April 23, 2009
Slow Progress Seen Against Cancer
An informative article in the New York Times describes the rather slow progress of attempts to cure cancer.
Cancer has always been an expensive priority. Since the war on cancer began, the National Cancer Institute, the federal government’s main cancer research entity, with 4,000 employees, has alone spent $105 billion.
If you think $105 billion sounds like a lot then look at this US GAO 2008 FY budget document. You can find multiple departments that each in a single year burn thru several times what the US government has spent in total to cure cancer. $105 billion is chump change for solving a problem that is, absent a cure, going to extremely painfully kill a large percentage of those reading this. To put it another way, its a little over $300 per American citizen. The costs of one year's lost productivity alone exceeds the total amount spent researching to find a cure. I'm digressing. But there's a point: We should try much harder to develop curative treatments for cancer.
After decades of new treatments the death rate from cancer hasn't declined much.
Yet the death rate for cancer, adjusted for the size and age of the population, dropped only 5 percent from 1950 to 2005. In contrast, the death rate for heart disease dropped 64 percent in that time, and for flu and pneumonia, it fell 58 percent.
It is a lot easier thru diet to cut heart disease risk than to cut cancer risk. It is also a lot easier to use drugs to alter metabolism to lower heart disease and other cardiovascular disease risks. Statins and blood pressure drugs will cut your heart disease risks. Also, emergency treatments for heart attack can reduce fatality rates long enough that drugs and diet can cut the risk of recurrence. Even still, you can chance your diet in many useful ways to cut your cancer risks. Do what you can to cut your risks. You might just avoid cancer long enough to still be around when cures are developed.
Think great progress has been made against cancer? Once a cancer mutates to enable metastasis the odds of survival become very low.
With breast cancer, for example, only 20 percent with metastatic disease — cancer that has spread outside the breast, like to bones, brain, lungs or liver — live five years or more, barely changed since the war on cancer began.
With colorectal cancer, only 10 percent with metastatic disease survive five years. That number, too, has hardly changed over the past four decades. The number has long been about 30 percent for metastatic prostate cancer, and in the single digits for lung cancer.
This illustrates the value of early detection. The earlier the detection the greater the chance that the cancer hasn't spread to more locations - especially not to inoperable locations. More powerful testing techniques might lead to more earlier detection. But I suspect that to really make early detection the means to cure more cancers will require development of assay technologies that work at home. To reliably detect cancers before metastasis but after they've has gotten big enough to create a clear biochemical signature in blood, saliva, or other secretions might require very frequent testing.
The article quotes a medical researcher who argues that the funding for treatment development is too conservative and aimed at developing treatments that will yield small increases in survival at lower risk of experimental failure. We need funding for higher risk but potentially much higher benefit treatments.
The problem with cancer is that it is your own cells going wild. It is very very hard to selectively kill all cancer cells while at the same time killing few of your own normal cells. To achieve such a high degree of selectivity requires an enormous amount of understanding of how cancer cell metabolism differs from normal cell metabolism. That, in turn, requires experimental tools far more powerful than what cancer researchers have had to work with for the vast bulk of the time they've been doing the research. Even today scientists still do not have a sufficiently detailed understanding of cellular regulation to know all the mechanisms where genetic mutation and epigenetic state change can turn cells cancerous, capable of extended growth, and metastatic.
Perhaps a nice, possibly cheaper way to lower the rate is to develop ways that it could easily, quickly, and cheaply be tested for by the consumer so they can test themselves on a monthly basis. Even if the test isn't the most accurate, it might still be a good indicator of a need for more extensive testing. Also, I had a friend who developed a breast tumor that could have been cancerous. It took her months (maybe only a couple, I don't remember) just to get all of the proper tests done and to determine whether or not it was. That time wait isn't exactly helpful either.
"This illustrates the value of early detection. "
I'd say that the tiny reduction in mortality shows the opposite: we're finding a lot of cancers that would never have progressed, at a huge cost in false-positives. Further, mammograms and other radiological exams cause cancer: every annual mammogram raises the risk of cancer later by 1%!
We spend a tiny amount on something that would yield much larger returns, not only for cancer but for everything else, like Alzheimer's: longevity research. We spend perhaps $30M on the really basic longevity research that's needed, while spending billions on other, much less rewarding research.
I agree: medical research, esp longevity research, is badly underfunded.
"Every organization says, ‘Oh, we want to fund high-risk research.’ And I think they mean it. But as a matter of fact, they don’t do it.”
The basic problem? Careers are advanced by incremental research. Researchers care about their careers, not so much about curing anybody.
Oh well, we all need to contribute in one way or another, and be paid too, but it seems true that there's a huge sinkhole in seemingly endless cancer research and barely a dent in net net mortality rates.
Here's a link to PhD Comics that has an informative comic on cancer pointing out that there never will be a 'cure'. There's just too many types of cancer!
" there never will be a 'cure'. There's just too many types of cancer! "
Perhaps. On the other hand, you can pretty much eliminate cancer (all types) in lab animals with Caloric Restriction. Where's the 100's of millions of dollars in research into the mechanisms of CR?
What's the biggest predictor of cancer? Age. Where's the 100's of millions of dollars in research into the basic mechanisms of aging?
Even the Natl Institute of Aging puts only a small % of it's funding into the basic mechanisms of aging. Most of it goes into outrageously unhelpful things like social research into family coping mechanisms when caring for the Alzheimer patient!!
There was a 5% drop in cancer mortality from 1950 to 2005, but the article didn't mention that the drop from 1950 to 2002 was 0%.
It doesn't have the data for the past three years either.
It also fails to mention anything on the breakthroughs being investigated like nano targeting among others.
Overall, a bad article.
Sure, more powerful tech is being brought to bear. But how close are we getting? You want to predict by what year more than half of metastatic cancer cases will become curable? 2015? 2020? 2025?
Maybe it'll happen very suddenly. Maybe some key technological breakthru will cause a huge shift in a single year. You think?
The biggest reason we do not have a cure yet is the problem is incredibly hard. Not only is the problem hard but scientists did not have tools commensurate with the scale of the problem. Scientists needed tools to figure out really complex genetic regulatory networks that control cell growth. Then with that knowledge they can begin to intervene.
I learned this a long time ago from an old Cornell biochemist named Ephraim Racker. He was one of the scientists called together to fight the war on cancer by Nixon. He said he knew then it wouldn't succeed because they didn't have the knowledge on how cells control their growth. We've been waiting for decades for biotechnology to advance far enough that scientists can begin to figure it out.
Alternatively, we need big advances in immunology to use the immune system to selectively attack cancer cells.
On the bright side, the tools are starting to become powerful enough to make serious headway. Microfluidic devices, gene chips, robotics automating lab tasks, lots of assay methods, computers for collecting and analyzing data, computers for doing simulations, it all adds up.
I have thought since 2001 that 2010-2015 will be the sea change since computer power (modeling) wlll keep increasing and there will have been a decade since the human genome project was completed. There are significant advances in nano targeting and David Lane, discoverer of the p53 gene, seems convinced his method currently in trials will cut mortality 50% from today in 2013. Maybe he'll be wrong, but I have strongly suspected a 3 year collapse in mortality during 2010 to 2015. Maybe that won't get everything, but I think the end of most death from cancer is coming.
The article was bad since it didn't mention any advances, just the understandable disappointment that cancer still kills millions around the world every year.
Have you seen any good data for 2005-2008? The National Cancer Institute has been saying 2015 would mark a dramatic reduction - are they still saying that?
All I know is the yearly report that has shown 1 to 2% declines in 2006,2007 and I think gains slowed.
I think the NCI's statement is still up, but they are hoping for no death from cancer by 2015. I think we are close to seeing dramatic gains, but it may be a 3, 5 or even 10 year process. I think it will be a three year period. Just a guess.