Conquering Cancer or Not
There surely have been important advances in cancer treatment and prevention. Think of some of the biggest successes for breast cancer: herceptin for her2positive cancers, Tamoxifen and now Arimidex for prevention for high risk women, the longer times that women stay on hormonal/anti-endocrine treatments with improving statistics for lowered recurrence rates. What we don't have, what we are not even close to, is a cure.
When President Nixon announced the War on Cancer in 1971, I suspect that he and others truly believed that by 2013, almost 2014, cancer would be curable and maybe even preventable. Hadn't that happened with polio and smallpox and so many other diseases that were killers? Turns out that cancer is many different diseases and incredibly complex and smart, and we are chipping away at it--but not winning. It reminds me of those cliches about not messing with Mother Nature--you throw something small at her, and she comes back with a lightening bolt.
This is an excellent editorial from Lancet that summarizes and explains. If you have time to read it, you will find it both reassuring and hopeful and discouraging. Here is the start and then a link:Conquering cancer
The latest cancer statistics, released last week, are concerning. GLOBOCAN 2012, the International Agency for Research on Cancer's online database, shows that the global burden of cancer increased in 2012 to 14·1 million new cases and 8·2 million deaths, compared with 12·7 million and 7·6 million in 2008. Furthermore, GLOBOCAN 2012 predicts that there will be 19·3 million new cancer cases per year by 2025 due to growth and ageing of the global population. It confirms—as the last update GLOBOCAN 2008 did—that cancer is a global health priority. More than half of all cancers and cancer deaths in 2012 occurred in low-resource settings, and these proportions will increase further by 2025.
Clearly, although progress in treatment has been made, the war on cancer—declared by US President Richard Nixon in 1971—has not been won. What are some of the solutions to this crisis? In the first paper in The Cancer Wars clinical Series published online this week in The Lancet, Paolo Vineis and Christopher Wild champion primary prevention. The authors note that between a third and a half of cancers are preventable on the basis of present knowledge but that health promotion alone is insufficient; structural changes are needed through urban planning, taxation, and bans.
Implementation of such interventions, however, remains patchy worldwide. For policy makers in need of more reasons to act, Vineis and Wild present a compelling argument about the cobenefits associated with primary prevention. Such policies can benefit other people (eg, by reduction in exposure to secondhand smoke), reduce shared risks factors associated with other non-communicable diseases (eg, heart disease), and can completely remove or reduce some long-term causes of cancer (eg, bans on occupational carcinogens).