Frontline Cancer: Transformative period in cancer prevention
• FRONTLINE CANCER:
One year ago this month, a pair of distinguished researchers at Johns Hopkins University published a study that essentially concluded getting cancer is just “bad luck,” the unfortunate result of random mutations during DNA replication.
It was a startling statement, undermining the fundamental premise of cancer prevention, and it quickly prompted contentious debate among scientists and doctors. New research testing the Hopkins’ hypothesis published last month in Nature has come to the opposite conclusion: Cancer is not bad luck. It is, in fact, mostly preventable.
This hopeful message was recently proclaimed in a special report on the future of cancer prevention research, published in the journal of the American Association for Cancer Research (AACR) by some of the nation’s leading cancer researchers, including Elizabeth Blackburn, former president of AACR, new president of Salk Institute for Biological Studies and an attendee at the recent World Economic Forum in Davos-Klosters, Switzerland to discuss the topic.
(Full disclosure: I’m a co-author of the report, member of the AACR Board of Directors and Cancer Prevention Committee and editor-in-chief of Cancer Prevention Research. This is a topic close to my heart and an emphasis in my decades of cancer research and practice.)
The National Cancer Institute (NCI) has also highlighted this transformation in its Jan. 13 Cancer Currents Blog by Barry Kramer, director of National Cancer Institute’s Division of Cancer Prevention.
We have entered a transformative period in cancer prevention, and just in time. The American Cancer Society recently described a “rising global cancer epidemic,” with nearly 8 million people dying from cancer each year worldwide. The recent pace of cancer prevention research and translation has been astonishing, with advances in next-generation sequencing, liquid biopsy technology, big data analytics and immune oncology. These approaches are revealing the molecular and cellular events that launch the genetic, epigenetic (changes in gene expression without changes in the actual DNA) and tumor inflammatory microenvironment alterations that drive development of cancer.
In other words, this is the work that can – and will – lead to new drugs, vaccines and therapies that prevent the mutations that result in “bad luck,” treat premalignancy and detect cancer at an earlier, curable stage.
The AACR special report has much to say. Here are some of the major cancer prevention advances in just the last two years, largely through precision medicine and immune-oncology (boosting the body’s natural defenses to fend off malignancies):
Advances in genomics and the improving ability to crunch extraordinary amounts of data are fueling efforts like those of investigators at the Iris and Matthew Strauss Center for the Early Detection of Ovarian Cancer, who reported last year the discovery of six ovarian tumor-specific mRNA isoforms (from more than 350,000 genome-wide) and now in clinic trial at Moores for early detection of ovarian cancer with a pap smear. Other related efforts include the Cancer Cell Mapping Initiative, a collaboration involving Moores Cancer Center, the Helen Diller Family Comprehensive Cancer Center at UC San Francisco and others. Similarly, there is a “Pre-Cancer Genome Atlas” in the works.
Genomic markers for early detection of colon and lung cancer have been validated for standard clinical use. Liquid biopsy technologies, which seek to identify tell-tale clues of lurking cancers in blood samples, have shown promise in pancreatic cancer research. Moores is part of a five-center team (funded last year by the NCI), which includes UCSF and MD Anderson, that focuses on the critical need for blood-based biomarkers and imaging tools for early detection of pancreatic neoplasms at a potentially curable stage.
There have been major advances in the global implementation of the human papillomavirus vaccine and development of non-viral vaccines for colon and breast cancer, including in hereditary cancer syndromes, such as BRCA mutation carriers.
More expansive screenings and improved lifestyle research on major cancer risk factors, such as obesity and physical activity, are reducing the risk of cancer. Population-science researchers at Moores, funded by the National Institutes of Health, have contributed substantially to national and international guidelines and innovations like GPS devices that help prompt beneficial behavioral change. Obesity control is also a major focus of a recently awarded, unique NCI-funded partnership between UC San Diego and San Diego State University to reduce cancer in Hispanic populations in San Diego and Imperial counties.
These are just some of the diverse efforts in progress. We stand at the edge of a new frontier. It’s been a long journey, with plenty of wrong turns and dead-ends. Cancer possesses the ungodly ability to defy effective treatment. Cancer and premalignant cells can change their surrounding microenvironment to cloak their presence while drawing out additional sustenance and support from its host (us). They are diverse and complex cell masses that mutate and evolve constantly, reducing the odds of total destruction while increasing the chances of rebound, return, spread and kill.
President Obama recently challenged American medical science to cure cancer, “once and for all.” That is a very tall order. It won’t happen anytime soon. It may be easier – and happen earlier – if we simply learn, and effectively implement, how to prevent this scourge and its “bad luck” from happening in the first place.
— Scott M. Lippman, MD, is director of UC San Diego Moores Cancer Center. His column on medical advances from the front lines of cancer research and care appears in the La Jolla Light the fourth Thursday of each month. You can reach Dr. Lippman at firstname.lastname@example.org