Mads Melbye was the session coordinater for the prevention session at the Danish Cancer Research Days 2023. Photo: DKD2023, Jesper Balleby.
20-09-2023
It is both possible and necessary to enhance cancer prevention in the future. This was the main message conveyed by the five presenters during the first session of the Danish Cancer Research Days 2023.
A 90-minute session was dedicated to prevention at the Danish Cancer Research Days 2023. The ambition set by the session coordinator, Mads Melbye, Research Director at the Danish Cancer Society, was for the session to comprehensively cover all aspects of cancer prevention. This implied that the participants would acquire a more comprehensive understanding of both primary, secondary, and tertiary prevention.
The session took place immediately after the opening speech by Sophie Løhde, the Minister of the Interior and Health. After a brief introduction by Mads Melbye, Niels Them, Head of Tobacco Control at the Danish Cancer Society, took the stage.
Where there is a will, there is a way
Niels Them's presentation focused on smoking and the role of new nicotine products in the risk of developing cancer. He stated that one in five cancer cases in Denmark is developed due to smoking, and that smoking increases the risk of 15 different types of cancer. It is not surprising that smoking is associated with an increased risk of developing cancer. Nevertheless, Niels Them's pointed out that Denmark experiences a significantly higher number of smoking-related cancer cases compared to many of the countries we typically compare ourselves to.
According to Niels Them, it is indeed possible to limit smoking. In Denmark, we have twice as many daily smokers as in Sweden and Norway. However, there is no reason to doubt that we can emulate our neighboring countries. Where there is a will, there is a way – and that way involves children and young people.
Niels Them emphasized that the way to address smoking in Denmark involves expanding smoke-free environments, increasing support for smoking cessation, and gradually phasing out tobacco. Furthermore, he assessed that a substantial price increase in both tobacco and other nicotine products is necessary. This is crucial to curbing the rise in sales of e-cigarettes, snus, and other 'novel' nicotine products as well.
- Snus is not associated with the same cancer risk as tobacco, but it does lead to nicotine addiction. In that way, these new products can be the start of a lifelong addiction, explained Niels Them.
Insulin can be the intermediary
Research Leader Anne Tjønneland from the Center for Cancer Research, Danish Cancer Society, delivered the second presentation of the session, which focused on the relationship between cancer and obesity. She emphasized that severe obesity is increasingly becoming the primary preventable cause of cancer. Obesity increases the risk of up to 18 different types of cancer.
The underlying mechanism behind this relationship is not yet fully clear, but research suggests that chronically elevated insulin levels may be a contributing factor.
- Insulin is a growth factor; we use it in laboratories to make cancer cells grow. We also know that hyperinsulinemia inhibits fat breakdown if the body has abundant glucose in the blood which needs to be burned first. Losing weight becomes extremely challenging when dealing with hyperinsulinemia due to the inhibitory effects of insulin, explained Anne Tjønneland.
Irrespective of the degree to which insulin and other contributing factors impact obesity, Anne Tjønneland's concluding statement emphasized the importance of addressing the ongoing increase in prevalence of overweight.
Smarter screening in the future
The third and fourth presentations of the session were about screening.
First up was Rolf I. Skotheim from the Institute of Cancer Research, Oslo University Hospital. The presentation provided an overview of how genetic testing can improve prostate cancer screening. He pointed out that there is significant genetic variation in prostate cancer and that this variation often occurs as multifocal. Therefore, addressing this heterogeneity is crucial for genetic testing to enhance screening in the future.
Next, Ilse Vejborg, Head of the Mammography Screening Programme in the Capital Region of Denmark, took the stage to enlighten the participants about the prospects of artificial intelligence in mammography screening. She explained that the primary goal of her work in introducing artificial intelligence to the screening service was to reduce the radiologist's workload without compromising on quality.
And the results are promising: when AI examines mammograms, it performs well, especially in low-risk groups, where AI assessments are consistently followed up by a radiologist. For intermediate and high-risk groups, mammograms are reviewed by two radiologists, who can be assisted by artificial intelligence.
In general, Ilse Vejborg's research demonstrates that AI can be used in breast cancer screening without compromising quality. In fact, there has been a significant improvement in the number of cancer cases detected by screening. This is achieved while reducing the radiologist's workload by up to 35 percent. Therefore, Ilse Vejborg assessed that there is significant potential for utilizing artificial intelligence in her field.
New hope for patient-targeted cancer vaccines
The final presentation of the session was delivered by Mads Hald Andersen, Director at the National Center for Cancer Immune Therapy. He provided an update on research related to therapeutic cancer vaccines targeting individual patients. A research area that, despite significant hype, has been awaiting results. However, Mads Hald Andersen assured that the wait for results will not be much longer.
- We have never been closer, and it is an incredibly exciting time for cancer vaccines. Based on our previous results, we have high expectations, and if they are met, we have a potent vaccine that can make an incredible difference to cancer patients.
Furthermore, Mads Hald Andersen explained that the fundamental idea is to remove the 'brakes' on T-cells so that the spontaneous response can be targeted. In contrast to the past, where these vaccines were used late in the cancer process, the new approach is to combine them with, for example, immune therapy early in the cancer process - and that is what makes all the difference.
- In the past, we observed that the activity generated by the vaccines was not sufficient in the late stages. The cancer was simply too widespread. Although the basic mechanism of the vaccines is nearly the same today as it was back then, we now see many success stories because we intervened earlier and added other forms of immune therapy.