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Why Hasn't Cancer Been Cured? It's Complicated

 

In 1971, in the wake of the eradication of polio and the first man on the moon, then-President Richard M. Nixon signed a bill into law called the National Cancer Act. Jon Huntsman, Sr., served on his staff at the time. The bill expanded the powers of the National Cancer Institute and designated more money to the effort to cure cancer.

Although cancer has been recognized for a great deal of time—since ancient Egypt in about 3000 BC—and many doctors and scientists were already dedicated to curing the disease, the bill accelerated work in what became known as the War on Cancer.

Some guessed that the disease would be eradicated by 1976.

There are many reasons that a cure hasn’t been found more than 40 years and hundreds of billions of dollars later, but not least among them that is that curing cancer is far more complex than perhaps any other human undertaking.


It’s perhaps common sense that the best way to stop something is to understand how it started in the first place, but the technology available in the 1970s was woefully inadequate for the job. As a result, cancer was very poorly understood, and the first techniques to treat cancer were based more on trial-and-error than anything else. The first treatment suggested was surgery to excise “moveable” tumors that had not yet invaded nearby tissues, by a Scottish surgeon in the 1700s. When anesthesia was developed and use of the modern microscope became widespread in the 1800s, true cancer operations flourished and became more successful. Modern treatment techniques did not come about until much later. Radiation was developed in 1899 and the first cancer patient was cured with chemotherapy in 1956.

Indeed, it wasn’t until the late 1800s that it was correctly proposed that cancerous cells arise from normal cells and that they can spread inside the body. For over a century, it was believed that cancer is contagious (which is 100% false), because women from the same household sometimes developed breast cancer. Even with that knowledge, it was thought the cancer resulted from trauma up until the 1920s (this is also false).

Despite not understanding how cancer worked, scientists learned that certain things could cause it. A scientist in London recognized tobacco as a carcinogen in the 1700s, and Japanese scientists induced cancer in rabbits in 1915 by exposing their skin to coal tar. In 1911, an American researcher began work that would prove cancer could be caused by viruses.

It wasn’t until scientists began to gain an understanding of DNA and genes after the 1960s that it became possible to truly comprehend how cancer happens and what it might take to eradicate it. Imagine their disappointment when it slowly became clear that cancer was not one disease but hundreds of separate diseases with some commonalities—meaning that it could never have one cure.

As it turns out, there are more problems than just that cancer isn’t a single disease:

  • To some extent, every individual’s cancer is genetically unique. In fact, metastatic tumors are often genetically distinct from the primary tumor in the same patient. This could mean that a treatment which works for one colon cancer patient may not work as well for another even if their diagnosis is the same. It could also explain why a treatment might work well for a patient before their cancer metastasizes, but poorly after.
  • It’s not just one mutation that leads to cancer, but somewhere between 2 and 8 driver mutations alongside hundreds of other more inert mutations.
  • Sometimes two cancer patients can have identical genetic mutations that lead to cancer, but the tumors can arise in different places in the body. Each area of the body can carry with it unique challenges, so those patients may not have the same course of treatment despite the common origins of their cancer.
  • The way cancer works is so complicated that decades of basic research into the subject still have not fully explained the processes in question.
  • It’s sometimes hard for researchers to find suitable patients to study.
  • The development of drugs is also incredibly complex in its own way. Their creation and approval is also very costly and time consuming. Most potential drugs fail in testing. Only 1 in every 10,000 to 20,000 will ever reach the market (although scientists still learn valuable things in the course of developing and testing the failures). A scientist who dedicates their entire career to developing new drugs will be lucky if one of their potential drugs ever reaches the market.

So what has been accomplished?

By 2005, death rates for almost every major cancer had fallen for 15 years straight, due to both prevention and early screening techniques. Significant strides have also been made in cancer prevention. There are many environmental factors that can play a role in a person’s development of cancer, things like smoking, UV exposure, obesity, and viral infections. A great number of these could be avoided in order to help prevent cancer. However, one of the processes that can damage DNA and lead to cancer is the process of aging itself, and it’s thus very unlikely that we can ever entirely prevent the development of cancer in humans. This puts the focus back on treatment.

Surgical treatments are far less dangerous, physically costly, and invasive than they were in 1971. The treatment for breast cancer at the time was total removal of the breast, which was painful and disfiguring. The treatment for prostate cancer was generally removal of the prostate, resulting in urinary incontinence and sexual dysfunction. Surgical treatments for these same cancers are more precise and less compromising than they used to be.

Patients today live longer after diagnosis than the cancer patients of yesterday. Of the patients diagnosed between 1975-1977, 50% were alive 5 years later. For patients diagnosed between 1999 and 2006, that number climbed to 68%.

In recent decades, scientists have focused more on basic science that would allow for a deeper understanding of the workings of the various forms of cancer, to better know how it’s mechanisms can be halted. The more we learn, the better treatments get. The drugs resulting from this research are called targeted therapies. The first was developed in 1973, called tamoxifen. Biochemist V. Craig Jordan wrote, “For the first time in the history of cancer, a drug, its target, and a cancer cell had been conjoined by a core molecular logic.” These treatments exploit weaknesses in cancer cells to stop them in their tracks. In the last 10 years, more than 20 such treatments have been approved for use by the FDA.

In the late 1990s, a drug was approved by the FDA that was the first of its kind, called immunotherapy. It and other treatments like it attempt to kill cancer by enhancing a patient’s immune system and giving it the tools to attack the tumor itself. This contrasts with traditional treatments where a patient’s immune system might be suppressed so drugs have a better chance of affecting tumor cells.

All of these strides have been brought about by the hard work of cancer researchers like those at Huntsman Cancer Institute.

Dr. Mary Beckerle, CEO and Director of Huntsman Cancer Institute, says, “When the world united around the effort to defeat cancer forty years ago, scientists believed that cancer was but one disease and had a single cause. The last several decades of research have revealed a much different truth: a diverse set of genetic changes underlies cancer. Hundreds of kinds of cancer exist. As we learn more about the unique characteristics of cancer, we learn ways to prevent it and treat it at the genetic level…When the ‘War on Cancer’ was launched in 1971, it was unfathomable even to imagine what’s possible today.” She continues, “We are poised to change cancer care for the entire planet. Now is the time, Utah’s the place.”


Sources:

"An Unstoppable Killer: New Research Suggests Cancer Can't Be Eradicated." NPR. NPR, 21 Aug. 2014. Web. 03 Aug. 2017.

Childs, Oliver. "Don't believe the hype – 10 persistent cancer myths debunked." Cancer Research UK - Science blog. N.p., 24 Mar. 2014. Web. 03 Aug. 2017.

Ewens, Hannah. "We Asked an Expert: Why Haven't We Cured Cancer Yet?" Vice. N.p., 28 Jan. 2016. Web. 03 Aug. 2017.

Gorski, David. "Why haven’t we cured cancer yet?" Science-Based Medicine. N.p., 14 Feb. 2011. Web. 03 Aug. 2017.

Report, Retro. "The War on Cancer: From Nixon Until Now." The New York Times. The New York Times, n.d. Web. 03 Aug. 2017.

Terry, Nancy R. "40-Year War on Cancer: Can We Win?" Medscape. Medscape, n.d. Web. 03 Aug. 2017.

"The History of Cancer | First Cancer Diagnosis." American Cancer Society. N.p., n.d. Web. 03 Aug. 2017.

"Why cancer has not been cured." The Economist. The Economist Newspaper, 07 July 2016. Web. 03 Aug. 2017.

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