Is the War on Cancer Hopeless?

 

The New York Times has an interesting piece up about the incredible tenacity of cancer. I apologize in advance for the multitude of long quotes, but because science is involved and I am not an expert, I thought it safer to let the author, George Johnson, speak for himself:

Half a century ago, the story goes, a person was far more likely to die from heart disease. Now cancer is on the verge of overtaking it as the No. 1 cause of death.

Troubling as this sounds, the comparison is unfair. Cancer is, by far, the harder problem — a condition deeply ingrained in the nature of evolution and multicellular life. Given that obstacle, cancer researchers are fighting and even winning smaller battles: reducing the death toll from childhood cancers and preventing — and sometimes curing — cancers that strike people in their prime. But when it comes to diseases of the elderly, there can be no decisive victory. This is, in the end, a zero-sum game.

Old people usually die either of heart disease or cancer — meaning that if you manage to escape being killed by one, you’ll likely live long enough to be killed by the other.

Grim as that sounds, Johnson looks at it in a (sort of) positive light:

The newest cancer report, which came out in mid-December, put the best possible face on things. If one accounts for the advancing age of the population — with the graying of the baby boomers, death itself is on the rise — cancer mortality has actually been decreasing bit by bit in recent decades. But the decline has been modest compared with other threats.

graph from the Centers for Disease Control and Prevention tells the story. There are two lines representing the age-adjusted mortality rate from heart disease and from cancer. In 1958, when the diagram begins, the line for heart disease is decisively on top. But it plunges by 68 percent while cancer declines so slowly — by only about 10 percent — that the slope appears far less significant.

Measuring from 1990, when tobacco had finished the worst of its damage and cancer deaths were peaking, the difference is somewhat less pronounced: a decline of 44 percent for heart disease and 20 percent for cancer. But as the collision course continues, cancer seems insistent on becoming the one left standing — death’s final resort. (The wild card in the equation is death from complications of Alzheimer’s disease, which has been advancing year after year.)

Though not exactly consoling, the fact that we have reached this standoff is a kind of success. A century ago average life expectancy at birth was in the low to mid-50s. Now it is almost 79, and if you make it to 65 you’re likely to live into your mid-80s. The median age of cancer death is 72. We live long enough for it to get us.

Johnson explains that while heart disease — as well as earlier mass killers like smallpox, bubonic plague, and tuberculosis — is a problem with specific causes that can be tackled or mechanical issues that can be overcome, cancer is more of “a phenomenon, the result of a basic evolutionary compromise”:

As a body lives and grows, its cells are constantly dividing, copying their DNA — this vast genetic library — and bequeathing it to the daughter cells. They in turn pass it to their own progeny: copies of copies of copies. Along the way, errors inevitably occur. Some are caused by carcinogens but most are random misprints.

Over the eons, cells have developed complex mechanisms that identify and correct many of the glitches. But the process is not perfect, nor can it ever be. Mutations are the engine of evolution. Without them we never would have evolved. The trade-off is that every so often a certain combination will give an individual cell too much power. It begins to evolve independently of the rest of the body. Like a new species thriving in an ecosystem, it grows into a cancerous tumor. For that there can be no easy fix.

These microscopic rebellions have been happening for at least half a billion years, since the advent of complex multicellular life — collectives of cells that must work together, holding back, as best each can, the natural tendency to proliferate. Those that do not — the cancer cells — are doing, in a Darwinian sense, what they are supposed to do: mutating, evolving and increasing in fitness compared with their neighbors, the better behaved cells of the body. And these are left at a competitive disadvantage, shackled by a compulsion to obey the rules.

Thus, even in a world completely free of carcinogens, cancer will eventually get you if you manage not to die of something else first.

The good news is that childhood cancer has fallen by about half since 1975, and some early stage cancers in older people have been significantly reduced (meaning patients are either cured or their cancers are held at bay for long periods). Also, because 15-20% of cancers around the world are caused by infectious agents, improvements in refrigeration and sanitation have had a positive impact. Anti-smoking campaigns have caused some diminishment in lung cancer in the US (although, and I recognize that this is purely anecdotal, the only people I’ve ever known who died of lung cancer were non-smokers).

Still, even if the more susceptible cancers are outwitted by science early on, odds are that you will eventually succumb to it:

For most cancers the only identifiable cause is entropy, the random genetic mutations that are an inevitable part of multicellular life.

Advances in the science will continue. For some cancers, new immune system therapies that bolster the body’s own defenses have shown glints of promise. Genomic scans determining a cancer’s precise genetic signature, nano robots that repair and reverse cellular damage — there are always new possibilities to explore.

Maybe someday some of us will live to be 200. But barring an elixir for immortality, a body will come to a point where it has outwitted every peril life has thrown at it. And for each added year, more mutations will have accumulated. If the heart holds out, then waiting at the end will be cancer.

Medical Ricochetti, what’s your take on this?

There are 84 comments.

Become a member to join the conversation. Or sign in if you're already a member.
  1. Profile Photo Inactive
    @Mendel
    Judith Levy, Ed. 

    But when it comes to diseases of the elderly, there can be no decisive victory. This is, in the end, a zero-sum game.

    This is the key point. Despite the entire history of medicine, the overall long-term survival rate still stands at 0%.

    In other words, we all have to die of something. And cancer is the logical “something” to die of once we have dealt with all of the other “#1 killers.” As the article points out, it is something of an inevitability of system of cellular reproduction given enough time.

    We shouldn’t focus as much on what is killing people, but when. As the article points out, medicine has made great strides against diseases which kill people before retirement age. That is the most important task.

    And even developments in cancer treatment will most likely just prolong patients’ lives before they develop another form of cancer. 

    • #1
  2. Profile Photo Member
    @Kozak

    Yup. Given a long enough time line mortality is 100%. Even if we somehow cured all disease you would eventually have a fatal accident.

    • #2
  3. Profile Photo Inactive
    @IsraelP
    Kozak: Yup. Given a long enough time line mortality is 100%. Even if we somehow cured all disease you would eventually have a fatal accident. · 6 minutes ago

    Or be offed by someone who is tired of hearing you say “Everyone has to die of something.”

    • #3
  4. Profile Photo Coolidge
    @iWe

    It saddens me how many people obsess about extending their own lives, but give little or no thought to making their life valuable by any other metric save for maximizing enjoyment.

    Life should not be its own raison d’etre.

    • #4
  5. Profile Photo Thatcher
    @JohnHanson

    Success against cancer has to be measured in the context of additional years of enjoyable life added, not in some absolute sense.   The “War” against cancer has been successful in that light and thus should continue. 

    • #5
  6. Profile Photo Inactive
    @PsychLynne

    I find that non-medical people often think of “cancer” as a single disease – it really is one word that describes a complex disease process that can happen in a variety of locations in the body – blood, bones, solid organs (colon) and others.  

    So, while a global cure for cancer is hopeless, huge strides have been made and as John Hanson points out, the metric of success should be additional years of life – although surviving cancer treatments has it own set of costs that aren’t always well understood.  

    • #6
  7. Profile Photo Inactive
    @PsychLynne

    If you find the article interesting, you should consider reading 

    The Emperor of All Maladies:  A Biography of Cancer

    by Sidhartha Mukherjee

    It’s phenomenal and weaves history, science, and patient stories together in a really beautiful and informative way.

    • #7
  8. Profile Photo Member
    @Ansonia

    Re comment # 4 For some reason, when the only thing you’re out to do with your life is extend it and maximize your own enjoyment, you don’t enjoy your life much.

    • #8
  9. Profile Photo Member
    @DannyAlexander

    Does it bring down the quality of the thread by throwing this in for a bit of musical (if not actually comic) relief?:

    • #9
  10. Profile Photo Inactive
    @dittoheadadt

    Since Danny has, as it were, broken Hearts, I’ll play mine:

    The cancer cells are…mutating, evolving and increasing in fitness compared with their neighbors, the better behaved cells of the body. And these are left at a competitive disadvantage, shackled by a compulsion to obey the rules.

    Is that not a metaphor for America’s Liberals and conservatives, or what?

    • #10
  11. Profile Photo Inactive
    @ManfredArcane

    The answer to the title question: “Is the War on Cancer Hopeless” is obviously, “No”. 

    Cancer will be cured in a hundred years, of that there is no doubt.  Every day we have a clearer and clearer picture of how all the myriad pieces of the miracle that is life work, thanks be to our decoding of DNA and RNA, etc., that with the new advances in nano-technology (manipulating small bits), means that Cancer will be defeated and utterly crushed in our kids’, or their kids’, lifetimes.

    Now whether any of us listening into this thread will be the direct beneficiaries of this victory is unknown.  But cancer will become an adversary that we will “soon” be able to 1) detect at its earliest stages, 2) contain by treatments so that it maintains only at worst a chronic background presence, then ultimately 3) cleanse from the body entirely.

    I would fear more what mischief our burgeoning mastery of biological processes will work in the field of bio-terrorism.  It seems inevitable that the new powers let lose will enable targeting of single individuals, possibly family members, even possibly members of separate races based on shared characteristics of their DNA.

    • #11
  12. Profile Photo Coolidge
    @Skyler

    1. This is in the NYT so it has little credibility. They love their little sensational claims.

    2. Some scientists said we would never be able to fly. Then they said we would never exceed the speed of sound. Then they said we might not survive in zero gravity. Then they said we might go blind in zero gravity because our eyeballs may become misshapen.

    3. Mankind will be around for a long time. So long as we remain free, which is becoming more doubtful at present, and unemcumbered by religious zealotry such as the current crop of fanatical Islam, we will continue to fight this and other scourges. We will win.

    • #12
  13. Profile Photo Inactive
    @dittoheadadt

    Skyler, to your point, 30 or more years ago, when I was a kid, I got a book for Xmas called “The Experts Speak.”  As I recall it was a good 2 inches thick, and filled with expert pronouncements that were flat-out wrong.  The cover’s different now, but the experts (“I can think of no reason why private individuals would need a computer.”) are still wrong.

    51yLDhx4FML._SY344_PJlook-inside-v2-TopRight-1-0_SH20_BO1-204-203-200_.jpg

    • #13
  14. Profile Photo Inactive
    @ManfredArcane

    Just to follow up my earlier assertions, here are just a few of the advances (chosen at random) being made every week in fighting cancer (I did not even include the new, promising immunology approaches cited in the NYTs article):

    http://www.rdmag.com/news/2013/04/cancer-killing-treatment-has-no-side-effects

    http://www.rdmag.com/news/2013/10/gold-plated-nanobits-find-destroy-cancer-cells

    http://www.rdmag.com/news/2013/10/can-thermodynamics-help-us-better-understand-human-cancers

    Now I know that hype is rampant in the field for researching cures, but these kind of notices appear so regularly, and are so pregnant with potential, that they convince me there is no way cancer can last more than a few decades without a major, major dent put in its armor.

    • #14
  15. Profile Photo Inactive
    @GroupCaptainMandrake

    I read an article recently about the apparent resistance of naked mole rats to cancer.  So far, no incidence of cancer has ever been observed in such an animal, and scientists may have an explanation, although it doesn’t follow that it would directly help humans.  Similarly, the blind mole rate shows resistance to chemically induced cancers.  I mention the latter animal because some of the most recent research was done at Haifa University.

    • #15
  16. Profile Photo Inactive
    @KayBee

     

    PsychLynne: If you find the article interesting, you should consider reading 

    The Emperor of All Maladies:  A Biography of Cancer

    by Sidhartha Mukherjee

    It’s phenomenal and weaves history, science, and patient stories together in a really beautiful and informative way. · 1 hour ago

    I second this.  Well worth the read. 

    • #16
  17. Profile Photo Inactive
    @KayBee

    I think the answer is : No, the war on cancer isn’t hopeless.  Thirteen years ago, I was diagnosed for the first time.  This year, God willing, I will finally reach the 5 year cancer free milestone.  Chemo, radiation, maintenance drugs, exercise, stress reduction–all weapons in my own battle, and all weapons that are really constantly being refined.  Like the “War on Terrorism”, the war on cancer isn’t hopeless.  We may never win the big war, but that doesn’t mean we should never fight the small battles. To me, those small battles–real people–are what make the war worth fighting, even if we never reach the point of eradicating all cancers. 

    • #17
  18. Profile Photo Inactive
    @flownover

    Cancer ? pshaw !

    In order to insure the results, I have rented a large truck which lurks just around the corner. Sometime in my 80s hopefully, this truck will speed up  and flatten me on the far side of town away from the hospital. They won’t need to send an ambulance, but rather a spatula. The hospital will be denied it’s $100,000 heroic measures “golden kiss” . The undertaker will be denied any cosmetic reconstruction as I hope for a speedy shake n bake cremation. Too bad the check to the undertakers will bounce as good financial planning succeeds.

    Seriously though, aren’t we shortchanging the death panels a bit ? Or did the NY Times forget about them ? tsk tsk

    • #18
  19. Profile Photo Inactive
    @Tuck

    It’s hopeless as it’s currently being fought. 

    The notion that cancer is caused by genetic mutation appears to be in error, or at least incomplete.  Some cases of cancer have been identified where there are literally tens of thousands of different mutations, other cancers have been identified that appear despite not having the genetic mutation thought to cause the cancer.

    Genetics is far more complicated than initially thought when the mutations-cause-cancer theory was developed decades ago, and the interplay between genetics and the environment is far more complicated than ever imagined.There are clearly huge environmental influences on cancer that are poorly understood.  (For instance, some populations have extremely low rates of cancer, even cancers caused by obvious causes, like smoking.) And the notion that cancer is inevitable with old age is also clearly mistaken: people in traditional societies often live as long, and avoid the typical Diseases of Civilization, like heart disease and cancer.And the medical profession is pretty clueless about all this.  The answer’s not coming from there, unless they find a pill to sell you.

    See Daniel Lieberman’s The Story of the Human Body for the Evolutionary Medicine perspective.

    • #19
  20. Profile Photo Member
    @JClimacus
     

    … The trade-off is that every so often a certain combination will give an individual cell too much power. It begins to evolve independently of the rest of the body. Like a new species thriving in an ecosystem, it grows into a cancerous tumor.

    These microscopic rebellions have been happening for at least half a billion years, since the advent of complex multicellular life — collectives of cells that must work together, holding back, as best each can, the natural tendency to proliferate. Those that do not — the cancer cells — are doing, in a Darwinian sense, what they are supposed to do: mutating, evolving and increasing in fitness compared with their neighbors, the better behaved cells of the body. And these are left at a competitive disadvantage, shackled by a compulsion to obey the rules.

    How has a cell “evolved” if it mutates in a way that destroys not only its neighbors but itself, and any ability it might have to pass on its genes? That’s not doing what they are supposed to do in a Darwinian sense.

    • #20
  21. Profile Photo Member
    @
    I wouldn’t rely too much on the statistics. They ask my 82 yr old mom at every visit if she ever smoked. She quit when she was in her late 30’s but her eventual death would probably be ‘linked’. In the questionaires at the hospital and Dr’s office they neglect to get a key piece of information: her dementia was caused by a heart operation. She went in fine, came out with severe memory probs. I am not blaming the docs, just stating how statistics aren’t very good indicators many times.Also, both of my grandfathers were very healthy and active into their 90’s. They both dropped suddenly because of ‘heart problems’. Well, yeah, their hearts gave out.Also, notice how the article (and the science) could have done very well on its own without bringing evolution into it- but it was brought up and adds virtually nothing to the conversation. It always makes good copy, though.
    • #21
  22. Profile Photo Inactive
    @Tuck

    “How has a cell “evolved” if it mutates in a way that destroys not only its neighbors but itself, and any ability it might have to pass on its genes? That’s not doing what they are supposed to do in a Darwinian sense.”

    They aren’t “evolving”, they’re reverting to an earlier state when cells did not cooperate to form an organism.  Every man for himself, as it were.

    But you seem to misunderstand Darwin: most mutations will be harmful, and will be weeded out of the population.   Cancer is a harmful change, not a beneficial one, obviously.

    • #22
  23. Profile Photo Member
    @JClimacus
    Tuck

    “How has a cell “evolved” if it mutates in a way that destroys not only its neighbors but itself, and any ability it might have to pass on its genes? That’s not doing what they are supposed to do in a Darwinian sense.”

    They aren’t “evolving”, they’re reverting to an earlier state when cells did not cooperate to form an organism.  Every man for himself, as it were.

    But you seem to misunderstand Darwin: most mutations will be harmful, and will be weeded out of the population.   Cancer is a harmful change, not a beneficial one, obviously. · 1 minute ago

    Edited 0 minutes ago

    I agree they aren’t evolving, which is why I pointed out that the author was wrong to say they were.

    • #23
  24. Profile Photo Inactive
    @Mendel

    A big problem in this article is one of semantics: what does it mean to “beat” cancer?

    We sometimes think of “beating” a disease to mean eradicating it, they way humanity eradicated smallpox: by making it non-existent.

    But then there is strep throat, which nearly every person gets multiple times in their life, yet has been made harmless by antibiotics (knock on wood that it remains so).

    I think the best we can hope for with cancer is the latter: that it will always plague mankind, but  we will be able to easily keep most types in check with medicine. And it may well be that at a certain age, many people will constantly be (mostly successfully) fighting one type of cancer or another for their entire lives.

    • #24
  25. Profile Photo Thatcher
    @DougKimball

    Over time our cells become less efficient, fail to sufficiently reproduce or simply die off (atrophy.)  This is the fact of aging.  Sometimes cells lose their sense of purpose entirely and if these cells reproduce, we call this a tumor.  If the cells within this “tumor” reproduce quickly, we call this a “malignancy.”  If these tumors invade surrounding tissues or break off and migrate to other parts of the body, we say that this malignancy has metastasized.  Since these are our own tissues, our immune system has difficulty identifying the tumors as a threat. Eventually, these nutrient needy malignancies crowd out and starve surrounding tissues, causing organ failure and death.  Cancer.

    We know that chemicals, radiation and environmental factors contribute to the genetic mechanisms that cause cells to lose their purpose and dedicate themselves to reproduction.  What we don’t know is how to reverse this confusion.  Rather, our strategies (not cures) target cell growth or ways to get our immune systems to better identify cancerous cells as harmful and target them for destruction.  The second strategy is showing great promise, however, “modern” cancer treatments generally are the modern equivalent of the colonic physic and bloodletting of the 19th century.    

    • #25
  26. Profile Photo Member
    @Sandy

     One can argue around the issue by talking about the aged and longevity stats, but are not the young central to this issue?  So we read:  “The good news is that childhood cancer has fallen by about half since 1975” 

     This sounds great, but I assume this means that the survival rate is better, and not that the incidence has fallen.  That is a kind of improvement, but not the one we really want. I am old enough to remember a time when childhood cancer was almost unknown.  When my young mother developed leukemia in the 1940’s, her doctors were unable to diagnose it until she was nearly dead–not because leukemia was new  but because it was so rare.  

    Money spent  dealing with prevention is a better deal, I think, and whatever you think of the EPA (and I, too, worry about how the agency is being used), that means cleaning up our air and water and using fewer pesticides, etc.  

    We also suffer greatly from  chronic diseases–some quite nasty–and not only among the aged.  There may be healthy populations in the world, but despite our longevity, I do not see that we are among them.

    • #26
  27. Profile Photo Inactive
    @EricJablow
    J Climacus

    How has a cell “evolved” if it mutates in a way that destroys not only its neighbors but itself, and any ability it might have to pass on its genes? That’s not doing what they are supposed to do in a Darwinian sense. · 1 hour ago

    The HeLa line of cells, derived from Henrietta Lacks’ cancer cells, have survived long after her death. They have contaminated and displaced lines of cultured cells in many laboratories. They may be impossible to eradicate.

    • #27
  28. Profile Photo Inactive
    @Valiuth

    Having spent the last 6 years around nothing but Biologist everything in this article seems like old news to me. From the lectures I remember most Biologists had concluded the inevitability of cancer at least a decade ago. I guess it just goes to show how slowly knowledge disseminates out from the professional world, if this is only coming now to the public’s general attention. 

    • #28
  29. Profile Photo Inactive
    @Tuck

    “They have contaminated and displaced lines of cultured cells in many laboratories.”

    And that means that some unknown amount of cancer research done since 1951 (!) is worthless, since they were working with this freakish line of cells, and not what they thought they were working with…

    Oops.

    • #29
  30. Profile Photo Inactive
    @CatoRand
    Manfred Arcane: Just to follow up my earlier assertions, here are just a few of the advances (chosen at random) being made every week in fighting cancer (I did not even include the new, promising immunology approaches cited in the NYTs article):

    http://www.rdmag.com/news/2013/04/cancer-killing-treatment-has-no-side-effects

    http://www.rdmag.com/news/2013/10/gold-plated-nanobits-find-destroy-cancer-cells

    http://www.rdmag.com/news/2013/10/can-thermodynamics-help-us-better-understand-human-cancers

    Now I know that hype is rampant in the field for researching cures, but these kind of notices appear so regularly, and are so pregnant with potential, that they convince me there is no way cancer can last more than a few decades without a major, major dent put in its armor. · 2 hours ago

    I’m reluctant to predict the date of cancers’ death (and I put the apostrophe where I did on purpose) but certainly real progress is being made on many fronts and I expect that in the future it will be possible to prolong many lives longer, and maintain quality of many lives better, than it is today.

    • #30

Comments are closed because this post is more than six months old. Please write a new post if you would like to continue this conversation.