13 ms·

Why haven't we cured cancer yet?

231 points by vibrunazo 15y ago

donaldc 15y ago
Given the article talks about decades-long lead times before a cancer metastasizes, I hope that more attention begins to be focused on much earlier-stage detection and treatment. I think a lot of the problem is, by the time a cancer has metastasized and one begins showing symptoms, it's already very late in the game to try and fix things. From the article: Moreover, as was discussed in at least a couple of talks at the AACR meeting, an evolution-based analysis of tumors using the latest NGS techniques indicates that for most solid tumors the time from founder mutation to clinically apparent metastasis is between 20 and 30 years. For example, for pancreatic cancer it’s a median of around 21 years, and for colon cancer it’s around 30 years.
- jimmyvanhalen 15y ago
  early-stage detection and treatment is critical. I lost love ones to cancer because the cancer was not diagnosed early enough. somewhat related to the discussion. saw this last week. Daily Aspirin May Help Prevent and Treat Cancer “What really jumps out at you in terms of prevention is the striking 75 percent reduction in esophageal cancer and a 40 to 50 percent reduction in colorectal cancer, which is the most common cancer right now,” Dr. Rothwell said. “In terms of prevention, anyone with a family history would be sensible to take aspirin,” he added. http://www.nytimes.com/2012/03/21/health/research/studies-link-aspirin-daily-use-to-reduced-cancer-risk.html http://www.nytimes.com/2012/03/21/health/research/studies-li... http://online.wsj.com/article/SB10001424052702304724404577295462452273218.html http://online.wsj.com/article/SB1000142405270230472440457729... http://www.webmd.com/cancer/news/20120320/daily-aspirin-may-help-prevent-and-treat-cancer http://www.webmd.com/cancer/news/20120320/daily-aspirin-may-...
siculars 15y ago
... Because PhD's can barely feed themselves. ... Because the "smart" people work on Wall Street/for consulting firms. ... Because Facebook acquired Instagram.
- viraptor 15y ago
  1) is simply not true everywhere. I'm sure it varies depending on a country, but I know PhDs in a number of fields and all of them are doing at least "ok" financially. I'd like to see any kind of proof of 3)... it may be actually the opposite, because it shows that if market has enough money for a dotcom bubble 2.0, some of the transaction value is likely to fuel research to some extent (via taxes, etc.). Good economy is good for many people. (simplified, but true to some extent)
- polyfractal 15y ago
  This needs some more love. Consider the cycle of academic career: -Grad school for 5-8 years, averaging around 7 for most molecular and cellular biologists. You make $23-28k a year depending on where you live. You steal whatever free food is lying around your department -Post graduation, you obtain a Post-Doc position for ~2 years (if everything goes well). This pays ~40k/year, again varying depending on region. -If you got lucky and had a successful Post-doc, skip to the next bullet. Otherwise, go back to the last bullet for another 2-8 years. -Get a junior professor tenure-track position. Salary is much better, probably around 60-80k. You have five years to prove you are awesome. At five years, go to the next bullet -Tenure review! How many awesome papers did you publish? ---Not enough? go try again at a different university...hopefully your family is willing to relocate or there is one nearby. If you fail tenure review twice, you get to be an adjunct professor (zero job security, crap salary) for the rest of your life. ---Well, you don't completely suck...so we are giving you another two years to prove tenure. Go back to the last bullet. ---Wow! You got tenure! Welcome to the elite minority that actually make tenure. You get a nice salary bump up to 100-150k, have total job security, do zero science anymore (glorified manager now) and are probably in your 40's. Feels good, huh? And people wonder why things are slow in biology? If this was a sales funnel, you would notice hideous conversion rates between all the steps. People burn out because of intense competition for few spots, crappy salary and crappy hours. If you work finance, you may work 90 hour weeks but at least you make lots of money. In biology...you work 70 hour weeks for food stamps and the hope of getting tenure when you are 40.
  - alexholehouse 15y ago
noonespecial 15y ago
The National Cancer Institute's average yearly budget for cancer research is around $4.9 billion. NFL football revenue? $9 billion. Priorities.
- maratd 15y ago
  What's the point of living if you can't have a little fun? Living merely for the sake of living is pointless.
  - noonespecial 15y ago
    Its odd. I was quite curious to float this opinion in this crowd. It is of course, wildly unpopular among the non-geeks in my "regular" life. I wondered if it would also be so here. Affirmative. It always seemed to me that we should "take care of our business" first, and then play later. To see these numbers backwards (IMHO) struck me as a childish "play first" attitude. I wouldn't go so far as to say "cancel sports until we get our health problems sorted out" but a shift in priorities would be refreshing. Football is fun, finally cracking our genome to make disease obsolete (and I think nothing less than 100% of this cures cancer)... now that would be something to cheer about.
    - maratd 15y ago
      > It always seemed to me that we should "take care of our business" first, and then play later. This sentiment only works when the "business" is a low hanging fruit. In other words, very doable with reasonable effort with results in the short-term. Anything else, and you hunker down for the long haul. And that means plenty of playing in the interim. For "business" that can take a lifetime or several lifetimes, no, you should definitely make sure you play and play vigorously. Nobody should be asked to sacrifice the quality of their life for the sake of hypothetical benefits for future generations.
    - goblin89 15y ago
      > a shift in priorities would be refreshing. Agree, but as tptacek pointed out, there's a lot of commerce happening in football. If majority will shift their concerns to health problems, then the commerce will be happening there. Not sure if it would be necessarily a good thing, and it likely would require strict regulation.
jakeonthemove 15y ago
Very interesting read... it boggles my mind how complex our organisms are and how cancer forms and takes everything over from the inside. We can't even "cure" a relatively simple virus like the cold or influenza, and cancer is like 10,000x times more complicated - gotta respect all the hackers who're working in the medical field...
- Peaker 15y ago
  Viruses and bacteria evolve much faster than cancer, because they: * Use horizontal genetic exchange, so different evolutionary branches can share features. This increases evolutionary speed exponentially. * Evolve over a much larger eco-system, whereas cancer has to evolve "from scratch" in each individual over a relatively short time-span. Thus, I think cancer should be a much easier problem, from the evolutionary perspective, than bacteria and viruses.
- bradley 15y ago
  I had more appreciation for the complexity of the human organism after reading this NYTimes article about our microbiome: http://www.nytimes.com/2010/07/13/science/13micro.html?_r=1&pagewanted=all http://www.nytimes.com/2010/07/13/science/13micro.html?_r=1&... 10 times more microbial than 'human' DNA in our body.
Craiggybear 15y ago
Because, like AI, molecular biology is complicated and there are no quick hacks. Some things are meant to take time and be right. First time. Survival rates are spectacularly better than they were fifteen or twenty years ago and they are getting better all the time. Also there is no one type of lung cancer, brain tumour or bladder or bowel cancer either. There are many different types. Half the battle is identifying (and successfully treating) the right sort. I still think there will be cancer in fifty years time. But we won't have to die from it. We may never eradicate it though, because it is a tough, complex bio-engineering problem, closely allied to programmed cell death and immortality. That's another tough nut to crack for the same reasons, inexorably intertwined as they are.
- dailyrorschach 15y ago
  I think it's also important to note that our understanding of molecular biology while impressive is still so incomplete and there is much to learn. This is a kind of cool Wiki article: http://en.wikipedia.org/wiki/History_of_molecular_biology http://en.wikipedia.org/wiki/History_of_molecular_biology But the discipline isn't even 100 years old yet, and really only in the last couple of decades have we been able to have technology to really take advantage of isolation. We have learned so much about modern medicine, but have so much more to go.
- pessimist 15y ago
  Do you have a reference for survival rates? Note that there are many confounding factors - lung cancer incidence has dropped a lot although lung cancer itself remains intractable to average cancer survival rates may have improved.
  - Craiggybear 15y ago
    Small cell, granuloma, take your pick. The data is available world-wide. The fact is that lung cancer is one from which there is never a good prognosis regardless of type. People can expect 4-5 years on average (although I know people who have gone past ten and have a good quality of life). It also is one where heredity and genetics plays an enormous role (as opposed to purely environmental conditions). Like I said, molecular biology is something we've only just noticed far less got a handle on. Ars Longa Vita Brevis.
Retric 15y ago
This is one of the most fascinating and frightening things I have ever read. It really feels like staring cthulhu in the face. TLDR: Breast cancers, for instance, have been shown to harbor at least 1,700 different mutations, but only three of them showed up in at least 10% of patients, with the great majority of them being unique to each patient. The most recent study in Nature discussed above shows that even a single subtype of breast cancer that is generally treated clinically more or less the same, TNBC, varies wildly (and almost continuously) in the genomic changes and mutations each tumor has. Not only that, but each TNBC is in essence several diseases, because each TNBC is made up of many different clones that have evolved as the tumor itself grew, progressed, and evolved. All of this occurs even before the tumor has been subjected to any treatment at all. As if that’s not bad enough, it would appear that tumors are a mosaic of groups of many different tumor cell types that develop through branching evolution such that metastases can be very different from the primary tumor and even different regions of the primary tumor can be very different from each other, so much so that finding a “favorable prognosis signature” on a core biopsy means only that that one area biopsied has that gene signature. Large areas elsewhere in the tumor could have the unfavorable prognosis signature. And even more interesting if you look at the history of a tumor the mutations goes back for a fairly long time, possibly on the order of 30+ years. While it may not be an actual cure, removing abnormal cells early may be more effective than trying to treat cancer in the last 1-10% of it's lifetime when it's already become a diversified killing machine.
- albertcardona 15y ago
  A focus on the common properties of cancer would perhaps provide more hope. The most obvious is the need for angiogenesis: the formation of new blood vessels to irrigate deep layers of a tumor. There are drugs out there targeting angiogenesis. Another obvious property is cell proliferation, without which a cancer is not a cancer. Both of these are core functions of most of the human body, but there is such thing as therapeutic windows: a time interval with a dose just so to have a greater effect on tumors rather than on the rest of the body.
- micro_cam 15y ago
  All this genetic diversity seems daunting at first but I think it is also indicative of something that gives me great hope. Cancer isn't like a virus or pathogen that has evolved to avoid it our immune systems and treatments as it passes from individual. It is a degenerative state of the same system that produces healthy cells and fertile humans. It is genetically very diverse. Part of this is because cancers cells often have mesed up chromosomal replication which produces more variability. Part of this may be because numerous genetic variations can have similar effects because they effect the same gene or network of genes. As the author alludes to at the end of the paper, there are a number of things a tumor must do to be successful. These include avoiding the immune system, avoiding programed cell death, recruiting blood vessels/nutrients etc. There has been lots of really promising research in the last few years that looks at analyzing and targeting the pathways that control these things. Further as projects like the the Cancer Genome Atlas (which I work on as a Software Engineer) produce terabytes of data about cancer, we are able to apply modern data analysis to better understand the system, hopefully discovering what separates the biochemical state of an aggressive cancer from one the body handles without issue which will hopefully lead to some novel drug targets.
millzlane 15y ago
I have the answer. It's a simple one word answer. GREED. But seriously It's the money that keeps us from curing cancer, or lack thereof. Nothing else. As human beings we really need to decide what's more important....Wealth or our survival and wellbeing. We're too smart as a society to let things like lack of money keep us from curing disease and exploring other planets.
- aidenn0 15y ago
  It's not lack of money, it's lack of what money represents, which is goods, services, and in general labor. If the US wanted to spend $100 trillion on cancer cures it could, but the moment it printed all that money, the purchasing power of it would decline to the point that they wouldn't actually have enough money to cure cancer. Consider a single cancer researcher. They need to eat. They need machines that sequence genes that use techniques developed by other researchers, designed by engineers, built by people in factories. All of those people need to eat. The raw materials are mined out of the ground in work that is environmentally damaging, hard work, and often dangerous work. It is not possible to snap your fingers and have more work immediately happen. There have been exceptions to the above, but it has been temporary in export economies with exportable natural resources attainable at a below-market level (e.g. OPEC, Soviet Union). You can't just say "Is it really just money that keeps us from doing X?" since money isn't the issue, it's that we don't have enough of the value that backs the currency.
- tsotha 15y ago
  It's not lack of money at all. How many researchers, worldwide, do you think have the expertise necessary to make a nontrivial contribution? The problem is we simply don't have the technology to develop a cure for cancer, and we don't even know the precursor technologies we need to develop a cure for cancer.
Rhapso 15y ago
<rant type="likely-naive"/> We can never "cure" cancer. We might be able to save most individuals from dying from it some day but cancer is just a mutation that makes a cell's behavior damaging/lethal to the host body. The only way to prevent "bad" mutation (because there is no sure way to discern 'bad' from any other mutation) is to stop mutation all together, and even if there way a way to do this (removal of radiation does not stop transcription errors) stopping mutation is a nice kindly way to ensure the extinction of the species (no chance for future biological adaptation, because there are no mutations). So, as evil and painful as cancer is, it is a symptom of a good thing, biological mutation and variation in our species, and any through and final "cure to all cancer everywhere" will have to stop the cause of cancer, mutation, which we as a society and species should not allow. </rant>
- avgarrison 15y ago
  I disagree that we should not allow such a thing if it existed. I think humans are a bit past the need for biological evolution. Technology can provide us with the ability to adapt to new challenges and environments, and can do so much more quickly.
  - aidenn0 15y ago
    Also, plenty of biological evolution can happen in the absence of mutation.
    - mindcruzer 15y ago
      I'm not sure why you're being downvoted. Evolution is simply the changing of allele frequencies over time, which can certainly happen in the absence of mutation. Although, I don't know that I would say "plenty" of evolution can happen without mutations, but I guess that depends on what you think "plenty" is.
      - revelation 15y ago
        Only changing allele frequencies is proven to result in a stable state. You need mutation for evolution.
nextparadigms 15y ago
I don't think we can cure cancer until nanotechnology tools can be used in many hospitals. Send some nanorobots to eradicate all cancer cells in the body, and that's it. But we're probably at least 20-30 years away from that.
joeycfan 15y ago
It's right around the corner. Also limb re-growing and other miracles. All the fruit of AIDS research.
elchief 15y ago
We haven't cured a lot of things. Well, we've cured lots of small things, but few of the doozies. A baldness cure has been ten years away for the last thirty years. No cure for blindness, AIDS, lost limbs. Remember the blue denim dye that killed cancer? What happened to it? If something is "ten years away", it means we simply don't know how to do it, we are just hoping for someone else to come up with the tech to solve it for us. Even if it's "five years away", it's suspect. Why not just release it now? Oh, because it doesn't work. I'll believe something if it's being currently tested on monkeys. We simply don't have the technology yet to solve these problems. These problems won't likely be solved in medicine, but in another field that discovers the solution accidentally, likely in nano or AI/statistics. If you want to speed things along, make sure the government is dropping lots of coin in R&D in many NEW or PROMISING fields, not just medicine. Encourage intellectual property rights for innovative firms that do real R&D, and not just relabel their old products. Encourage your smart friend to go into bio-stats and not quantitative finance.
- officialchicken 15y ago
  I totally agree, but it doesn't explain why there are so many treatments not available in the U.S., but available elsewhere. Islet cell graphs, for example. Personally, I'd encourage EVERYONE with a chronic disease to become a quant, so that they may live long and healthy lives (after leaving finance).
- Retric 15y ago
  Most of the big things we cured where diseases that no-longer seem to be a big deal because they where cured. Food born illness, measles, and smallpox are all things that have killed more people than AIDS and are no longer a problem in the western world. Measles what's that? If vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected. http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm And "Smallpox is believed to have emerged in human populations about 10,000 BC... Smallpox was responsible for an estimated 300–500 million deaths during the 20th century" http://en.wikipedia.org/wiki/Smallpox http://en.wikipedia.org/wiki/Smallpox We are talking about something that killed around A BILLION PEOPLE and now it's 'gone'. At it's current rate AIDS might catch up to Smallpox 200-600 years from now. But, that's just deaths the side effects where far more common. She might not be dead but I don't like seeing this picture. http://en.wikipedia.org/wiki/File:Child_with_Smallpox_Bangladesh.jpg http://en.wikipedia.org/wiki/File:Child_with_Smallpox_Bangla... PS: You say there is no cure for blindness, but smallpox was responsible for 1/3 of all blindness cases which just don't happen any more.
JumpCrisscross 15y ago
Fascinating paper on returns on cancer research out of the NBER argues that for about $300 billion in cancer research expenditures from 1988 to 2000 the US created 23 million life-years worth, in aggregate, about $1.9 trillion [1]. That comes to about a 52% smoothed return. Pretty good given that the S&P 500 grew at about 14.6% over the same period (though if similarly smoothed yielded about 42%). [1] http://www.nber.org/papers/w15574.pdf?new_window=1 http://www.nber.org/papers/w15574.pdf?new_window=1 [2] http://quicktake.morningstar.com/index/IndexCharts.aspx?Country=USA&Symbol=SPX http://quicktake.morningstar.com/index/IndexCharts.aspx?Coun...
- radu_floricica 15y ago
  Cancer research... but you need to also factor in cancer treatment costs.
- hollerith 15y ago
  If creating life-years is the goal, paying poor people in 3rd-world countries to have kids will be at least 10 times as efficient as cancer research.
- ximeng 15y ago
  Is there some way to make a fund investing in research with returns based on the effectiveness of the results?
  - JumpCrisscross 15y ago
    If you could find a counter-party to enter into a swap with you can base it on anything. But given that it would be virtually impossible to hedge you would have the odds severely stacked against.
  - deleted 15y ago
    [deleted]
  - deleted 15y ago
    [deleted]
officialchicken 15y ago
Which business model do you prefer - ongoing revenue or one-time payment? There's more money to be made by treating the symptoms than there is providing a cure. Anyone you know with a chronic disease will tell you that since their diagnosis, the price of everything related to the condition has gone up dramatically... cancer, ADD, diabetes, asthma, etc. I wonder what ad-supported pharmacology business model would be like? Medicaid meets Madison Ave.
- Palomides 15y ago
  any corporation with a cure would have an immense advantage over any competitors
  - Symmetry 15y ago
    Also, even if there were only one corporation with a total healthcare monopoly then provided it could charge whatever it wanted it would still be able to make more money by just curing the cancer since it's providing a more valuable service by doing that.
blinkingled 15y ago
Highly recommended reading on the subject : The Emperor of All Maladies : Kindle URL - http://www.amazon.com/Emperor-All-Maladies-ebook/dp/B003UYUP58/ref=sr_1_1_title_1_kin?s=books&ie=UTF8&qid=1333996630&sr=1-1 http://www.amazon.com/Emperor-All-Maladies-ebook/dp/B003UYUP...
omerta 15y ago
Not a surprise cancer hasn't been cured. Most diseases have not been cured, yet. Even bacterial infections. People can still die from staph infections.
joeycfan 15y ago
PhD comics handled this nicely http://www.phdcomics.com/comics.php?f=1162 http://www.phdcomics.com/comics.php?f=1162
goronbjorn 15y ago
Because it isn't nearly as important as Instagram, apparently: http://www.evernote.com/shard/s146/sh/eb8c59f9-44b5-48bc-a246-30f7478c101c/7ff15abcd6a9d9d91c23c23f8408c908 http://www.evernote.com/shard/s146/sh/eb8c59f9-44b5-48bc-a24...
throughnothing 15y ago
Because "Cancer is Serious Business" https://www.youtube.com/watch?v=Be1ihuZNg84 https://www.youtube.com/watch?v=Be1ihuZNg84
mmphosis 15y ago
because 99% of money raised to "fight" cancer is spent on finding a "cure" whereas only 1% of money raised is spent on prevention. 0% is spent looking at environmental factors: - nuclear waste alone: bomb testing in the 60's and 70's, uranium mining, Chernobyl, bullets tipped with depleted uranium used in recent wars, Fukushima Daiichi - systematic poisoning of the industrial food supply: genetically modified food, petrochemicals, drugs that are put in food - systematic poisoning of the environment, water, air, and land.
alexholehouse 15y ago
One angle I feel is often missed in the whole cancer discussion is that it's a multidimensional problem. 1) Developing drugs which can damage cancer cells selectively. Like selecting a few needles in a haystack, cancer cells typically "look" the same as healthy cells, which makes selectively destroying them very difficult. Some cancers (such as CML) have a specific driver mutant proteins which allows for a pinpoint attack (Gleevec), but if this target protein mutates and Gleevec can no longer bind then that drug instantly becomes totally ineffective. 2) Identifying malignant tissue Surgery is still one of the most important tools against many forms of cancer, yet being able to identify malignant tissue vs. healthy stuff has always been a problem. In the first half of the 20th century the radical mastectomy was all the rage, but in reality provided little benefit. I was lucky enough to see Roger Tsein speak a few years ago (Nobel prize for GFP) who is pioneering a way to fluorescent tag malignant tissue which can be viewed in real time to give surgeons an augmented reality overview of a tumour to maximize the chance of getting all the malignant cells.[http://en.wikipedia.org/wiki/Roger_Y._Tsien#Fluorescence-assisted_cancer_surgery http://en.wikipedia.org/wiki/Roger_Y._Tsien#Fluorescence-ass...]. 3) Stopping metastasis Even if a patient presents with a tumour and that tumour is removed, it's impossible to tell if any of the maligant cells have managed to escape to other parts of the body, where they slowly start to regroup before launching a subsequent attack. This is the primary reason why cancer survivors have 5Y and 10Y survival rates as opposed to, "You're cured". The mechanism and time in a cancer at which this happens depends on so many factors its currently almost impossible the predict. 4) Drug delivery The tumour micro environment is so foreign compared to the normal stromal environment, and moreover so heterogeneous between tumour types (which in turn depends both on a cancer's underlying genotype and its associated tissue, vascularization and a wide range of additional factors) that creating drugs which can just survive long enough to act on their target can be difficult. This, combined with the fact that tumours are, compared to normal tissue, often poorly vascularized, means just getting drugs in can be a major challenge. I remember reading how often the vascularization of a tumour can be proportional to rate of growth and inversely proportional to chemotherapeutic efficacy (although don't quote me because I can't find the reference) meaning smaller, slower growing tumours often represent those most difficult to treat while larger, more aggressive ones may respond better, if caught in time. 5) Cancer is effectively microscale evolution Perhaps the biggest problem is that once cancer cells begin to acquire some initial mutations (and lie in a pre-cancerous form) they're often more susceptible to further mutations. In a way, this allows them to employ a sort of bet-hedging strategy, such as that seen by yeast or other single celled organisms. No longer can we treat the cancer cells as part of our multicellular body, but as a separate, single celled population. This means that even if certain drugs are effective, there will be a small population of cancer cells who may have mutated in such a way that they are resistant, so even if a treatment gets 99% of the cells, that final 1% can restart and the same bet-hedging strategy is re-employed to create another, diverse set of cells. This is totally analogous to antibiotic resistance. The range of this diversity varies significantly between cancers, but as we "pick out" the easier ones with an obvious target, this will become an every increasing issue. These are just a few points - there are more, but I've tried to focus on ones not yet brought up in discussion. This is an area I have some experience with, and if anything is unclear let me know and I'll do my best to explain. [EDIT]: This is not meant to be quite as, "we're all doomed" as it appeared. I think Dn_Ab's post summarizes how I feel more accurately. The development in a range of different areas has been staggering (childhood leakemia, CML, Her2+ BC etc), and the reason this is such a daunting task is because the magnitude has only reared its large, complex head in the last 10-15 years or so. Despite the challenges, it is a very exciting time to be a cancer biologist.
alanh 15y ago
Cynical answer: Because we keep inventing new carcinogens.
Dn_Ab 15y ago
What I got from this: - Cancer is complex, its profile is not that of 1 disease but many hundreds of diseases - Sequencing Cancers and attempting to find a match to suggest a treatment will not work, each cancer is unique and itself made up of a diverse population - Cancer is mutiny combined with the greed of evil dictators. A bunch of cells give up the chain of command and start co-opting resources to feed their opulent lifestyles. What this means is that no simple cure is going to work, cancer effectively exists to solve the problem of maximizing its growth or survival rate. Treatments are just another constraint that increase the dimensionality of the cancers' search space. - Tumorous cell lines are invaders even if they originate from the body and evolve at a breakneck pace. This is why many treatments fail to work - not that the ideas behind them are wrong but the system has outsmarted it. Cancer is dynamic not static. I found this inspiring and positive. While some may despair from a lack of a cure what I see is progress. We've gone from the boundless optimism that comes from ignorance to the sober determination that comes from an awareness of the extent of our ignorance. So now maybe the real work can begin. He says tackling the evolutionary aspect of cancer will be key. I wonder if game theory will inform future treatments. Or if there will be things people will take to reduce mutations or lend better error correction - outside immune and optionally germ cells. Or ubiquity of sensors allowing one to cluster features which determine the onset of cancer and forming tests to pinpoint and drugs to eradicate before the cancer stage. I wish I was not so ignorant.
- epistasis 15y ago
  >- Sequencing Cancers and attempting to find a match to suggest a treatment will not work, each cancer is unique and itself made up of a diverse population It seems to me that sequencing is a must, rather than a "not work," as without that type of intelligence one can't even know what you're up against. You just need to take into account the diversity of mutations, and not assume that you've seen everything that's currently in the population.
  - Dn_Ab 15y ago
    You are right. I did not mean that sequencing shouldn't be done, what I meant was that the simple idea of sequence -> nearest match -> most appropriate treatment won't work due to the massive amount of variance involved. So the sequencing will be more useful at higher level. So more understanding patterns and devising strategies than personalizing cocktails.
linker3000 15y ago
Maybe we have... http://www.telegraph.co.uk/science/science-news/9191848/Universal-cancer-vaccine-developed.html http://www.telegraph.co.uk/science/science-news/9191848/Univ...
- aakashamin 15y ago
  it's hype. Read the blog post!
gfodor 15y ago
See also: "Facebook acquires Instagram [for $1B]"
Peaker 15y ago
If p53 is so critical that many cancers disable it, couldn't we genetically replicate it in our genome many times, to make it far harder for cancer to disable? Why didn't this happen naturally, by evolutionary processes? Is it because all copies of p53 can be disabled simultaneously via RNAi? If so, maybe particular disablers of p53 can be targeted too?
- alexholehouse 15y ago
  p53 operates as a tetramer (4 individual p53 [monomeric] proteins come together to form the active protein complex), and can have a dominant negative effect if one of the two p53 genes are mutated. This basically means we have two copies of the gene, but if one is mutated and you form a tetramer and 1 or more of the tetramer's monomers are mutants then that tetramer is far less active. Even if you had lots of copies of p53, its effect could still be down-regulated by a single mutant. There's been some work to try and reactivate p53 where it's been knocked out, although I'm not sure how successful it's been. http://www.ejcancer.info/article/S0959-8049(03)00454-4/abstract http://www.ejcancer.info/article/S0959-8049(03)00454-4/abstr...
tsotha 15y ago
Good God, this article is depressing. I used to think we'd have some therapies to at least suppress new growth in my lifetime. If I'm understanding what he's written they don't even have a game plan for an effective treatment.
- crusso 15y ago
  That was my first thought too. I've always thought of cancer as being beatable in ways that bacteria and viruses aren't since the latter get the benefit of evolution. It makes a lot of sense that rapid evolution is exactly why cancer has been so difficult to tackle. The good news is that: 1. Cancer survival rates have improved over the past and are continuing to improve; so we're still moving forward. 2. I have a lot of hope in the power of technology to come to our rescue. a. Sequencing has to get to a point where it's done in minutes or seconds on a chip. b. Physicians' computer aids need to be Watson+. In order to be able to constantly categorize and target each mutation with a drug or suggestion for other treatment. c. Ideally, we need to get to the point where we can automate the synthesis of different types of drugs so that the cancer attacking system can customize treatments at the molecular level to dynamically attack cancers that are mutating.
hooande 15y ago
The part that jumped out at me was this: "for most solid tumors the time from founder mutation to clinically apparent metastasis is between 20 and 30 years" If cancer is really this ultimate chimearan opponent, why don't we put more emphasis on detecting it during the twenty years before it becomes dangerous? It would be difficult to detect changes at the cellular level at any location in the human body. But it sounds like a problem that will scale with "Big Data" a lot better than trying to fight evolution.
Apocryphon 15y ago
It seems like there needs to be a combination of cultural/societal changes favoring education in the life sciences, combined with funding. The launch of Sputnik led to an upsurge of focus in math and science education during the Cold War. To a much smaller degree, C.S.I. inspired a generation of forensic scientists. Maybe the startup response to this piece should be to figure out ways to spark public interest in tackling this problems.
samth 15y ago
The whole concept of "curing" cancer is silly, and best abandoned. Cancer is just the name we give to the failure of certain kinds of cell regulatory systems, particularly those relating to growth and cell death. Coming up with a "cure" for "cancer" makes no more sense than coming up with a "cure" for buggy web programs. Just like with web programs, there are certain common patterns in cancers that can be addressed and mitigated (XSS, estrogen receptors). But over a long time horizon, all complex systems have failure modes, and that's all cancer is.
begus 15y ago
Because profit stops at the moment of the cure. While "treatment" is profitable till death.
lucian1900 15y ago
Well, we have cured many kinds of cancer. There are many more left, of course. People looking for a general cure lose sight of the amazing accomplishments already achieved.
chmars 15y ago
A major reason is probably nuclear pollution. Nuclear tests have been replaced by radioactive waste and the results of many small and large incidents in nuclear facilities. An accident like Fukushima pollutes the whole planet, not just Japan and some parts of the Pacific. It would be much easier to fight such major reasons for cancer instead of trying to cure cancer.
MrTibbles 15y ago
Perhaps its because "finding a cure" is so much more lucrative than actually finding a cure. But by all means, keep walking your way to a cure lol. Im sure all the fat cats appreciate your efforts :D
krollew 15y ago
I think that there is no widely known cure for cancer not because nobody know one but because currently used cancer therapies are much more profitable. For example there is something like Gerson's Therapy, I've never heard that someone proved it wrong. Why it's not used widely? Because there is no money to earn, there are just fresh vegetables so noone want to prove it right.

231 points by vibrunazo 15y ago

Given the article talks about decades-long lead times before a cancer metastasizes, I hope that more attention begins to be focused on much earlier-stage detection and treatment. I think a lot of the problem is, by the time a cancer has metastasized and one begins showing symptoms, it's already very late in the game to try and fix things. From the article: Moreover, as was discussed in at least a couple of talks at the AACR meeting, an evolution-based analysis of tumors using the latest NGS techniques indicates that for most solid tumors the time from founder mutation to clinically apparent metastasis is between 20 and 30 years. For example, for pancreatic cancer it’s a median of around 21 years, and for colon cancer it’s around 30 years.

jimmyvanhalen 15y ago
early-stage detection and treatment is critical. I lost love ones to cancer because the cancer was not diagnosed early enough. somewhat related to the discussion. saw this last week. Daily Aspirin May Help Prevent and Treat Cancer “What really jumps out at you in terms of prevention is the striking 75 percent reduction in esophageal cancer and a 40 to 50 percent reduction in colorectal cancer, which is the most common cancer right now,” Dr. Rothwell said. “In terms of prevention, anyone with a family history would be sensible to take aspirin,” he added. http://www.nytimes.com/2012/03/21/health/research/studies-link-aspirin-daily-use-to-reduced-cancer-risk.html http://www.nytimes.com/2012/03/21/health/research/studies-li... http://online.wsj.com/article/SB10001424052702304724404577295462452273218.html http://online.wsj.com/article/SB1000142405270230472440457729... http://www.webmd.com/cancer/news/20120320/daily-aspirin-may-help-prevent-and-treat-cancer http://www.webmd.com/cancer/news/20120320/daily-aspirin-may-...

siculars 15y ago

... Because PhD's can barely feed themselves. ... Because the "smart" people work on Wall Street/for consulting firms. ... Because Facebook acquired Instagram.

viraptor 15y ago
1) is simply not true everywhere. I'm sure it varies depending on a country, but I know PhDs in a number of fields and all of them are doing at least "ok" financially. I'd like to see any kind of proof of 3)... it may be actually the opposite, because it shows that if market has enough money for a dotcom bubble 2.0, some of the transaction value is likely to fuel research to some extent (via taxes, etc.). Good economy is good for many people. (simplified, but true to some extent)
polyfractal 15y ago
This needs some more love. Consider the cycle of academic career: -Grad school for 5-8 years, averaging around 7 for most molecular and cellular biologists. You make $23-28k a year depending on where you live. You steal whatever free food is lying around your department -Post graduation, you obtain a Post-Doc position for ~2 years (if everything goes well). This pays ~40k/year, again varying depending on region. -If you got lucky and had a successful Post-doc, skip to the next bullet. Otherwise, go back to the last bullet for another 2-8 years. -Get a junior professor tenure-track position. Salary is much better, probably around 60-80k. You have five years to prove you are awesome. At five years, go to the next bullet -Tenure review! How many awesome papers did you publish? ---Not enough? go try again at a different university...hopefully your family is willing to relocate or there is one nearby. If you fail tenure review twice, you get to be an adjunct professor (zero job security, crap salary) for the rest of your life. ---Well, you don't completely suck...so we are giving you another two years to prove tenure. Go back to the last bullet. ---Wow! You got tenure! Welcome to the elite minority that actually make tenure. You get a nice salary bump up to 100-150k, have total job security, do zero science anymore (glorified manager now) and are probably in your 40's. Feels good, huh? And people wonder why things are slow in biology? If this was a sales funnel, you would notice hideous conversion rates between all the steps. People burn out because of intense competition for few spots, crappy salary and crappy hours. If you work finance, you may work 90 hour weeks but at least you make lots of money. In biology...you work 70 hour weeks for food stamps and the hope of getting tenure when you are 40.
- alexholehouse 15y ago

noonespecial 15y ago

The National Cancer Institute's average yearly budget for cancer research is around $4.9 billion. NFL football revenue? $9 billion. Priorities.

maratd 15y ago
What's the point of living if you can't have a little fun? Living merely for the sake of living is pointless.
- noonespecial 15y ago
  Its odd. I was quite curious to float this opinion in this crowd. It is of course, wildly unpopular among the non-geeks in my "regular" life. I wondered if it would also be so here. Affirmative. It always seemed to me that we should "take care of our business" first, and then play later. To see these numbers backwards (IMHO) struck me as a childish "play first" attitude. I wouldn't go so far as to say "cancel sports until we get our health problems sorted out" but a shift in priorities would be refreshing. Football is fun, finally cracking our genome to make disease obsolete (and I think nothing less than 100% of this cures cancer)... now that would be something to cheer about.
  - maratd 15y ago
    > It always seemed to me that we should "take care of our business" first, and then play later. This sentiment only works when the "business" is a low hanging fruit. In other words, very doable with reasonable effort with results in the short-term. Anything else, and you hunker down for the long haul. And that means plenty of playing in the interim. For "business" that can take a lifetime or several lifetimes, no, you should definitely make sure you play and play vigorously. Nobody should be asked to sacrifice the quality of their life for the sake of hypothetical benefits for future generations.
  - goblin89 15y ago
    > a shift in priorities would be refreshing. Agree, but as tptacek pointed out, there's a lot of commerce happening in football. If majority will shift their concerns to health problems, then the commerce will be happening there. Not sure if it would be necessarily a good thing, and it likely would require strict regulation.

jakeonthemove 15y ago

Very interesting read... it boggles my mind how complex our organisms are and how cancer forms and takes everything over from the inside. We can't even "cure" a relatively simple virus like the cold or influenza, and cancer is like 10,000x times more complicated - gotta respect all the hackers who're working in the medical field...

Peaker 15y ago
Viruses and bacteria evolve much faster than cancer, because they: * Use horizontal genetic exchange, so different evolutionary branches can share features. This increases evolutionary speed exponentially. * Evolve over a much larger eco-system, whereas cancer has to evolve "from scratch" in each individual over a relatively short time-span. Thus, I think cancer should be a much easier problem, from the evolutionary perspective, than bacteria and viruses.
bradley 15y ago
I had more appreciation for the complexity of the human organism after reading this NYTimes article about our microbiome: http://www.nytimes.com/2010/07/13/science/13micro.html?_r=1&pagewanted=all http://www.nytimes.com/2010/07/13/science/13micro.html?_r=1&... 10 times more microbial than 'human' DNA in our body.

Craiggybear 15y ago

Because, like AI, molecular biology is complicated and there are no quick hacks. Some things are meant to take time and be right. First time. Survival rates are spectacularly better than they were fifteen or twenty years ago and they are getting better all the time. Also there is no one type of lung cancer, brain tumour or bladder or bowel cancer either. There are many different types. Half the battle is identifying (and successfully treating) the right sort. I still think there will be cancer in fifty years time. But we won't have to die from it. We may never eradicate it though, because it is a tough, complex bio-engineering problem, closely allied to programmed cell death and immortality. That's another tough nut to crack for the same reasons, inexorably intertwined as they are.

dailyrorschach 15y ago
I think it's also important to note that our understanding of molecular biology while impressive is still so incomplete and there is much to learn. This is a kind of cool Wiki article: http://en.wikipedia.org/wiki/History_of_molecular_biology http://en.wikipedia.org/wiki/History_of_molecular_biology But the discipline isn't even 100 years old yet, and really only in the last couple of decades have we been able to have technology to really take advantage of isolation. We have learned so much about modern medicine, but have so much more to go.
pessimist 15y ago
Do you have a reference for survival rates? Note that there are many confounding factors - lung cancer incidence has dropped a lot although lung cancer itself remains intractable to average cancer survival rates may have improved.
- Craiggybear 15y ago
  Small cell, granuloma, take your pick. The data is available world-wide. The fact is that lung cancer is one from which there is never a good prognosis regardless of type. People can expect 4-5 years on average (although I know people who have gone past ten and have a good quality of life). It also is one where heredity and genetics plays an enormous role (as opposed to purely environmental conditions). Like I said, molecular biology is something we've only just noticed far less got a handle on. Ars Longa Vita Brevis.

Retric 15y ago

This is one of the most fascinating and frightening things I have ever read. It really feels like staring cthulhu in the face. TLDR: Breast cancers, for instance, have been shown to harbor at least 1,700 different mutations, but only three of them showed up in at least 10% of patients, with the great majority of them being unique to each patient. The most recent study in Nature discussed above shows that even a single subtype of breast cancer that is generally treated clinically more or less the same, TNBC, varies wildly (and almost continuously) in the genomic changes and mutations each tumor has. Not only that, but each TNBC is in essence several diseases, because each TNBC is made up of many different clones that have evolved as the tumor itself grew, progressed, and evolved. All of this occurs even before the tumor has been subjected to any treatment at all. As if that’s not bad enough, it would appear that tumors are a mosaic of groups of many different tumor cell types that develop through branching evolution such that metastases can be very different from the primary tumor and even different regions of the primary tumor can be very different from each other, so much so that finding a “favorable prognosis signature” on a core biopsy means only that that one area biopsied has that gene signature. Large areas elsewhere in the tumor could have the unfavorable prognosis signature. And even more interesting if you look at the history of a tumor the mutations goes back for a fairly long time, possibly on the order of 30+ years. While it may not be an actual cure, removing abnormal cells early may be more effective than trying to treat cancer in the last 1-10% of it's lifetime when it's already become a diversified killing machine.

albertcardona 15y ago
A focus on the common properties of cancer would perhaps provide more hope. The most obvious is the need for angiogenesis: the formation of new blood vessels to irrigate deep layers of a tumor. There are drugs out there targeting angiogenesis. Another obvious property is cell proliferation, without which a cancer is not a cancer. Both of these are core functions of most of the human body, but there is such thing as therapeutic windows: a time interval with a dose just so to have a greater effect on tumors rather than on the rest of the body.
micro_cam 15y ago
All this genetic diversity seems daunting at first but I think it is also indicative of something that gives me great hope. Cancer isn't like a virus or pathogen that has evolved to avoid it our immune systems and treatments as it passes from individual. It is a degenerative state of the same system that produces healthy cells and fertile humans. It is genetically very diverse. Part of this is because cancers cells often have mesed up chromosomal replication which produces more variability. Part of this may be because numerous genetic variations can have similar effects because they effect the same gene or network of genes. As the author alludes to at the end of the paper, there are a number of things a tumor must do to be successful. These include avoiding the immune system, avoiding programed cell death, recruiting blood vessels/nutrients etc. There has been lots of really promising research in the last few years that looks at analyzing and targeting the pathways that control these things. Further as projects like the the Cancer Genome Atlas (which I work on as a Software Engineer) produce terabytes of data about cancer, we are able to apply modern data analysis to better understand the system, hopefully discovering what separates the biochemical state of an aggressive cancer from one the body handles without issue which will hopefully lead to some novel drug targets.

millzlane 15y ago

I have the answer. It's a simple one word answer. GREED. But seriously It's the money that keeps us from curing cancer, or lack thereof. Nothing else. As human beings we really need to decide what's more important....Wealth or our survival and wellbeing. We're too smart as a society to let things like lack of money keep us from curing disease and exploring other planets.

aidenn0 15y ago
It's not lack of money, it's lack of what money represents, which is goods, services, and in general labor. If the US wanted to spend $100 trillion on cancer cures it could, but the moment it printed all that money, the purchasing power of it would decline to the point that they wouldn't actually have enough money to cure cancer. Consider a single cancer researcher. They need to eat. They need machines that sequence genes that use techniques developed by other researchers, designed by engineers, built by people in factories. All of those people need to eat. The raw materials are mined out of the ground in work that is environmentally damaging, hard work, and often dangerous work. It is not possible to snap your fingers and have more work immediately happen. There have been exceptions to the above, but it has been temporary in export economies with exportable natural resources attainable at a below-market level (e.g. OPEC, Soviet Union). You can't just say "Is it really just money that keeps us from doing X?" since money isn't the issue, it's that we don't have enough of the value that backs the currency.
tsotha 15y ago
It's not lack of money at all. How many researchers, worldwide, do you think have the expertise necessary to make a nontrivial contribution? The problem is we simply don't have the technology to develop a cure for cancer, and we don't even know the precursor technologies we need to develop a cure for cancer.

Rhapso 15y ago

<rant type="likely-naive"/> We can never "cure" cancer. We might be able to save most individuals from dying from it some day but cancer is just a mutation that makes a cell's behavior damaging/lethal to the host body. The only way to prevent "bad" mutation (because there is no sure way to discern 'bad' from any other mutation) is to stop mutation all together, and even if there way a way to do this (removal of radiation does not stop transcription errors) stopping mutation is a nice kindly way to ensure the extinction of the species (no chance for future biological adaptation, because there are no mutations). So, as evil and painful as cancer is, it is a symptom of a good thing, biological mutation and variation in our species, and any through and final "cure to all cancer everywhere" will have to stop the cause of cancer, mutation, which we as a society and species should not allow. </rant>

avgarrison 15y ago
I disagree that we should not allow such a thing if it existed. I think humans are a bit past the need for biological evolution. Technology can provide us with the ability to adapt to new challenges and environments, and can do so much more quickly.
- aidenn0 15y ago
  Also, plenty of biological evolution can happen in the absence of mutation.
  - mindcruzer 15y ago
    I'm not sure why you're being downvoted. Evolution is simply the changing of allele frequencies over time, which can certainly happen in the absence of mutation. Although, I don't know that I would say "plenty" of evolution can happen without mutations, but I guess that depends on what you think "plenty" is.
    - revelation 15y ago
      Only changing allele frequencies is proven to result in a stable state. You need mutation for evolution.

nextparadigms 15y ago

I don't think we can cure cancer until nanotechnology tools can be used in many hospitals. Send some nanorobots to eradicate all cancer cells in the body, and that's it. But we're probably at least 20-30 years away from that.

joeycfan 15y ago

It's right around the corner. Also limb re-growing and other miracles. All the fruit of AIDS research.

elchief 15y ago

We haven't cured a lot of things. Well, we've cured lots of small things, but few of the doozies. A baldness cure has been ten years away for the last thirty years. No cure for blindness, AIDS, lost limbs. Remember the blue denim dye that killed cancer? What happened to it? If something is "ten years away", it means we simply don't know how to do it, we are just hoping for someone else to come up with the tech to solve it for us. Even if it's "five years away", it's suspect. Why not just release it now? Oh, because it doesn't work. I'll believe something if it's being currently tested on monkeys. We simply don't have the technology yet to solve these problems. These problems won't likely be solved in medicine, but in another field that discovers the solution accidentally, likely in nano or AI/statistics. If you want to speed things along, make sure the government is dropping lots of coin in R&D in many NEW or PROMISING fields, not just medicine. Encourage intellectual property rights for innovative firms that do real R&D, and not just relabel their old products. Encourage your smart friend to go into bio-stats and not quantitative finance.

officialchicken 15y ago
I totally agree, but it doesn't explain why there are so many treatments not available in the U.S., but available elsewhere. Islet cell graphs, for example. Personally, I'd encourage EVERYONE with a chronic disease to become a quant, so that they may live long and healthy lives (after leaving finance).
Retric 15y ago
Most of the big things we cured where diseases that no-longer seem to be a big deal because they where cured. Food born illness, measles, and smallpox are all things that have killed more people than AIDS and are no longer a problem in the western world. Measles what's that? If vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected. http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm And "Smallpox is believed to have emerged in human populations about 10,000 BC... Smallpox was responsible for an estimated 300–500 million deaths during the 20th century" http://en.wikipedia.org/wiki/Smallpox http://en.wikipedia.org/wiki/Smallpox We are talking about something that killed around A BILLION PEOPLE and now it's 'gone'. At it's current rate AIDS might catch up to Smallpox 200-600 years from now. But, that's just deaths the side effects where far more common. She might not be dead but I don't like seeing this picture. http://en.wikipedia.org/wiki/File:Child_with_Smallpox_Bangladesh.jpg http://en.wikipedia.org/wiki/File:Child_with_Smallpox_Bangla... PS: You say there is no cure for blindness, but smallpox was responsible for 1/3 of all blindness cases which just don't happen any more.

JumpCrisscross 15y ago

Fascinating paper on returns on cancer research out of the NBER argues that for about $300 billion in cancer research expenditures from 1988 to 2000 the US created 23 million life-years worth, in aggregate, about $1.9 trillion [1]. That comes to about a 52% smoothed return. Pretty good given that the S&P 500 grew at about 14.6% over the same period (though if similarly smoothed yielded about 42%). [1] http://www.nber.org/papers/w15574.pdf?new_window=1 http://www.nber.org/papers/w15574.pdf?new_window=1 [2] http://quicktake.morningstar.com/index/IndexCharts.aspx?Country=USA&Symbol=SPX http://quicktake.morningstar.com/index/IndexCharts.aspx?Coun...

radu_floricica 15y ago
Cancer research... but you need to also factor in cancer treatment costs.
hollerith 15y ago
If creating life-years is the goal, paying poor people in 3rd-world countries to have kids will be at least 10 times as efficient as cancer research.
ximeng 15y ago
Is there some way to make a fund investing in research with returns based on the effectiveness of the results?
- JumpCrisscross 15y ago
  If you could find a counter-party to enter into a swap with you can base it on anything. But given that it would be virtually impossible to hedge you would have the odds severely stacked against.
- deleted 15y ago
  [deleted]
- deleted 15y ago
  [deleted]

officialchicken 15y ago

Which business model do you prefer - ongoing revenue or one-time payment? There's more money to be made by treating the symptoms than there is providing a cure. Anyone you know with a chronic disease will tell you that since their diagnosis, the price of everything related to the condition has gone up dramatically... cancer, ADD, diabetes, asthma, etc. I wonder what ad-supported pharmacology business model would be like? Medicaid meets Madison Ave.

Palomides 15y ago
any corporation with a cure would have an immense advantage over any competitors
- Symmetry 15y ago
  Also, even if there were only one corporation with a total healthcare monopoly then provided it could charge whatever it wanted it would still be able to make more money by just curing the cancer since it's providing a more valuable service by doing that.

blinkingled 15y ago

Highly recommended reading on the subject : The Emperor of All Maladies : Kindle URL - http://www.amazon.com/Emperor-All-Maladies-ebook/dp/B003UYUP58/ref=sr_1_1_title_1_kin?s=books&ie=UTF8&qid=1333996630&sr=1-1 http://www.amazon.com/Emperor-All-Maladies-ebook/dp/B003UYUP...

omerta 15y ago

Not a surprise cancer hasn't been cured. Most diseases have not been cured, yet. Even bacterial infections. People can still die from staph infections.

joeycfan 15y ago

PhD comics handled this nicely http://www.phdcomics.com/comics.php?f=1162 http://www.phdcomics.com/comics.php?f=1162

goronbjorn 15y ago

Because it isn't nearly as important as Instagram, apparently: http://www.evernote.com/shard/s146/sh/eb8c59f9-44b5-48bc-a246-30f7478c101c/7ff15abcd6a9d9d91c23c23f8408c908 http://www.evernote.com/shard/s146/sh/eb8c59f9-44b5-48bc-a24...

throughnothing 15y ago

Because "Cancer is Serious Business" https://www.youtube.com/watch?v=Be1ihuZNg84 https://www.youtube.com/watch?v=Be1ihuZNg84

mmphosis 15y ago

because 99% of money raised to "fight" cancer is spent on finding a "cure" whereas only 1% of money raised is spent on prevention. 0% is spent looking at environmental factors: - nuclear waste alone: bomb testing in the 60's and 70's, uranium mining, Chernobyl, bullets tipped with depleted uranium used in recent wars, Fukushima Daiichi - systematic poisoning of the industrial food supply: genetically modified food, petrochemicals, drugs that are put in food - systematic poisoning of the environment, water, air, and land.

alexholehouse 15y ago

One angle I feel is often missed in the whole cancer discussion is that it's a multidimensional problem. 1) Developing drugs which can damage cancer cells selectively. Like selecting a few needles in a haystack, cancer cells typically "look" the same as healthy cells, which makes selectively destroying them very difficult. Some cancers (such as CML) have a specific driver mutant proteins which allows for a pinpoint attack (Gleevec), but if this target protein mutates and Gleevec can no longer bind then that drug instantly becomes totally ineffective. 2) Identifying malignant tissue Surgery is still one of the most important tools against many forms of cancer, yet being able to identify malignant tissue vs. healthy stuff has always been a problem. In the first half of the 20th century the radical mastectomy was all the rage, but in reality provided little benefit. I was lucky enough to see Roger Tsein speak a few years ago (Nobel prize for GFP) who is pioneering a way to fluorescent tag malignant tissue which can be viewed in real time to give surgeons an augmented reality overview of a tumour to maximize the chance of getting all the malignant cells.[http://en.wikipedia.org/wiki/Roger_Y._Tsien#Fluorescence-assisted_cancer_surgery http://en.wikipedia.org/wiki/Roger_Y._Tsien#Fluorescence-ass...]. 3) Stopping metastasis Even if a patient presents with a tumour and that tumour is removed, it's impossible to tell if any of the maligant cells have managed to escape to other parts of the body, where they slowly start to regroup before launching a subsequent attack. This is the primary reason why cancer survivors have 5Y and 10Y survival rates as opposed to, "You're cured". The mechanism and time in a cancer at which this happens depends on so many factors its currently almost impossible the predict. 4) Drug delivery The tumour micro environment is so foreign compared to the normal stromal environment, and moreover so heterogeneous between tumour types (which in turn depends both on a cancer's underlying genotype and its associated tissue, vascularization and a wide range of additional factors) that creating drugs which can just survive long enough to act on their target can be difficult. This, combined with the fact that tumours are, compared to normal tissue, often poorly vascularized, means just getting drugs in can be a major challenge. I remember reading how often the vascularization of a tumour can be proportional to rate of growth and inversely proportional to chemotherapeutic efficacy (although don't quote me because I can't find the reference) meaning smaller, slower growing tumours often represent those most difficult to treat while larger, more aggressive ones may respond better, if caught in time. 5) Cancer is effectively microscale evolution Perhaps the biggest problem is that once cancer cells begin to acquire some initial mutations (and lie in a pre-cancerous form) they're often more susceptible to further mutations. In a way, this allows them to employ a sort of bet-hedging strategy, such as that seen by yeast or other single celled organisms. No longer can we treat the cancer cells as part of our multicellular body, but as a separate, single celled population. This means that even if certain drugs are effective, there will be a small population of cancer cells who may have mutated in such a way that they are resistant, so even if a treatment gets 99% of the cells, that final 1% can restart and the same bet-hedging strategy is re-employed to create another, diverse set of cells. This is totally analogous to antibiotic resistance. The range of this diversity varies significantly between cancers, but as we "pick out" the easier ones with an obvious target, this will become an every increasing issue. These are just a few points - there are more, but I've tried to focus on ones not yet brought up in discussion. This is an area I have some experience with, and if anything is unclear let me know and I'll do my best to explain. [EDIT]: This is not meant to be quite as, "we're all doomed" as it appeared. I think Dn_Ab's post summarizes how I feel more accurately. The development in a range of different areas has been staggering (childhood leakemia, CML, Her2+ BC etc), and the reason this is such a daunting task is because the magnitude has only reared its large, complex head in the last 10-15 years or so. Despite the challenges, it is a very exciting time to be a cancer biologist.

alanh 15y ago

Cynical answer: Because we keep inventing new carcinogens.

Dn_Ab 15y ago

What I got from this: - Cancer is complex, its profile is not that of 1 disease but many hundreds of diseases - Sequencing Cancers and attempting to find a match to suggest a treatment will not work, each cancer is unique and itself made up of a diverse population - Cancer is mutiny combined with the greed of evil dictators. A bunch of cells give up the chain of command and start co-opting resources to feed their opulent lifestyles. What this means is that no simple cure is going to work, cancer effectively exists to solve the problem of maximizing its growth or survival rate. Treatments are just another constraint that increase the dimensionality of the cancers' search space. - Tumorous cell lines are invaders even if they originate from the body and evolve at a breakneck pace. This is why many treatments fail to work - not that the ideas behind them are wrong but the system has outsmarted it. Cancer is dynamic not static. I found this inspiring and positive. While some may despair from a lack of a cure what I see is progress. We've gone from the boundless optimism that comes from ignorance to the sober determination that comes from an awareness of the extent of our ignorance. So now maybe the real work can begin. He says tackling the evolutionary aspect of cancer will be key. I wonder if game theory will inform future treatments. Or if there will be things people will take to reduce mutations or lend better error correction - outside immune and optionally germ cells. Or ubiquity of sensors allowing one to cluster features which determine the onset of cancer and forming tests to pinpoint and drugs to eradicate before the cancer stage. I wish I was not so ignorant.

epistasis 15y ago
>- Sequencing Cancers and attempting to find a match to suggest a treatment will not work, each cancer is unique and itself made up of a diverse population It seems to me that sequencing is a must, rather than a "not work," as without that type of intelligence one can't even know what you're up against. You just need to take into account the diversity of mutations, and not assume that you've seen everything that's currently in the population.
- Dn_Ab 15y ago
  You are right. I did not mean that sequencing shouldn't be done, what I meant was that the simple idea of sequence -> nearest match -> most appropriate treatment won't work due to the massive amount of variance involved. So the sequencing will be more useful at higher level. So more understanding patterns and devising strategies than personalizing cocktails.

linker3000 15y ago

Maybe we have... http://www.telegraph.co.uk/science/science-news/9191848/Universal-cancer-vaccine-developed.html http://www.telegraph.co.uk/science/science-news/9191848/Univ...

aakashamin 15y ago
it's hype. Read the blog post!

gfodor 15y ago

See also: "Facebook acquires Instagram [for $1B]"

Peaker 15y ago

If p53 is so critical that many cancers disable it, couldn't we genetically replicate it in our genome many times, to make it far harder for cancer to disable? Why didn't this happen naturally, by evolutionary processes? Is it because all copies of p53 can be disabled simultaneously via RNAi? If so, maybe particular disablers of p53 can be targeted too?

alexholehouse 15y ago
p53 operates as a tetramer (4 individual p53 [monomeric] proteins come together to form the active protein complex), and can have a dominant negative effect if one of the two p53 genes are mutated. This basically means we have two copies of the gene, but if one is mutated and you form a tetramer and 1 or more of the tetramer's monomers are mutants then that tetramer is far less active. Even if you had lots of copies of p53, its effect could still be down-regulated by a single mutant. There's been some work to try and reactivate p53 where it's been knocked out, although I'm not sure how successful it's been. http://www.ejcancer.info/article/S0959-8049(03)00454-4/abstract http://www.ejcancer.info/article/S0959-8049(03)00454-4/abstr...

tsotha 15y ago

Good God, this article is depressing. I used to think we'd have some therapies to at least suppress new growth in my lifetime. If I'm understanding what he's written they don't even have a game plan for an effective treatment.

crusso 15y ago
That was my first thought too. I've always thought of cancer as being beatable in ways that bacteria and viruses aren't since the latter get the benefit of evolution. It makes a lot of sense that rapid evolution is exactly why cancer has been so difficult to tackle. The good news is that: 1. Cancer survival rates have improved over the past and are continuing to improve; so we're still moving forward. 2. I have a lot of hope in the power of technology to come to our rescue. a. Sequencing has to get to a point where it's done in minutes or seconds on a chip. b. Physicians' computer aids need to be Watson+. In order to be able to constantly categorize and target each mutation with a drug or suggestion for other treatment. c. Ideally, we need to get to the point where we can automate the synthesis of different types of drugs so that the cancer attacking system can customize treatments at the molecular level to dynamically attack cancers that are mutating.

hooande 15y ago

The part that jumped out at me was this: "for most solid tumors the time from founder mutation to clinically apparent metastasis is between 20 and 30 years" If cancer is really this ultimate chimearan opponent, why don't we put more emphasis on detecting it during the twenty years before it becomes dangerous? It would be difficult to detect changes at the cellular level at any location in the human body. But it sounds like a problem that will scale with "Big Data" a lot better than trying to fight evolution.

Apocryphon 15y ago

It seems like there needs to be a combination of cultural/societal changes favoring education in the life sciences, combined with funding. The launch of Sputnik led to an upsurge of focus in math and science education during the Cold War. To a much smaller degree, C.S.I. inspired a generation of forensic scientists. Maybe the startup response to this piece should be to figure out ways to spark public interest in tackling this problems.

samth 15y ago

The whole concept of "curing" cancer is silly, and best abandoned. Cancer is just the name we give to the failure of certain kinds of cell regulatory systems, particularly those relating to growth and cell death. Coming up with a "cure" for "cancer" makes no more sense than coming up with a "cure" for buggy web programs. Just like with web programs, there are certain common patterns in cancers that can be addressed and mitigated (XSS, estrogen receptors). But over a long time horizon, all complex systems have failure modes, and that's all cancer is.

begus 15y ago

Because profit stops at the moment of the cure. While "treatment" is profitable till death.

lucian1900 15y ago

Well, we have cured many kinds of cancer. There are many more left, of course. People looking for a general cure lose sight of the amazing accomplishments already achieved.

chmars 15y ago

A major reason is probably nuclear pollution. Nuclear tests have been replaced by radioactive waste and the results of many small and large incidents in nuclear facilities. An accident like Fukushima pollutes the whole planet, not just Japan and some parts of the Pacific. It would be much easier to fight such major reasons for cancer instead of trying to cure cancer.

MrTibbles 15y ago

Perhaps its because "finding a cure" is so much more lucrative than actually finding a cure. But by all means, keep walking your way to a cure lol. Im sure all the fat cats appreciate your efforts :D

krollew 15y ago

I think that there is no widely known cure for cancer not because nobody know one but because currently used cancer therapies are much more profitable. For example there is something like Gerson's Therapy, I've never heard that someone proved it wrong. Why it's not used widely? Because there is no money to earn, there are just fresh vegetables so noone want to prove it right.