The War on Cancer
In 1971, President Nixon signed the National Cancer Act, a milestone considered the beginning of the "war on cancer" in the United States. One side effect of his declaration of war was making the National Cancer Institute, already well established as one of the institutes in the National Institutes of Health, more independent and providing a burst of funding to accelerate the scientific search for new treatments and cures.
Now, more than 40 years later, when we see cancer deaths rising in the United States and worldwide, people conclude that we are losing the war on cancer. While the added funding and focus on cancer research was a positive outcome of Nixon's declaration, other aspects have created a public relations challenge for people studying cancer and treating cancer patients. In hopes of spreading some light on the diseases we call cancer, I would like to offer the following observations. Of course, in a few paragraphs, I cannot do justice to the discussion, let alone compete with the fabulous book The Emperor of All Maladies by Siddhartha Mukherjee, which provides a fascinating overview of cancer that is quite readable by non-specialists.
1. Cancer is many diseases, not one disease. Even breast cancer or lung cancer, two common diseases, actually exist as hundreds, if not thousands, of distinct types of tumors, each with its own unique physical characteristics, genetic mutations, hormonal sensitivity, response to radiation therapy, propensity to spread, lethality and the like. Hence we should not lump the thousands of different tumors into one category called "cancer."
2. We now have a high success rate against some cancers through early detection and treatment. When I was in medical school, Hodgkin's disease and childhood leukemia were usually fatal diseases. Now a significant fraction of patients with these cancers, as well as others, can be successfully treated and regain a normal life. Nearly every week, new insights into the biology of cancer lead to amazing new treatments.
3. Patients speak of being "cancer survivors" with good reason— few diseases, including cancer, are cured by modern medical science, but many diseases can be treated so successfully that life expectancy and quality of life return to near normal.
4. With increased information comes more patient-specific treatments for cancer. A relative of a colleague was recently diagnosed with breast cancer. The biopsy showed a specific type of breast cancer, and further analysis showed that the woman's tumor did not have any of the three known receptors for which selective chemotherapy can be highly effective. The next step is to sequence the genome of the tumor to determine whether there are specific mutations that are responsive to another set of chemotherapy drugs.
5. The old saw "an ounce of prevention is worth a pound of cure" is exemplified by the relatively recent introduction of a vaccine by Merck, Gardasil, that effectively immunizes young women against the human papilloma virus, which was found to cause about 70 percent of cases of cervical cancer. Recent studies using immunotherapy for cancer have had amazing successes as well.
The message of cancer in the 21st century is that continuing discoveries coming out of the labs at places like the Salk Institute are shedding light on what goes awry in tumors and what specific drugs may be effective at destroying or at least stopping the growth of that cancer. Given the genetic map of the tumor and information about other specific "markers," we are literally developing smart bombs that can selectively target the aberrant cells.