By the year 2030, we could have about 28 million new cancer cases each year… It is a significant global challenge…that we cannot afford to ignore.
— Franco Cavalli, MD, FRCP
Switzerland, a landlocked country with a population about that of New York City, has four geographic regions, each with its own official language. Internationally regarded lymphoma and breast cancer expert, Franco Cavalli, MD, FRCP, was born and raised in Locarno, a town in the Italian region of Switzerland, which hugs the banks of the massive Lake Maggiore at the foot of the Alps. “I went from primary school on through college, and was the first in my family to achieve an advanced degree. At that time, there were three classical professions: lawyer, engineer, or physician,” said Dr. Cavalli. Dr. Cavalli concedes that since he didn’t like math and had mixed opinions about lawyers, becoming a doctor was essentially a process of elimination.
His choice to become a doctor faced one hurdle: There was no medical college in the Italian-speaking region of Switzerland. “I had to go north of the Alps to either the French- or German-speaking region of the country. Since French is similar to Italian, I decided to go to medical school in the German region so I’d learn the language along with getting my medical degree,” said Dr. Cavalli.
Early Interest in Psychiatry Leads to Oncology
Dr. Cavalli said that when he went to medical school, there were an unlimited number of seats. “Today, medical school entrance is highly competitive, but I was accepted directly following college, after passing the entrance exam. To this day, all the universities in Switzerland are public, with very little variance in the quality of education. And the tuition is very low; anyone can afford to go to a university. This helped in my case, since I came from a family of meager means,” said Dr. Cavalli.
Dr. Cavalli passed his final exam in medical school in 1968, a turbulent time in global politics. “I was very engaged in political movements when I was a young medical school student. There was so much anxiety in the air at that time among young students that I convinced myself to become a psychiatrist,” said Dr. Cavalli. After graduating medical school, he spent two and a half years studying psychiatry.
Part of his training included a compulsory stint in internal medicine. “By the time I started the internal medicine, I was disappointed in psychiatry. During this period I met a fascinating professor named Kurt Brunner, MD, who influenced my decision to switch careers to oncology. He said that my combined interests in human behavior and science made oncology a perfect fit. He was right,” said Dr. Cavalli.
Founds Oncology Institute of Southern Switzerland
Dr. Cavalli explained that several Swiss oncologists, Dr. Brunner among them, traveled to the United States to work and study at Roswell Park Cancer Institute, and it was the knowledge they brought back that, in part, launched Switzerland’s first cancer institutes. “It was an exciting time for me, as at that time Switzerland had the most aggressive clinical research programs in Europe,” said Dr. Cavalli.
In 1978, after completing his medical training, Dr. Cavalli returned to the Italian region of Switzerland to practice oncology. “But there were no oncology programs at the time, so with a part-time secretary and part-time nurse I started and built what is now the Oncology Institute of Southern Switzerland (IOSI), the comprehensive cancer center for the Italian-speaking part of Switzerland,” noted Dr. Cavalli, adding, “I now have 250 coworkers in our center, which is based on the U.S. template of the multidisciplinary comprehensive cancer center.”
Addressing a Global Challenge
In 1995, Dr. Cavalli’s lifelong sociopolitical passions were further realized when he became a member of the Swiss Parliament, where he continued to focus on debates about health care and health policy issues. He is particularly interested in palliative care and end-of-life issues, emphasizing underserved populations. More than 2 decades ago, Dr. Cavalli and fellow doctors in Italian-speaking Switzerland founded the Association for Medical Aid to Central America.
Through this growing collaboration, Dr. Cavalli has coordinated many projects in Nicaragua, El Salvador, Guatemala, and Mexico. In 2006, he was voted Switzerland’s “Person of the Year” for his contributions to society, largely due to his work in cancer and palliative care in the developing world. “In 1980, the number of cancer deaths was the same in the developed and developing world. In 2002 there were 11 million new cancer cases. By the year 2030, we could have about 28 million new cancer cases each year with 80% of cancer deaths occurring in low- and middle-income countries. It is a significant global challenge. Cancer currently kills more people than tuberculosis, AIDS, and malaria combined. It’s a challenge that we cannot afford to ignore,” stressed Dr. Cavalli.
Focus on the Future of Oncology
Although still vigorously pursuing multiple activities in global oncology, Dr. Cavalli was recently forced by Switzerland’s mandatory retirement age of 70 years to step down from his role as Director of the Oncology Institute of Southern Switzerland. “I’m still the Institute’s Scientific Director and my main focus is to further develop robust translational research efforts. We have about 40 basic and bench scientists in labs. To that end, I want to increase our efforts in developing solid phase I trials,” said Dr. Cavalli.
He continued, “I also want to continue working in malignant lymphomas, which has long been my major clinical interest. Working in concert with many of the world’s foremost experts, I led the development of the International Conference on Malignant Lymphoma in Lugano, Switzerland, the leading international forum for basic and clinical research in lymphomas. It is the most important gathering in the field of lymphomas. So I’m very proud of this continuing effort.”
Asked about his view of oncology’s future, Dr. Cavalli said, “I remain an optimist. If you’re not an optimist, you won’t last in the field of oncology; it is too demanding—but it is also tremendously rewarding. I’ve seen great advances since my first rounds on the oncology wards. Moving forward, we need to be mindful of strategies that involve new and extremely costly cancer therapies—an approach that is often proving unsustainable. We must make a better effort to advance proven ways to prevent cancer incidence. That’s an area where we can truly relieve the burden and suffering of cancer.”
Dr. Cavalli has seven children and several grandchildren, one of whom is planning to follow in her famous grandfather’s footsteps by pursuing a career in medicine. To recharge his battery, Dr. Cavalli seeks contemplative time alone with his dog, hiking in the towering mountains to a small cabin that is stocked with books. An avid and omnivorous reader, Dr. Cavalli said one of favorite writers is the American novelist Philip Roth. When it was pointed out that the octogenarian writer recently said he was finished, that there would be no more books, Dr. Cavalli thought a moment and then said, “I wonder why someone so talented would want to retire.” ■