# Umberto Veronesi

Umberto Veronesi M.D. Knight Grand Cross OMRI (Italian pronunciation:; 28 November 1925 – 8 November 2016) was an Italian oncologist, physician, scientist, and politician, internationally known for his contributions on prevention and treatment of breast cancer throughout a career spanning over fifty years. He was the founder and president of the Umberto Veronesi Foundation. He also founded and held the role of scientific director and scientific director emeritus of the European Institute of Oncology. During his life and career, Veronesi was awarded a number of prizes for his contributions.
Veronesi was the scientific director of the National Cancer Institute in Milan from 1976 to 1994. His clinical and research activity focused on the prevention and treatment of cancer. In particular, he dealt with breast cancer, the leading cause of cancer death in women, and was the first theorist and staunch proponent of quadrantectomy; he demonstrated how in the majority of cases the survival curves of this technique, provided it is combined with radiotherapy, are the same as those of mastectomy but with a better aesthetic and psychosexual impact. As a politician, Veronesi was Minister of Health from 2000 to 2001 and a member of the Senate of the Republic. He was also a supporter of civil rights, vegetarianism, and animal rights.

## Early life, family, and education

Veronesi was born in Milan on 28 November 1925. He grew up in via Vallazze, in Casoretto, in the then agricultural suburbs of Milan, with four older brothers and a younger sister. Veronesi failed high school twice. Given the early death of his father, the maternal figure of Erminia Verganti, to whom he dedicated the book Dell'amore e del dolore delle donne, was fundamental for him. Veronesi was born into a Catholic family and was also a practitioner but distanced himself from religion by the age of 14, becoming agnostic. He later declared that, after Auschwitz, the study of oncology had increasingly convinced him of the non-existence of God. In 2010, he said: "Religion, by definition, is fundamentalist, while science lives in doubt, in the search for truth." Veronesi obtained his professional degree in medicine and surgery from the University of Milan in 1951, and specialised in surgery in 1956 at the University of Pavia. Veronesi dedicated his professional life to the study and treatment of cancer.

## Scientific career

After spending brief periods in England and France, Veronesi joined the Italian Cancer Institute in Milan as a volunteer, and in 1975 became its director. Veronesi challenged the dominant paradigm among surgeons that cancer could only be treated with aggressive surgery. He championed a paradigm shift in cancer care from "maximum tolerated" to "minimum effective" treatment. In 1965, he participated in the foundation of the Italian Cancer Research Association and founded the European School of Oncology in 1982. He was also a founding member of the Italian Association of Medical Oncology. Among his numerous roles, there was that of president of the European Organisation for Research and Treatment of Cancer from 1985 to 1988. In 1991, he founded the European Institute of Oncology, becoming its scientific director; it was an innovative oncology hospital model based on the three principles of patient centrality, integration between laboratory research and clinical research, and prevention. The Umberto Veronesi Foundation for the progress of science, with the aim of supporting scientific research at a national level in oncology, cardiology, and neurosciences and promoting scientific dissemination, was established in 2003.
Veronesi's name is linked to scientific and cultural contributions recognised and appreciated throughout the world, the most relevant scientific contributions concerning the invention of conservative surgery for the treatment of breast tumors. A pioneer of breast-conserving surgery in early breast cancer as an alternative to a radical mastectomy, he developed the technique of quadrantectomy, which limits surgical resection to the affected quarter of the breast. Between 1973 and 1980, Veronesi led the first prospective randomised trial of breast-conserving surgery, known as the Milan I trial, which compared outcomes from radical mastectomy against quadrantectomy. The results, published in 1981, and confirmed in 2002 in a 20-year follow-up study, played a key role in establishing breast conserving surgery as the standard of care for patients with early breast cancer, alongside results from trials of lumpectomy led by the American breast surgeon Bernard Fisher. In June 2005, 1,800 surgeons called for Veronesi to be awarded a Nobel Prize for having revolutionised cancer treatment.
Veronesi, who was chairman of the BioGeM Scientific Committee and also a member of the boards of directors of Mondadori, supported and promoted scientific research aimed at improving conservative surgical techniques, including sentinel lymph node biopsy, which resulted in axillary dissection in breast cancer with clinically negative lymph nodes no longer being performed. He contributed to breast cancer prevention conducting studies on tamoxifen and retinoids, and verifying their capabilities to prevent the formation of carcinoma. He was also an activist in anti-tobacco campaigns. In May 1994, the European Institute of Oncology was inaugurated and officially opened in January 1996; he was its director from 1994 to 2000 and from 2001 to 2014. In 2009, through his foundation, he started the project "Science for Peace", in order to promote peaceful relations through scientific development. In 2010, he was appointed president of the Scientific Committee of the Italy-USA Foundation. In 2012, some Italian websites reported that the institute led by Veronesi had purportedly certified the effectiveness of the Di Bella method, which he had already dismissed as part of the 1998 parliamentary commission and again in 2005; the news proved to be a hoax and Veronesi described it as fake news and confirmed the ineffectiveness of the Di Bella method.

## Political career

During his early life, Veronesi shared his father's reformist socialist views and was close to the Italian Socialist Party (PSI). During the 1980s, he was called by the then PSI leader Bettino Craxi to be part of the party's national assembly. When the PSI was dissolved in 1994, he became an independent politician. In 1993 and 1998, after being appointed by the then health minister Raffaele Costa, he was respectively member of the National Commission Against Cancer to draw up a plan against tumor diseases and of the parliamentary commission for the evaluation of the Di Bella therapy against cancer. In 1995, he campaigned for drug liberalisation through the decriminalisation and legalisation of soft drugs, with the aim of achieving regulation of hemp derivatives, mainly for therapeutic use. On 25 April 2000, he was appointed to the Ministry of Health as part of the second Amato government, and was in office until 11 June 2001. Citing the health effects of tobacco, he was instrumental in the promotion of anti-smoking legislation in public places, calling for non-smokers to take to the streets with posters, hold marches, and occupy the Italian Parliament to have the law passed; the law was implemented by his successor Girolamo Sirchia. Under The Union banner, Veronesi was considered a candidate for mayor of Milan but this did not materialise.
In 2008, Veronesi was the successful main candidate in Milan for the Democratic Party (PD) to the Senate of the Republic. From 2010 to 2011, he was also chairman of Italy's Nuclear Safety Agency. After being appointed on 5 November 2010 as the head of the Italian Nuclear Safety Agency, Veronesi, who was a member of the 7th Public Education Commission on Cultural Heritage from 22 May 2008 to 22 February 2011, renounced to his senatorial seat in order to preside over the Nuclear Safety Agency. He was succeeded by Francesco Monaco. Later on 3 November 2011, Veronesi left the Nuclear Safety Agency, after announcing his resignation on 3 September 2011, in a controversy with the fourth Berlusconi government, complaining about the absence of headquarters, a formal appointment decree, and the minimum structures to allow the agency to begin and carry out its activities. His opposition to what he described as "the unjustified bogeyman" of nuclear power and his support for the usefulness and harmlessness of incineration earned him criticism from Beppe Grillo. For the 2012 Italian centre-left primary election, he said that he was inclined to vote for the left-wing candidate Nichi Vendola of Left Ecology Freedom (SEL). In the 2016 Milan municipal election, he expressed his support for the centre-left coalition candidate and eventual winner Giuseppe Sala.

## Personal life and death

Veronesi was married to Sultana Susanna "Susy" Razon, a pediatrician of Jewish faith and Turkish origins who had survived the Nazi concentration camps. Together, they had seven children (five boys and two girls), two of whom, Paolo and Giulia, followed in his footsteps and are surgeons, while a third, Alberto Veronesi, is an orchestra director. Veronesi died in his home in Milan on 8 November 2016, aged 90. Many politicians and public figures, including the incumbent Italian president Sergio Mattarella, the then Italian prime minister Matteo Renzi, the then health minister Beatrice Lorenzin, the then Chamber of Deputies president Laura Boldrini, the then Senate of the Republic president Pietro Grasso, the then Lombardy president Roberto Maroni, and Milan mayor Giuseppe Sala, paid tributes to him. The secular funeral took place at Palazzo Marino in the presence of Sala and many ordinary people; his son Alberto honoured him with two musical pieces by Ludwig van Beethoven and Giacomo Puccini. After the funeral, his body was cremated.

## Activism and political campaigns

Among the various campaigns promoted by Veronesi was that in 1995 for the decriminalisation and regulation of soft drugs and hemp derivates, especially for its therapeutic uses in the field of pain therapy. He argued that legalisation had positive effects, citing the liberal drug policy of Switzerland as having decreased the number of drug addicts. He was part of the guarantors of the Liberta e Giustizia association, which acts in defense of the secular state and the balance between powers. He was in favour of genetically modified organisms (GMOs). In March 2005, on the occasion of a conference on environmental communication, Veronesi mentioned the toxins contained in certain foods, for example polenta, potatoes, flour, or basil. This statement, which was widely reported in the Italian press, including Corriere della Sera, Il Giornale, Il Giorno, Il Messaggero, La Repubblica, Il Secolo XIX, and La Stampa, provoked indignation from slow food, organic food growers, and movements against the legalisation of GMOs, including Beppe Grillo. On 11 December 2006, on the occasion of the awarding of the honorary degree in Agricultural Sciences and Technologies at the University of Naples Federico II, Veronesi reiterated that "genetic engineering is not a magic wand for solving the problems of humanity, but it is an extremely intelligent method to fight world hunger, to reduce the impact of pesticides, to combat desertification."
In 2008, Veronesi declared that he was in principle against telephone tapping. He was also against the death penalty and life imprisonment, and carried out an abolitionist campaign with the Science for Peace association, stating that "our system of neurons is not immutable but is renewed because the brain is equipped with stem cells capable of generating new cells. So the person we locked up in prison is not the same twenty years later. For every man there is the possibility to change and evolve. Secondly, DNA studies demonstrate that violence is not a biological imperative. On the contrary, the message of our genetic code is the perpetuation of the species, a natural predisposition to solidarity." In 2009, Veronesi became ambassador of the Internet for Peace movement, which was founded by Wired Italia with the aim of nominating the Internet for the Nobel Peace Prize in 2010. That same year, through the Umberto Veronesi Foundation, he also launched the Science for Peace project, an international peace movement led by personalities from the scientific world, including several Nobel Prize winners. The aim was to address the root causes of conflicts and inequalities with a scientific approach and propose concrete solutions to overcome them. In this regard, Veronesi, who defined himself as "an extremist pacifist", stated: "I started the movement for universal peace, but in the Tolstoyan sense, peace not as the absence of war, or not only as the absence of war, but as a return to a natural, peaceful, profound condition of our thinking. So we are fighting for peace in the world, against wars, against weapons, against abuses of power, against violence, against the death penalty, in favour of women whose identity is trampled upon in many countries. And therefore we could say that it is a great movement for non-violence."

## Ethical views

Over the years, Veronesi publicly expressed his views on several ethical and bioethical issues in interviews, televised debates, and his books, and was known for his support of civil rights. He was opposed in principle to a doctors' strike, saying: "It is a legitimate instrument of struggle ... but, in my opinion, not for those doctors who work in hospitals." In 1981, he was threatened with death by the Red Brigades. Veronesi identified himself as an agnostic, not believing in any form of afterlife. He argued that human beings should not consider death a terrifying moment but rather accept it as a biological necessity. Veronesi supported active euthanasia, affirming the right of any individual to end their life if it became unbearable due to suffering or loss of dignity. He advocated the necessity to regulate euthanasia at a national level, citing the Dutch euthanasia legislation as a good starting point; Veronesi promoted a campaign for the introduction of living will as a legally binding agreement between the doctor and the incapacitated patient. He was also in favour of egalitarian marriage and LGBT adoption.
Veronesi was personally opposed to abortion, describing it as "a dramatic and traumatic event that everyone would like to avoid", but was equally opposed to anti-abortion laws, and supported the legalisation of abortion to protect "those who find themselves facing it", as he argued that criminalisation does not stop abortions and that in fact the abortion law in Italy had reduced the number of abortions, as well as contraception pills, which he also advocated to reduce ovarian cancer, and mifepristone. Veronesi supported the moral and intellectual superiority of women over men. He wrote that "a woman's greatness is instinctive and complete, a genetic greatness because it is based on a combination of DNA, and mental characteristics, which leads to a better ability to adapt". In his opinion, women would be more resistant to pain and fatigue, more loyal to the company or institution they represent, less aggressive, more decisive, and more devoted to harmony, peace, and civil progress.
Veronesi was an ethical vegetarian and an animal rights advocate. He was a vegetarian for ethical reasons but also promoted the health benefits of a lacto-ovo vegetarian diet. In 2012, Veronesi co-authored Verso la scelta vegetariana (Towards the Vegetarian Choice) with Mario Pappagallo. The book included 200 vegetarian recipes. Veronesi supported GMOs as a way to produce food with higher nutritional capabilities and deprived of potentially carcinogenic substances. He criticised the opposition to GMOs as being due to a lack of scientific knowledge. During a public conference in 2005, Veronesi stated that some toxins contained in particular foods caused cancer rather than GMOs, a statement that sparked criticism and various controversies from the slow food movement, among others. In a 2006 statement, he further underlined how GMOs can be used to fight world hunger, reduce the impact of pesticides, and combat desertification.

## Awards

Veronesi received thirteen national and international honorary degrees in medicine, medical biotechnologies, agricultural sciences, pedagogical sciences, and physics. On 8 November 1974, he was awarded the gold medal for Merit in Public Health. On 5 January 1982, he was made Grand Knight of the Order of Merit of the Italian Republic. In 1983, he was awarded the Minerva Anna Maria Mammoliti Men's Award "for his commitment to research against women's cancers". In 2002, Veronesi received the King Faisal International Prize. In this regard, he stated: "In recent years, I have been increasingly involved in curing Islamic women. They started to come to me and undergo surgery at the European Institute of Oncology after I received in 2002 in Saudi Arabia the King Faisal International Prize for my studies on conservative breast surgery. As a matter of fact, for the Islamic world that recognition is a kind of Nobel."
Veronesi became an honorary citizen of several cities, including Asti on 31 January 2004, Monte Argentario in 2006, and Inveruno in 2015. In 2009, he received the America Prize of the Italy–USA Foundation. On 2 August 2010, a piece of beachfront at Jesolo Beach was named after him. In 2012, he received the Art, Science and Peace Prize for his career. In 2014, Veronesi won the inaugural Vespasiano Gonzaga National Golden Fleece Award, which is intended for those who "exceptionally honoured society without limits of age, nationality, sex, rank, profession and political or religious affiliation", for "the extraordinary scientific contributions provided to oncology research, prevention, diagnosis and treatment of tumors". In March 2017, the European School of Oncology, of which he was the founder, named after him the Umberto Veronesi Memorial Award, a biennial award given to researchers who contribute to the advancement of research in the treatment of breast cancer. The first award was given to Giuseppe Curigliano.

## Works

* Da bambino avevo un sogno. Tra ricerca e cura, la mia lotta al tumore (2002)
* Una carezza per guarire. La nuova medicina tra scienza e coscienza (with Mario Pappagallo, 2005)
* Il diritto di morire. La libertà del laico di fronte alla sofferenza (2005)
* La fecondazione assistita. Riflessioni di otto grandi giuristi (2005, preface)
* Essere laico (with Alain Elkann, 2007)
* L'ombra e la luce. La mia lotta contro il male (2008)
* Dell'amore e del dolore delle donne (2010)
* Scienza e pace (with Alessandro Cecchi Paone, 2011)
* Il diritto di non soffrire. Cure palliative, testamento biologico, eutanasia (2011)
* Verso la scelta vegetariana. Il tumore si previene anche a tavola (with Mario Pappagallo, 2011)
* Longevità (2012)
* Responsabilità della vita (2013, with Giovanni Reale)
* La dieta del digiuno. Perdere peso e prevenire le malattie con la restrizione calorica (2013)
* Il mestiere di uomo (2014)
* Il mio mondo è donna (2015 with Maria Giovanni Luini)
* Tre sere alla settimana. 300 film, 12 anni di passione cinematografica (2015)
* Breast Cancer: Innovations in Research and Management (with Aron Goldhirsch, 2017)
* Il diritto di essere umani (2018)
* I segreti della lunga vita (with Mario Pappagallo, 2021)