Posted Thursday, Feb. 7, 2013, at 5:18 PM
Photo by Phillippe Huguen/AFP/Getty Images
This question originally appeared on Quora.
Answer by David Chan, MD, Oncologist :
I'll be the first to admit that despite all the billions put into cancer research, the end results of preventing cancer and treating advanced cancer have been disappointing.
Unlike reducing deaths from heart attacks and stroke, progress in reducing deaths from cancer has been disappointingly slow. Sure, we've had our breakthrough drugs like Gleevec, the targeted drug for chronic myelogenous leukemia, and Herceptin for a certain type of breast cancer. But for a lot of other cancers, the treatments aren't giving us bang for the buck. Spending $100,000 to $200,000 a year to extend life for an additional three to six months may be very important to those individuals with cancer, but are a very poor return on investment for society. It's not sustainable, and that's why a lot of national health care programs won't pay for drugs like Avastin, Sutent, Yervoy, and Provenge.
Dr. Margaret Cuomo (sister of New York Gov. Andrew Cuomo) wrote about her perspective on this in her recent book, A World Without Cancer.
On the amount spent on cancer research:
"More than 40 years after the war on cancer was declared, we have spent billions fighting the good fight. The National Cancer Institute has spent some $90 billion on research and treatment during that time. Some 260 nonprofit organizations in the United States have dedicated themselves to cancer — more than the number established for heart disease, AIDS, Alzheimer’s disease, and stroke combined. Together, these 260 organizations have budgets that top $2.2 billion."
On how ineffective the research has been for end results:
"It’s true there have been small declines in some common cancers since the early 1990s, including male lung cancer and colon and rectal cancer in both men and women. And the fall in the cancer death rate — by approximately 1 percent a year since 1990 — has been slightly more impressive. Still, that’s hardly cause for celebration. Cancer’s role in one out of every four deaths in this country remains a haunting statistic."
What does she suggest?
"Simply put, we have not adequately channeled our scientific know-how, funding, and energy into a full exploration of the one path certain to save lives: prevention. That it should become the ultimate goal of cancer research has been recognized since the war on cancer began. When I look at NCI’s budget request for fiscal year 2012, I’m deeply disappointed, though past experience tells me I shouldn’t be surprised. It is business as usual at the nation’s foremost cancer research establishment. More than $2 billion is requested for basic research into the mechanism and causes of cancer. Another $1.3 billion is requested for treatment. And cancer prevention and control? It gets $232 million altogether. (Remarkably, in the very same budget report, the NCI states, “Much of the progress against cancer in recent decades has stemmed from successes in the areas of prevention and control.”)"
As a result of the billions put into cancer research, we do know a lot about what causes cancer, how cancers grow, and how cancers spread. We have ideas about how to stop cancer. But the process of translating laboratory advances into the clinic has been agonizingly slow. This because cancer isn't one disease, but a general term for many diseases that have some things in common and many things that vary from one type of cancer to another.
Even within a cancer, like breast cancer, we are finding that there are different subtypes that have different molecular signatures that should be attacked in different ways. And we're making progress.
But we should also understand that for the most part, cancer is a disease of aging, and we aren't close to solving that problem. We're finding that cancer survivors are developing second and third cancers. So there are going to be significant limits on what cancer treatment can accomplish. I don't think that we'll ever defeat aging.
Let's also accept some personal responsibility. The leading cause of cancer death is lung cancer. We know what causes it, and we know how to prevent it. But people continue to smoke. So in America ...
"Lung cancer causes more deaths than the next three most common cancers combined (colon, breast, and prostate). An estimated 160,340 Americans were expected to die from lung cancer in 2012, accounting for approximately 28 percent of all cancer deaths."
Cancer researchers can't be blamed for that statistic. Stop smoking and that death rate will drop by 85 percent.
What about obesity. It's pretty clear that about one-third of all cancers are related to being overweight. We've publicized the data, and yet we're getting fatter by the year.
"Results from the 2007-2008 (NHANES) show that 68 percent of U.S. adults age 20 years and older are overweight or obese."
"One study, using NCI Surveillance, Epidemiology, and End Results (SEER) data, estimated that in 2007 in the United States, about 34,000 new cases of cancer in men (4 percent) and 50,500 in women (7 percent) were due to obesity."
Why don't we like cancer prevention? Isn't prevention better than cure? Cancer researchers know that hepatitis B is the leading cause of liver cancer and HPV is the leading cause of cancers of the cervix, anal canal, and contributes to many head and neck cancers.
But 50 percent of Americans have not been vaccinated for hepatitis B. The HPV vaccine rate is even lower.
"The 2010 version of the CDC's National Immunization Survey-Teen was published in a recent . The survey found that the proportion of adolescents ages 13-17 who had received at least one dose of HPV vaccine increased from 44.3 percent in 2009 to 48.7 last year. The proportion of teens who had completed the series increased from 26.7 percent to 32.0 percent."
If we're not curing cancer effectively, we know how to reduce the risk preventatively, but as a society, we're not doing that.
We haven't spent our money wisely, the graph on proportional cancer funding for research shows how much is spent on breast cancer relatively to other cancers. This is because of how effective the breast cancer lobbying and activist groups have been in obtaining research funding.
But what about the results? As a breast cancer specialist, I can say that we spending multiple hundreds of millions on clinical studies that show improvements of 2 percent to 3 percent. These small incremental advances in treatment would be laughable or ignored in other cancers. We aren't spending our money efficiently.
In summary, I can say that we've made progress. Cancer patients are living longer, and the newer treatments definitely have less side effects. There are a lot of very dedicated researchers doing their utmost best to find treatments and cures for this terrible group of diseases. I think that everyone in the cancer field feels badly that we haven't done better with the resources given us.
But at the end of the day, we've got to accept responsibility for our lifestyles. And we have to understand and accept that we're not going to stop aging. So we're not going to stop getting cancers.
More questions on cancer:
- What can I do to live as long as possible?
- What are the latest and most promising cancer fighting drugs/treatments on the market?
- What are some resources for wives whose husbands have been diagnosed with cancer?
Update, Feb. 11, 2013: This post was updated to include the title of the book by Margaret Cuomo that the author quoted from.