As a physician-scientist specializing in oncology, I find President Obama’s State of the Union announcement of a “cancer moonshot,” as some have called it, exciting and hopeful.
Cancer is the second most common killer of Americans and is destined to become the leading cause of death within the next decade. The American Cancer Society estimates that 1.69 million Americans will be diagnosed and 596,000 Americans will die of it in 2016. It is estimated that one in three American women and one in two American men will be diagnosed. It is a disease that affects virtually every American. We all have friends or relatives who have faced cancer diagnoses.
From my position, I get to see what has been accomplished and what can be. With current knowledge, we can do so much more to prevent considerable numbers of people from suffering and dying from this disease and do it much more efficiently. The more we learn, the closer we get to controlling this dreaded disease.
I like the moonshot analogy. We need a concerted, organized effort with a leader and a goal.
What cancer research and cancer medicine need right now is someone to take command and control it. In the 1960s, the NASA administrator served this function in the original moonshots. The administrator’s job was to determine how money could best and most efficiently be spent. The federal government has had an AIDS czar for more than two decades. The command-and-control approach has been very effective in reducing the impact of the HIV/AIDS epidemic.
The President’s commitment to a moonshot against cancer, led by Vice President Joe Biden, is a galvanizing call for a renewed effort to find new tools to fight cancer.
What is the ‘moon’ made of?
Cancer is more than 200 illnesses with uncontrolled cell growth (or mitoses) in common. All cancers will not be cured this year, in 10 years, 50 or even 100 years; but we can do better. It is very reasonable to expect more cancers will be curable in the future. Even more cancers will become controllable, meaning some cancers will become more like diabetes or HIV. Patients will live with long-term treatment in peaceful coexistence with their disease, enjoying a good quality of life for prolonged periods.
When it comes to cancer, we live in times of tremendous opportunity and promise.
In just the past few years, numerous molecular targets important in malignancy have been discovered and many drugs developed to affect those targets. Today, chemotherapy can cure many leukemias, lymphomas and testes cancers.
Screening and early detection, combined with appropriate therapy, clearly lower the risk of death from breast, lung, colon and cervix cancer. Good scientific studies show that screening and appropriate intervention actually prevent development of some colon and cervix cancers. Science has also told us the major causes of cancer. This has helped us prevent some cancer and realize that about 40% of cancers are preventable.
In 1971, President Richard Nixon signed the National Cancer Act into law. This legislation provided money and programs that have been useful in determining the causes of cancer and outlining interventions to prevent it and have given us a tremendous understanding of the cellular and molecular biology of cancer.
Research, treatment and prevention
Research has given us a better understanding of cancer and helped redefine it from a 19th-century definition that involved what it looked like under a microscope, to a 21st-century definition that involves a microscopic description and genomics.
While Obama’s proposal seems heavily focused on development of new treatments, there does need to be support for research in prevention, screening and the dissemination of new research findings.
Cancer medicine, like all of American medicine, is at a crossroads. America spends more per person on health care than any country in the world, and cancer care costs have been rising faster than other medical costs. We are not getting our money’s worth. Despite the highest costs, America does not have the lowest cancer death rates.
Many G8 countries have better outcomes because larger proportions of their cancer patients get high-quality care. The American health care system is dogged with terrible inefficiency and waste. The problem is not just that substantial numbers of Americans have limited or no access to treatment. The problem is also that substantial proportions of American cancer patients get less than optimal cancer prevention and treatment.
Evidence that we can prevent thousands of cancer deaths by better use of current technologies is not hard to find. America has had a 40% decline in the age-adjusted breast cancer death rate since the early 1990s. This number reflects dramatic declines in 36 states, without a decline in the other 14, which need to be caught up. There are similar examples in colorectal and other cancers. Medical science has already made huge leaps in our understanding of the inner workings of the cancer cell, and there is much left to learn.
Done right, the cancer moonshot can build on our past investment, and spur even more progress against the disease.
Finally, we should not underestimate the effectiveness of cancer prevention. The U.S. has had a 23% decrease in age-adjusted cancer mortality rates since 1990, and research has shown us that the leading reason for the decline is prevention activities. Improvements in treatment and improvements in screening are also important in the decline but to a lesser extent.
However, we should remember that just as important as continuing to explore new therapeutics and prevention is a concerted effort to gather what we already know about cancer and find ways to apply these tools more effectively to save lives.
