Frontline Cancer: A one-size-fits-all strategy doesn't work fighting cancer

FRONTLINE CANCER:

Almost two years ago in his 2016 State of the Union address, President Obama launched the U.S. Cancer Moonshot initiative, a bold, ambitious set of goals to fight cancer, including achieving a decade's worth measurable, significant progress in half the time.

Almost half a century earlier, another president — Richard Nixon — famously declared "war on cancer," also during a State of the Union address. The resulting National Cancer Act of 1971 provided new emphasis and funding to defeat cancer, but it's hard to say who is winning.

In 2017, there will be an estimated 1.6 million new cancer cases and more than 600,000 cancer deaths, according to the American Cancer Society. In 22 states, including California, cancer has surpassed heart disease as the leading cause of death. Just 17 years ago, that fact was true in only two states (Alaska and Minnesota). In the 1950s, more than two-and-a-half times more people died of heart disease than cancer.

Following form this year, Congress passed the 21st Century Cures Act, 11 months after President Obama's call to action, allocating almost $2 billion in funding for cancer research, treatment and prevention.

Funding is crucial, of course, but perhaps more important is the question of how that money will be spent? How will the aspirations of the Moonshot initiative translate into real-world progress, in lives saved and cancers prevented.

Oncology Report

Recently, the Lancet Oncology commission, a product of the venerable British medical journal The Lancet (founded in 1823), issued a major report on what must happen next. In a nutshell, the commission declared that what happens next must be different than what has happened before.

I was one of the primary authors of the report, which featured input from dozens of the world's brightest minds in cancer research and treatment. The full report is both expansive and remarkably detailed, providing a roadmap with directions and 13 priority areas related to, among other things, early detection, immunotherapy, imaging, surgery, drug access, disparities and prevention.

That last effort is a particular focus of mine. Only half of patients who develop cancer can be cured with existing therapies; the other half will die of their disease. It is far better and more efficacious to prevent cancer than to try to ameliorate its effects, let alone find a cure.

Past efforts to prevent cancer have been limited and sometimes hindered by serious and substantial disparities. For a disease (really diseases) as disparate as cancer, a one-size-fits-all strategy does not work. The treatments and drugs for lung cancer are not the same necessarily for cervical cancer. Nor are any two cases of the "same" cancer the same in different patients. That's the premise of precision medicine and it should be for prevention efforts as well, such as screenings, which should be tailored by age, risk, demographics and other factors.

Colorectal screening rates, for example, are extremely low in Latinos, especially of poor income, but there are new programs that overcome language and social barriers to boost breadth and success. Obesity research is crucial given the growing global epidemic and promise of recent work in special energetics, sedentary behavior and meal timing. These strategies will have a great effect on minimizing morbidities and mortality from cancer in future generations.

Cancer prevention

Every element of the Lancet commission report is important and compelling. Patients, doctors, researchers and policy makers should read it carefully, take heed and take action. But I also note this: More than half of cancers are preventable.

Diet, nutrition, physical inactivity, chronic emotional stress, inadequate social support and obesity are all believed to be important contributors to increasing global cancer incidence. Our genes may predispose some of us to cancer, but they are not our fate. As individuals and as a society, we can reduce our cancer risk and burden by simply changing the way we live.

When enough people take these words to heart, cancer's days will be numbered even as our own grow.

 

— Scott M. Lippman, M.D., is director of UC San Diego Moores Cancer Center. His column on medical advances from the front lines of cancer research and care appear monthly in La Jolla Light. You can reach Dr. Lippman by e-mail: mcc-dir-lippman@ucsd.edu

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