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?

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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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Getting to the core of the runaway cell division and stopping it will cure cancer. All cancer.

My mother (a smoker), died of lung cancer, as did her brother, her father, her grandfather, et al all the way back to whichever progenitor it was who flipped the magic gene creating the "family curse."

It's the type of lung cancer unrelated to smoking. My forebears succumbed to it -- whether they smoked or not.

The BS-Level in the modern medical industry (no, I will not call it a "profession") is off the charts. I once spent about a week in two hospitals (checking myself out "AMA" from the first, when the POS MD who nearly killed me REFUSED to "allow" me a second opinion! His exact words to the best of my recollection were, "No, I'm not going to allow that at this time." Whoa! When "best interests of the patient" crosses with "CYA", guess which prevailing wind fills the mainsail?)

I ended up having to have my lawyer dictate a script to me, to write on the "AMA" forms to self-release me from their clutches, to ensure that they wouldn't be able to KEEP me against my will. Incredible!

During this nightmare, I was bleeding internally, in my colon (aftermath of botched precancerous polyp removal, "numerous" polyps (they gave up counting them, and used "the 'n' word").

Rather than go back in and stop the bleeding (IMO due entirely to "liability" motivations), I was leaned on like you would not believe -- to coerce me to accept "public" blood transfusions.

I refused, for the obvious reasons, i.e., apart from the "accidents", like swapped labels, improperly sterilized machinery, etc., there's the never-ending discovery (after the damage is done) of exciting new diseases, and, the brass ring, HIV: It resides in the blood for a LONG time before it shows up on tests, thus rendering any screening absurd.

And I know for a fact that there are people who will "engage in risky behavior", and then, too ashamed to ask for an HIV test, use the Red Cross as a "blood test". One person told me he knew he was clean, because right after he copulated with a certain woman, he went and donated blood -- and, he never heard anything back from the Red Cross -- therefore, he "knows he's clean".

This person, the last time I saw him, was still about six foot three, but, he was down to about 125 lbs. No, that is neither a typo nor hyperbole. It's his actual weight. So you tell me.

Anyway, it doesn't take a rocket scientist to realize the risks involved with accepting "anyonymous" public blood. And, the meditradesmen realise it too, of course.

I tried to compromise -- I said I'd accept blood from friends or relatives -- people I knew and trusted. Nope. It was prohibited. I was ONLY "allowed" to accept anonymous blood. These POS's (and I use the term charitably) are very invested with NOT allowing ANYTHING that even might confirm doubt or fear regarding public/anonymous blood.

Finally, after several days of being badgered (I'd even told them I was a JW, which SHOULD have made them STFU period from that point forth -- but it didn't!), I stopped playing nice.

I said, OK, you are certain that this anonymous blood is perfectly safe for me to have piped into my veins?

Oh, YES, I was told. Absolutely safe! (They wre getting excited at the prospect of having finally beaten me down! They were very scared that I'd die on 'em, and thus leave them with an UGLY liability problem. I was told I had about a half hour to live unless I said OK and took the blood.)

I said, OK, then I have only one more question. What would YOU do, if, while administering the transfusion, one of the hoses leaked, and a drop or two of that "perfectly safe" blood landed on your arm?

I caught them off guard. I got the automatic/preprogrammed "bodily fluids contact" answer. I got the TRUTH. I was told that he'd immediately stop everything and go scrub down with disinfectant.

I said, I see. It's safe enough to pump into MY veins, but it's NOT safe enough to sit ON your SKIN! No, I don't think I'll have it, thanks anyway.

Kinda shut 'em up. Finally.

"Medicine" is a major trade, operated according to one rule, bifurcated in two sub-rules. The rule is MONEY, and the subrules are "grab as much as you can, as quickly as you can", and "CYA."

As an aside, an example regarding the first sub-rule: A doctor, an GP (or PCP as they prefer to be worshipped as today) "referred" me to a "specialist" (whom I joking refer to as "his cousin" -- small town, one Paki import MD sends me off to see... another Paki import MD!) This joker sat me down, gave a ten minute prepackaged spiel, boiling down to all the ills of the world being caused by apnea, and then telling me I'd need to come BACK for an examination, sleep study, blah blah blah) -- and then a month or so later, we get a bill from them for $65 bucks.

My wife was a bit... pissed. Pissed that they'd charge that much for that silly little ten-minute "talk", and pissed that they didn't even manage to submit the bill to Blue Cross.

Well, as it turns out, it was OUR mistake. They did submit the bill to Blue Cross. The $65 was our ten percent co-pay. The actual cost of that ten minutes of USDA-Pure BS was six hundred and fifty dollars!

I served a coupla terms (resigned mid-term of second appointment) as a Michigan HMO Commissioner. I "saw how sausage is made". I have next to NO respect for the fat, greedy, entirely SELF-interested money-grubbing, patient-KILLING (look up the statistics!) industry that has managed to take hold of this economy by the short hairs.

Smoking? LOL! Let's try dealing with the iatrogenic death rate, before tackling small-potatoes stuff like "smoking"!

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