This year marks the 40th anniversary of the National Cancer Act of 1971, the law that increased the budget, profile, and responsibilities of the U.S. National Cancer Institute (NCI) while ushering in what has become known as—for better or worse—“The War on Cancer”. So after four decades, $90 billion of NCI funding, and an even greater sum of private investment, how are we doing? At the risk of providing an unsatisfyingly evasive answer: it depends. On one hand, the steady collection of small victories in prevention, diagnosis, and treatment have led to a 20% decrease in the overall cancer-related U.S. mortality rate from the early 1990s until today. Nonetheless, for certain types of cancers—of the pancreas, brain, and liver, for example– things are moving slower. To extend the imperfect metaphor, then, cancer research is most definitely a slow, grinding, gradual war of attrition and not one of swift, sweeping, total victory.
The notion of a “cure for cancer” is perhaps complicated by an unfair comparison to public health triumphs against infectious diseases. During the 20th century, for example, smallpox was responsible for an estimated 300-500 million deaths. Widespread vaccination efforts have dropped that number to a big fat zero. In comparison, consider the numbers for childhood leukemia—diseases that are described as “cured” by many qualified oncologists. According to recent statistics, the current relative five-year survival rate for children afflicted with the two most common forms of this disease, acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML), is 77%. Though this number represents a nearly two-fold improvement in survival relative to what was achieved in the mid-1970s (42%), it provides a clear illustration of the tempered expectations associated with cancer treatment.
So why is it such a difficult foe to combat? Well if you can imagine a villain who is a shape-shifting master of disguise, can strike anywhere at any time by way of a vast array of different weaponry and (if that isn’t enough) can endlessly make copies of its destructive self, then you might begin to understand the challenges being faced. Metaphors aside, the reality is sobering: there are more than 100 different anatomical and histological subtypes of cancer with many of them having multiple molecular variants with different prognosis, clinical features, and susceptibility to treatment. The inherent genetic instability of cancers allows them to change rapidly and generate clones that are resistant to treatment.
The improved, if not completely satisfying, survival statistics for cancers such as childhood leukemia resulted from vital innovations in treatment, specifically, combination chemotherapy (combining several anticancer drugs) and adjuvant therapy (additional treatment given even after the disease is no longer detectable). Equally important are the two other “war fronts” of prevention and diagnosis. At the risk of blatant self-flattery, our Diagnostics & Biomedical Technology Domain here at the GE Global Research Center has played and will continue to play a crucial role in each of these broad efforts.
In fact, many of the more recent successes in cancer diagnosis and treatment over the past few years can be attributed to our specific project achievements, including ones that have been highlighted previously on Edison’s Desk. To provide a quick (re-) summary, we have:
– yielded new imaging platforms and agents for improved surgical precision in tumor removal
– generated enhanced analysis of tissue samples at the molecular level for better diagnosis
– provided crucial links between patient drug response and cancer disease markers
And these are only a few examples. With the myriad challenges still in existence, we can at least take some solace in the equally myriad opportunities for innovation that present themselves—opportunities that our diverse Diagnostics and Biomedical Technologies research team is uniquely qualified to address. So yes, the “war” rages on, 40 years and counting, definite progress, but many discoveries that need to be made. Needless to say, it’s time to get back to the lab . . .