Cancer Surgeon Dr. Alberto Costa Receives 2010 ESMO Award

Fran Lowry

October 27, 2010

Dr. Alberto Costa

October 27, 2010 — Alberto Costa, MD, director of the European School of Oncology (ESO), in Milan, Italy, has been awarded the 2010 ESMO Award by the European Society of Medical Oncology (ESMO), in recognition of his key role in the development of international guidelines for breast cancer and his ongoing commitment to the education of oncologists.

The award was presented to Dr. Costa during the 35th ESMO Congress held recently in Milan.

In an interview with Medscape Medical News, Dr. Costa noted that one of the reasons ESMO officials gave for the honor — his role in developing international guidelines for breast cancer — is somewhat misleading.

"It is true that I've been a member for years and years of the panel of experts that write the St. Gallen [consensus report] guidelines, which affect clinical practice and the policy of pharmaceutical companies and healthcare agencies all over the world. It is true that I have been part of this process, but certainly this is not my main activity. First and foremost, I am a surgeon," he stated.

Dr. Costa, one of the investigators in the renowned Milan trial, was a newly minted surgeon in 1973 when that study began. The trial, under the leadership of Umberto Veronesi, MD, randomized women with early breast cancer less than 2 cm in diameter and no palpable lymph nodes to undergo either Halsted mastectomy, which was the traditional treatment at the time, or lumpectomy, in which only the tumor was removed. The trial famously found that disease-free survival and overall survival were the same for both treatments.

These studies have really changed the surgical treatment of breast cancer.

Two years later, the findings were confirmed in a similar trial led by Bernard Fisher, MD, from the University of Pittsburgh in Pennsylvania, and his colleagues.

"These studies have really changed the surgical treatment of breast cancer. I was very lucky to be in the right place at the right time," Dr. Costa said.

Desire to Benefit Mankind

It was a youthful desire to do something to benefit mankind that drove him to a career in medicine. Dr. Costa was born in 1951 and came of age in the late 1960s, which was a time of hope, optimism, and altruism in Europe.

"I was 16 or 17 when I decided to become a doctor. There was a great sense of dedication to society, to humanity, in the great social wave of 1967/68 in Europe. It looked to me as if medicine was a good opportunity for that. It was quite a romantic approach, not scientific," he recalled. "Then I went to the Cancer Research Institute in Milan and I discovered that I was very attracted to oncology. So I didn't go to Africa to treat malaria, which was my original plan; I stayed in Milan."

From Milan, Dr. Costa went to the United Kingdom, where he continued his surgical training at St. Hillier Hospital and Wimbledon Hospital. "I learned so much in terms of surgery in London. I'm very grateful to them."

In 1985, he moved to the National Cancer Institute in Bethesda, Maryland, where he began work on chemoprevention.

Chemoprevention is a term that was coined in 1976 by Michael B. Sporn, MD, currently professor of pharmacology, toxicology and medicine at Dartmouth University Medical School, Hanover, New Hampshire, Dr. Costa explained. "The concept at the time was that if we have chemical substances that can generate cancer, there must be chemical substances that prevent cancer. We developed this line of research and started investigating vitamin A and vitamin C as potential chemicals for defending the body from cancer. This is probably where my main contribution lies," Dr. Costa said.

Eventually, this work led to the development of tamoxifen, which has shown a clear benefit in preventing breast cancer in 3 large trials of women at high risk for the disease.

Milan for Past 30 Years

Dr. Costa has been at the ESO for almost 30 years. The school was founded thanks to an endowment and donations from a group of Italian and Swiss families and, as a result, is able to finance courses, fellowships, and training activities independent of commercial involvement.

"We are very privileged," Dr. Costa noted.

The focus at the ESO is on general oncology — in particular, the training of surgeons. "There are a number of courses and educational activities in medical oncology because the pharmaceutical companies are willing to sponsor those events, but surgical training is a bit of an orphan. At the ESO, we try to fund surgery, radiotherapy, pediatrics — areas that really need support and education," he explained.

Not All Work, No Play

Life is not all work and no play for Dr. Costa. His large family, which includes 5 children, 2 grandchildren, and 3 ex-wives, is a source of tremendous satisfaction and joy, he told Medscape Medical News.

"I have 5 children with 3 mothers, so I had a very intense married and family life. We are very happy, we all go very well together. The first son is 34 and the last is only 10, so I have a great range of ages, problems, and schools. I am a grandfather because my first son has children, so I am enjoying both situations," he said.

One thing that all the Costas enjoy is horseback riding. In fact, Dr. Costa and his family just returned from a holiday on a dude ranch in Colorado. "We all love riding, so that is the combination of family and fun," he said.

Dr. Costa retains the same sense of optimism that he had starting out as a surgeon in the early 1970s.

"I have the feeling that we are doing well in the fight against cancer," he said.

"I'm not frustrated; I don't have the feeling that we have not made progress. In my field, certainly in breast cancer and in breast cancer surgery, we've made such progress, and this is the best incentive to continue," he said. "Of course, like everybody, I would have probably done some things differently, but I feel quite privileged and fortunate for the opportunities I have had. I have very, very few regrets."

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