4 ms·

We don't have a cure for breast cancer, but we do have a cure for cervical cancer, especially now that we know that's caused by a virus (hpv). And, we have gen

by lsb 6y ago

We don't have a cure for breast cancer, but we do have a cure for cervical cancer, especially now that we know that's caused by a virus (hpv). And, we have generics to prevent HIV infection, and we have promising new mRNA therapies, that were in development (with woefully little funding!) at U Penn, when this bet was being placed! Perhaps this is unwarranted optimism in the specific case, but as a broader expression of hope in future scientific progress, the long bet wins.

jillesvangurp 6y ago
There are more types of cancer than we have organs. The practice of naming cancers after where they are found is maybe a bit misleading. Especially since the aggressive/deadly varieties tend to spread through the body. Some cancers are very treatable at this point. The hard part is usually classifying them correctly and before they do a lot of damage. Breast cancer sounds more specific than it is. The reason it's such a common location for cancer and why it used to be so deadly is that they are connected to the lymphatic system, which how a lot of aggressive cancers spread through your body. Generally very treatable but some varieties still kill young women. Fun fact, the Pfizer corona vaccine was developed by Turkish-German women who has been working on developing a solution on fighting cancer with basically an mRNA vaccine. She pivoted to tackling corona last year but is looking to get back to tackling cancer. https://www.nytimes.com/2020/11/10/business/biontech-covid-vaccine.html https://www.nytimes.com/2020/11/10/business/biontech-covid-v... 2012 was maybe a bit optimistic but the last year has shown we can get results in under 12 months if the stakes are high enough.
- whizzter 6y ago
  I think that the mRNA vaccines success will lead to a huge influx of universities/investors sponsoring mRNA research and techniques since they see it as something viable now(possibly initially a negative if it means less sharing). Now combine that with decreasing DNA sequencing costs, it should put us on a path where the feasibility of cancer sequencing as a standard method of _exact_ identification and mRNA treatments targeting those identified exactly becomes standard fare within a few years (even if there probably is a bunch of cancerous mutations the number should be somewhat restricted considering much of the risks are hereditary).
- DharmaPolice 6y ago
  Since outcomes vary so heavily depending on how early cancer is detected I wonder what scope there is for big improvements in testing. National programs for breast/cervical screening do seem to work but they're expensive (although still probably cost effective [0]) and by their nature can't be done very often. Will we ever get to the stage where we will be able to self-administer a test every 6 months to catch these things in the very earliest stages? Or is that just fantasy due to the nature of cancer? 0 - https://doi.org/10.2147/BCTT.S123558 https://doi.org/10.2147/BCTT.S123558
  - gjulianm 6y ago
    Not a doctor, but from what I've read there are quite a lot of problems in the way: - Lead time bias. If you discover cancers early and patients survive more, is it because you're treating better or because you discovered (and started counting) earlier? - False positives and negatives. All tests will have them, and for low prevalence cancers it might mean that testing doesn't give too much information and just increases load on healthcare systems and puts patients through unnecessary tests and procedures. - Indolent diseases. Extensive testing might discover tumors that don't have symptoms and are not life-threatening, so you might treat people (with the risks associated) that didn't need to be treated. And that's if the tests themselves can be developed. Apparently there are a lot of types of cancer, each with different markers, behaviors, affecting different cells. It doesn't seem likely that a single test will be able to catch cancer in general.
  - bluGill 6y ago
    It is at least partially fantasy. There are a lot of cancers that grow in the body for a while and then just die off without causing any problems. Treating those cancers would be worse then letting them be. Not to mention all the mental baggage of "I have cancer". Then there is the problem of false positives which happen with most tests. Not all cancers grow fast. I've been told (read I'm not enough of an expert to evaluate the claim though it seems reasonable) there are some cancers that basically everybody has, but they grow so slowly that science won't worry about them until lifespans reach 150.
    - 6y ago
tchalla 6y ago
> Perhaps this is unwarranted optimism in the specific case, but as a broader expression of hope in future scientific progress, the long bet wins. Scientific progress has and will always win. However, it's almost impossible to predict which dimension/aspect of the scientific progress will accelerate. mRNA is a prime example of it.
- dmos62 6y ago
  Scientific progress can fail in case of catastrophe (meteor destroys civilization), or if you're constrained by time (e.g. find solution to all problems before next world war starts).
  - gotostatement 6y ago
    it also fails if it's corrupted or constrained by outside social forces
- mynameisash 6y ago
  > Scientific progress has and will always win I wish I could share this optimism, but one thing we've seen in the last year is that people will put themselves and others at risk as part of tribal signaling: "humans are motivated reasoners who alter their thinking, feeling, and behaving when thinking, feeling, and behaving in certain ways might upset their peers."[0] Maybe I'm reading your statement in a different way than you intend it. The science itself is good, but if society isn't leveraging that knowledge for our own betterment, is science winning? [0] https://youarenotsosmart.com/2020/07/31/yanss-185-why-the-reason-behind-why-some-people-refuse-to-wear-masks-during-a-pandemic-has-little-to-do-with-the-masks-themselves/ https://youarenotsosmart.com/2020/07/31/yanss-185-why-the-re...
  - nradov 6y ago
    Are you suggesting that eliminating all possible risk to ourselves and others is somehow better? Or if there is an acceptable level of risk then please quantify it. I put others at risk every time I drive my car. In theory I could eliminate that risk by walking everywhere, but I'm unwilling to do so.
surfsvammel 6y ago
I agree. We are beating cancer. One step at a time. People are waiting for a “cure for cancer” but there doesn’t seem to be one catch-all remedy. We need to celebrate the incremental improvements that we do achieve.
Metacelsus 6y ago
> we do a cure for cervical cancer We have a vaccine to prevent it, not a cure for it.
Herodotus38 6y ago
Unfortunately, there are some types of cervical cancer that are not caused by HPV, but rather by underlying bad luck with genetics. But you are right we could eradicate the vast majority with HPV. Edit: also there is a hormone called DES that was used in the past (a hormone like estrogen) that if used by mom during pregnancy increased offspring risk of cervical cancer.
- toomuchtodo 6y ago
  > Unfortunately, there are some types of cervical cancer that are not caused by HPV, but rather by underlying bad luck with genetics. Can we fix that last bit with CRISPR?
  - Herodotus38 6y ago
    I'm not an expert in CRISPR but I don't believe it is being used regularly outside of some very initial studies to human beings. Assuming you could use CRISPR to edit out a bad gene or change to a good gene, then I think yes it would work, but you have second problem. That second problem is finding those very rare people with the inherited risk of HPV negative cervical cancer before it becomes a problem, which would require us to a point where we have full genetic screening of the entire population as a standard thing (not to mention being sure we know which genes are for sure high risk for HPV negative adenocarcinoma of the cervix, which I don't think we have a clear picture yet).
AnimalMuppet 6y ago
Are all cervical cancers caused by HPV? Or just some? (Honest question; I don't know.)
- Tagbert 6y ago
  HPV causes 75% of cervical cancers https://en.wikipedia.org/wiki/Cervical_cancer#Causes https://en.wikipedia.org/wiki/Cervical_cancer#Causes

by lsb 6y ago

jillesvangurp 6y ago

There are more types of cancer than we have organs. The practice of naming cancers after where they are found is maybe a bit misleading. Especially since the aggressive/deadly varieties tend to spread through the body. Some cancers are very treatable at this point. The hard part is usually classifying them correctly and before they do a lot of damage. Breast cancer sounds more specific than it is. The reason it's such a common location for cancer and why it used to be so deadly is that they are connected to the lymphatic system, which how a lot of aggressive cancers spread through your body. Generally very treatable but some varieties still kill young women. Fun fact, the Pfizer corona vaccine was developed by Turkish-German women who has been working on developing a solution on fighting cancer with basically an mRNA vaccine. She pivoted to tackling corona last year but is looking to get back to tackling cancer. https://www.nytimes.com/2020/11/10/business/biontech-covid-vaccine.html https://www.nytimes.com/2020/11/10/business/biontech-covid-v... 2012 was maybe a bit optimistic but the last year has shown we can get results in under 12 months if the stakes are high enough.

whizzter 6y ago
I think that the mRNA vaccines success will lead to a huge influx of universities/investors sponsoring mRNA research and techniques since they see it as something viable now(possibly initially a negative if it means less sharing). Now combine that with decreasing DNA sequencing costs, it should put us on a path where the feasibility of cancer sequencing as a standard method of _exact_ identification and mRNA treatments targeting those identified exactly becomes standard fare within a few years (even if there probably is a bunch of cancerous mutations the number should be somewhat restricted considering much of the risks are hereditary).
DharmaPolice 6y ago
Since outcomes vary so heavily depending on how early cancer is detected I wonder what scope there is for big improvements in testing. National programs for breast/cervical screening do seem to work but they're expensive (although still probably cost effective [0]) and by their nature can't be done very often. Will we ever get to the stage where we will be able to self-administer a test every 6 months to catch these things in the very earliest stages? Or is that just fantasy due to the nature of cancer? 0 - https://doi.org/10.2147/BCTT.S123558 https://doi.org/10.2147/BCTT.S123558
- gjulianm 6y ago
  Not a doctor, but from what I've read there are quite a lot of problems in the way: - Lead time bias. If you discover cancers early and patients survive more, is it because you're treating better or because you discovered (and started counting) earlier? - False positives and negatives. All tests will have them, and for low prevalence cancers it might mean that testing doesn't give too much information and just increases load on healthcare systems and puts patients through unnecessary tests and procedures. - Indolent diseases. Extensive testing might discover tumors that don't have symptoms and are not life-threatening, so you might treat people (with the risks associated) that didn't need to be treated. And that's if the tests themselves can be developed. Apparently there are a lot of types of cancer, each with different markers, behaviors, affecting different cells. It doesn't seem likely that a single test will be able to catch cancer in general.
- bluGill 6y ago
  It is at least partially fantasy. There are a lot of cancers that grow in the body for a while and then just die off without causing any problems. Treating those cancers would be worse then letting them be. Not to mention all the mental baggage of "I have cancer". Then there is the problem of false positives which happen with most tests. Not all cancers grow fast. I've been told (read I'm not enough of an expert to evaluate the claim though it seems reasonable) there are some cancers that basically everybody has, but they grow so slowly that science won't worry about them until lifespans reach 150.
  - 6y ago

tchalla 6y ago

> Perhaps this is unwarranted optimism in the specific case, but as a broader expression of hope in future scientific progress, the long bet wins. Scientific progress has and will always win. However, it's almost impossible to predict which dimension/aspect of the scientific progress will accelerate. mRNA is a prime example of it.

dmos62 6y ago
Scientific progress can fail in case of catastrophe (meteor destroys civilization), or if you're constrained by time (e.g. find solution to all problems before next world war starts).
- gotostatement 6y ago
  it also fails if it's corrupted or constrained by outside social forces
mynameisash 6y ago
> Scientific progress has and will always win I wish I could share this optimism, but one thing we've seen in the last year is that people will put themselves and others at risk as part of tribal signaling: "humans are motivated reasoners who alter their thinking, feeling, and behaving when thinking, feeling, and behaving in certain ways might upset their peers."[0] Maybe I'm reading your statement in a different way than you intend it. The science itself is good, but if society isn't leveraging that knowledge for our own betterment, is science winning? [0] https://youarenotsosmart.com/2020/07/31/yanss-185-why-the-reason-behind-why-some-people-refuse-to-wear-masks-during-a-pandemic-has-little-to-do-with-the-masks-themselves/ https://youarenotsosmart.com/2020/07/31/yanss-185-why-the-re...
- nradov 6y ago
  Are you suggesting that eliminating all possible risk to ourselves and others is somehow better? Or if there is an acceptable level of risk then please quantify it. I put others at risk every time I drive my car. In theory I could eliminate that risk by walking everywhere, but I'm unwilling to do so.

surfsvammel 6y ago

I agree. We are beating cancer. One step at a time. People are waiting for a “cure for cancer” but there doesn’t seem to be one catch-all remedy. We need to celebrate the incremental improvements that we do achieve.

Metacelsus 6y ago

> we do a cure for cervical cancer We have a vaccine to prevent it, not a cure for it.

Herodotus38 6y ago

Unfortunately, there are some types of cervical cancer that are not caused by HPV, but rather by underlying bad luck with genetics. But you are right we could eradicate the vast majority with HPV. Edit: also there is a hormone called DES that was used in the past (a hormone like estrogen) that if used by mom during pregnancy increased offspring risk of cervical cancer.

toomuchtodo 6y ago
> Unfortunately, there are some types of cervical cancer that are not caused by HPV, but rather by underlying bad luck with genetics. Can we fix that last bit with CRISPR?
- Herodotus38 6y ago
  I'm not an expert in CRISPR but I don't believe it is being used regularly outside of some very initial studies to human beings. Assuming you could use CRISPR to edit out a bad gene or change to a good gene, then I think yes it would work, but you have second problem. That second problem is finding those very rare people with the inherited risk of HPV negative cervical cancer before it becomes a problem, which would require us to a point where we have full genetic screening of the entire population as a standard thing (not to mention being sure we know which genes are for sure high risk for HPV negative adenocarcinoma of the cervix, which I don't think we have a clear picture yet).

AnimalMuppet 6y ago

Are all cervical cancers caused by HPV? Or just some? (Honest question; I don't know.)

Tagbert 6y ago
HPV causes 75% of cervical cancers https://en.wikipedia.org/wiki/Cervical_cancer#Causes https://en.wikipedia.org/wiki/Cervical_cancer#Causes