The Future of Cancer in America
While cancer rates continue to rise, cancer mortality rates are declining. In fact, mortality rates have decreased continuously since the early 1990s, having dropped 20% since their peak in 1991. These declines already represent over a million lives saved, and experts hope to see the trend continue with groundbreaking research and better prevention efforts.
Headlines on new cancer research can be misleading. The array of cancer research is undoubtedly promising, but new drugs, treatments and detection methods take years to take from the lab into trials and practice.
According to the National Cancer Institute, inherited genetics play a major role in five to ten percent of all cancers. Handed down from parents to children, specific mutations in a person's genes can dramatically increase cancer risk. Scientists have already identified 50 of these dangerous mutations, and tests are available to determine if you have them. Fortunately, such mutations are usually very rare, and tests and preventative measures are available to combat their occurrence and effects. To get an idea of just how dangerous they are, here are a couple of examples:
BRCA1 and BRCA2
Passed down genetically from generation to generation, a mutation of either of these two genes can interfere with the body's production of tumor suppressor proteins, which has obvious repercussions for one's cancer risk. Mutations of BRCA1 and BRCA2 have been linked closely to breast and ovarian cancer but can increase risk of pancreatic and colon cancer as well. How much can these mutations increase risk? Take a look at the following stats:
- Around 12% of women will develop breast cancer sometime in their lives, but for women with a BRCA1 or BRCA2 mutation, that risk shoots up to 45 to 65%, depending on which of the two genes is mutated. For ovarian cancer, lifetime risk jumps from 1.4% to 14% for women with a BRCA2 mutation, and 39% for women with BRCA1.
- People with Norwegian, Dutch or Icelandic ancestry or an Ashkenazi Jewish heritage have a higher risk of harmful BRCA1 and BRCA2 mutations. Fortunately, testing and preventative measures are available. For more information, visit the National Cancer Institute.
Familial Adenomatous Polyposis (FAP)
Caused by a mutation in an individual's APC gene, this inherited condition causes polyps to develop in the gastrointestinal tract and, if left untreated, almost certainly leads to colon cancer. The mutation also increases risk of other cancers, and people carrying it have a one in two chance of passing it onto their children.
However, knowing is invaluable. People with the condition can receive regular screenings for polyp development, and for parents-to-be, prenatal screenings for the mutation are available. For more information, visit the Children's Hospital of Philadelphia FAP webpage.
Although scientists have already mapped all the genes of the human genome, there is still a lot to learn about each gene and its proteins. Scientists anticipate major advancements in detection for the hereditary factors of cancer in the coming years, particularly in genetic testing.
Cancer tumors protect themselves by destroying the immune cells that fight tumor growth. Scientists, however, have found a way to reinvigorate these immune cells and fight the cancer. It is a new area of treatment, but it has already shown promise.
Cancer vaccines come in two forms: preventative, meaning they prevent cancer in healthy people, and therapeutic, meaning they train the immune system to fight cancer in people who are already sick.
It is on the therapeutic side where major developments have occurred in recent years. Here are a couple of examples of progress made thanks to the latest cancer fighting vaccines:
- In 2013, the premier academic journal, Science, named such immunotherapies as the breakthrough of the year. One such drug, called ipilimumab, for metastatic melanoma, shrunk tumors by about half or more in 31% of those with melanoma, 29% with kidney cancer, and 17% with lung cancer.
- Another drug called a delta inhibitor, still in early development, helps the immune system fight cancer itself and has been given "Breakthrough Therapy status" by the FDA. In tests with mice, the drug increased survival rates across a broad range of cancer types, doubling the survival rate for mice with breast cancer.
So far, the FDA has approved just two preventative vaccines against viruses known to cause cancer: hepatitis B which is known to cause liver cancer and HPV, an infection that causes 70% of cervical cancer cases. For now, such vaccines could only prevent cancer by preventing viruses, and most forms of cancer are not caused by infections.
Alongside vaccines, targeted therapies offer the next big hope for the future of cancer treatment. Unlike chemotherapy, which attacks all rapidly dividing cells, targeted therapies use a patient's genetic information to attack only the specific molecules involved in the growth and spread of cancer. These treatments are more precise, so they have the potential to be more effective.
An entire cocktail of such drugs is already on the market, using slightly different approaches to combat cancer. Here are some of the common tactics:
- Hormone therapies: These choke off the growth of certain tumors that require specific hormones to grow. The drugs interfere with the body's ability to produce the hormone tumor feeds on, essentially starving the tumor out.
- Apoptosis Inducers: These drugs cause apoptosis, or cell death, in the cancerous cells.
- Angiogenesis Inhibitors: By blocking the growth of new blood vessels to tumors, these drugs starve tumors of the blood they need to grow.
- Signal transduction Inhibitors: Malignant cells receive inappropriate signals to divide continuously, setting off chain reactions that lead to tumor growth. These drugs seek to shut down this out-of-control signaling.
Within each of these types of targeted therapy there are a number of FDA-approved drugs. An oncologist can walk you through the best plan of attack for your particular situation. In many cases, an oncologist may suggest the use of off-label drugs. Keep in mind that these drugs are cheaper, but still as effective and regulated by the FDA.
A key advantage of these therapies are their relatively low side effects when compared to traditional chemotherapy, making cancer significantly less uncomfortable.
Pain Management and Palliative Care
It used to be that "palliative care" referred to the process of making a cancer patient feel as comfortable as possible during their final stages of life. Now that advanced treatments are extending patient lives and putting more patients into remission, palliative care is often a matter of relieving pain during treatment.
A full 60% of the 1.7 million patients diagnosed with cancer each year experience pain during treatment. Even after treatment ends, one third of cancer patients are in pain and as a result suffer from insomnia, physical limitations and anxiety. When chronic, these side effects are difficult to treat. The American Cancer Society is currently funding more than $26 million in survivorship and quality of life research.
Limitations and Future Goals
We all hope the future will offer major breakthroughs in cancer treatment, but it is important to recognize the limitations we face. The latest vaccines and immunotherapies cost patients a fortune, and they typically extend life by only a few months. For example, Provenge, one of the first approved immunotherapies for prostate cancer, hit the market in 2010, costing a whopping $93,000 per patient per year, while only extending life by an average of four months. Yervoy, another high-cost targeted therapy for melanoma, has only been shown to extend life by 3.5-10 months on average.
These discouraging results are largely because cancer has proven to be a crafty enemy. As soon as a new treatment cuts cancer off one way, it mutates and becomes resistant to the treatment, and then continues its growth. Scientists and doctors remain hopeful, however, that their treatments are getting more precise ― the idea being that when used in the right combinations, cancer will not have a chance to mutate around them.