October 7, 2013

Researchers review decades of progress in fight against cancer

The fight against cancer stands at a place of unprecedented progress, with research yielding new drugs, more knowledge about cancer-causing genes, better prevention and improved public awareness.

When Surgeon General Luther Terry released a groundbreaking report in 1964 linking smoking to cancer, the disease was a whispered word – and a likely death sentence.

In the decades since, researchers and doctors have worked to stamp out the many diseases known as cancer. And today, the fight against cancer stands at a place of unprecedented progress, with research yielding new drugs, more knowledge about cancer-causing genes, better prevention and improved public awareness.

Dr. Otis W. Brawley, chief medical officer for the American Cancer Society, estimates that more than 1 million American cancer deaths have been averted over the past 20 years.

In “1991 ... a lot of things that we learned about cancer actually started kicking in,” Brawley said. “It takes a long time to apply them, and then once you start applying them, you finally, finally ... get to a point where things start getting better.”

Researchers and physicians such as Brawley have watched in recent years as care has become increasingly personalized and highly targeted. Today, the risk of death from cancer is 20 percent lower than it was 20 years ago, according to society figures.

Certain cancers have seen even greater declines in death rates: There has been a 39 percent decline in colorectal cancer death rates, a 34 percent decline for breast cancer and a 20 percent decline for lung cancer, Brawley said.

Progress has occurred on all fronts, including disease prevention, detection strategies, surgery, radiation therapy and systemic treatments, according to Dr. William Nelson, director of the Baltimore-based Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Drug advances working

For progress to continue, innovation like this cannot be stifled by policy change, said Andy Hill, a Republican state senator in Washington, who was diagnosed with lung cancer in 2009 at 46.

“My hope is that when my kids are 50, 60, 70, and they’re diagnosed with cancer, they do a test and take a pill to vanquish it,” he said.

Given recent advances, Hill’s vision seems increasingly possible.

Researchers say new knowledge about what goes wrong in cells and the study of specific genes is creating more pinpointed treatments. Further, the development of anti-cancer drugs has taken off and become more cost effective, making it easier to get new drugs approved, Nelson said.

“As we have defined the processes that are involved in a cell becoming cancerous, we’ve actually started redefining cancer,” Brawley said. “We’ve gone from a 19th-century definition of cancer to a 21st-century” one.

“That will help us fine-tune our treatments even further,” he added.

Individualized care

Under this new definition, a patient’s specific type of cancer will be less important than which gene causes it. Doctors can identify the genes that are “acting up” and use targeted drugs to block their activity, Brawley said. Some such drugs are already being successfully used.

Chronic myeloid leukemia, breast cancer and prostate cancer are among the diseases that have responded well to these gene-targeting treatments, said Dr. Ruben A. Mesa, deputy director of the Mayo Clinic Cancer Center.

“Really, it is a tremendous era of trying to individualize cancer care,” Mesa said. “We’re at the beginning of the new wave.”

Hill, the Washington state senator, was among the first patients to ride that wave. After his cancer spread to both lungs and his lymph nodes, Hill found a trial drug called crizotinib that could target his specific gene mutation.

“It was really miraculous. Within a week most of my symptoms had disappeared and within three weeks I was jogging again,” he said.

Hill is an example of an increasingly common new breed of cancer survivor: one who may not be cured but can live with the disease.

“I’m not able to say that we’re going to have a cure,” Brawley said. “My vision of cancer in the future is that many of these diseases are going to become much more like diabetes: They will be chronic diseases.”

Other doctors are optimistic that some cancers can still be eradicated completely.

“We are curing cancers, even in a very advanced stage, ever more often than we were,” Nelson said. “There’s a huge amount of hope that we finally understand enough about how the immune system works that we’re going to be able to use it to control and eradicate these cancers more effectively.”

The progress has been aided by increased public awareness and better prevention. As facts about cancer become common knowledge, people are becoming more proactive about health. For example, self-detection is now the second most common way breast cancer is found, Brawley said.

Research money key

Funding is arguably the most vital link in the chain of continuing progress.

“One of the problems of talking about this today is that the federal research program is being impacted right now by the government shutdown. It’s a juxtaposition of the most promising signs (of progress) ever and some very unfortunate political decisions leading to an unnecessary slowing of research,” said Dr. Clifford A. Hudis, chief of breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York, referring to federal budget cuts and the current government shutdown.

In spite of such challenges, experts agree that the fight against cancer is at a better place than ever.

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