Breast cancer, new policy proposals to keep high attention

In Italy, one in nine women is affected by breast cancer throughout their life. In 2020, 55,000 new cases were diagnosed. With 12 thousand deaths every year, breast cancer is confirmed as the most common cancer among the female population. But the pandemic has had important health and social implications for everyone, particularly for women living with a diagnosis of breast cancer. According to a survey carried out by the National Screening Observatory which compared the examinations carried out between January 1st and September 30th 2020, compared to the same period in 2019, 947,322 fewer mammography screenings (-34.5%) were performed. 610,803 fewer tests (-43.5%), the accumulated delay is equal to 3.9 standard months while the estimate of breast cancer diagnoses stands at 27,932. These are just some of the data that emerged during the webinar entitled “Cancer breast in Italy: from pathology to the person – Policy proposals with the contribution of the Third Sector “promoted by the Foundation for Subsidiarity, in collaboration with Novartis Italia, which involved the main patient associations in this therapeutic area: Andos Onlus, Europe Donna Italia, IncontraDonna Onlus and Salute Donna Onlus. The meeting was attended by personalities from the academic and political world, including the Minister for Equal Opportunities and the Family, Elena Bonetti.During the online debate, the associations presented a policy proposal to be submitted to the legislators, which frames the topic breast cancer in Italy in its not only health but also social dimension, by virtue of the transversal role that women play in the community. The analysis and proposal document, created with the scientific supervision of Giuseppe Curigliano, Director of Development of New Drugs for Innovative Therapies of the European Institute of Oncology (Ieo), focuses on the patient at every stage of the process, from prevention to diagnosis, from treatment of life beyond the pathology with a view to social sustainability and inclusion. A policy proposal that also takes into account the guidelines of the so-called ‘gender medicine’. “We meet today around an issue that profoundly affects the lives of women – said Minister Elena Bonetti -. Breast cancer affects a large number every day. It is therefore a question of keeping attention high and promoting serious and widespread awareness in this regard, and implementing policies that allow women to access prevention more and more effectively. commitment for women of all ages and in all territories of our country is to contribute to realizing not only the right to health but also that principle of equal opportunities that animates us as a country ‘. According to Giorgio Vittadini, president of the Foundation for Subsidiarity ” the Covid-19 pandemic has brought out, with new strength, the ability to react and aggregate people to respond collectively to new and old needs, in a newfound community dimension. In this – he reiterated – the importance of subsidiary culture is also shown in alleviating suffering, in making the prevention and treatment of diseases more effective. The pandemic and the return of infectious diseases have made us understand that health is not individual but belongs to everyone. Health is a collective issue ”. The proposals contained in the document are in line with what is indicated in the European Plan to fight cancer and are developed around 4 pillars: prevention, diagnosis, treatment and life with and beyond breast cancer. In terms of prevention, the greatest criticality is undoubtedly the territorial inhomogeneity relating to mammography screening programs, with strong disparities between the North, Center and South of the country regarding the dissemination of aids, the updating of equipment and the definition of personal criteria to access the screening itself. “For breast cancer, in addition to primary prevention, based on a correct lifestyle, therefore healthy nutrition and good practices – recalled Flori Degrassi, president of Andos Onlus – there is secondary prevention, given by a very large public health program set up since the 1990s, which is the screening program for the three main cancers: colorectal, cervix and breast. All women can access this program. However, in Italy there is a difference in adherence to screening from the North (62%) to the Center (53%) to the South (38%) ”. Furthermore, “the most advanced Regions – again Degrassi – widen the age range of women to be screened: in some cases from 40 to 79 years. And this is a further problem because it cannot be extended to all regions. If the local screening program does not have a membership higher than 60% it cannot be opened to other age groups. Yet, more and more young people get sick as do more and more people who come out of the age of screening, after 69 years of age ”. Action in this area is urgent – as emerged from the webinar – especially to recover the ground lost during the pandemic, which saw a collapse of these secondary prevention activities. “Another thing we fight on – concluded Degrassi – concerns the equipment, all mammograms must be of the latest generation”. On the diagnosis front, Adriana Bonifacino, president of IncontraDonna Onlus has no doubts: “For women outside age for the screening program – he stressed – especially for the youngest we can talk about recommendations. Smoking, for example, isn’t just a cause of lung cancer. A woman who smokes has three times the risk of getting breast cancer. But we must not forget older women too, because life does not end with screening at 74 or 79. We had a diagnosis of breast cancer in a 101-year-old woman who asks to be treated and is entitled to it “. But when the cancer arrives,” because it arrives for one in nine women, the most important thing to do immediately – has said Rosanna D’Antona, president of Europa Donna Italia – is looking for the right place to go for treatment, in this case it is the Breast Health Center where the patient has an 18% more chance of surviving the disease “. During the webinar it emerged that particularly critical, in the diagnostic field, is the insufficient accessibility to the analysis tests of gene expression profiles. There are still few territorial realities that have included this type of genomic test among the essential levels of assistance (Lea), very useful for adapting therapies to each patient in an increasingly personalized way, allowing a reduction in chemotherapy treatments. “It is extremely important – reiterated Giuseppe Curigliano – to extend to everyone, according to criteria of homogeneity, inclusiveness and gratuitousness, access to gene sequencing technologies that help us to precisely identify the genetic mutations that can predispose to a specific type of pathology. This is the indispensable premise for defining more appropriately and promptly the most suitable therapeutic pathways for each patient, in which the new generation molecular target drugs, which have the potential to revolutionize the treatment path, can play a decisive role ‘. “With this initiative – underlined Gianluca Ansalone, Novartis Head of Public Affairs and Sustainability – we wanted to make a contribution in the management of a pathology in which Novartis is at the forefront. It is good that we continue to pay attention to the pandemic. However, it is necessary to return to treatment as soon as possible. This is an absolute urgency because we risk a second pandemic: last year we lost almost 2 million cancer screenings, but I fear these are underestimated. Not to mention the other pathologies: cancer is the second killer in Europe, in first place there are cardiovascular diseases for which there has been a reduction dramatic diagnosis and access to the emergency room “. It is therefore “necessary to restore access to treatment and diagnosis – according to Ansalone – and in the case of cancer, early diagnosis is everything. The funding was already there before the NRP. In August 2020, the government allocated half a billion euros for the disposal of waiting lists, in the hope that there would not be a further wave of the pandemic in the autumn, which unfortunately occurred. The Government then decided to extend the allocation of these funds. The money is there – he concluded – it is important to coagulate political will and organizational capacity together with the sensitivity of patients who must not be afraid to return to treatment “.