Cancer is Not a Matter of Bad Luck – Prof. Mantovani on Corriere della Sera

Based on Prof. Mantovani‘s article on the Italian newspaper Corriere della Sera.

Bert Vogelstein, a renowned scientist who has played an extraordinary role in understanding the molecular genetic mechanisms that lead to cancer development, published a provocative study in the scientific journal Science 2 years ago entitled Variation in cancer risk among tissues can be explained by the number of stem cell divisions.” Using complex mathematical analyses, he estimated the incidence of healthy cells spontaneously transforming into cancer cells, with no carcinogens present, on the basis of the number of staminal cells present and their reproduction frequency in various organs.

Unfortunately, the author’s intentions were distorted, and the message of the study was misinterpreted by many as “cancer is a question of bad luck”. Given that two out of the three tumors presented are due to “bad luck” rather than genetic or lifestyle factors, it solidified the conclusion that greater efforts should be invested into early detection rather than prevention.

How local and lifestyle factors influence cancer development

Vogelstein’s latest study extends his findings to populations outside of the USA; the journal Science has just recently published it along with a perspective article that underlines some of the flaws and limitations of the study. Firstly, the mathematical models cannot be completely comprehensive in a phenomenon as complex as tumor growth; nevertheless, they have high potential to improve patients’ quality of life, so they must be extremely carefully developed. Secondly, the study pays little attention to countries such as India, where rapid life style changes have dramatically affected the rate of cancer incidence in the local population. Based on cancer epidemiology, we know that 2nd generation Japanese females who moved to the United States have a 10-fold increase in the risk of getting breast cancer. This irrefutable data suggest therefore, that lifestyle and environment variables are determining factors on cancer incidence.

Prevention and early diagnosis

Caution should thus be exercised concerning the conclusions drawn from Vogelstein’s study to avoid any misleading interpretation. We can do nothing about luck – good or bad – but we can succeed in controlling other factors. We must therefore do everything in our power to beat cancer: prevention and early diagnosis, and research that leads to new diagnostic and therapeutic strategies. Data show that Italy is doing well in the field of cancer treatment. The national health service guarantees access to early diagnosis tools, which play an extremely important role in this battle, along with proper treatment paths.

What we can and must do

We can and must do better with regards to our individual and communal prevention efforts. Greater effort can be placed into improving lifestyle norms. The 0-5-30 rule can be adopted: 0 cigarettes, at least 5 portions of fresh fruit and vegetables, and 30 minutes of moderate exercise. By doing our part in our societies we can move towards reducing pollution and decreasing our carbon footprint. We can also aid efforts in the battle against cancer through scientific advances. Studies that relate to genetic and environmental risk factors are crucial. Additionally, better understanding of the molecular mechanisms behind cancer development and progression and the immunological defenses that watch over our organisms by eliminating cancer cells can be used as new therapeutic weapons.

Cancer is not just a question of chance. Its defeat involves multiple complex factors and thus depends on all of us.


Humanitas is a highly specialized Hospital, Research and Teaching Center. Built around centers for the prevention and treatment of cancer, cardiovascular, neurological and orthopedic disease – together with an Ophthalmic Center and a Fertility Center – Humanitas also operates a highly specialised Emergency Department.