¿Ha aumentado la incidencia del cáncer en el mundo?

0:01 The day to day is full of urgent news, noise, polemics and fanfare. But for the quiet, the analysis and what we like to call slow - cooking journalism are my questions. A half- hurry program made by KFAM inspiring smiles. It is predicted that by two thousand and fifty cancer cases will increase by seventy- seven percent. Finding a cure for this disease seems to be the cause of the human species. What are the treatments that exist today, why we have not been able to find a cure for this chapter.

0:47 We spoke with radiologist Germán Arango, with former Health Minister Alejandro Gaviria. Rafael Sánchez Paris, Executive Director of the Center for Cancer Treatment and Research, Scarlos Sarmiento Angulo and Lina María Trujillo, Deputy Director of Medical Care and Teaching at the National Cancer Institute. I am Roberto Pombo and this is chapter seventy- eight of my questions. Welcome. The human has taken all his history, understanding himself, the world around him and the connection between all. Since the arbors of our conscience, we have asked ourselves questions and it was not enough for us to be bipeds and to have opposable thumbs. We have explored the world all its seas and depths, volcanoes and its wild force and glaciers, jungle deserts. We study every species with which we share the planet at some point in history. It wasn' t enough for us what was around us.

1:49 Then we looked up and looked for explanations to what was beyond our reach at the time. So someone once created a device to find out what those lights were all about, shining in what we call heaven. We saw them moving at a pace we could predict. Then we gave them names, finding their characteristics. We realized our place in the Universe, the immensity and infinity, of what was beyond the earth. We have found explanations for the universe, its galaxies, black holes, nebulae and stars. All that wasn' t enough for us. And just as someone created a telescope to see and understand what was at distances and times almost impossible to reach. Someone created a microscope to see what was inside us. So we did the same thing at quantum level, that is, not outwards, but inwards, at the level of molecules and atoms. At one point we said that that was the limit point, which was indivisible, the micro thing that existed. However, as it seems, custom was temporary to and someone else discovered that it could be seen beyond the atom and later divided it. I am dazzled to see the level of knowledge we have acquired as a species. It will seem that there is nothing impossible for this wonderful species that we are, with its lights and shadows. And although out there, in space so far and on a macro scale, there are aspects that seem to overcome us and determine our existence,

3:24 although around us there are depths and elements that threaten our existence. It is at the atomic level within us that there is a phenomenon that owns our fears and that today is a threat to humanity, cancer cells. Cancer is not something new. Human beings and other animals have had cancer throughout history and there are records of that disease in fossils and most holy scriptures. Some of the first cancer tests are among fossilized bone tumors, human mummies from ancient Egypt, and ancient manuscripts. For example, mummies have been found with growths that suggest bone cancer called hostium sarcoma. The oldest description you have did not include the word cancer was discovered in Egypt and dates back to the year three thousand BC, in a papyrus known as Papyrus Edwin Smith, which is part of a book on trauma surgery and is said to be the first surgical treatise in history.

4:29 This document describes eight cases of breast tumors or ulcers that were removed by cauterization with a tool called a fire drill. The paper says about the disease there is no treatment. It was not until the 19th century, when the anesthesia appeared that the first surgeries were performed to remove some types of cancer. But, even though this disease has shared so much time with humans, understanding it has not been easy. One of the many statements that have been made on the subject is that we all have cancer cells, but that' s how we go about parts. This disease arises from random genetic changes, called mutations within healthy cells acquired over time. These mutations can occur for several reasons, such as lifestyle choices, family predispositions, long- term existing health conditions, or even exposing hazardous chemicals. As mutated cells build up, they become cancerous. A cell that is able to grow without control accumulates errors in its DNA code, which makes a gene or set of genes malfunction. If the cell also loses certain safety mechanisms this pushes it toward cancer. In other words, several factors need to come together to make a cell cancerous. And any cell in the body has the potential to do so. It can be divided

6:01 if it accumulates errors with certain genes and if these failures cause it to grow out of control. According to doctors Hugur Shain and Oslem Duressi, founders of the biotechnology company Biontech, these random genetic changes that occur in cancer cells arise two implications. The first is that each cancer is as unique as the individual it affects, that is, that even those people who are diagnosed with the same type of cancer have only a fraction of shared mutations. And the second implication is that each tumor is a intricate tapestry of billions of different cells that constantly learn to adapt, to evade the immune system and to resist the therapeutic strategies that medicine and technology has investigated And it is that possible cures therapies, varying shock treatments have not been lacking in history. Since surgeries to remove tumors, the use of radiation and official artis intelligence have been part of human innovation to combat that inner enemy. I looked for Dr Rafael Sánchez Paris, Executive Director of the Cancer Treatment and Research Center, Juis Carlos Sarmiento Angulou, to better answer the big question why is it so difficult to find a cure for cancer? This he told me, cancer is not just a disease. It is a group of really different diseases, caused by factors sometimes different from each

7:34 other. Therefore, at the outset there are some more curable than others. In addition, today the number of patients with advanced disease is higher than with early disease. When cancer is diagnosed early, the cure percentage is higher and this is directly related to timely access to health services and self- care. Finally, the genomic changes within the disease are dynamic and progressive. That is, cells learn to survive the treatments given, which complements treatment over time.

8:26 A recent report was published in the journal b m Jota Oncology, which concludes, among other things, that the global incidence of early- onset cancer increased by seventy- nine comma one percent, and the number of early- oncology deaths increased by twenty- seven comma seven percent between one thousand nine hundred ninety - two thousand nineteen. In more concise terms, the number of people under the age of 50 diagnosed with this disease worldwide has increased by almost eighty percent in the last three decades alone, and the findings of the study do not stop there. Projections indicated that the overall number of incidences and deaths from early - onset cancer would increase by thirty- one percent and twenty- one percent by two thousand thirty, respectively. And excuse me for all the bad news.

9:16 But, according to the World Health Organization, more than thirty- five million new cases are predicted for two thousand fifty, an increase of seventy- seven percent, compared with the estimated twenty million cases for two thousand twenty- two. All these figures of the rapidly growing global burden of cancer reflect the ageing and growth of the world population, as well as changes in people' s exposure to risk factors of which several are associated with socio- economic development. All these numbers for the future are not encouraging A little over a month ago, the International Agency for Cancer Research published the latest estimates of the global burden of cancer, in which they found data like First, in only two thousand twenty- two there were twenty million new cases and nine seven million deaths from this disease. Second, about one in five people develop cancer throughout their lives and finally, about one in nine men and one in twelve women die from the disease. All these numbers of such impressive proportions leave me with many questions, but especially one way to reverse all these estimates about the future incidence of cancer. I looked for arina María Trujillo and assistant director of medical care and teaching at the National Cancer Institute. To answer this, he told me the first thing is to declare that cancer is not a single disease. It

10:50 is a word that groups different diseases that have different origins, different causalities and, by that of different approach, not only of annassic treatment, then there is no common strategy. The only thing we could talk about is that we could change in a relatively feasible time frame according to the calculations of interim neck cancer, cancer whose torino has a global elimination strategy that, in fact, Cartagena is the headquarters of the Global Forum on the Elimination of Cervical Cancer, in which three strategies are proposed. Thanks to the fact that with terino neck cancer we know who produces it, we have tools to diagnose it before it becomes cancer and we have how to treat it properly. Once it' s a cancer, which we have to prevent, vaccines against the human papillomavirus, which is the causal people, which we have to diagnose in a timely manner before it' s a cancer, papilloma virus tests and psitologies and we have how to treat it. Colombia has enough staff and enough technology to cope with the different stages of cancer of Colombian women, although cancer, as it already says, is an anti- disease to what this alarming increase is due to, According to the authors of the study published in bm J, oncology.

12:07 Genetic factors are likely to influence, but diets rich in meat, red and salt and low without fruits and milk, in addition to alcohol and tobacco consumption, are the main risk factors behind the most common cancers among those under 50 years of age, in addition to physical inactivity, excess weight and high blood sugar levels. According to this research, I quote the changes in diet, lifestyle and environment since the beginning of the 20th century that have led to an increase in rates and obesity. Physical inactivity, Westernized diets, and environmental pollution may have affected the incidence of early onset cancer. In addition, alcohol, smoking and harmful exposures during pregnancy may also have affected closing quotes and make a lot of sense. Just think about how I change the human' s life, his work routines, or the way we feed or consume products such as alcohol, nicotine, or ultraprocessed edibles. On the latter, a study by the University of Viennam in collaboration with the International Agency for Cancer Research found that the higher the consumption of ultraprocessed foods, the greater the risk of suffering a combination of chronic diseases such as cancer, diabetes or heart disease. Another of these changes in modern life that have helped to increase cases of this disease is air pollution, as if global warming was no longer enough. At the presidential

13:39 symposium itself two thousand twenty- two, Professor Charles Schanton of the Francis Creek Institute, a biomedical research center in London, presented an investigation that highlighted that the same particles that contribute to climate change are impacting human health through an important mechanism that causes cancer in lung cells. The Lancet Commission on Pollution and Health established that all forms of pollution cause forty- three percent of lung cancer deaths. Air pollution alone causes twenty- nine percent of all lung cancer deaths and clear estimates give, according to WHO, ninety- nine percent are breathing unhealthy air. As Dr Emmanuel Ricard told him by the voice of the French League against Cancer in the medium Frans van Cat, it is mainly about pollution by fine particles and the gases emitted by the saying are one of the main sources of these particles. However, a study published in the British journal of cancer, the greatest risk factor for most cancers is simply aging. According to the study, more than three quarters of all people diagnosed with this disease in the UK are sixty years of age or older, and this is because cancer is a disease of our genes. Fragments of the DNA Code that contain instructions for all microscopic machinery within our cells and over time, errors accumulate in this code

15:09 and scientists can now see them imprinted on the cancer DNA, and it is these errors that can drive a cell' s journey. They are reached, but not all are bad news. According to the nation' s annual report on the cancer situation in general, mortality rates for this disease decreased by an average of two comma three per cent per year among men and an average of one comma nine per cent per year among women. The overall cancer mortality rate in the United States declined by one third between one thousand nine hundred and ninety - one and two thousand nineteen. This is largely because fewer people smoke and develop lung cancer, also because as screening tests, prevention and treatments have improved for all types of cancer it is, this decrease has continued and even accelerated.

16:03 The national cancer mortality rate is falling by about two percent each year and in Colombia the survival of childhood cancer is sixty percent. Early detection is one of the ways in which it can help more people survive this disease and for this purpose, it seems that artificial intelligence can play a key role. It couldn' t be used just to make fake videos of politicians. And that ' s because, according to research published in The Lancet Oncology suggests that artificial intelligence could diagnose cancer with twice as much accuracy as a doctor' s biopsy.

16:45 I looked for radiologist Germán Arango, who already uses this technology for medical purposes, and asked him how artificial intelligence can help detect cancer in a timely manner. This he told me. Artificial intelligence can be significantly helped in early detection of cancer through various methods and applications. The first and most important of these is in the analysis of diagnostic medical images, where, especially deep learning has shown remarkable effectiveness in the analysis of diagnostic medical images. Like MRIs, CT scans, mammograms, X- rays. Artificial intelligence algorithms can detect abnormalities in images that can be indicative of cancer, often with the accuracy that equals or exceeds that of human specialists. Here it is important to highlight a new technique, which is total body resonance or diamar powder, which is an advanced imaging technique that allows you to obtain detailed images of the whole body in a single exposure, being especially valuable in the early detection of cancer. The editing of artificial intelligence to the diagnostic process of this technique substantially increases its performance and accuracy, taking into account that it generates large volumes of information. Other fronts where artificial intelligence contributes to the early diagnosis of cancer. These are pattern analyses, assisted diagnosis, personalization of detection, research and development, and continuous dying.

18:12 In short, artificial interedency is transforming the field of ecological diagnosis, improving accuracy and efficiency in early scope detection, which can lead to better prognosis and higher survival rates for patients. Attempts to overcome this disease do not begin or end with artificial intelligence. From surgery to chemotherapy, treatments have become more friendly or less invasive. For example, if someone was diagnosed with breast cancer 100 years ago, doctors had to take drastic measures, such as removing the entire breast, along with the underlying pectoral muscles and all the lymph nodes in the armpit. However, in nineteen hundred and sixty, a type of surgery was discovered that was less invasive or snomizing the side effects. The same has happened with other treatments, such as radiation therapy and chemotherapy, which over time have refined and refined their procedures to minimize side effects. And, as I mentioned before, as well as our faces and our actillary footprints, each case of cancer is unique. Researchers have discovered many ways to reduce the negative impacts of treatments, adapting them to individual needs such as modulated intensity radiation therapy, in which radiation rays vary in intensity strength, allowing them to shape to point to a precise area, either in the exact form of a tumor, if used to reduce it before surgery, or the immediate area around where there was until the last. In fact, the pandemic left something good and it was that

19:48 research to develop the vaccine against covid nineteen inspired the use of this same molecule to create a vaccine against pancras cancer. Last year the results of the first trials in patients, a group of sixteen people in a first batch of trials showed promising results. Fifty percent of the patients had positive results for this trial had to create a personalized vaccine for each patient. However, and even though different treatments have been tried for the many types of cancer, accessing them is not always easy. The WHO Global Survey on Universal Health Coverage and Cancer shows that only thirty- nine per cent of participating countries covered basic aspects of cancer management as part of their basic health services funded for all citizens, health benefit packages, and only 28 per cent of participating countries additionally covered care for people in need of palliative care, including pain relief in general, and not just cancer- related care. The case of Colombia is not the worst, but neither is the best. According to an article by the University of Rosario, cancer mortality rates are higher in Colombia due to greater barriers to early diagnosis, which is that mortality rates are higher in middle- and low- income countries, which shows that there are fewer preventive actions and greater access barriers to diagnosis and early initiation of treatment. According to the newspaper, La República with data

21:25 from ASEMI, phase- cold and feat, the patient with standard cancer in two thousand twenty a year is worth twenty comma two million pesos, which today represents about twenty- six million average of treatment per person per year. If the disease is already detected in metastases, it could cost up to$ 229 million. According to Cruz, there may be even higher costs, such as experimental treatments, which can cost$ 10, 000 a month or last- line treatments. But in addition, the country allocates nearly ten eight billion a year in resources to care for cancer patients. According to figures from the National Cancer Institute. In Colombia, about eighty- one thousand and five hundred ninety - six new cases of cancer are detected each year and about forty- three hundred people die each year on account of that disease. According to a report of the epidomiological panorama of anif cancer and according to the data provided in the high cost account. It is evident that for cancers with higher mortality and incidence mom and prostate, the national indicator of early detection decreased. That same report shows another problem for Oro Comillas. On the one hand, there are limitations in access for certain departments and that in recent years the specific expenditure on detection has decreased, which is reflected in a smaller proportion of cases identified in the early Cierro Comillas age. The document concludes that Horo Comillas, Colombia, is

22:56 a country whose expenditure on the disease is mainly focusing on diagnosis and treatment but not on early detection. This has a negative impact. Not only about the lives of patients with this disease, but it ends up imposing high costs for stan closing quotes. Looking at the picture, I have one question about how well or how badly Colombia is in the fight against cancer. After that, I will give the question to the former Minister of Health, Alejandro Gavilla, who was also a cancer patient and he told me this. Colombia has a cancer prevalence of approximately 6 percent six out of every 100 people suffering from cancer.

23:37 This has been similar to the average number of Latin American countries. Colombia to implement successful preventive policies against cancer. The most important, the most successful has been the anti- smoking policy, which has led to a reduction in the incidence of tobacco use by approximately 500, 000 people in recent years, a fact that has had a positive impact, for obvious reasons, on cancer control. Colombia, with regard to treatments, has also made decisive progress in what is known as financial protection. Unlike in many Latin American countries, a low- income family in Colombia does not have to borrow or sell its home to pay for cancer treatment. The coverage of the system of more than ninety - five percent has, of course, been instrumental for this to happen.

24:25 There are still difficulties and problems. This should be recognized in the opportunity of treatment in two periods, the time between the suspicion of diagnosis and the definitive diagnosis and the time between the definitive diagnosis and the beginning of treatment. After finishing my treatment, against a non- hotking report, being Minister of Health and being an exercise that is anecdotal, but can be illustrative, we found two patients from the subsidized regimen, a milkman from the municipality of ubate and a domestic employee who had been diagnosed the same day by the same disease. I started treatment one hundred and twenty days later they, on average, started treatment between forty and forty- five days later the three of us finished treatment successfully and seven months after the treatment started, we were declared on permission on February 4, World Cancer Day was commemorated. A few days later a close friend died from this disease, but he was not the first. I disagree with this claim that a dying cancer patient lost the battle against the disease.

25:32 I think it' s more of a battle that we should all give as a species from the trench of science. It' s a cruel disease, but I' m sure that just as we get to the moon and divide the atom, we' re also going to be able to find a solution. But I don' t want to leave without hearing the testimony of a person who has suffered from this disease. So I looked for Diana Buitrago, a cheerleader who' s been around for several months with a fibroadenoma on her right zero, I asked her to tell us how she' s changed her life to UFFF I feel the emotional part is the strongest. Not because you barely read the word to Carcinoma and googlea, because I thought I was going to die and I thought it was my son. Nothing. The first thing he did was like starting a notebook and I said" hue puche" if I remember, because I left something for him and right now. I realize that since there are many treatments, there are many researches and the chances of survival are too high. Look, there was something very, very curious going on, and it' s that the first week of the diagnosis I couldn ' t sleep and I was feeling a cold here on the back and I was saying poached egg is the death that' s here next to me breathing in my back, but then I really realized the simple fact of being alive means that death is there next to whispering, because we can die coming down the stairs in the shower, a car or a robbery. I don' t know there' s a thousand ways to die. So I feel like cancer was like that cube, although you' re gonna understand that, yeah, you' re here right now, but you don' t know if

27:04 you' re gonna be here tomorrow. Then I started doing the things I felt sorry for doing, I started dressing the way I liked it. I would have liked to dress, but I felt sorry because I said, because no one dresses like that. Or and I started to do it because, because I die And what is it, because here it won' t matter to anything and to me it' s the only one that I' m going to say garlic puja I didn' t and I started to think more about priorities. My priorities used to be very focused on each other. They ' re still there, but right now, I' m before me then like the most important thing was to prioritize myself and give the real importance to the things that deserve it time with the people that I love not leaving anything for tomorrow, that is, I know it sounds super cliche. I' m in that process that for medicine and all that, because apparently, there is a tomorrow, but that' s like giving the real importance here the time. I am Roberto Pombo and this was chapter seventy- eight of my questions. See you in the next chapter from now on. This chapter of my questions is available on all podcast platforms. This episode was made possible by Kafam, inspiring Smiles. Dirección Roberto Pombo, Producción General, juan Abel Gutiérrez, editorial advisor, Daniel San Pedro Espina, scripts juan Abel Gutiérrez and Johnny Rodríguez. Field production Marcela Salazar and Lucía Beltrán. Post- production of audio Carlos Bernar