The reality of the timeline of 'curing' cancer

In 1971, President Nixon declared a war on cancer. In the more than fifty years since that declaration, how much money do you think has been spent on cancer research globally?

The answer: about half a trillion dollars – yes, half a trillion dollars, at least according to Dr. Harriet Feilotter, a genetics professor at Queen’s University and Director, Molecular Diagnostics at Kingston Health Sciences Centre.

So, why haven’t we cured cancer yet? What’s taking so long, you might be wondering? (To shorten your reading, go to “Event News” at the end of this note and watch the TED Talks on this topic later).

First, cancer is in fact a rare disease. And rare diseases are hard to treat because they are often not well understood. Now, you’re probably wondering, how can cancer be a rare disease when it’s the second leading cause of death globally, the leading cause of death in Canada, and with 2 in 5 Canadians expected to be diagnosed with cancer in their lifetime? Isn’t cancer a frighteningly common disease?

However, cancer originates from a single cell, and there are over 200 different cell types in the human body, if not more. As such, what we think of as one disease – cancer – is at least 200 different diseases because it can come from any one of these different cell types. It’s taking a long time and a lot of money to “cure cancer” because scientists aren’t searching for a singular cure for cancer.

Second, even if scientists find cures for the approximately 200 different types of cancer we know exist, that’s likely not enough to claim victory. Thanks to scientific research, with a large portion of that research funded through philanthropy, we now know that every cancer arises from different causes, for different reasons, and it responds differently to treatment. Cancer cells mutate and as the tumor grows, more and more mutations accumulate. And because every tumor has a unique set of mutations, a drug, for example, that works for one person might have no effect on another.

Interestingly, this can even apply to identical twins, who share 100% of the same DNA. But twins are exposed to different environmental factors throughout their life which can switch normal genes on and off, such as the tumor-suppressor genes responsible for shutting down cancer cells when they begin to grow. Thus, no two cancers are the same, even if two patients are diagnosed with the same cancer, at the same stage of disease progression, and have other attributes in common such as their age, gender, socio-economic backgrounds, or lifestyle risk factors. Every cancer is unique, making any individual cancer patient’s disease “rare”, hence the need for more “personalized medicine”.

Third, it’s also taking a long time to “cure cancer” because through cancer research, we’ve learned that tumors are not static entities. Tumors evolve over time, usually in response to the treatments they’re being given. Cancer cells can even become immune to treatment or, more disconcertingly, hide from treatment, as we’ve learned from recent research at The Princess Margaret (see the podcast with Princess Margaret researcher, Dr. Catherine O’Brien, on how colorectal cancer cells can “hibernate”). And if a cancer stem cell manages to evade the drugs given to a patient, a relapse could happen several years later, even if the initial treatment appeared to be a success. In other words, some cancer cells are very good at staying alive and this makes any form of cancer potentially very hard to “cure”.

Despite how things may seem, though, cancer treatment has improved significantly over the last several decades. That half a trillion dollars spent globally since 1971 has not gone to waste! Survival rates have doubled since the 70s in the developed world, with 50% of all cancer patients now going on to live for at least 10 years after their diagnosis, and survival rates for some cancers as high as 80%-90%. Of course, a lot more work needs to be done in global cancer control, to which our Global Cancer Program at The Princess Margaret is dedicated. But there have also been improvements in the early detection and treatment of cancer, including a simple blood test to detect cancer early, often years before symptoms may appear, invented by Princess Margaret scientists funded by the Gattuso and Slaight Family. And immunotherapy is now a common cancer treatment, not to mention the major successes we’ve seen over the decades in cancer prevention, especially with regards to the dangers of smoking, UV radiation, and obesity.?

Finally, in 2022, an estimated 233,900 new cancer cases will be diagnosed in Canada, and 85,100 Canadians are expected to die from their cancer. It can be daunting to think about how we can put a dent in these numbers, as well as depressing to think about all the money spent on cancer research over the decades, especially in the absence of proper context. But at The Princess Margaret, we shift paradigms in cancer. And through research, we now know that cancer is a disease where every instance of the disease is different, where every instance of the disease may be more than one disease process, and where the disease process changes over time. In other words, just as our reasons for supporting cancer research are as individual and unique as every person (see the attached photos from this weekend’s Northern Pass to Conquer Cancer), so too is every person’s cancer.

Shifting our thinking about cancer to a rare disease since no two cancers are exactly alike, even though cancer is commonly diagnosed, helps us to understand both the urgency for even greater funding for cancer research, as well as appreciate how far we have come over the past few decades in our understanding of cancer – and in cancer survival rates. So, just because we don’t hear about breakthroughs in cancer research all the time, doesn’t mean they’re not happening. At The Princess Margaret, thanks to our supporters and our world-leading scientists and clinicians, progress is being made every day.

Best,

Miyo

Events News:

To learn more about today’s Mission Monday topic, check out these talks:

• Why Haven’t We Cured Cancer? 2018 TEDx Talk at Queen’s University by Dr. Harriet Feilotter
• Why Is It So Hard to Cure Cancer? 2017 TED-Ed talk by Dr. Kyusun Yun
• SciShow: Why We Haven’t Cured Cancer 2015

To learn more about our early detection technologies, join our Breaking Ground webinar on Tuesday, August 9 from 11:00 a.m. to 12:00 p.m. EST, where you’ll hear from our world-leading researchers in genetics and early detection, and special guest, Dr. Arif Bhalwani, Co-Founder and CEO of Third Eye Capital and the lead donor of The Bhalwani Familial Cancer Clinic. Register here.