Cancer: the prognosis

news@nature.com ^ | 16 August 2006 | Helen Pearson

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Published online: 16 August 2006; | doi:10.1038/news060814-7

Cancer: the prognosis

Helen Pearson finds out how far we have come, and have to go, to cure cancer.

When was cancer first recognized?

Cancer has been recognized as a disease for millennia: one of the oldest descriptions comes from an Egyptian papyrus describing breast tumours, and dated to 1500 BC or earlier. By the 1800s it was proposed that cancer was a transformation of normal tissue rather than an invading pathogen. In the eighteenth and nineteenth centuries, hemlock poisoning, swallowing a lizard, or applying ice and salt were some practiced treatments. It wasn't until the Second World War that a drug was finally shown to work — albeit modestly — against cancer.

How far have we come since then?

We now know that surgery, chemicals and radiation can remove or shrink many cancers, and this remains a mainstay of modern treatment. In the past two decades, major advances in molecular biology and genetics have helped researchers to reveal far more about the molecular changes that occur in cells as they morph from healthy to cancerous ones.

Yet today, the World Health Organisation estimates that the runaway cell division that causes cancer kills more than 7 million people each year, accounting for around 12.5% of all deaths worldwide.

Are there some types of cancer that can now be 'cured'?

A combination of earlier detection, better surgery, radiation, chemotherapy and drugs means that more patients live longer. In the United States, two out of three patients diagnosed with cancer will survive for 5 years after diagnosis, although some cancers can recur many years later. This year, US statistics showed a tiny drop in the absolute number of cancer deaths from 2002 to 2003, despite a growing and aging population. It's the first such decline since records began in 1930.

The prognosis varies radically from one type of cancer to the next. Testicular cancer is one example with very good survival rates: the vast majority of patients go on to live long lives if their cancer is detected early. This is mainly because of a platinum-containing drug called cisplatin, approved for cancer in the 1970s. Cisplatin acts by crosslinking DNA, making it impossible for the cells to duplicate their DNA and thus divide.

Or prevented?

CANCER SPECIAL PACKAGE
FEATURES New fronts in an old war
WEB FOCUS Cancer

The one thing that could cut cancer rates more than anything else is wiping out tobacco: it is thought to be the cause of at least 30% of cancer deaths in the United States.

Similarly, alcohol, poor diet, lack of exercise and obesity are significant, often unappreciated, contributors to cancer and could account for as much as one-third of cancer deaths, says Carolyn Runowicz at the University of Connecticut Health Center, Farmington, and president of the American Cancer Society. This means that the battle against cancer is actually becoming part of a broader fight against obesity and unhealthy lifestyles. "It's not really what people want to hear," Runowicz says, "they want to know that we can take a pill."

Another strand in prevention is the identification of genetic sequences that predispose people to certain cancers and may allow them to take preventive action. Women carrying certain mutations in the BRCA genes are at high risk of breast and ovarian cancer and can be watched more closely for early signs of disease, or even choose to have a mastectomy to prevent any future disease. But this approach is unlikely to work for all cancer types: for many, an as-yet unknown combination of low-risk genes probably makes people susceptible.

How far do we still have to go?

The survival statistics for certain cancers remain grim because they are often detected late and do not respond well to conventional therapies. In the United States, less than 5% of people with pancreatic cancer and 10% of those with liver cancer survive beyond 5 years after diagnosis. And cancers that have spread to other parts of the body, called metastases, are particularly difficult to treat.

A major part of the problem is that cancer is an enormous collection of different diseases masquerading under one name. There are around 200 different anatomically different cancers — and an estimated 250,000 different ones when they are subdivided according to the molecules underlying the disease, says Cancer Research UK's director of clinical programmes Richard Sullivan. In reality, every cancer is subtly different because it arises in a genetically unique individual, by a unique set of changes in their cells. "It's phenomenally complicated," Sullivan says.

What types of new treatments look the most promising?

Researchers are particularly excited by targeted therapies such as the leukaemia drug Gleevec and breast-cancer drug Herceptin, which show that it is possible to identify a protein gone awry and design drugs that specifically act on it. This contrasts with conventional cancer drugs that typically blast all dividing cells indiscriminately and have toxic side effects.

The general aim is to repeat the 'targeted' approach for a host of key proteins now known to be switched on or off inappropriately in subtypes of cancer.

Many researchers are also carrying out more detailed profiles of the genes and proteins that make up certain cancer types. They hope that a particular profile could be used to predict how rapidly a cancer is likely to progress, which drugs will attack it best and whether they are working. "We're just scratching the surface," says cancer biologist Riccardo Dalla-Favera at Columbia University Medical Center in New York.

Will cancer be cured this century?

It is more likely that the death rates will continue to drop slowly rather than cancer vanishing completely. And even then, for some very elderly people, cancer is likely to prove fatal as a part of normal ageing. "You'll never completely eradicate cancer because your body eventually gives up," Sullivan says.

In the meantime, the fight is swallowing enormous amount of money. The National Cancer Institute, one of the biggest spenders, has a budget of US$4.9 billion for 2006 — around 17% of the National Institutes of Health total.

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[Jedi Master Pikachu]

Why single out California? Other states have smokers, too, and other states have people against smoking.

[cgbg]

since the early 90s, the american medical types gave up on curing those things they could 'manage'... indefinitely. This has come to be very concerning for the future of american medicine

You will love this quote:

"Associations were formed to 'control cancer'. They have been more successful in controlling the cancer business".

p.41

"Your Life Is Their Toy",

Emanuel M. Josephson, Chedney Press,

1940!

[Lexinom]

CA=medicalspeak for carcinoma

[Rightwing Conspiratr1]

We agree that cancer has become rampant the last 40 years. What has caused the increase?

Water fluoridation.

[muir_redwoods]

"OK. 30% smoked?"

Uhh, no. Quite obvious to anyone with a shred of logic, there were 30% fewer cases since the large contribution made by tobacco to cancer cases wasn't there before people smoked.

This means cancer cases have increased in number, a finding consistent with most people's anecdotal observations.

[tacticalogic]

We agree that cancer has become rampant the last 40 years. What has caused the increase?

Mostly, the ability of medical science to eliminate a lot of the other things people were dying of first, leaving the cancer victims with the lion's share of the media attention.

[tacticalogic]

Uhh, no. Quite obvious to anyone with a shred of logic, there were 30% fewer cases since the large contribution made by tobacco to cancer cases wasn't there before people smoked.

That's a gross mischaracterization. For that to be true they'd have to have been able to not only accurately diagnose cancer but be able accurately attribute it's cause before people started using tobacco.

[MaDeuce]

"The one thing that could cut cancer rates more than anything else is wiping out tobacco: it is thought to be the cause of at least 30% of cancer deaths in the United States.
Where are my Pufflist buddies?"

They'll have to pry my cigars from my cold dead hands!

[will of the people]

Just for the sake of argument, Imogen an article from the medial establishment about HIV/AIDS that read

X% of HIV/AIDS is a result of male homosexual intercourse and
Y% is the result intravenous drug usage.

Would the proposed answer in the article more likely be:
1. eliminate male homosexual intercourse and
2. eliminate intravenous drug use


or

We know that these things are never going to be eliminated, so lets put a latex barrier on one group and hand out sterile needles to the other group

And while we're banning tobacco because it causes cancer, let's legalize marijuana to make the patients more comfortable

If smoking were the darling of the left, there would be posters in every public area calling from tolerance and acceptance of people who are just exercising their freedoms under the constitution.

There's always talk about secondhand smoke risk (although WHO studies tend to disprove that), but the last time I checked, when cops are patting down a suspect (perhaps a result of their drug use) they don't say- 'Do you have any cigarette butts in your pockets, or any tobacco or anything that might cause me to come in contact with nicotine?'

They say 'Do you have any needles, anything sharp anything I might stick myself with, (anything that might penetrate the almighty layer of latex I have covered my hands with and bring me into contact with a potentially deadly virus)?'

I'm not advocating smoking (although I do have the occasional cigar), I'm advocating intellectual honesty in our science.

Will

[tacticalogic]

From the article:

The one thing that could cut cancer rates more than anything else is wiping out tobacco: it is thought to be the cause of at least 30% of cancer deaths in the United States.

Similarly, alcohol, poor diet, lack of exercise and obesity are significant, often unappreciated, contributors to cancer

People are trying to read that first sentence as meaning that if we were able to wipe out tobacco, none of those people in that 30% would ever have gotten cancer. The very next sentence should be enough to tell anyone "with a shred of logic" that conclusion is just plain wrong.

[muir_redwoods]

It's not gross mischaracterization, it is a reasonable mathematical inference from the data given.

[tacticalogic]

It is not reasonable to assume that if none of those people had ever smoked none of them would ever have gotten cancer attributable to some other cause, or simply old age.

[Beth528]

In my family alone there have been four people that have died with different cancers..besides me of course and mine was breast cancer,,and was caused by hormones I took..A type of cancer you could not tell was there by the method we are given to examine our breast..Only x-rays found this..If I had not of taken a mammogram every year I would be dead now..This was a fast growing cancer and my doctors told me I would have been dead in six months if it had not of been found..I am not dead and i have been free of the awful disease for three years..I can't stress enough that people should get checked and have mammograms..And that includes you men..

What really angers me is moneys are pouring in for AIDS research..It is time we have more money for the research of Cancer..Aids could be done away with if the Queers would have from the beginning been put in isolation or on an island..Cancer can't be cured like that..we didn't choose to have this killer disease and we should have more money to stop it..

[Beth528]

I should mention here,my father had lung cancer he never smoked a day in his life and none of his family member smoked either..he had a lung removed and lived twenty years after that..

[toddlintown]

It is extremely frustraing to find Hollywood-types and bleeding heart liberals wailing about AIDS, holding fundraisers, etc. while cancer and heart disease are the leading causes of death in this country.

Good luck with your continued progress.

[alrea]

the american medical types gave up on curing those things they could 'manage'... indefinitely. This has come to be very concerning for the future of american medicine.

yeh but in places like China there are several million scientists trying to get rich creating drugs for americans. and other shining cities are rising.

diet science is not really part of american medicine either and that gravy train is slowing down. people are beginning to realize you fall apart when you suck on sugar all day.

[Beth528]

Thank you!!

[Smokin' Joe]

Quite obvious to anyone with a sense of logic, since people live considerably longer, 30% more cancer cases is meaningless. More than when? When the lifespan was 45 or so?

Just because you aren't being crushed under the oxcart or slain by Goths or Vandals does not mean that tobacco is the sole--or even main cause of lung cancer.

Besides, that completely ignores everything from peat fires in hide huts to the coal smoke of the industrial revolution.

The only real tobacco users up until the 1600s were in America, and I do not believe most tribes kept those stats.

But cancer was around, even then--and in places where tobacco was not known.

No one alive is able to give an "anectdotal observation" on the number of cancer cases in the last few millennia.

But while we are discussing "a shred of logic" in the last half-century many practices and substances have come into the fore which previously did not exist in anywhere near the concentrations we are exposed to today, if at all.

Those include, as I stated in a previous post, everything from the formaldehydes from carpeting and solvents from plastics to pesticides, air fresheners, and even radionucleides released by atmospheric nuclear testing when that was done (learn about that, you'd be amazed at where the fallout went).

The use of devices which emit RF has increased so steeply since the 1950's that I am at a loss to define the function, "exponentially" might not cut it.

Food is routinely parted out into byproducts which are reassembled to form 'convenience foods'--read the label!

"Fresh" foods are plucked green from the vine and later ripened using ethylene for the grocer's shelves. My parents ate locally grown foods picked ripe and sold within a day or two or grown at home.

As for the lowly genus Nicotina well, that had been in use for nearly 400 years, so why the sudden increase if tobacco is the villian?

Maybe something else which has increased in prevalence in the last 50 years is the cause? YMMV.

The bottom line remains, fortunes are being squandered on tobacco control and 'studies' to justify it which would be better put to basic research into the mechanisms of cancer and curing the disease.

How much sooner might it have been discovered that uterine cancer is linked to a virus, had money not been pi$$ed down the tobacco rathole?

How many other breakthroughs await someone who will jump off the tobacco jihad bandwagon and do some fundamental research--which won't happen if the funding is being diverted to the politically correct cause of gigging the tobacco boogeyman.

So give it a rest, tobacco is bad for us, we know that. We don't need another gozillion pages of nonsensical studies to tell us that.

So save that money that would be dumped on more "tobacco is the epitomy of evil" studies and spend the money on the cure.

[Einigkeit_Recht_Freiheit]

Smoking causes cancer? Really? But the tobacco companies didn't tell me that. I thought it was only this:

[Einigkeit_Recht_Freiheit]

There was supposed to be a picture of this: http://tools.fodey.com/generators/cigarette_packet/preview.jpg I will try again, but am having trouble: