doi 10.1723/3091.30833 | PDF Download (103,2 kb) Ital J Gender-Specific Med 2018;4(4):133-135 In memory of Umberto Veronesi. Values and teachings of a great doctor and scientist titolo - split_articolo,controlla_titolo - art_titolo In memory of Umberto Veronesi. Values and teachings of a great doctor and scientist autori - vau_aut_id Monica Ramaioli affiliazione_autori - art_affiliazioni General Director of the Umberto Veronesi Foundation testo - art_testo Science fears certainties and teaches us to doubt. It is modest, it doesn’t preach. It acknowledges that its task is to always push the frontiers of what we know a little farther. By its very nature it has to “look beyond”, to go against the tide with respect to the society that expresses it. In the intent not to affirm itself, but to try to understand and learn from mistakes. Umberto Veronesi Two years have passed since the death of Professor Umberto Veronesi, a leading figure on the international scientific scene. Umberto Veronesi was an extraordinary doctor: he fought hard against cancer to save the lives of his patients. He was an enlightened researcher: overcoming great difficulties, he developed an innovative surgical technique called quadrantectomy, which revolutionised surgery to treat breast cancer. He was a fine thinker, a cultivated and open-minded man: he always made his voice heard in the world of science, culture and civil society. It was only natural for his legacy as a passionate researcher, scientist and contemporary intellectual to be cherished and fostered by the Foundation that bears his name and that he created in 2003, with the aim of promoting “the progress of science,” a synthesis that accompanies the logo of the Umberto Veronesi Foundation. Promoting scientific progress means, first of all, financing scientific research that can change the fate of millions of patients, and spread a culture of science and prevention, starting with younger generations. Two years after his death, we wish to briefly retrace the key moments of his life as a scientist, remembering, in particular, the last years spent mostly at his Foundation. A life in scrubs I never thought of doing another job. I have always loved women and with love I have always carried on my passion for medicine. The honest truth is this: you have to love people to be a doctor. Umberto Veronesi From the beginning of his medical career, Umberto Veronesi made innovative and courageous choices, engaging in a particularly complex field at the time, that of oncology. After graduating in medicine and early work experience in Great Britain and France, he began his career as a breast surgeon at the Istituto Nazionale Tumori in Milan, of which he was Scientific Director from 1976 to 1994. From 1994 to 2014 he was Scientific Director of the European Institute of Oncology in Milan, which he founded in 1991 and of which he was later appointed Emeritus Scientific Director. During his long life as a doctor he operated thousands of women with breast cancer, in the belief of the importance of taking care of patients in all their complexity. Umberto Veronesi was one of the first surgeons in Italy to raise awareness in the medical and scientific world and in public opinion on the psychological impact of cancer on women and all cancer patients. He always passed on to his staff, even by example, the precious and incalculable value of taking care of individuals and not just of their illness. To best treat a person, you need to know him or her, not just his or her body, but even his or her mind. If a woman tells you about her children, her work, the people around her, how she sees life, her illness, the hospital and doctors, then you know what the best treatments for her are. Umberto Veronesi The eternal fight against cancer I started dealing with breast cancer 50 years ago, when it was a death sentence and most women died of it. It is an ancient disease – Herodotus says that Atossa, queen of Persia, daughter of Cyrus the Great and wife of Darius, died of breast cancer – but it was a rare disease until two or three generations ago, when women stopped having many children and spending much of their adult lives breast-feeding them, protecting them from breast cancer. When I arrived, I was a young doctor, and the figures were dramatic. And the first hopes? The disease had an extraordinary feature: if discovered at an early stage, a patient could heal. This was the first light that lit up: we understood that early diagnosis made the difference between life and death. Umberto Veronesi Breast cancer is the most common female neoplasm and the leading cause of death due to cancer among women: more than 50,000 women are diagnosed with this disease in Italy every year. Umberto Veronesi always “looked ahead” compared to the rest of the world in treating breast cancer, especially surgically. When in 1969 he first presented his research project on “quadrantectomy” in Geneva, the conservative surgical technique that allows limiting the removal of tissues in small tumours, compared to mastectomy, he challenged a dogma and told of a hostile reception. I was young, I was Italian, and we were considered second-rate scientists. And most of all, I was going against the orthodoxy of the time. In short, they said I was mad. Umberto Veronesi He never gave up and he carried out a randomized trial, which lasted from 1973 to 1980. In this trial, for the first time 701 patients with a tumour smaller than 2 centimetres underwent quadrantectomy and mastectomy in order to compare the results of the two procedures. In July 1981, the New England Journal of Medicine published the results of his research: there was no difference between the two methods. Finally, the new technique was accepted by the international scientific community. In 2002 came another confirmation: more than 20 years after surgery, the survival of women undergoing quadrantectomy was the same as that of women whose whole breast had been removed. Conservative surgery is now applied to early-stage breast cancer: differentiating the technique according to the severity of the disease was Professor Veronesi’s enlightened intuition. Hence his constant commitment to prevention and early diagnosis: detecting breast cancer at an early stage increases the chances of recovery and reduces the often physically and emotionally devastating impact on a woman’s body. Breast cancer is now one with the highest healability. If discovered in time, when it is impalpable and only detectable instrumentally, it can be cured in almost all cases and with interventions that respect the integrity of the female body. So, salvation for women exists: early diagnosis with mammography and ultrasound. Umberto Veronesi After this work, other studies followed, together with a group of excellent collaborators, always seeking the ‘minimally effective therapy’ instead of the ‘maximum tolerable one’. This is how the “sentinel lymph node biopsy” was born. In many cases it avoids the removal of axillary lymph nodes with axillary excavation, a procedure with often burdensome consequences for women; and the use of ‘intraoperative radiotherapy’, which in some women allows irradiating the breast at the same time as the procedure, with results similar to cycles of external radiotherapy. The female universe and disease I would like to be remembered as someone who helped to improve the quality of life, especially of women. Umberto Veronesi Some sources say that he treated about 30,000 women: whatever the number, Professor Veronesi fought against breast cancer for each of those women. But quadrantectomy is only the pinnacle of his constant attention to safeguard the integrity of the ‘female patient’. In his long experience as a doctor he fought relentlessly against the idea of mutilating the female essence that breast cancer and breast surgery have meant for millions of women. For the first time, a large number of patients have managed to recover from breast cancer without any serious damage to their image. The breast is a symbol of femininity because it harmoniously encloses the value of sensuality and motherhood and a diagnosis of cancer destroys the harmony between a woman and her body. That’s why I always tell my doctors that you have to eradicate the tumour not only from the body, but also from the mind. Senology is greatly committed in this regard, establishing an alliance with plastic and reconstructive surgery and attaching importance to the aesthetic result of surgery. Today I believe that if a woman is understood in her depth by doctors and family members, she can find within herself the resources to heal even psychologically from breast cancer. Umberto Veronesi The future of women is scientific research An increasing percentage of women who develop cancer heal. I myself have witnessed a real revolution that has transformed cancer from a disease whose name was not even pronounced out loud into a condition that is often cured or effectively controlled. But science is never satisfied. Umberto Veronesi Research was always a fundamental part of his life. Thanks to research, medicine – and not only – has made great strides. Unfortunately, limited economic resources, like those allocated for years to scientific research in Italy, do not allow us to broaden as necessary the areas of study to achieve new results, or retain young Italian researchers in our institutes of excellence. For this reason, too, Umberto Veronesi established the Foundation that bears his name. In 15 years, the Veronesi Foundation has financed the work of over 1,400 researchers in 157 institutes of excellence in Italy and abroad; it has supported 115 high-profile scientific projects; it has allowed the opening of 8 treatment protocols and 3 observational studies for paediatric oncology that would otherwise not have seen the light of day. The research supported by the Foundation covers various fields of medicine, such as oncology, cardiology, neuroscience and nutrigenomics. As far as oncology is concerned, to which Professor Veronesi devoted his entire life as a doctor and researcher, most of the researchers funded by the Foundation are committed to the fight against female cancer, in particular breast cancer, in line with the sensitivity to the health of the female universe transmitted by Professor Veronesi. The Umberto Veronesi Foundation and the Professor I am thinking of a science that is inspired, like the Foundation I created, by three fundamental principles: freedom, solidarity and tolerance. Umberto Veronesi Umberto Veronesi is our constant point of reference and sheds his light on the path he traced from 2003 to 2016, the year in which he passed away. At his Foundation, too, he gave ample space to women, creating a team of “feminine” work and thought that has grown steadily over time. For all he was a personality capable of leaving an indelible mark on the history of Italian medicine and scientific culture. It is a legacy more alive today than ever before. biblio_titolo - ignora Reference books bibliografia - art_bibliografia Veronesi U. Il diritto di essere umani. La battaglia di una vita. Milano: Solferino 2018. Veronesi U, Pravettoni G. Senza paura. Vincere il tumore con la medicina della persona. Milano: Mondadori Electa 2015. testo - art_testo Conflict of interest statement: the Author declares no conflicts of interest.