Cancer. The mere word incites so much anxiety for many that it has a name — Cancer Phobia. Such is the intense fear of, and uncommon interest in, the disease.
Most any cancer news, especially if pitched as a “breakthrough,” gains outsized media play, often headlined as a potential “cure.” Regrettably, much of this is high-sounding hype, raising false hopes and leaving oncologists to tell desperate patients that the proclaimed therapy won’t be available for years, if ever.
Recently, TV viewers were pummeled with slick ads from Houston’s MD Anderson Cancer Center promising its “moonshot” initiative would “… make cancer history.” Deep down we know it’s exaggeration, but we want to believe it.
President Obama recently signed legislation unleashing $1.8 billion to boost efforts to find a cancer cure “once and for all.” He also called his initiative a “moonshot,” as in the notion that if we can land humans on the moon we can surely cure cancer (or any other malady).
President Richard Nixon used the moon-landing analogy way back in 1971 when he declared “war on cancer.” Some predicted a cure would be found by the nation’s 1976 bicentennial.
Now, 45 years and $100 billion after the onset of Nixon’s “war,” there are 1.65 million new cancer cases annually, making it America’s second-leading cause of death (in Minnesota, cancer leads).
What’s going on here?
First, there’s a broad misunderstanding that cancer is a single disease, like polio, that could be taken out by simply finding a “silver bullet” therapy.
In reality, cancer is dazzlingly complex. Depending on who’s counting, there are some 400 cancers with a spectrum of traits that require a range of treatments.
Some grow fast, some grow slow; some stay in place, others spread (or “metastasize”); some are treatable, some aren’t. All cancer cells can change (mutate), requiring treatments to be adjusted. Some even mutate into resistant forms that can make treatment impossible.
Some cancers arise from tainted cells embedded in inherited DNA, although those predisposed may never develop cancer. But to intervene into hereditary cancer, scientists must understand much, much more about how the hugely complex human genome drives cell function.
So, is it realistic to expect that cancers and their many variants can be “cured”?
“Not this year,” mused Dr. Otis Brawley of the American Cancer Society, adding that the current focus is on reducing cancer’s “devastating impact.”
The human body has some 40 trillion cells that work incredibly well, especially in healthy folks under age 50. DNA is the blueprint for cell function, so when there are glitches, DNA enables repairs, or, failing that, kills off corrupted cells (millions of “programmed cell deaths” occur daily).
But DNA itself can be damaged by exposure to ever-increasing chemicals in our food, water and air, and by things like sun radiation or home radon levels. Impaired DNA can lose its ability to repair damaged cells or, worse, to kill off the corrupted ones — which then go on a growth rampage.
That’s what cancer is: uncontrolled cell growth. Untreated, the rogue cells continue to divide and grow, crowding out healthy cells and eventually shutting down vital organs.
While the mechanics and effects of cancer are understood, there’s far less known about underlying causes of the disease and how to effectively treat it.
“Doctors still have much to learn about what triggers a cell to become cancerous and why some people do better than others,” says cancer specialist Dr. Timothy Moynihan at Rochester’s Mayo Clinic. “We can make generalizations about cancer, but the disease is always unique to each individual.”
Dr. Arek Dudek at St. Paul’s Regions Hospital agrees: “All the very good cancer research that’s gone on has in some respects shown how little we really know.” Dudek, an oncologist, is experienced in new-drug trials.
So has the “war on cancer” failed?
“Certainly not,” Dudek said, pointing to improved treatments that give ever-more patients longer, higher quality lives than just a decade ago. Breast cancer survivor numbers are increasing, most skin cancers are fully treatable, and with early diagnosis other varieties like neck and prostate cancers respond well to treatment.
The billions of research dollars made available since Nixon’s “war” began have advanced an array of drugs that target specific cancers to improve treatment results while reducing nasty side effects, chiefly from chemotherapy. Other drugs target highly resistant cancers.
The current big buzz is over “immunotherapy” agents that prompt the body’s own immune system to seek out and destroy cancer. Mostly in testing, the approach has shown capacity to treat melanoma and, recently, cancers like lung, bladder, kidney, head and neck, and Hodgkin’s lymphoma.
But emerging drugs often have side effects, some so debilitating that quality of life is compromised. They also can be very expensive; immunotherapy treatment, for example, can cost up to $250,000.
Alongside improved cancer care, human longevity has been improved through much better management of heart disease and suppression of once-deadly infectious diseases. There is also better sanitation, safer drinking water, safer transportation and workplaces, and the like.
With all that, the average life span of Americans has gone from around 40 years just a century ago to near 80 today.
Which leads to a seeming irony: Cancer is generally an old person’s disease; DNA degrades with age and loses ability to regulate cells that, in turn, can become cancerous. So people who live longer survive long enough to, among other things … develop cancer.
A century ago, cancer was not as prominent in the U.S. as it is today — just as it’s not common today in societies whose populations have shorter life spans. That’s because people in shorter-lived communities die of something else before they develop cancer.
Rather than “curing” the disease, we should expect there will be more cancer, wrote Jarle Breivik earlier this year in the New York Times. Breivik is professor of medicine at the University of Oslo, Norway.
What all this comes down to is that it’s frankly deceitful to claim a “cure” is imminent or even possible.
The deceit starts with overly enthusiastic claims by prestigious universities and treatment centers — by wise people who give “cure” claims undeserved credibility.
The deceit is amplified by news media eager to trumpet anything that’s claimed to be a “breakthrough.” It’s made worse when the media fails to describe the years of testing required to validate any drug, or a drug’s harmful side effects, or the eye-popping costs should the heralded therapy become available.
Why are “cure” claims made?
“The different actors are outbidding one another for attention and funding,” Breivik wrote.
In other words, researchers and their institutions rely on cancer hype to gain publicity to get noticed and attract billions of available research dollars. A larger objective is to become a publicly established cancer treatment center so as to attract patients who annually spend some $150 billion on the disease.
In short, treatment is where the money is.
Lost in the new-drug frenzy is attention to the most complete “cure” of all — and that’s cancer that doesn’t occur.
“Most cancer is preventable,” editorialized JAMA Oncology in September, noting that smoking-related cancers could be reduced as much as 90 percent (or 202,000 cases annually), and lifestyle-related cancers like colorectal and bladder could be reduced by 60 percent. Smoking annually accounts for 30 percent of all cancer deaths, says the Centers for Disease Control and Prevention.
We’ve often heard about simple things anyone can do: Stop smoking and excessive drinking (the biggies), eat healthy foods, get weight below obesity levels and exercise often.
So why the inordinate attention on treating cancer (or diabetes, or …) and comparatively little on prevention — mindful of the enduring truism that an ounce of prevention is worth, in this case, tons of cure?
One could argue, as many have, that American “health care” and its “fee for service” model is really a “sickness care” system that focuses on lucrative illness treatments rather than on small or no-profit prevention.
In short, prevention is where the money is not.
Ron Way lives in Edina.