Champalimaud Foundation: First Breast Cancer Surgery in the Metaverse

And now we are using technology to empower surgeons with new powers, with a new vision that goes beyond human vision capabilities. Suddenly we have marvels in our operating rooms transforming surgeons in unnatural superheroes that could see beyond patient skin and remove the tumor safely in order to improve oncological outcomes. Welcome to the special English edition of Degorsa Neustadt, a German podcast series by Zabille Bar, in which she talks to pioneering leaders who, inspired by the World Economic Forum's great reset initiative, create revolutionary projects that actually do make our world smarter, greener and fairer. I welcome Dr. Pedro Gouvea, surgeon and designer of the breast unit of the Champa-Limote Clinical Center in Lisbon. Dr. Gouvea is a trailblazer in Metaverse medical procedure. In May this year, he performed the first successful breast cancer operation in the Metaverse. But not only that, while he and the patient were in the operating theater in Portugal, his colleague was intervening and supervising from the University of Saragossa in Spain, 900 kilometers away, and yet they worked in the same room. Thanks to augmented reality and 5G, artificial intelligence and his special digital goggles, this pioneering experiment he called the breast 4.0 has won him the best and greatest Portuguese technology award. Good morning Dr. Gouvea in Lisbon and congratulations first. All of that sounds fantastic. Please tell us everything about your breast cancer operation in the Metaverse. Hi Sebel and once again thank you very much for this kind invitation. It's a pleasure for us to be present in your podcast. This surgery took place May 5 this year and we wanted to prove a proof of concept that it is possible that someone far away could supervise remotely an ongoing real surgery, in this case a breast cancer surgery. So I was in Lisbon at Champalimo Foundation with my patient and Roger Lula, my colleague was in Spain at Saragossa in an international conference about breast cancer with surgeons obviously. So what we want to showcase is that me as a mentee and Kujeliu as a mentor, we could be connected not on an ordinary video conference but I was wearing a headset of augmented reality HoloLens 2 by Microsoft and while the conference was ongoing Kujeliu was showcasing in the screen what I could see with my headset. It means that he could be on with me on a real setting observing and visualizing everything I could see in my field of vision including the patient. Now besides this ordinary video conference, what allowed this experiment was that Kujeliu Luna through augmented reality was able to give me instructions about the surgical procedure. As an example, he inserted a virtual object in my vision field within my HoloLens looking into the patient and this virtual object was in the form of a surgical indication about the surgical incision in the patient's breast. So he was able to suggest me where I should cut to make my incision in the patient's breast in order to remove the tumor and most important how to perform a partial breast reconstruction in order to avoid a volume defect that would have a major problem in terms of the aesthetic results of a breast cancer conservative surgery. So this means that why sometimes we speak about technology and why technology is important. So nowadays what we have is that surgeons get a specific training, sometimes they go abroad, they learn how to do it and then they come back to their original hospital and start doing themselves surgical operation. Now the problem is that when the mentee goes back to the hospital he is alone. So he's going to start surgical procedures and no mentorship is available because we didn't have the tools to do it. Now we documented reality and 5G now we can enter on a new era in the surgical matterverse education where it is possible that the mentorship could continue when the mentee goes back to the hospital and his mentor could continue to help him doing what he's doing, making corrections and interacting. Now you probably could understand that when we are driving a car and we may say go there and go there instead of saying go left or go right. Now in a surgery in a specific field of operation it's a small field and it's really difficult if you are observing on a normal video conference and stating go there are you seeing that? I was seeing the artery so it's pretty difficult. I would say it's impossible but with the computer graphics on a video conference like the ones that we can allow it to do with the HoloLens augmented reality it means that the mentor could draw in my field of vision what should I do, how can I do it and also help me identify specific anatomic structures like a vein, an artery, a node, a tumor, an organ, whatever and to assist me and to help me to operate the patient with safety and to fulfill the oncological outcomes that here in breast cancer are very important. Yeah and I watched some of your YouTube videos about your breast cancer operation and you show how to look into the patient. Right now we don't have the video here. Can you explain that in more detail so that we can all imagine how it works? Well imagine that for example let's forget the use case of the surgery for a for a misnomer so imagine that you are operating a machine with 50 buttons and half of them have the same color and they have different numbers. It's very hard without instructions book to operate the machine and do it immediately but now imagine that I'm looking to a machine with 50 buttons and you are the engineer that knows all about about these 50 buttons. Now imagine that I'm seeing the machine the 50 buttons and you are connected to my HoloLens and you are able to see the 50 buttons. Now in order you to tell me now count from right to left 10 and push the button number 10 instead of it you can draw a circle within the button in my field of vision so like in seconds I can identify the right button where should I push so this is different because if I have to count I can make a mistake and if it's a serious button you know a button where everything will blow up I will double count and that will lose time. Now it means that the ability to insert computer graphics on a normal video conference on a real environment it allows us to improve speed, action from the user and a correct movement. Now transponding this situation from a machine to 50 buttons to surgery it means that I am looking to the patient and while you are drawing an incision or appointing to a specific anatomic structure I have this immediate image interpretation of what you are saying without any doubts because you are pointing out a specific region of interest in what I am seeing so this means that it allows the user to have real-time information when he most needs in an accurate way and without fault so that's the I don't know if I am correct to your question but it's the ability for the mentor to give you instant instructions that are immediately visualized and understood by your brain by your eyes and that allows you to proceed to a specific procedure in this case with a breast cancer conservative surgery. Fascinating and you mentioned the HoloLens several times I also understood that you invented the I don't know you called it goggles right you you you did what did you do how how did you do that? Well I didn't invent the goggles so the headset is from Microsoft so we didn't need to invent new hardware everything we needed was software we bought the hardware and a good internet connection boosted by 5G. Now you might ask why 5G was important to these surgery is because of latency now everybody knows what latency is specifically because of the pandemics where everybody starts doing video conferences all the time and most of them most of the listeners should try this experiment when on a video conference with someone when they turn the the head to the right there was a delay a significant delay so that is provided by latency now imagine that I'm seeing a specific I have two pens and I am looking to one and to the other because of latency and heads movement I can point out one pen but due to latency my graphic information could be displaced and is standing pointing the the the pen A I could be pointing to the pen B which will give a wrong information to the user and we don't want that the same thing happens if you have four cars running on a highway very close from each other due to latency if I commanding is if I am in in the command a remote command the four cars if I ask them to stop immediately both at once due to latency there could be a car crash because the cars and the sensors that allows them to check the distance between both cars due to latency will give a wrong information to system that will cause a crash a car crash now with 5G what we earn is that we reduce to a maximum latency that allows us that everything voice video and computer graphics instructions are all done with the minimum possible latency to avoid spatial errors meaning to avoid saying cut the artery and suddenly because of latency I am pointing to the vein and instead of cutting the artery I will cut the vein or a nerve so that's why it's very important so regarding healthcare everything we when we apply technology we have to think on high fidelity it's not something that could go it is okay but we need high fidelity and we currently with Wi-Fi and 4G that is not possible even with 5G we had a problem because currently HoloLens 2 do not have 5G connection so we have to through a wire connect a 5G mobile phone to the headset in order to provide a 5G connection to HoloLens 2 in order to be able to showcase that having 5G in Lisbon and 5G in Saragossa connected through internet we could have an optimal setting that ultimately could prove this proof of concept in breast cancer conservative surgery now this was not the first time that someone did this regarding breast cancer was the first time but other use cases retina surgery they were also tried before but we are really speaking in an era where these medical metaverse with high connection speed with reducing latency could allow healthcare to join in this new era of fast communications in order to create new proof of concept but always with high fidelity because we need accuracy at the end we have a policy not to harm the patient with whatever technology we are applying yeah so as far as I understood that operating on a breast is particularly difficult today because the surgeons cannot really see and identify the tumor exactly and in the medical metaverse they are able to is that correct well that is different those are different concepts so one concept was to showcase a proof of concept of in the medical metaverse surgical education field that a mentor could remotely supervise the mentee during an ongoing real breast cancer surgery but that is for the metaverse education now the other concept is the most ambitious one which we call breast 4.0 it's it aims to create a medical device that could enable surgeons to see beyond patient's keen now why is this important well let me tell you a small story about breast cancer breast cancer is the most common cancer worldwide so before pandemics uh lung cancer was the most common uh worldwide and we used to say that breast cancer was the most common cancer in women but since 2020 breast cancer has surpassed lung cancer and is nowadays most common cancer worldwide but on the other side breast cancer treatment has been very effective it means that after 10 years more than more than 80% of patients will survive which is very good but that also gives us the responsibility to think that if survival is is big it means that this patient will live long lives with the dire consequences of uh treatments either are physical or emotional and regarding breast cancer local treatment the gold standard nowadays is breast cancer conservative surgery it means that for the majority of patients we don't need to remove the entire breast a mastectomy which is a mutilating surgery and safely we can do a breast cancer conservative surgery so we can we'd only need to remove the tumor instead of removing whole the breast which will cause a major impact in the self-esteem of these patients that will be mutilated and because of screening efforts more and more the lesions are diagnosed in an early stage meaning very small now if we to perform for the majority of patients breast cancer conservative surgeries and more and more we have small lesion these small lesions are not palpable now how the surgeon could remove the tumor if he cannot fill it so that's why this is the beginning of breast cancer conservative surgery we need to use invasive localization techniques that could guide the surgeon during his surgical procedure the most used now worldwide methods to localize the tumor is a metallic wire that is literally stick into the patient's breast you know just to guide the surgeon towards the tumor and on the other side you can imagine that you know when we are diagnosed treating a patient with breast cancer we have several imaging modalities like ultrasound like mammography I don't know if all listeners that are male they know what is a mammography but it's something that is it's an exam that we acquire images from what it is inside the breast where the patient is literally squeezed in a machine in order to diagnose suspicious lesion and each of these modality has a clinical report for example breast MRI another imaging modality the patient is laying down on a bed but on a prone position meaning with the belly down facing to the bed and the breasts are deformed by gravity and the MRI coil and they have also a clinical report so that means that a surgeon when he's facing patients with breast cancer proposing a breast cancer conservative surgery has to do a mental cognitive fusion to understand where the tumor is it has to analyze more than 300 images and to read different clinical reports and then to understand where it is and because that is not enough it has to have an invasive localization technique by the wire guidance there are other methods but they are all invasive now breast 4.0 started by imagining if it was possible to build a digital breast model that would be created through a fusion process between a breast MRI and a surface scan so we start surface scanning the patient in the upright position and if you remember we acquired breast MRI on prone position with belly down facing to the bed now this means that we needed to apply for this deformed the non-rigid registration meaning that the breast is highly deformable because it's soft it's a soft tissue so we use artificial intelligence to simulate a post transformation of this breast deformed by gravity and to simulate how it looked like when the patient is upright position and then diffuse these simulated 3d reconstruction of the breast MRI and diffuse with the patient with a surface scan that's how we achieved a patient specific digital breast model with tumor included and then we started with an experimentary concept to insert this digital breast model into augmented reality headset hollow ends and for the first time we were able to produce a breath hologram with a visible tumor and that's how breast 4.0 started now we envision at that time that we could create a digital and non-invasive method to localize breast cancer during a surgery enabling surgeons with a superhuman vision that they don't have in order to treat better patients and to improve oncological outcomes and the aesthetic results and because nowadays we as humans we have normal limited capabilities and now we are using technology you know it's a to to empower surgeons with new powers with a new vision that goes beyond human vision capabilities suddenly we have marvel in our operating rooms transforming surgeons in unnatural superheroes that could see beyond patient skin and remove the tumor safely in order to improve oncological outcomes and aesthetic results and that's how started this thing of breast 4.0 later on we have done these experiments with remote telemetering of a real breast cancer surgery but actually this whole new concept and this ecosystem meaning that we are definitely into entering in a new era of a real use case of the metaverse that sometimes people don't know how to define and for surgeons it's pretty natural because when we are operating we are we don't have access to medical information because in order to do that because we are completely sterilized we have to take off our gloves take off our clothes go to a computer and then wash the hands again put the gloves again and go to the surgery so this setting of getting out and getting in is not possible during an ongoing surgery and if we define metaverse as internet access through an augmented reality headset now we could say that the surgeon could be operating a patient and having internet access with his augmented reality headset or mix reality headset he is able to check and to access medical information that could be on the written form or images from exams or holograms fully synchronized with the patient's body in order to allow the surgeon to see beyond patient skin what is important for that surgery in my case was a tumor but it could be a bone it could be a vein artery or other tumors in different positions so this this means that the metaverse will have a higher impact within our daily lives with patients because it will help us to be better and when we put the question why we need technology well the answer is that clear and simple to better treat our patients to ever better better results and not because technology is fancy and we like it so we really have to build this use case and at the moment as we speak most of these use cases need research science so we need to start doing clinical trials within the metaverse to prove that these new methods can be compared with efficacy with the standard one now if we have a medical device that localize tumors on a digital and non-invasive way well definitely everybody could understand that could that if it is not non-inferior to standard invasive methods we have a bigger advantage because at the end we are also speaking not only about oncological outcomes but also quality of life now no one likes I don't know I don't know if you like signal of going to take some blood sample analysis you know a needle goes into your vein you are fully awakened and you feel the pain of the needle getting inside the vein for a small collection of blood now imagine that for some reason a woman has a breast cancer and before surgery she has to feel a metallic wire to be literally stick in to the patient's breast it gives you pain anxiety there are some complications that may arise and so by by by by describing this opportunity to improve not only oncological outcomes but also quality of life we are fulfilling an entire benefit for the entire ecosystem for the for the major stakeholders in healthcare which are doctors patients and the healthcare systems this means that the metaverse will allow doctors for rapid image interpretation and to see better beyond what they can do even looking beyond patient's scheme for patients it it will also allow better quality of life and an improvable Indian oncological outcomes and for the healthcare systems if technology allows her to be better to have better outcomes it means that they could have better results and avoid second surgeries because the tumor was not removed completely now if we save on re-exisions and and we have good oncological outcomes and don't need to spend more money treating that patient also means that healthcare systems gain efficiency and that the money we save on second surgeries we can invest that money into better drugs to treat cancer so so we are looking to something that could bring sustainability into the healthcare ecosystem using a new technology that besides that needs to prove his way so it has a fantastic way ahead but clinical trials must must be started there are some hurdles also to solve but we need to prove that this technology can be can replace standard methods regarding for example breast cancer surgery yeah before we go further into that medicine 4.0 and the false industrial revolution which you talk a lot about can I just just be very clear that I understood it correctly you with your new technology you are able to operate the tumor you basically pinpointed take it out without damaging the breast right now with the conservative approach we we don't know exactly where it is because we haven't got your technology let's say a doctor here I'm in in the south of France a doctor hasn't got a technology here and the chances that we are very invasive and probably half destroy the breast are much higher than with your technology is that correct have I understood that correct well first of all potentially that is the vision but what we are doing here is research so this is a research product that is very immature so I would say that if we apply the technology resonance level classification we are between three and four so we are seeking now validation of this system with patients within a clinical trial but with this technology we could completely remove the tumor on a surgery so the surgery will not change we still have to cut the skin to get inside the patient's breast and to remove the tumor the difference is that instead of having a wire pointing where the tumor is that can be inaccurate and ultimately could lead to a situation where after tumor removal we find out in pathology lab results that we have positive margins and there will be cancer cells inside the patient's breast that was not removed not because the surgeon was not good but because the surgeon cannot see where the tumor is or microscopic cancer cells obviously so with augmented reality with metaverse we can apply a new imaging modality with fusion from a surface scan to a breast MRI transfer this model to a whole land allows the surgeon to look into the patient's breast and immediately recognize the tumor inside the patient's breast into in a form of an hologram now that gives us the ability to immediately know where the tumor is so it's a tactical image that is instantly interpreted by the surgeon and allows us to make my immediate pre-operative planning inside the operating room and go for tumor removal it is a new talk because from what you are saying with the new technology you you are also able to improve the patient's entire emotional journey if women know that the whole procedure is so much more advanced and professional and of course less invasive it must be an enormous relief for patients well we can reimagine any entire patient journey so it started with imaging registration pre-operative setting so we have to study the patient to make the exams to do proper planning and then for the patient we will avoid a necessary exam of wire placement that is always painful so one procedure left to be pointed to the patient as the procedure that we will have to know that the patient suffers with pain when using the process so definitely we could remove one exam one painful exam and replacing it through technology with a digital non-invasive technique and that is for tumor localization but the metaverse skin surgical patients are not only related to tumor localization now there are ongoing trials so we are not we did not start that yet at Champalimo Foundation but we intend to do next year but imagine also that you are using a virtual reality headset in your head and you know that you have a cancer that you are going to the operating room and obviously you are nervous you feel anxiety because you know you're going to be someone is going to put you sleeping and there will be a tumor removal so of course it's something that scares patients and there are a lot of trials that are starting right now where patients before when they are already in the surgical bed but not inside the operating room they are waiting for their time so there are some trials where we put a virtual reality headset into the patient's head and while they are waiting for the surgery they are experimenting a new form of entertainment but with a very clear clinical objective to diminish anxiety we are trying to boost and to improve quality of life of patients in a crucial moment which is the moment that proceeds surgery where the patient is still awake so there is an entire ecosystem that it goes from metaverse education to metaverse surgery to metaverse emotions control before surgery and you know if you think how much an operating room costs or the machines that we use they cost how much does it cost sorry well the most expensive equipment that they can be in the hospital they are normally on the radiation department imaging and in the operating room because it's a specific structure in controlled one but if you imagine that with for example the quest to have fat from meta that cost around 500 and 600 euros you can spend not so much money but to offer essentially quality of life to these patients with these new forms that you know it's inspiring that you can replace a pill for example a tranquilizer with an in immersive content that is purely natural nowadays Europe is seeking bio food and what about in specific setting try to replace drugs to diminish anxiety and put a headset to the patient improving how he feels but diminishing anxiety so helping him to be calm for the moment that will happen a few minutes after that when the anesthesiologist arrives and put the patient sleeping so I mean I think we are living a moment where patients will feel a full impact of these new immersive technologies that will help not only doctors but only patients in their daily journeys we just need to prove this because everybody can understand that most of for sure it will work but in healthcare we need to prove so we need clinical trials to set up clinical outcomes to prove in terms of statistics that there is a statistically significant advantage of using these technology and comparing these technologies to the other one yeah and so Desi finds work that needs to be done and for sure we will do it yeah I which reminds me of watching your future of health recording and you you basically said that medicine 4.0 is powered by artificial intelligence and augmented reality and you divide it into three pillars basically the healthcare system clinical practice the digital patient can you can you go into a bit more detail here my my point of view comes from reading also what other colleagues said and there is a particular US cardiologist Eric Topol that I love what you wrote and in 2019 on a special issue about artificial intelligence in medicine published by nature he has published a beautiful paper talking about the convergency of artificial intelligence with humans towards high-performance medicine and he has made this division between the different healthcare stakeholders for doctors for patients and for the healthcare system now when we think artificial intelligence sometimes we think on humanoids and robots but that's not how artificial intelligence is making is it's such successful steps in medicine so artificial intelligence is tackling doctors by allowing them for rapid image interpretation give you an example nowadays there are several apps that are currently being used to detect through a picture uh took by a mobile phone uh if the patient has a high probability of having a melanoma or not it means that you have an app you take a picture to a skin lesion and the app will give you with more accuracy than a human being what is the likelihood of that skin lesion could be a melanoma a skin cancer so it means that if we apply artificial intelligence on computer vision so through images and not only through robots and humanoids that comes on from science fiction movies actually nowadays it's through computer vision a field of artificial intelligence that we have the most successful use cases in healthcare regarding this convergency of artificial intelligence and humans to a high-performance medicine so it means that we can clearly in a matter of seconds instead of waiting 30 minutes analyzing hundreds of images and reading different clinical reports we can access rapid image interpretation using AI algorithms in order to assist a doctor to do a better and a fast diagnosis and also helping us to reduce medical errors because we doctors we are humans and sometimes we make mistakes but those mistakes can have a serious impact on patients so why not to use technology to boost our performance in what we are doing either for diagnosis or for treatment so that is the main advantage that is being applied for doctors using AI now for patients obviously they will have adventures regarding to better diagnosis better treatments quality of life but the main advantage is that with AI patients we will get access to their own medical data now I can put you a question Sebel do you have your digital healthcare data and you will say to me yeah I have some printed PDF with my blood sample analysis results I have my data but you don't have you have papers that is not digital data hospitals own your own healthcare data and you can you cannot access to them so that you cannot boost your own research regarding your health or your disease and how to better treat it so with AI definitely patients that today are nobody and Mr Eric Topol wrote a book about this and the patients will became the chief operating officer of the healthcare ecosystem meaning that by gaining access to their own healthcare data they could promote their health and also treatment finding better places to be treated and we should be proud as Europeans that the European Commission has set up a new directive that in five years we have to start sharing healthcare data the interoperability in the healthcare sector that does not exist today either in the United States but we have now a goal that in five years that healthcare data could be exchanged patients could easily get access to it and not by the way they do it today that they they beg for a CD with an MRI in the hospitals or for a clinical report because everything is secured and closed within hospitals that is wrong you know no now when you are using a new technology to put some justice in the system everybody will say yes I want that definitely I want to have access to my healthcare data to promote my own health and if I am sick to promote my disease treatment so that that is we will be the biggest impact with the regarding patients getting them access to their own healthcare data now for healthcare systems it's much more logical and easy to explain so this if this interaction between doctors and patients is better and improved by artificial intelligence then the healthcare systems will gain efficiency and they could control their mission that is balanced through sustainability so treat better new drugs they cost more money and if in the workflow on the patient journey I can turn down everything or the whole process more efficient then I can reallocate resources when they are most needed for the most expensive treatment in order to give an advantage to patient to improve not only survival but also quality of life and so I would say that healthcare 4.0 will benefit definitely whole stakeholders and this digital transformation of having nowadays physical patients in hospitals will be transformed into a new concept that will have physical patients and digital patients and why is this important well if you understand anyone can understand that we have less than 1% of the healthcare data of a patient because and we are happy with it it passes less than 1% of his time outside the hospital it means that we only record information when the patients go to hospital to see the doctor the nurse to do an exam and so we can we can rely on these new technologies to boost the information that we get from patients so it means that we have the information from the hospitals but we also could expand that retrieval from patients with wearables and IoT of what is happening outside the hospital's ecosystem and this means and we can put new interaction new data to analyze and to boost something that people now want to know more about their own body body composition my exercise what do we do and to see the the ongoing results of my efforts to stay healthy to have better options but always we respect so at the end we can all we should always respect even the patients or the persons that don't want to stay healthy because we are living in a democracy and I have to respect as I respect patients that refuse treatment because they have the right to it but at the end better and and more offers to the patients they it can be really be an advantage to society and to people people you as a breast surgeon and the Champagne-Limo Foundation are in the forefront of science how long does the transformation take what is your prediction well I would say that for patients to gain full access to their own care to their own health care data I think the next five years will be crucial I expect that in 10 years that vision of total access to health care data in the usage of and the power of AI implementation we could see the first results robust results in 10 years because you know when we're speaking about cancer for example we need to check survival and quality of life yeah yeah if you start something this year a proper evaluation needs five years to see survival relapses quality of life issues through questionaries that are perfectly established so it's not something that it is immediate so it means that although we think that the metaverse is here we have to major the use cases do clinical trials and you prove that this technology could truly be helpful for patients and we need those numbers research needs to be done to major these technologies in order to them to be used on a daily practice within hospital clinics and in patients homes talking about numbers during my research and we discussed it yesterday briefly on on linkedin on linkedin I found out that in 2020 the world saw 2.3 million new cases of breast cancer and the frightening revelation for me was it seems to be mainly an illness of western societies because according to the world cancer research fund the top 10 countries with the highest incidents are all in the western world let by let me take a look led by Belgium and followed by the Netherlands Luxembourg Denmark United States have you got an explanation for that well if you if we go back 150 years medium life expectancy was 40 so most of the people died with infection we did not have anti-biotics it means that through pills we have boosted our longevity and now people live the double after 150 years from 40 we pass it for more than 80 now with aging new disease ever right through mainly through three categories cardiovascular disease neurological disorders and cancer so you may say that these three diseases are a product of aging process now cancer as an aging process is also related to our lifestyle meaning that cancer risk is mainly affected by our lifestyle give you an example in Japan gastric cancer is very common and if you go to the United States in terms of digestive cancers colorectal cancer is the prevalent cancer in the digestive organ system so it means that we have gastric cancer in Japan and colorectal cancer in the US now when Japan citizens move to US to live in the US Japanese immigrants establish it in the United States the first generation remains with high levels of gastric cancer incidence but the second generation start to have higher incidence of colorectal cancer and to lower incidence of gastric cancer and the second and the third and the fourth generation they will look like Americans in terms of their colorectal incidence cancer incidence it means that changing dietary habits as a law would a change in cancer incidence from a high prevalence of gastric cancer to a high prevalence of colorectal cancer now if you look into breast cancer which is the most common cancer worldwide there are several things that affect breast cancer incidence for example alcohol more and more there is a highly relationship between cancer and alcohol consumption it means that it's easy to explain so most of tumors are boosted by hormones now alcohol transforms into fat and fat transforms into strogens now if you have more strogens in your body you have a higher likelihood of having a breast cancer and how the and this is how alcohol consumption could change a healthy environment to prone environment to get a cancer obesity so if you have a lot of fat cells in your body some of those fat cells will transform into a strogen this means that this that having more strogens female hormones could also put the patient in risk of getting a breast cancer and exercise also so we can speak about dietary habits lifestyle exercise stress people that don't eat at the right time they don't sleep sleep well it's an entire wrong lifestyle that gets people into serious ill conditions that could be cancer it could be cardiovascular hypertension and heart heart attack but this means that you know there is a new concept that is starting also in the in europe and in united states so we had normal appointments and we move to this longevity thing of regarding aging with specialized appointments doctors to doing these specialized medicines to boost longevity on patients and now we are also have doctors in the new ecosystem that is being created about lifestyle so how to put patients on and know or how to put persons that are not patients on the right track to help them to remain as healthy as they can this job needs to work to start at schools how to teach the young the youngest how to eat well and also in our home this means that for example the Mediterranean countries have one of the best dietary habits in the world so Portugal Spain South of France Italy Italy we have some communities where they have the most longevity scores that we have in the entire world that is because we have a diverse diet with fresh fish also would meet vegetables fruits soup and so we need to take care on how to eat well it is important for us to spend time to cook our own food and ought to be based on sandwiches lunches lunch that we most of the Europeans do like it but it's not healthy you know with creams mayonnaise with all those processed food that at the end will will be your cancer risk will rise because what you have done millions of times during your entire life at not taking breakfast and then eating something in the middle of the morning and then eat a lot and processed food sandwiches at lunch not doing exercise smoking so smoking also has a is a risk factor for breast cancer so we really need to in our freedom we can do whatever we want but then you have to accept the consequences if you didn't work to to stay on a healthy pathway if I yeah if I absolutely agree with you if I look at this statistic that was over 70% of all new cases and 81% of all deaths observed in women age 50 and above that is terrifying does it mean especially women live really a wrong life well I well let's try to the wrong the wrong lives so people I always like to people make their own option and as a European I believe in freedom but I also believe that your freedom is attached to responsibilities and consequences that you must accept so if you don't want to take responsibility off or taking charge of that consequences so when you have to think earlier you have to be educated in order to to to stay on the right track this means that we cannot sell chocolate and unnaturally juices in schools because otherwise we will teach our kids that eating juice drinking juices and eating chocolate it's normal and it's something that is encouraged which it should not be so that means that we have to take care to be careful to what we teach to our kids the habits what they learn with the adults and and so we have to remain on the safe side if we want to have our to boost our longevity obviously inevitably sometimes things go wrong and you didn't did anything wrong because biology is like that so you have always done a healthy lifestyle and then you have a terrible disease it's unfair obviously it's unfair but we are speaking about mathematical models meaning that if you generally apply to a general population a healthy lifestyle you have a statistical advantage of having reduced cancer incidence in that specific population that is public health and governments in western countries have ways to make new policies in order to protect their populations and even in companies so more and more sometimes nowadays when someone is seeking a job is not only looking for money for a salary is also looking for quality of life can i work remote part of the time can i have access to gym in at work so i can work in the and in my workplace i also have access to a gym to do my exercise if i have an insurance healthcare policy and if that comes with benefits meaning imagine that you are i am a beast i'm getting into a new job and they pay me an healthcare insurance policy and i have benefits if i reduce my weight meaning that there is a an agreement between the company the worker and the insurance company that if that work worker reduces his weight so less likely with the half having disease so the insurance company will benefit but the the worker will also benefit by boosting his health and the company will also gain because if that worker does not get sick he will not have to take a leave of the job he will continue working so it's a benefit to these three stakeholders just because they are all taking care of the worker healthcare and that brings sustainability to a specific company ecosystem so we need to rethink on how to give bonus and benefit to the workers that they try to remain healthy and give them an option and a price if they are on the right track and i think this is i know well we may say that this may affect freedom it means that i won't get extra vacation days because i want to continue to eating a lot well but you know i think it's for a good reason and i think that if you are not extreme we can really help us to setting a new lifestyle where benefits can affect several stakeholders when everybody could be happy in an inclusive society and we are i like to think that we Europeans are just like that coming back to to to your work and and what you do i mean you are a very young doctor who has achieved a lot in a very short time where do you see yourself in the next few years and all that techno technological transformation well i'm pretty excited to work when i work at Champa Lima foundation and do i live in a moment where we are trying to be hybrid so i'll not i will not move away to the technology field i will always continue to be a surgeon because i like to be with patients and i like to be on the problem side in order to find the best solutions through technology to help patients and doctors and here at Champa Lima foundation we are challenging moments coming up ahead for the first time we are trying so Champa Lima foundation was born 10 years ago a non-profit organization and it started with a neuroscience fundamental research program later on a clinical cancer care program was established in a at Champa Lima foundation and since the beginning the board wanted that the neuroscience research team could connect and make research with the clinical cancer care program now this is not obvious because you know neuroscience deals with neuronal circuits and how can we connect neuronal circuits with the cancer cell so it's pretty hard so how we find a way of working together was through immersive content through augmented and virtual reality why because we were applying medical xr in our research using our limited reality allowing surgeons to see beyond patient scheme and new forms of remote telemetry and the neuroscience you know new fundamental neuroscience research they work with animal model so that we have a vivarium at our facility with mouses and fishes and they study behavior on mouses on specific conditions using augmented reality so they simulate a specific ecosystem to perform their experiments with mouses so we find out that augmented reality and immersive content was a common methodology between both research teams that work with on a very different manners so they work with animals we work with patients and the fun of it is that at Champa Lima foundation you have something unique that you cannot find anywhere else in the world so we have doctors we have patients we have researchers we have engineers we have animals sometimes you have a great hospital with great doctors and great patients but no engineers no animals then you have full buildings of technology buildings with engineers with machines advanced equipment but the hospital is far away the patients also then you have industries that build new drugs but they don't have the animals they don't have the patients neither the doctors and over there we have this new ecosystem that was built in freedom where everybody shares the same canteen so it's any it's a space where you can mix ideas it took us to 10 years to achieve it but now we have this responsibility of working together bring also sustainability to research in order to each one of us in their specific use cases we can be successful but using something that is shareable in research so I can see continue working here and you know there is an excitement about what is going to happen when you mix so completely different fields of knowledge from fundamental neuroscience research to surgeons that deals with cancer every day or oncologists and I'm really excited to see what this is going to produce in the upcoming years working together on a way that was not experimented before because we will be on the same place every day and so obviously interactions will happen and new ideas that we didn't think about it will arise with the youngest that will join us and start living this mixed environment will allow us to do better things and that and at the end to improve patients lives picking up on new ideas and that will be also my last question because you are a very busy doctor and we have got two more minutes I noticed that the Champalimol Foundation has a center for the unknown what is the center for the unknown well people might think that is an awkward name but it it means that so since I next year I will make 10 years of Champalimol Foundation one of the things that I most appreciate and I'm grateful to work here is freedom so everyone has freedom to think on new ideas and to propose them and to execute them no matter if on the beginning very unlikely you can be successful but they give you that freedom so if you take your mission seriously not as a normal job but as a mission you can be free you just have to write on a paper what you want it will be approved and then we help you to get your funding funded and so they give you they give you also certain a coach during your career not only as a doctor but as a researcher to give you the tool that you need to do and to fulfill your mission and that's the center of the unknown we never know what is going to happen because we are not some we are not blocked to an idea we are we welcome new ideas that's how suddenly a surgeon surgical team start working with an imaging team and with neuroscience because we were able to find something that could unite us it was not obvious at the end but you know there is this common feeling of freedom of the unknown and you know through time humans were always very curious and excited with the unknown it's a it's a question an open question and that brings you passion and makes you feel that you really want to dream and you you really want to navigate in that space that we call the unknown that was very beautiful it's also a very beautiful concept and it seems you you work at the almost not almost you work at the perfect place and all I can say is thank you very much dr. Kuvya and I wish you all the success and the happiness and that you keep on coming up with better and better ideas thank you very much thank you Sibyl and I invite you to visit us at Champagne Foundation whenever you want you are very welcome and I would love to receive you here thank you very much you've been listening to a special English edition of De Gwosa Neustadt a German podcast series by Zibylla Baden in which she talks to pioneering leaders who are committed to making our world smarter greener and fairer for more information please visit www.zibyllabaden.com and the official site of the world economic foreign