Cancer research in Italy: hormone therapy, an interview with Prof. Andrea De Censi
Medical Oncologist, Andrea De Censi is a full professor at the Queen Mary University of London. After graduation and specialization, he worked at IST in Genoa first, and then at the European Institute of Oncology in Milan, where he became Director of the Division of Cancer Prevention and Genetics and, in 2004, Director of the Medical Oncology Unit of Ospedali Galliera in Genoa. Expert member of the European Commission on Public Health Genomics in Cancer, he has authored over 200 scientific publications. He is currently responsible for 20 ongoing clinical trials, funded among the others by the European Union, the U.S. National Cancer Institute, the Italian Ministry of Health and the Italian Association for Cancer Research (AIRC), from which he has obtained an Investigator Grant.
In his recent study, published in Gynecological Oncology, he has investigated the role of hormone therapies in the treatment of ovarian cancer by carrying out a systematic review of the literature published over the last 40 years on this topic.
Professor De Censi, what is the role played by sexual hormones in cancer?
Female hormones (oestrogens and progesterones) have a tendency to promote mammary gland proliferation and are involved in the onset of breast cancer in women. Androgens (testosterone and derivatives) have the same effects on prostate cancer. The role of oestrogens in the development of ovarian and colon cancers has been investigated less, but it is equally important. We can say that sexual hormones are essential for life, but may have some side effects as well.
What hormone therapies are available and which ones are the most effective, today?
In Oncology, hormone therapy refers to the inhibition of the effects of oestrogens or of androgens in breast cancer and prostate cancer, respectively. In our study, we showed that also in ovarian cancer we can achieve an effective inhibition of the effect of oestrogens with Tamoxifen or aromatase inhibitors.
When is hormone therapy used and in what type of tumours?
In breast cancer, we use it when the hormone receptor is expressed in the tumour tissue. In prostate cancer, we use it in all cases. In ovarian cancer, we have shown that in about half of the cases hormone receptors are expressed, making them potentially responsive to oestrogens.
Is it possible to use hormone therapy as a prevention method?
Post-menopausal hormone therapy (based on oestrogens, in this case) is used to prevent diseases associated with menopause. In this case, the risk for breast cancer may slightly increase. Conversely, with anti-oestrogens (Tamoxifen, Raloxifene, aromatase inhibitors) a reduction of 40 to 50% in the risk of developing breast cancer has been shown in women at increased risk.
Can hormone therapy have any side effects?
Yes, like any drugs. Tamoxifen slightly increases the risk for thrombophlebitis and uterine tumours, while aromatase inhibitors increase the risk for osteoporosis and cause joint pain.
In this research field, what is the situation in Italy as compared to other countries?
Italy has a great scientific tradition in the field of hormone therapy for breast cancer and prostate cancer. In ovarian cancer, our team is among the first ones to have worked in this research branch.
What is your typical day as a researcher?
It is a continuous battle against time because besides passion, research requires a lot of time and concentration, as well as a bit of sacrifice for yourself and your family. I often devote part of the week-end to study.
How do you manage to reconcile research work with clinical practice?
Non-profit research, i.e. research stemming spontaneously from labs or wards (for example, research funded by AIRC), is the most creative part and also has a salvation function for doctors. Doctors who are involved in research are reassuring for patients because they are obliged to keep up to date. Research is the engine that gives enthusiasm to daily work and reduces the risk of burn-out, which is very high for oncologists.
When and why did you decide to be involved in cancer research?
In the 1980s, when I attended the School of Medicine, I worked in a Medical Oncology ward and I realized that clinical practice without research was inadequate. The advances made over the last 30 years thanks to research in terms of reduction of cancer mortality rates are very impressive.
Would you make the same choice again?
Absolutely yes. This is one of the best choices I have made in my life and I strongly recommend it to young physicians.