Frontline Cancer: A fight for the ages

No one dismisses the health threat of cancer. The disease, in its myriad forms (hundreds and counting), kills almost 575,000 Americans annually, reports the U.S. Centers for Disease Control and Prevention. And yet sometimes, I think, the enormity of cancer’s threat is not fully realized.

Heart disease is currently the nation’s No. 1 killer: Almost 600,000 American deaths annually. But drawn on a graph, the lines representing the mortality rates of cancer and heart disease are converging. As George Johnson recently noted in his excellent

New York Times

essay titled “Why Everyone Seems to Have Cancer,” cancer is on the verge of becoming the No. 1 cause of death.

In San Diego, that’s already happened.

To be sure, there have been distinct and significant advances in the treatment and prevention of both killers.

It’s just that there have been comparatively more in the case of heart disease. Profound improvements in lifestyles and behavior (diet, exercise, no smoking), for example, combined with new drugs, devices and surgeries mean the average American today is much less likely to die of heart disease than just a generation ago.

The same cannot be said of cancer. Progress has been decidedly more gradual. Only a handful of cancers, primarily those of childhood, have been dramatically tamed. All human diseases are complicated, but none more so than cancer. Confounding this fact even further, cancer is a disease of aging — and of living.

We are all in a constant state of flux, with cells continuously dividing and copying DNA to produce replacement cells, over and over and over throughout our lives. Errors or mutations inevitably occur. They are, as Johnson notes, “the engines of evolution.” Sometimes these mutations are benign and transient. Sometimes, they are beneficial and change a species for the better. Sometimes, they produce cancer.

Our bodies have evolved marvelous ways to identify and fix most of these glitches, but not all. And as we age, mutations accumulate and some consequently result in cancer. Indeed, as Trey Ideker, Ph.D., leader of the cancer genomes and networks program at Moores Cancer Center, and colleagues recently noted in published research: Cancer is a kind of accelerated aging. Tumor cells divide and grow with rapid abandon, wreaking havoc and eventually overwhelming our aging and increasingly less robust system of defenses.

Live long enough, it’s said, and everyone dies of cancer.

The war against cancer is a slog. Understanding its mysteries, distinct for each type in each patient, is hard work. It demands novel and evolving ways of thinking and creative, changeable approaches in science.

One example can be seen in the on-going work at the Sanford Consortium for Regenerative Medicine (SCRM), an unprecedented collaboration of five leading scientific institutions on the Mesa: La Jolla Institute for Allergy & Immunology, the Salk Institute for Biological Studies, the Sanford-Burnham Medical Research Institute, The Scripps Research Institute and UC San Diego (of which Moores Cancer Center is part).

The mission of SCRM is to advance stem cell research. It does so through two different types of teamwork that, outside of San Diego, are often unheard of, but are critical to catalyze major advances in cancer research and care.

First, SCRM literally brings together stem cell scientists from different disciplines and institutions. They share the same building and vision, leading to “out of the box” approaches to transforming cancer care.

Examples abound: Catriona Jamieson, M.D., Ph.D., an associate professor of medicine in the School of Medicine, who co-leads the hematologic malignancies program at Moores Cancer Center, studies and treats blood diseases, works with Larry Goldstein, Ph.D., director of the UCSD Stem Cell Program, on different forms of leukemia.

Both collaborate with John Reed, M.D., Ph.D., the former chief executive of Sanford-Burnham Medical Institute.

Similarly, Maike Sander, M.D., a professor and pancreatic developmental biologist at UCSD is collaborating with Tannishtha Reya, Ph.D., a professor in the Department of Pharmacology and Moores Cancer Center who is investigating how stem cells determine their fate — a decision that has profound implications for leukemia and pancreatic cancer.

The second type of teamwork involves sharing unique, expensive equipment and core facilities — the next-generation devices and technologies that make it possible to probe the deeper mysteries of cancer. One such effort involves single cell genomics — the ability to identify differences between individual cells in a seemingly homogeneous population.

In other words, to perhaps find and target a solitary cancer cell hiding among many healthy neighbors.

This kind of work, which is being done by UCSD scientists like Gene Yeo, Ph.D., an assistant professor of cellular and molecular medicine, often means extending and developing resources beyond those of academia. It means creating public-private partnerships with drug and biotech companies that share goals and aspirations.

Recently, the World Health Organization projected that new cancer cases would skyrocket globally from an estimated 14 million annually in 2013 to 22 million each year by 2034. Cancer deaths worldwide would rise from 8.2 million annually to 13 million each year.

These are gloomy numbers, but they are not inevitable. We can — and must — do better. I believe we are — and will — do better through efforts like SCRM. It represents a real and legitimately new way to fight cancer. We won’t win the war anytime soon, but I think we’ll all live long enough to see some major victories.

— 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