Today is World Cancer Day, a good time to try to answer the question everyone wants to know: "When will there be a cure for cancer?" The question is understandable, as the lifetime risk of cancer is 1 in 3 for women, 1 in 2 for men.
But it's the wrong question. Rather than a cure for cancer, there will likely be many cures for cancers. Indeed, there already are some. Understanding the plurals here is not hair-splitting. It is the key to appreciating and ultimately rewarding valuable innovation against the many complex diseases we know simply as cancer.
The myth that cancer is one disease remains fairly widespread. Recently, Lilly's oncology team released the PACE Cancer Perceptions Index -- a six-country survey designed to understand public knowledge and attitudes around cancer (see www.PACENetwork.com). The survey found that 43 percent of people across all of the countries surveyed believe that cancer is a single disease that can appear in different parts of the body. Americans did better than average, with 29 percent taking the "single disease" view -- still nearly one in three people.
In fact, the most significant common denominators among cancers are out-of-control cell growth -- malignancy -- and invasion of other tissues -- metastasis. Malignancy can occur in different ways, however, and the underlying genetic changes can be set off by yet other biological triggers. Cancers also are subdivided according to the types of cells in which they originate. The resulting genetics and disease-based matrix includes about 150 different diseases for which prognosis and treatment options are defined, and the number continues to grow as more variations come to light.
Any cancer is a terrible disease, whether it is called "diffuse large B-cell lymphoma" or "HER-2 receptor positive breast cancer." From the perspectives of investment and health-care policy, however, understanding the diversity of cancer is important for at least three reasons.
First, since cancer is some 150 significantly different diseases, it stands to reason that no single "cure" will be found to shut down cancer writ large, and that no single treatment makes sense for every individual patient. There must be unique standards of care for almost every kind of cancer and the best-available regimens can vary even further from person to person based on patients' genetic profiles, overall health and other factors. Therefore, having a wide range of treatment options is vital to effective cancer care, and doctors' ability to prescribe across this range should be restricted only with the greatest caution.
Second, the level of progress against cancers varies enormously, and so progress, along with investments in research, also should be evaluated on a cancer-by-cancer basis. A report released by the American Cancer Society and other groups last month showed a 20-percent drop in the rate of deaths from cancer in the last 20 years -- which became the focus of media reporting even though the same report's disease-specific statistics are much more revealing. Against most forms of breast cancer, for example, large investments in prevention, screening, R&D and new treatments appear to have paid off handsomely in long-term survival and even cures. For cancers of the pancreas, in contrast, there has been no improvement in death rates -- signaling that more or different investments are necessary.
Finally, given this wide range of unmet needs, it makes little sense to hold every new cancer treatment coming out of clinical trials to the same standard. Against cancers for which effective treatments already exist, we need to value new medicines that reduce side effects or are easier to administer. Against cancers for which the current prognoses are grim, we must recognize that new medicines that offer even a few weeks of average gains in survival can represent vital steps forward. In the cancer field, progress comes mostly in the form of accumulated, step-by-step gains rather than from isolated breakthroughs.
In the same Lilly Oncology survey I mentioned earlier, we learned that about 60 percent of people surveyed believe pharmaceutical companies are more interested in treating cancer than in finding cures for it. Yet the truth is -- proven time and again in recent decades -- new treatments beget new cures.
Medical research and a vibrant, healthy biopharmaceutical industry represent the best hope of finding cures for all 150 and more cancers. And progress must accelerate! Based on what we know today, even if we were to cure one individual form of cancer per year, we have more than a century of work ahead of us still if we're going to tackle all the various manifestations of this insidious disease!
Everyone involved in fighting cancer has a stake in setting the record straight about the diversity and complexity of these diseases. Without a wide range of treatment options, continued investments that target the most difficult diseases, and a more nuanced evaluation of new medicines, we will slip backwards in the fight against cancers -- emphasis on the "s."