Ron Way is absolutely correct in “Can we cure cancer? Or just keep up?” (Jan. 15): Healthy skepticism should be applied to claims to a cure for cancer. As Way pointed out, cancer is not a single disease with a single cause, and will not have a single cure. “Cancer” is an umbrella term describing hundreds of distinct diseases with two things in common: uncontrolled growth and spread to distant sites.
Despite the complexities, huge strides have been made in cancer treatment. In the 1960s, for example, about 90 percent of children with B-cell acute lymphocytic leukemia died within five years of their diagnosis. Now, 90 percent are long-term survivors. Similarly, Hodgkin lymphoma used to be universally fatal; now it is eminently curable with chemotherapy and radiation therapy.
While Way laments the billions of dollars spent on cancer research, these treatment successes depend on such research. Further, the federal dollars spent on cancer research pale in comparison to federal dollars spent on health care overall. Compare the approximately $5 billion National Cancer Institute annual budget to the more than $1 trillion spent on health care delivered by Medicare/Medicaid annually.
Essentially all of the “breakthrough” cancer therapies were created from federally funded research projects. These successes account for the estimated 15.5 million cancer survivors (about 5 percent of the population) in the United States. To continue on this pathway, we need robust, sustained, and predictable increased funding for cancer research, not less as suggested by Way.
Yes, preventing cancer is preferable to treating it, and through research we know how to prevent most of the deaths due to the most deadly cancer in men and women: lung cancer. Exposure to tobacco, which leads to DNA mutations and cellular changes, is why the vast majority of patients developed their disease. We need to create methods to keep non-smokers from ever starting and to eliminate cigarette addiction for active smokers. Further, we know that most cervical cancers and some head and neck cancers are driven by the human papilloma virus and we have a vaccine to prevent infection with this virus. We need to employ this vaccination population-wide.
For other cancers, the cause is less clear. Cancer arises from mutations in DNA. Mutations arise internally from copying errors, and some people are born with defects in DNA repair pathways and are at risk for developing breast, prostate, and colorectal cancer. Only a minority of people have this inherited risk, yet research into these heritable cancers has resulted in new therapies for treatment.
Damage to DNA can be caused by other environmental factors, such as ultraviolet light. Minimizing one’s exposure to known damaging agents is the best way we currently have to prevent or reduce cancer incidence.
So why don’t we spend more money on prevention, as Way asks? Well, in reality, a great deal of research money is being spent on cancer prevention and early screening — with success. For example, funding allowed the Masonic Cancer Center to identify a causal link between indoor tanning and skin cancers, providing strong evidence to allow our legislators to ban indoor tanning for all minors.
As Way suggests, there are lifestyle exposures that are linked to cancer development and many of these interventions do not require spending more money. Rather, they require partnership and education with populations at risk.
Even with successful prevention measures, cancer will always be with us. Genetic change, mutation, is part of our biology; it is a fundamental process for evolution. And because mutations accumulate over time despite best efforts at prevention, Way is correct to note cancer becomes more prevalent as our population ages.
The Masonic Cancer Center is a comprehensive cancer center as designated by the National Cancer Institute. It means we take a scientifically rigorous, comprehensive approach to the problem of cancer, including basic research, prevention, screening, treatment, survivorship, and palliative care. We talk to one another across this broad spectrum, and we share the knowledge with the community.
A cancer moonshot isn’t meant to rocket us all away from this disease, but rather to provide resources to create a stronger mission control. Sharing information and knowledge can help us transform the experience of cancer. It is reasonable to believe, with the right resources, we can make cancer preventable, manageable, treatable, or curable.
Douglas Yee is director of the Masonic Cancer Center in Minneapolis.