Weapons in the Fight

We know enough about cancer to think a cure might not be possible. But we’re well on our way to draining its power.

Cancer has plagued humanity for at least thousands of years. Finding a cure for cancer has been held up as a gold standard in medical breakthroughs that would usher in an era of long, happy lives. There are a couple things wrong with that outlook. One, the more we learn about cancer, the less the scientific community believes we can actually eradicate cancer. Two, as we get better at treating and preventing cancer, it becomes more of an affliction for the elderly. Our cells are constantly dividing, and it’s almost inevitable that some will have cancerous mutations. Thanks to research, we now know that cancer is not truly one disease, but more than 200 distinct diseases, each with many subtypes. We might never cure cancer altogether, but doctors and scientists do believe we will “end cancer as we know it today.”

Cancer Moonshot

The government has been fighting cancer on the federal level for a long time. The National Cancer Act of 1937 established the National Cancer Institute to research causes, diagnosis, and treatment of cancer. The National Cancer Act of 1971 strengthened that research, investing $1.5 billion over three years on research centers, clinical trials, and other infrastructure. It did not, as then-President Richard Nixon hoped, bring about a swift cure. But it did lead to a much greater understanding of the biology behind cancer and some breakthrough treatments. From its peak in 1991, the age-adjusted death rate for cancer patients has dropped more than 25%. That’s thanks to treatments for specific mutations, immunotherapies, vaccines, low-dose CT, and colonoscopies, to name a few tactics in a wholesale approach. We’ve been steadily making progress for decades.

The latest federal push is what the Biden administration calls the Cancer Moonshot. The goals are “to reduce the death rate from cancer by at least 50% over the next 25 years and improve the experience of people and their families living with and surviving cancer — and, by doing this and more, end cancer as we know it today.”

Cancer remains the second-leading cause of death in the U.S. and is expected to overtake heart disease in the next few years. The Cancer Moonshot initiative has increased funding for the National Institutes of Health and the NCI, along with the Advanced Research Projects Agency for Health. The concrete steps it aims for in reducing the ill effects are to prevent cancer cases, diagnose sooner, address inequities in research and screening, determine the right treatments for specific patients, speed progress against the most deadly cancers, and support and learn from patients, along with their families and caregivers.

Prevention & Early Detection

Of all those, prevention is the most important. It’s less costly in the long run and it’s obviously much easier to live a long, cancer-free life if you don’t get it in the first place.

“We will always need good treatments,” Timothy Rebbeck of the Harvard T.H. Chan School of Public Health and Dana-Farber Cancer Institute, told Harvard Public Health magazine, “but we can’t treat our way out of this problem. In order to make a dent in a public health sense, we must prevent cancer.”

To prevent cancer, you have to zero in on the chief causes. In the U.S., smoking rates have decreased considerably in the last 20 years, leading to significant declines in lung cancer. This is especially good because “many lung cancers are asymptomatic until they are very advanced,” says Sanford Health hematologist/oncologist Amy Sanford. Without screening, many lung cancer patients don’t know they have it until it’s too late to do much.

Unfortunately for the U.S. and other developed nations, much of the progress made thanks to a decrease in smoking has given way to a rise in obesity-related cancers. An estimated 40% of American adults are obese, and obesity could soon become the top cancer risk factor in the U.S. and worldwide.

Second to outright prevention is early detection, which can prevent cancers from spreading through the body and becoming untreatable. More screening for more people, with easier access, is the key here. That’s where technological advancements such as liquid biopsies come in.

“(O)ne can imagine a day when healthy individuals are routinely tested for these biomarkers to detect early cancers, along with lipid concentrations to detect early cardiac disease, at periodic visits to their physicians,” the Harvard scientists wrote in Science in 2018.

Reducing Risk

While researchers continue to work on breakthroughs and the government continues to fund the research, there are things we as individuals can do to reduce our risk of getting cancer. The European Union has gathered the most important as part of its European Code Against Cancer.

First and foremost is to not smoke or use any form of tobacco and to avoid exposure to tobacco smoke. Second is to keep your body healthy by being physically active every day and limit the amount of time you spend sitting. A companion to this is a diet with more whole grains, vegetables, and fruits, and less red meat and foods high in salt, sugar, or fat. Other steps are to limit alcohol consumption and sun exposure. Children are especially vulnerable to harmful sun exposure, so make sure to apply sunscreen to them. Have your home tested for radon if you haven’t yet and take actions to reduce radon levels if they are found to be high. Vaccinations against cancer-causing pathogens such as Hepatitis B and HPV can work wonders on prevention, and regular screenings such as colonoscopies, mammograms, and Pap smears or newer cervical screenings can catch cancers early.

The medical and scientific communities are working on ways to convince people these measures are worth it.

“We often develop interventions without thinking about the end users and what could get in the way of true impact, so shame on us as a field,” Harvard professor of social and behavioral sciences Karen Emmons said. “As a scientific community, we think, rather arrogantly, ‘Well, we’ve shown that colorectal cancer screening is important—why don’t community health centers just make sure that everybody has colorectal cancer screening? It’s clear that vaccines are important—why aren’t all kids getting the HPV vaccine?’ But the real question is: How do you structure systems to make those goals possible?”

It seems we won’t ever cure cancer, but with everyone doing their part, we can make it much less the scourge that has caused us so much suffering. That’s motivation enough.