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Friday 14 May 2021

Recommended Is it possible to cure a disease without making the person feel fully healed?

Is it possible to cure a pathology without making the person feel fully healed?

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I am a breast surgeon, I have been dealing with breast cancer for many years at the Policlinico Gemelli Foundation in Rome and I think that the comparison and contamination of knowledge is an extraordinary opportunity in such a crucial field as medicine. For this reason, I enthusiastically accepted the proposal received by the Pandolea Association to write about our experience in a magazine that also deals with food.

Breast cancer is still a problem of enormous social relevance, affecting over 50.000 Italian women every year; luckily it is also among the most treatable, if diagnosed in time and treated in highly specialized treatment centers.

In recent decades, we are increasingly able to provide patients who rely on our treatments with targeted treatments, less invasive and with success rates that were not imaginable until a few years ago.


If, however, the advancement of diagnostic techniques, the refinement of treatment methods and a greater social awareness of the problem have facilitated these results and the improvement of data on mortality, progress has been less in the field of primary prevention. This is confirmed by the progressive increase in the incidence of this disease in the general population, against the substantial investments in this field. Now solid data confirm that at least a third of breast cancers depend on incorrect behavior, especially sedentary lifestyle, alcohol abuse and unbalanced nutrition.

Unfortunately, the academic training of the medical class on the numerous evidences of the impact of lifestyles on the risks of chronic degenerative diseases, responsible for most disabilities and deaths in the middle-advanced age (in particular, cardiovascular diseases, tumors and diabetes) remains totally inadequate to face this social calamity. In other words, we are always better at remedying wrong behaviors than at preventing and correcting them before they produce irreversible (and sometimes fatal) damage.

In my clinical experience, I have had the opportunity to experience this "frustration", that is to cure a pathology without making the woman feel fully cured (even when the disease actually regresses), but also not to effectively propose a lasting and conscious change in the his behaviors, useful on the one hand to prevent relapses, on the other to make sense of the traumatic experience of illness and the suffering that it inevitably entails.

To try to give more concrete answers to this need, I came across casually in Chinese medicine and acupuncture studies, which made me know and appreciate a different vision of health and disease, absolutely complementary to ours and deeply enriched . In the Chinese vision, health depends on a harmonious balance of different needs and forces, which contribute to realizing the life project of each one, written in the heritage inherited from loved ones.

With the support of Susan Komen Italia, the main non-profit organization engaged in the prevention and improvement of the quality of life and care of women with breast cancer, we started in 2014, at the Policlinico Gemelli in Rome, a project of integrated therapies in senology, which supported the standard oncological therapies with advice on lifestyles and scientifically validated complementary treatments within the same care facility.

After five years of growth and clinical experience acquired in the field, last October 2019, we inaugurated the new Center for Integrative Oncology, at the Polo della Salute della Donna al Gemelli, where acupuncture, qigong, reflexology services are provided free of charge, phytotherapy, mindfulness, art-therapy laboratories, music therapy and writing for cancer patients.

At the basis of the integration of treatments, there remains advice on lifestyles, and in particular on the nutrition of women during and at the end of therapeutic courses. But what are the current recommendations most widely shared by scientific literature on cancer prevention, especially in breast cancer?

It should be specified that, rather than focusing on the curative or preventive power of individual foods, today a more holistic attitude seems to prevail which considers the study of food patterns, that is, the combination of foods within meals, the quality and origin of the same, the mode of consumption (including conviviality) and these factors in a wider framework that cannot be separated from the overall habits of the subject. In short, from his lifestyles.

If we then consider specifically the most recent recommendations of the World Cancer Research Fund, they can be summarized in a varied and balanced diet, mainly, but not exclusively, of vegetable and integral origin (rich in fiber). In other words, our Mediterranean diet, declared a UNESCO intangible heritage, and in whose transmission of knowledge "women play a fundamental role". (Http://www.unesco.it/it/PatrimonioImmateriale/Detail/384)

Not surprisingly, among the pillars of the Mediterranean diet, universally considered among the healthiest in the scientific field, there are precisely high quality foods from the vegetable world (wide variety of cereals, including non-industrially refined, legumes, vegetables and extra virgin olive oil ).

To these recommendations, we must add a limitation on the consumption of meat, including preserved meat, sugary drinks and alcohol. Oral supplementation with food supplements, in the absence of specific deficiencies, has no evidence of efficacy. (Https://www.wcrf.org/dietandcancer/cancer-prevention-recommendations)

All these indications have equal efficacy both in the primary prevention of a good number of solid tumors, including breast cancer, and in the prevention of its recurrence, and therefore should be part of the cultural background that an oncologist provides to the patient in a systemic approach to the problem for which he relies on our care.

Allow me also a brief mention of the importance of territoriality and seasonality, not only because this contributes to the protection of the environment and the quality of the product, but also of its "vitality". In other words, we are well aware that a vegetable product, for example with antioxidant vitamin properties, progressively (and fairly quickly) loses these properties as we temporarily move away from the time of its collection. For this reason, consuming a product a short time after harvest is equivalent to providing an individual health advantage, as well as greater authenticity and pleasantness.

I have repeatedly thought about why I am so passionate about discussing behaviors and lifestyles with the patients we treat for breast cancer, and how this interest of mine is combined with my surgeon activity. The answer I have given myself is that surgery, together with other necessary oncological treatments, seems to remedy a problem that pertains to that woman's past. The analysis of his habits and how to improve them in everyday life has to do with the present and above all with his future, that is, it gives a greater perspective of hope and positive change.

In conclusion, because our treatments are really centered on the person and not on his disease, even the most destabilizing as cancer can be, today it is necessary to frame the pathology according to the most modern and updated scientific evidence, but at the same time also the person , with its habits, preferences and expectations. Only in this way will we be able to guarantee that person a treatment that helps him / her to go through the traumatic experience of illness and its treatments, giving it greater chances of recovery, but also the tools for a favorable remodulation of its future.

di Stephen the Great

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