as those taken for menopause or contraceptives that are associated with an increased risk.
Before, there were many more children and much more breastfeeding, and this change in reproductive lifestyle in more developed countries has greatly contributed to the increase in breast cancer.
This, in terms of population, is very clear.
And the problem now is that as reproductive standards are changing in developing countries you are seeing an increase in breast cancers because they are starting to have the lifestyle that we have here.
And not only this, alcohol consumption, obesity and a sedentary life, all these factors have contributed to the increase in incidence since the fifties.
In the 2000s it has continued to increase, although not as much as in the 1990s.
Now it's more or less stabilized, but it's not going down.
Q.
What percentage of breast cancers have to do with the environmental factors you speak of?
R.
When we talk about the causes, we must be clear that there are factors that we can modify and others that we cannot.
Among those that we cannot change are family history, age, genetics and reproductive life, which you do not change for this.
Those that are easier to vary and that have to do with lifestyles, with making decisions, explain 25% or 30% of all breast cancers.
In other words, if we all had that perfect lifestyle and there were no external hormones, the incidence of breast cancer could be reduced by up to 25% or 30%.
But you still have a large majority that cannot be explained by the modifiable factors.
Therefore, at the population level, it is very difficult to change the risk because it would have to be a huge percentage of women who would make those changes.
Although on an individual level you can do them.
Q.
I understand that having knowledge is important, but why study these causes if nothing can be done?
A.
The fact that they are factors that cannot be modified does not mean that we cannot do anything.
In the last 10 years we have learned mainly about the genetics of breast cancer, which cannot be modified, but it does help us distinguish the women who are at higher risk.
This helps us to do prevention and early detection.
The information we had was based on a family history of breast cancer and mutations in high susceptibility genes that greatly increase the risk, but are very rare.
What we have discovered in recent years is that 90% of women have no family history and still have genetic susceptibility.
This knowledge is now being incorporated into models to estimate individual risk.
But something must be taken into account: in epidemiology, risk is a population concept.
I can't know exactly your risk.
I can say that people like you, with these characteristics and this lifestyle, have such a risk.
What we are learning is that if I only know your age, I can tell you the average risk of the population of your age in Spain, for example.
Although it is clear that women your age in Spain have a very diverse risk.
Montserrat García-Closas, in a moment of the interview. Jaime Villanueva
Q.
And once I've been informed of my risk, what?
R.
We are making progress on that now, not only in specifying that risk, but also in how it is communicated.
If you communicate the risk you must give information about what can be done.
There are several groups developing risk measurement and communication applications.
This is to help both medical professionals and women understand what this information means.
So far we have three categories of risk: high, medium and low with respect to the population mean.
What we are trying now is to improve the accuracy.
But we can look at accuracy in two ways;
One is to say which of these three groups you are in and have different recommendations depending on which group it is.
And another way to think about precision is that you can do smaller groups so you can adjust the interventions.
This is more complicated because you not only have to establish these groups, but you have to make the interventions different according to the level of risk.
But now we can know why you have an elevated risk of cancer, and this may change the decisions you have to make.
For example, if you have an increased risk because your breast density is high, it is different than if you have an increased risk due to genetic factors.
Accuracy is not only knowing your risk better, but knowing where it comes from.
And this can inform what kind of tailor-made interventions can be done.
For example, if you have an increased risk because your breast density is high, it is different than if you have an increased risk due to genetic factors.
Accuracy is not only knowing your risk better, but knowing where it comes from.
And this can inform what kind of tailor-made interventions can be done.
For example, if you have an increased risk because your breast density is high, it is different than if you have an increased risk due to genetic factors.
Accuracy is not only knowing your risk better, but knowing where it comes from.
And this can inform what kind of tailor-made interventions can be done.
Q.
And is this going to be applied in medical practice?
Are we going to go to the family medicine clinic and they are going to tell us, with your characteristics you have this specific risk of suffering from breast cancer and can you do this?
R.
Yes, in fact, it is already being done.
What happens now is that they only ask you three or four questions and they are focusing a lot on family history.
But we already have models to specify the risk more accurately, although they are not integrated into the health system.
Q.
Are you confident that this integration will take place soon?
R.
It is already happening, although not in most national health systems.
But in private medicine in the United States, for example, it is already being offered.
Changing medical practice in national health systems is going to take much longer because you have to take many factors into account: cost benefit analysis, etc.
Q.
And wouldn't it be a great saving to prevent?
R.
Yes, of course, but it is very difficult to prevent.
We can only detect earlier, so the calculation is not so clear.
If we could prevent, lower the incidence... But what we can do is improve early detection.
Screening systems (mammograms) are very expensive and many factors must be taken into account to modify them.
We will get there, but it will be difficult.
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