Speech given by Prof. Umberto Veronesi on receiving an honorary doctorate for his work in humanizing medicine King’s College London, November 3, 2011 The conferral of this honorary degree by one of the most prestigious universities in the world is a sign of international recognition of Italy as the birthplace of the principle of bodily integrity in the treatment of cancer. It was in Italy, in the late 1960s, that the tradition emerged of respecting integrity of the body, as a counterpart to integrity of the mind, and hence that the culture arose of acknowledging the psychological aspect of diseases, which always have two dimensions: the clinical element studied by the medical professional and the human element as experienced by every patient. We have expanded the scope of medicine from the quantitative improvement of life – that is, prolonging its duration – to the qualitative improvement of life, in the belief that a life without quality is only a half-life. Indeed, I am receiving this recognition for clinical studies that introduced a new paradigm in cancer treatment. Italian research showed that the principle to be followed in deciding on a course of therapy is not that of the maximum tolerable (that is, the greatest dose or intervention that a patient can tolerate) but that of the minimum effective (namely, the treatment which, effectiveness being equal, ensures the least level of invasiveness or toxicity for the patient). This brought about a Copernican revolution in oncology, which, once it spread, enabled therapeutic excesses to be avoided, thereby putting an end to unnecessary disfigurements and surgical removals. For breast cancer, this change of approach was crucial as, faced with a real possibility of saving their physical and mental health, women conquered their instinctive resistance to submitting to examinations and began to submit to early screening. Based on initial results, which allowed us to save thousands of women’s breasts by limiting mastectomy only to absolutely necessary cases, we advocated for years that the earlier a tumor was discovered the greater the chances would be of employing conservative treatment, and women paid us heed. The responsiveness of women has encouraged us to find diagnostic tools and technologies that are more and more accurate and capable of detecting lesions at increasingly earlier and therefore more treatable stages. A virtuous cycle has thus been created that has resulted in a reduction in mortality. In less than 50 years, the average recovery rate for breast cancer has risen from 40% to 80% of cases today. The process set in train has not yet come to an end: our goal now is to eliminate breast cancer from the list of causes of death in women. We have already done so in the case of cervical cancer: with women submitting en masse to pap tests, then to new early screening techniques, and finally to vaccination, we are potentially in a position to eliminate this tumor in Western countries. It still remains a problem in emerging countries, however, and it is to this that we are devoting our attentions, especially in Africa. The history of the advances made in the treatment of breast cancer therefore serves as a paradigm, a sign of hope and a demonstration of the excellence of Italian research. And I do not speak of the past. It is a difficult time for everyone, but Italian research efforts are not in bad shape. There definitely is a problem of reduced funding, but clinical studies are continuing to produce interesting results. Whilst our research has never been quantitatively extensive, it is of good quality. The individual output of our researchers is amongst the highest in the world. This, I believe, is because Italy has the historical characteristics and tradition of an international scientific community. In my case, I feel it is important to make clear that there is something – perhaps much – of the British method in my approach to being a doctor and a man of science. In the 1950s, I spent a year in London at the then Chester Beatty Research Institute, where I met Wilkins at King’s College, and also Crick and Watson, who received the Nobel Prize for discovering the structure of DNA. In a short time, I absorbed much of the Anglo-Saxon culture and scientific method, such as a love for the natural sciences and an appreciation for the use of applied statistics in science. In particular, I developed a typically British critical rigor towards individual results. I learned that the first concern after successfully completing any research must be to critically analyze it, to identify its weak points and areas requiring improvement. It was this way of thinking made it less difficult for me in 1969 to introduce – to a rather astonished WHO assembly – the concept of minimum effective treatment that would transform my life and that of millions of patients. 2.