A few months ago I was talking to someone and mentioned I volunteer in an advisory capacity at Dana Farber Cancer Institute. She looked at me and said, “It just shocks me that they haven’t found a cure for cancer. Actually, I think they have but the government and the pharmaceutical companies are hiding it from us because they would lose so much money.”
I was blown away. Really? Do others think that way? Should curing cancer be that simple? I took a step back and realized that because of the work I do and my personal interest in the topic my understanding may be very different from most.
This week I thought I would write about what I believe to be so exciting today in cancer research. As I sit here writing I realize that today is my mother’s birthday. She would have celebrated her 77th birthday if she hadn’t succumbed to one of the most lethal cancers around (lung cancer) and I think if only there had been something to help her, she would be here today celebrating with her loving family.
Let’s be honest. The word “cancer” makes most people uncomfortable. It is “cringe worthy” for sure. We all know someone who has had cancer or maybe we have had it ourselves and the word is still a difficult because of all it represents and the emotion it evokes. Cancer is not a topic most people want to discuss. I hope to show you the side of it that we can get excited about and talk about in a positive way.
Last week, PBS aired a program called “Cancer: The Emperor of All Maladies” based on the Pulitzer Prize winning book by Siddhartha Mukhurjee. It is absolutely fascinating and I urge you to watch it. It is not the lie on the couch, shut of your brain television that I often like to watch after an exhausting day but if you ever wondered why we haven’t cured cancer, why so many people are still dying from cancer you should check it out. http://cancerfilms.org
My husband always wonders why I would want to watch a show, read a book or have in-depth discussions about cancer because it has touched my family and me so personally. Again, it brings emotions to the surface we often like to bury. The answer is that I have a vested interest in what is being done scientifically to make a difference and prevent others from having to go through what I have been through. And it is because I have hope for the future. My hope is if I develop cancer again or someone in my family does, there will be something newly discovered to manage it and hopefully cure it. Honestly, we should all have a vested interest in this research. 1 in 2 men and 1 and 3 women will get cancer in their lifetime. 78% of those diagnoses will be in people over age 55. As we live longer the numbers will go up with our demographics. We are all in this together.
Did you know that as long as human beings have lived cancer has afflicted us? Our oldest description of cancer dates back to 3000 BC in Egypt. If you think about cancer in that way you might better get a sense of how complicated finding a cure is and how complex the subject it is. President Nixon declared a “War on Cancer” in 1971. Common thought was if we could put a man on the moon we should be able to cure cancer.
Holy cow. That was 44 years ago. Progress surely has not been at the pace that people had hoped for and expected. The reason is because it is tough to declare a war on something you don’t truly understand. What doctors did understand at the time was a cancer cell grew uncontrollably. What they did not understand was the complexity of why a healthy cell suddenly would grow out of control and how they could stop it, permanently.
Throughout the years cancer treatments have been developed through trial and error. I am an example of that trial and error. My first cancer, Hodgkin’s Lymphoma was one that had become treatable in the late 80’s. The theory was to throw as much chemotherapy and radiation as possible at it with hope of eradicating all disease. In years past it was a cancer that was typically fatal. In my case it worked. The problem was the toxicity it caused, the possible long-term side effects that were underestimated and the lack of understanding of the right balance of dosage to minimize these effects. That explains my second cancer, breast cancer.
Today is a new day. It is an extremely exciting time in cancer research. It is because all those twists and turns in the field of cancer have finally led to a place where scientists are truly beginning to understand the mechanisms and the inner workings of the human cell which causes cancer.
Have you ever wondered why two people who have breast cancer, for example, might have two different outcomes? For a very long time cancer was treated as if the two people’s cancer were the same. You were diagnosed with breast cancer and there was one protocol to follow. Treatments were designed and applied in a broad-brush fashion.
What researchers have learned is that cancer is not a “one size fits all” disease. Here is what I think is very interesting. It is no longer about where in the body the cancer started but rather the specific molecular and genetic makeup of the individual tumor. Therefore, two patients who present exactly the same, in the breast for example, could have totally different response rates and long-term outcomes if given the same treatment.
Precision medicine is a term you may have heard or will certainly start to hear more and more about in the future. President Obama talked about it in his State of the Union address in January. Most people don’t know exactly what this all means and I wanted to write a bit about it in non-scientific terms. Disclaimer: I am not a scientist and was never good in math or science so this is written in layman’s terms.
What researchers have learned is that normal cells become cancerous when they mutate and start multiplying uncontrollably. Why do they do this? Typically normal cells know when they need to make new cells and how to switch on and off. For example, if you cut your finger, cells will reproduce until there are enough new cells to mend your cut. They send chemical messages to each other so that they stop growing and dividing when growth or healing is complete. Think of a toggle switch that knows when and how to turn on and off when necessary.
When there is damage to the genetic makeup of the cell (mutation) the cell’s toggle switch is stuck in the “on” position. Think of a light you can turn on and off with a switch and suddenly the switch breaks and you can no longer turn the light off.
Precision medicine is about developing drugs targeted at specifically turning the cells’ “on” switch to the “off” position, basically repairing that toggle switch. That is how to explain what is going on in the simplest of terms.
What I find fascinating is that the type of cancer a person has is no longer about where in the body the cancer originates, such as the lung, colon or breast but more about the genetic mutation that is causing that abnormal cell growth. So, it is about targeting that mutation which for one person may show up in the lung and for another in the colon because they may share the same genetic mutation. That is why two people who have breast cancer and are treated the same way may have two completely different responses.
Dana Farber and Brigham and Women’s Hospital launched a research project, which is one of the nation’s most comprehensive personalized cancer initiatives, and have completed more than 10,000 genetic profiles on patient’s tumors. They are on the forefront of discoveries leading to targeted drug therapies specifically in lung, colon and breast cancers. I am in awe of this science and these discoveries every time I hear about these approaches. What does this all mean to me? What does this mean for you?
One word. Hope. Hope that we are getting closer and closer to finding ways to treat and manage this disease. With the hope comes understanding, that there will be more twists and turns and the process will remain complicated and unchartered territory. Cancer is not going away. There are many things that cause a gene to mutate. Some things we know (smoking, exposure to the sun, radiation or certain chemicals to name a few), others we do not.
My mother was enrolled in a clinical trial for a drug which is now FDA approved and used for people with a specific mutation in lung cancer. I am not sure if she had the mutation the drug targeted or if she was given the placebo as part of the trial. What I do know is her participation in the trial has helped pave the way for new discoveries and treatments and has led us to where we are today. The same goes for the treatments I received. This is a long road. I wish my mother were still here. And I can just hope that someday they will determine how to turn that switch off and spare others of her fate. The tipping point is near. Or so I hope.