Posted on 03/07/2017 2:06:10 PM PST by nickcarraway
The war on cancer has created more treatments, but could do more on prevention.
In his final State of the Union address one year ago, President Obama announced a “moonshot” initiative to “cure cancer once and for all.”
Though the moonshot will be one of Obama’s few health programs to continue under President Donald Trump — its $1.8 billion budget is secure — today, on World Cancer Day, it remains more difficult than ever to imagine a real cure.
Take the 50-year-old man diagnosed with prostate cancer in my clinic at Brigham and Women's Hospital in Boston. He received a novel procedure to remove his prostate, and later received focused radiation to try to eradicate any remaining cancer. Unfortunately, his disease returned a year later. But after two new therapies, his cancer now appears in check. And if his cancer does spread, a host of other treatments — including many not even on the market yet — may put his cancer back in remission.
As with most cancers after treatment, my patient’s disease is under control, but not cured. And it likely will never be.
The problem with the “moonshot” idea is that it focuses on magic bullets, at the expense of the majority of current and future cancer patients. To eliminate the global burden of cancer, patients and doctors need an equal focus on prevention as on cure — or we need to redefine the word “cure” altogether. With increased funding for prevention research and wider dissemination of prevention initiatives, we could be even closer to eradicating cancer entirely.
The biggest lesson from the war on cancer is that we are incredibly far from a cure Why do we think that we can cure cancer? In his book The Death of Cancer, former National Cancer Institute director Vincent DeVita writes that the United States' war on cancer came about in the 1970s due to an assortment of advocates and politicians. Their mission was articulated best by the National Panel of Consultants on the Conquest of Cancer, whose report in 1970 called for “the conquest of cancer.”
At the time, the concept of “cure” was eradication of cancers after they were diagnosed — to treat cancer with chemotherapy just as we treat infectious diseases with antibiotics. And so millions of dollars went toward funding research that studied and created novel therapies for cancer. And the idea of a “war on cancer” has persisted, with the “moonshot” its most ambitious attack yet.
The war on cancer has succeeded in creating more treatments, and oncologists have moved from extremely toxic chemotherapies to targeted molecular therapies, such as the drug imatinib for chronic myelogenous leukemia, which control cancer in many more individuals. Now cancer therapy has been revolutionized by “immunotherapies” that ramp up the body’s own immune system to fight cancer.
But perhaps the biggest lesson from the war on cancer is that we are incredibly far from a cure. Cancer is not one disease but thousands, each with its own causes and genetic markers.
Take non–small cell lung cancer (NSCLC), the most common cause of cancer death in the US. According to National Cancer Institute data, more than half of people with lung cancer are diagnosed after cancer has spread beyond the lung; more than 80 percent of these patients die within a year. Research on molecular targets has suggested that there are more than 15 different “driver” mutations in NSCLC, and most tumors possess a multitude of these mutations.
Just as it is difficult to defeat an army of enemies by picking off individual soldiers one at a time, even one targeted therapy in metastatic NSCLC is unlikely to eradicate the entire disease. That’s the case with most cancers and may explain why 63 percent of oncologists would never tell a patient that they are cured after treatment. Even newer immunotherapies at best delay the progression of cancer, but cannot cure it. It remains difficult, if not impossible, to cure cancers — if we define cure as treatment.
New treatments open up an entirely new vision of preventative “cures” Prevention may instead provide the solution we have long been seeking. The 23 percent reduction in the US cancer mortality rate over the past two decades — 1.7 million cancer deaths prevented — is due in large part to cancer prevention interventions. These include large-scale screening efforts in mammography and colonoscopy as well as increased vaccination efforts.
We can also find new innovations in prevention, some which may even eliminate incurable cancers. Hepatocellular carcinoma (HCC) is the third most common cause of cancer death in the world, and a major cause of morbidity globally. The hepatitis C virus is the major cause of HCC: Infected individuals have a 17-fold increased risk of developing HCC compared with non-infected individuals.
Until recently, hepatitis C was incurable, and treatment to control the disease was associated with significant side effects. But in 2013, the drug sofosbuvir (trade name Sovaldi) was approved and offered many patients the opportunity to permanently eliminate hepatitis C — and prevent the possibility of subsequent HCC.
Sofosbuvir, among other treatments, opens up an entirely new vision of “cure” in cancer, more proactive than our previous conceptions. The need for prevention is dire: Tobacco control, good nutrition, vaccinations, and physical activity could prevent almost half of all cancers. Unfortunately, rates of hepatitis and human papillomavirus vaccination have remained below 60 percent for a decade. By focusing our efforts on the upstream determinants of cancer, we can achieve the elimination of cancer that has eluded us for the past 50 years.
Unfortunately, there are no active moonshot grants funding prevention or early detection efforts. And the Blue Ribbon Panel Report, which describes the 10 research priorities for the moonshot, barely mentions prevention or early cancer detection. If this trend continues, funding for cancer prevention and control will be crowded out within the shrinking pie of federal research dollars.
Our cancer moonshot is a worthwhile goal — and will continue into Donald Trump’s presidency. More investment in eliminating cancer will accelerate progress. And developing new therapies is part of that strategy.
But we must acknowledge that a treatment that permanently eliminates cancer will likely never be found. Investing in creating and disseminating prevention strategies will save countless more lives than newer cancer treatments. This is the best chance of permanently eliminating cancer, nailing the cure that we all want.
A cure for cancer is like a cure for Aids-ain’t gonna happen. Keep your weight down, eat a lotta rabbit food, and keep it zipped up.
The closet we may ever get to a cancer cure, may be when it’s possible and feasible to change cellular DNA or RNA. We still don’t know much about how such treatment will effect genes and chromosomes in present or future generations.
If DNA or RNA is not sufficiently altered, the body of that patient will eventually revert to it’s inclination of producing cancerous cells in various organs and under various conditions. Sort of like the tendency for a body to grow fat even after the person has managed to lose a lot of weight. Eventually, the weight begins to accumulate for most people. I think much of such latency is inheirited.
http://www.nature.com/nature/journal/v454/n7203/full/nature07205.html
I think the Virchowian approach will lead to a cure. The reason the mutation theory doesn’t lead to cures is because its wrong. You need to have a good causal theory before working on a cure.
But facebook is full of posts about a cure for cancer being stopped by the evil drug companies.
My mother ate exactly like that. The Big C got her anyway.
Well, the optimism around here is astounding !
Bet this guy would have been a hit with potential Small Pox, Polio, TB victims. And whale oil was the only future for indoor lighting. Sheesh.
I think CRISPR technology has a good shot at doing this. Not just for cancer but for everything that is DNA related.
The Origami method for protein shaping looks promising.
Last I heard you don't grow more fat cells. You just add to their size depending on diet and exercise.
Cancer is a broad term and may refer to any number of diseases.
My mother died of vaginal cancer. She was 86. Never had a treatment. Probably had it for decades. Humans trying to fight abnormally growing cells have mixed results
One odd thing about types of cancer. This article refers to thousands, a medical person told me hundreds, and when asked, the net says “over 100”.
The medical guy said, like the article does, that each cancer requires its own cure, and that’s why we are nowhere near “curing cancer”.
Have we cured any? We have treatments, but cures?
And who is going to be in charge of Prevention? Liberals of course.
To Liberals, curing Cancer means more government bans, money and taxes and control for smoking, unhealthy foods, what you drive, etc.
Long term remissions. Cancer frequently returns
Even if a cure for cancer is found, by the time the federal government finishes forcing the cure to be tested, defining and redefining the format for cure and the ingredients in the cure, forcing the pharmaceutical companies to purchase the ingredients from their approved sources with their kickbacks, the feds deciding the taxes and correct packaging and approved sales requirements...........the cockroaches would have already taken over.
red
I was in cancer detection for 40+ years. It is so disheartening to read the writings of people who state ‘there is a cure for cancer, but we aren’t getting it because the medical industry makes more money if we stay sick’. I actually heard this from acquaintances and would say ‘do you not realize that everyone working in any area of cancer detection/research has lost someone they love to some form of cancer?’.There are probably thousands of types of cancer. Nearly every one will need it’s own treatment/cure. SOME treatments can be used on more than one type of cancer. There are several types of cancers that are cured, if found early. Skin cancers (non-melanomas) are easily eradicated if found early. Prostate cancer can be cured, if found early. Cervical cancer can be cured, if found early. We need to put money into diagnostic testing to find cancers earlier. But there is no blanket ‘cure’ for cancer.
There is no such word as "preventative." The word is PREVENTIVE.
Pet peeve ...
A cure for cancer is like a cure for Aids-ain’t gonna happen.
Not when we only spend 1.8 billion a year on the entire cancer program (I know it isn’t a program but it has many layers). I am disgusted and now know why we haven’t found a cure. You don’t spend any money on it. Heck Planned Parenthood gets half of that total and it does nothing. I think we should be spending 20 billion a year on research for cancer. It is a horrid disease. We spend more money on the EPA for goodness sake which does nothing. This is tragic. I guess Americans don’t care that we spend pennies on cancer.
My mother died of vaginal cancer. She was 86. Never had a treatment.
But if she had, she might have gotten another 20 years. That is the sad part for the family. I am so sorry for your loss especially since it was so sudden and treatable. God Bless.
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