I believe here are some myths about a “cure” in cancer that we need to debunk:
The idea of cancer as “a” disease and the fixation on a magic silver bullet.
Cancer is not “a” disease, and only in rare instances do you have a tight correlation between the cause of a cancer with “a” gene. Most of the time, cancer is a cumulative result from a combination of environmental stressors, genetic disposition, and lack of early detection/intervention.
This idea of cancer as “a” disease has led to the expectation of finding a silver bullet, and even with the advent of the so-called molecular therapies or targeted therapies, there are misnomers. You can have targeted therapies that would, for example, selectively target receptors that are upregulated/stimulated in a certain type of cancer. For example, Avastin is an anti-VEGF specific “targeted” antibody based therapy.
Here’s the problem: growth factors have normal functions of cell growth and regulation. Signaling pathways (chemical relays that tell a cell what to do in response to internal and external stimuli) have check-points, brakes, accelerators, and redundancies; the more involved a particular growth factor is in diverse cellular processes, the more complex these feedback “loops”.
When you target a specific growth factor, you are hoping that you are curbing the excessive signals coming from the abnormal stimulation of that growth factor. But you also risk affecting the normal cell processes that the same growth factor is regulating. Hence, in the case of growth-factor specific cancer drugs, we begin to see side effects that come from normal cell functions being affected adversely by a “targeted” drug.
The idea of “curing” cancer.
I think this is where we can make the most stride when approaching the cancer question as a society. We are completely focused on the cure, and I don’t blame our fixation on this concept. But we need to shift our thinking on “cure” in cancer.
We can look at prostate cancer as an example of how we can modulate our expectation with “beating” cancer. Of course now that we are living longer, we are going to see more people dying of cancer that they used to outlive, when life span was shorter. Prostate cancer for the most part is a cancer of old age in men. In the past, men didn’t live long enough to die of prostate cancer (there are exceptions, when young men die of aggressive forms of prostate cancer; I’m not talking about the exceptions).
Thus here are 2 ways to shift our thinking on “cure” in cancer:
- We do not outlive the cancer itself. The strategy here is to keep the cancer in its early stages such that it exists, but it doesn’t progress at a pace that can out-run our normal life span. Here the aim is to “die at our natural time” but with the cancer still inside. So we still die, but we don’t die of the cancer that exists in the body.
- We stabilize the cancer in its current state and attempt to outlive the cancer. The strategy here is to keep the cancer in its current stable condition, such that it does not progress but it doesn’t necessarily regress or spontaneously dissipate/disappear. This is our attempt to outlive the cancer, and we can only do this when the cancer does not change to the point where it interferes with our quantity and quality of life.
The idea of “a cure” in cancer
While it is true that you can resect / cut out an operable cancer, you can irradiate and chemically kill cancer cells by taking advantage of its faster replication rate, you can even replace entire blood cell systems via bone marrow transplants to aspire to “a cure”… but these are all gambles on odds. You are betting that:
- You have indeed cut out the entire tumor mass
- You have not missed any micrometastases circulating beyond the scalpel
- You will not cause secondary cancer by using radiation and chemotherapeutic agents that in themselves alter cell properties in dramatic fashion
- You will not have an additional cancer causing event
- You do not have genetic disposition to cancer that will be triggered after the procedure
I studied cancer biology at Roswell Park Cancer Institute, which was founded by Dr. Roswell Park in 1898, who rationalized that if we brought together physicians and scientists in different disciplines to collaboratively confront the cancer challenge in terms of treatment and research, we could “cure” cancer. Today there are many comprehensive cancer centers all over the world where multidisplinary teams come together to research cancer and aspire to improve outcomes for patients.
While we have made tremendous strides in our treatment of many cancers, we are not truly “curing” cancer. However, by using the above 2 contextual ideas of looking at cancer, I feel tremendous optimism that in spite of a lack of guarantee for a cure, we can expect an improvement in both quantity and quality of life if diagnosed with cancer.