Where do we stand with the war on cancer?

“Are we winning the war on cancer?” The Walrus asked provocatively in its most recent issue (September/October 2023). It’s not the first time this question has been raised of course, both in the popular press (“In the war on cancer, science is winning” as per The Wall Street Journal in 2021) or in established scientific journals such as the Journal of Clinical Oncology on the 40th anniversary of the U.S. National Cancer Act in 2011 (“Are we winning the war on cancer?”) or in the journal Nature, which declared last year that “The war on cancer isn’t won yet”.

It was back in 1971 when President Richard Nixon signed the second National Cancer Act (President Franklin D. Roosevelt signed the original Act in 1937). The new Act expanded the National Cancer Institute’s (NCI) mission and jump-started the development of NCI-designated comprehensive cancer centres across the United States. Nixon considered the National Cancer Act to be the “most significant” achievement of his administration, passionately pressing for it in his State of the Union message, declaring “The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dreaded disease. Let us make a total national commitment to achieve this goal." He called it the War on Cancer.

Over fifty years later, the “war” has produced some encouraging results. Today, 2 in 5 Canadians can expect to be diagnosed with cancer in their lifetime, down from 1 in 2 just a few years ago. And more people are surviving their cancer, particularly children. Since the early 1990s, five-year childhood cancer survival rates have increased from 75% to 85%, and five-year cancer survival rates among adults have risen from 55% to nearly 65%, according to Statistics Canada.

But we’ve also seen progress in how we think about cancer. Since the War on Cancer was first declared over fifty years ago, we no longer see cancer as a single disease, but rather hundreds of diseases, each different in its own way. We now know, for example, that two patients with seemingly identical cancers may respond to two totally different treatments. At the same time, our growing understanding of cancer has made medical oncology much tougher because it means there can be multiple approaches to treating the same tumor. We’re not yet at the day where physicians and their healthcare teams can say to all cancer patients, “This is the best therapy for your cancer, and we know that it’s going to work”.?

For long-standing supporters who have invested in the War on Cancer, this is potentially frustrating. It’s also potentially baffling for younger generations who may not realize that cancer is a complex set of over 200 diseases that affects individual patients differently and that despite declining rates of tobacco use and exposure to asbestos and other carcinogens, the War on Cancer is not yet “won”, even though multiple decades of investment have occurred. “What’s taking so long?, people may wonder!

But progress is occurring. As a society, we’ve made huge advances in anti-smoking efforts since the 1970s, resulting in a drop in lung cancer mortality rates from a peak of 50 deaths per 100,000 people in 1990 to around 30 deaths per 100,000 in 2010. We’ve also made progress in cancer screening. Modern mammography programs can reduce breast cancer mortality by more than 40%, according to a 2022 study published by the Centers for Disease Control and Prevention. The same study notes that the over-50% decrease in cervical cancer incidence and mortality in wealthy countries over the past three decades is largely due to screening with the Pap test, which can detect cervical cancer at an early stage as well as precancerous abnormalities. Finally, a 2023 study published by the Institute for Healthcare Policy and Innovation at the University of Michigan estimates that preventive cancer screenings undergone by Americans over the past 25 years have saved the U.S. economy at least $6.5 trillion!

Today, we’ve learned more about cancer in the previous five to ten years than the preceding fifty, enabling new advances in surgery, radiation, and new medications, many of which have been transformative. Only a small minority of patients diagnosed with breast cancer will die of their disease, thanks to treatments like tamoxifen, for example. Similarly, Gleevec has been revolutionary in the treatment of chronic myelogenous leukemia. There have been other advances too since President Nixon declared his War on Cancer, many of them developed and studied at Princess Margaret Cancer Centre and funded significantly, or exclusively, by philanthropy.

These include things like CAR-T cell therapy, which is the process of reengineering a patient’s own immune cells to attack cancer, and new Crispr gene-editing technology that deploys a molecular defense system borrowed from bacteria that kills invading viral cells by “unzippering” their DNA. We also have new vaccines against the human papillomavirus (HPV), which causes cervical and throat cancer, and scientists are testing vaccines for melanoma, leukemia, lung, and renal cancers. Additionally, we’re testing simple blood tests in clinical trials for catching between 50-70 common cancers early, often years before symptoms occur and when cancer is most likely to be treated successfully.

Against the backdrop of modern advances in diagnosing and treating cancer is the world of artificial intelligence (AI), which we are already applying at The Princess Margaret, but where we will need to make greater investments in the future. Today we’re living in a world where a single AI program can write as much text as all of humanity, or a single two Gb image-generation model running on a person’s laptop can compress all the pictures on the open web into a tool that generates images with extraordinary creativity and precision. As the world’s leading cancer centre for the world, The Princess Margaret will continue to harness AI to transform cancer outcomes and experiences.

Finally, “war” was probably the wrong metaphor for dealing with cancer, perhaps creating false expectations of a rapid cure in the eyes of the public, in addition to the problematic ways that battle language can affect cancer patients and their loved ones, according to Scientific American and many others. But we must remember that cancer was a little-understood disease in the Nixon era, and it was unlike NASA’s Apollo program, which was based on the scale-up of existing technology. By 1980, the proof that many cancers are caused by oncogenes – mutated genes that normally control cell growth – was still fresh from the laboratory bench. Desktop computers, ubiquitous and essential in modern scientific laboratories, were just entering the commercial marketplace. And successful mapping of the human genome was still two decades away.

Real progress against cancer has definitely been made since the Nixon era. But there is still much to be done. While scientists rarely talk of a broad cure for cancer anymore, we know we must now make headway against the shortcomings of current cancer therapies, by, for example, tackling the cancers for which there is little to offer patients, finding ways to reduce the side effects of harsh cancer therapies, and addressing the racial and socio-economic inequalities that affect access to clinical trials and cancer diagnostics and treatments, both in Canada and globally. Furthermore, we know we can continue to make progress against cancer through early detection, screening, and prevention, including greater awareness of modifiable risk factors for cancer, as well as end-of-life care for cancer patients.

All of this requires new and significant levels of financial support, however, as well as deep creativity, collaboration, and energy. Cancer remains the leading cause of death in Canada, with nearly 224,000 Canadians diagnosed with cancer last year and 85,100 cancer deaths. Globally, cancer kills more people every year than HIV/AIDS, malaria, and tuberculosis combined. Every sixth death in the world is due to cancer and by 2040, the number of new cancer cases is expected to rise to 29.5 million and the number of cancer-related deaths to 16.4 million per year. Fortunately, at The Princess Margaret, we have a long history of tackling the hardest cancer problems and we also have an exceptionally generous, and growing, community of supporters. We won’t rest until we transform cancer outcomes and experiences – not just for “our patients”, but for cancer patients across Canada and around the world.

Wishing you all a great next few weeks. Mission Monday will return on Monday, September 25th.

Event News

• This past weekend was our 21st annual Walk to Conquer Cancer. Congratulations to our top individual fundraiser, Nancy Carroll, and a very special thank you to our other PMCF Directors and community members who participated, Mark Allison, Christina Kramer, Christie Love Thomas, Stacey Madge, David McGraw, Kerri Parslow, Mary Robertson, and Maureen Shaughnessy Kitts, along with all our walkers, supporters, and volunteers. It was great to see you at The Walk, which raised over $3.4 million for The Princess Margaret, and is higher than our Walk in 2019 before the COVID-19 pandemic! Check out the attached pic of Team McCarthy Tétrault and the fundraising leaderboard here. The top individual fundraisers are Nancy Carroll, Leila Rafi, and Egan Fitzpatrick. The top corporate and community teams respectively are: Scotiabank Fight Club, Team Coca-Cola Canada, Team PwC, and Walking for Our Heroes, Family Love, and The Way Forward. Also, a very special thank you to Dr. Tak Mak for speaking about the progress against cancer, Nirupa Muthuraja, our survivor speaker, as well as Drs. Keith Stewart, Brad Wouters and Camilla Zimmermann from The Princess Margaret/UHN!
• Check out our upcoming events: Road Hockey to Conquer Cancer will take place on Saturday, September 30th. Our second annual One Life Gala takes place on Saturday, October 21st at 7 pm at the Royal York.

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