Dr Virgilio Sacchini

Dr. Virgilio Sacchini, a breast cancer surgeon at Memorial Sloan Kettering Cancer Center in New York, affirms that we are going to beat cancer.

Dr. Virgilio Sacchini, you work as a breast cancer surgeon at Memorial Sloan Kettering Cancer Center in New York and are a professor at the Università Statale in Milan. Your book “Andrà tutto bene” (“Everything Will Be OK,” published by Mondadori in Italy) is being released now. Can you explain why you chose such an optimistic title?

Because researchers are convinced that we are going to beat cancer. We’ve already beat some types of cancer, such as some leukaemia, many types of breast cancer, most types of thyroid cancer, prostate cancer, and in the future—I hope soon—we will beat other types of cancer that are less curable, such as pancreas cancer, lung cancer, and lymphatic cancer. By changing our lifestyles, we also know that we can decrease our risk significantly.

What kinds of changes?

For example, not smoking, avoiding obesity, and doing physical exercise.

But do we know where cancer comes from?

We know that there are different kinds of cancer, which is a very heterogeneous illness, with causes that are rather different. Fundamentally, this begins with damage to cellular DNA, which transforms cells focussed on specific functions into cells that are out of control.

Is cancer on the rise today?

It is more curable, but we have more cancer because our life expectancy is longer, and therefore, statistically speaking, there’s more risk of damage to our DNA. There is also more pollution with carcinogenic substances, and this increases our risk.

At what age are we most at risk?

In general, it depends on the cancer, but for the most frequently occurring types, risk starts at age fifty.

You have dedicated your life to curing cancer—doing research before Dr. Veronese at the Istituto Europeo di Oncologia in Milan, and now at Memorial Sloan Kettering in New York. Have you seen a lot of progress made in your work? Is the United States more advanced compared to other countries?

A lot of progress has been made, but it’s not enough. There are still too many people dying from this disease, and this is frustrating for those of us who have been working so hard over the years. Unfortunately, some paths taken have not led to the desired results, and other paths have allowed us to save many patients. We need to be able to better predict which research will be successful.

Certain illnesses like hypertension or diabetes are chronic yet they can be controlled with drugs. Why is cancer different?

We’ve been able to achieve the same results with some types of cancer, such as, for example, breast cancer, colon cancer, and cancer of the lymphatic system. We are trying to do the same for other types of cancer, but oncological diseases are much more complex due to the cellular differences in the tumour itself.

You spent twenty years at the most famous cancer centre. What did you learn there?

That funds are needed for research. You can’t do research without money, and in the last few years, the biggest difference between the United States and Europe is the large investment in “genomics,” or, in other words, the study of DNA in tumour cells. What we know now is that we can work on mutations in some genes using very specific drugs that don’t damage healthy cells. What they are doing now in the United States is classifying tumours based on genetic mutations rather than based on the organ that generated them.

What does your book “Andrà tutto bene” talk about?

That we will beat cancer sooner or later and that we need to have a lot of courage to treat our patients, and our patients have to have a lot of courage to face cancer treatment, and that researchers need to have a lot of courage to continue working to win this battle.

Do you talk about anecdotes from your life and your experiences in the book?

I talk about my training, and the courage I had and that I would like many doctors to have in changing their lives and treating patients with cancer. I talk about future frontiers for treating cancer and the scientific integrity needed to achieve the best pharmacological and research results.

You talk about “courage,” but haven’t you ever felt discouraged considering you work in a field that is so uncertain? Do you talk about this in your book?

I often still feel frustrated and helpless when, despite my best efforts, we lose a cancer patient. I’ve lost friends and colleagues to untreatable cancers, and sometimes I wonder how much more pain we must all have in our hearts.

But these times of being discouraged are followed by the desire and the need to continue this fight, which, fortunately, has also saved many lives.

Are patients frightened when they come to you?

Yes. They are very frightened because a cancer diagnosis is devastating for a patient, and he needs to feel like his doctor is an ally fighting alongside him to achieve the healing results hoped for.

Do cancer patients know how to take on this illness while being surrounded by healthy people in their lives?

We have to understand that it is ever more probable that we will get cancer, and our society needs to work harder to coexist with this disease. The psychological side for helping the patient and his family members is fundamental for allowing the cancer patient and his family to live as normally as possible. The most harmful thing for the patient and his family members is desperation. Doctors and treatment centres need to be committed to offering support so that patients and their families can live with a sense of peace.

Do patients take on cancer with a sense of hope?

Every person is unique, and every person has moments of hope and moments of deep depression, which is often not justified given the excellent chances for recovery. Our important task is to identify these phases of depression and take action so that there is a better equilibrium in the patient’s mood.

How do family members, colleagues, and partners react?

Some people run away, partners included. Others strengthen their relationships, and I think these experiences show our true bonds and true friendships, like in other times in life.

Are patients’ children understanding?

Generally, children react in a very positive way. Children strengthen their relationships with their parents and try to make up for lost time. They spend time with their parents and help them with the logistics and, sometimes, with the economic aspects involved in the treatment process.

How do you break bad news to a patient?  

I close the door, I turn off all telephones, I ask all the family members to come in, and I take as much time as needed in explaining the possible reasons for why therapy has not been successful and the outlook, focusing on any sources of hope that may be able to offer the patient and family members a positive sign.

Is “How long do I have to live?” the most frequent question you get?

Yes, and my response is always “Not very long if you don’t look both ways before you cross the street,” as a way to remind the patient that our lives are made up of risks and uncertainties. Often, a cancer diagnosis doesn’t change our destiny.

You deal with life and death every day. Are you able to have a normal life?

I can’t deny that I lose sleep some nights because I’m thinking about my patients. Despite what people say, you can never put up a wall around yourself.

New York

September 2017

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