War on Cancer
Encyclopedia
The War on Cancer refers to the effort to find a cure for cancer
by increased research
to improve the understanding of cancer biology and the development of more effective cancer treatments, such as targeted drug therapies
. The aim of such efforts is to eradicate cancer as a major cause of death
. The signing of the National Cancer Act of 1971 by then U.S. President Richard Nixon
is generally viewed as the beginning of the war on cancer, though it was not described as a "war" in the legislation itself.
Despite significant progress in the treatment of certain forms of cancer (such as childhood leukemia), cancer in general remains a major cause of death nearly 40 years after this war on cancer began, leading to a perceived lack of progress and to new legislation aimed at augmenting the original National Cancer Act of 1971.
New research directions, in part based on the results of the Human Genome Project
, hold promise for a better understanding of the genetic
factors underlying cancer, and the development of new diagnostics, therapies, preventive measures, and early detection ability. However, targeting cancer proteins can be difficult, as a protein can be undruggable
.
The act was intended "to amend the Public Health Service Act
so as to strengthen the National Cancer Institute
in order to more effectively carry out the national effort against cancer
".
It was signed into law by then U.S. President Richard Nixon
on December 23, 1971.
, the director of the National Cancer Institute
issued a challenge "to eliminate the suffering and death from cancer, and to do so by 2015".
This was supported by the American Association for Cancer Research
in 2005
though some scientists felt this goal was impossible to reach and undermined von Eschenbach's credibility.
John E. Niederhuber
, who succeeded Andrew von Eschenbach as NCI director, noted that cancer is a global health crisis, with 12.9 million new cases diagnosed in 2009 worldwide and that by 2030, this number could rise to 27 million including 17 million deaths "unless we take more pressing action."
Harold Varmus, former director of the NIH and current director of the NCI
,
held a town hall meeting in 2010
in which he outlined his priorities for improving the cancer research program, including the following:
On July 15, 2008, the United States Senate Committee on Health, Education, Labor, and Pensions
convened a panel discussion titled, Cancer: Challenges and Opportunities in the 21st Century.
It included interviews with noted cancer survivors such as Arlen Specter
, Elizabeth Edwards
and Lance Armstrong
, who came out of retirement in 2008, returning to competitive cycling "to raise awareness of the global cancer burden."
(LAF) created the LIVESTRONG Global Cancer Campaign to address the burden of cancer worldwide and encourage nations to make commitments to battle the disease and provide better access to care.
In April 2009, the LAF announced that the Hashemite Kingdom of Jordan pledged $300 million to fund three important cancer control initiatives – building a cutting-edge cancer treatment and research facility, developing a national cancer control plan and creating an Office of Advocacy and Survivorship.
The LAF encourages similar commitments from other nations to combat the disease.
LIVESTRONG Day is an annual event established by the LAF to serve as "a global day of action to raise awareness about the fight against cancer." Individuals from around the world are encouraged to host cancer-oriented events in their local communities and then register their events with the LAF website.
In 2009, LIVESTRONG Day occurred on October 2.
on 26 March 2009 issued a new bill (S. 717), the 21st Century Cancer Access to Life-Saving Early detection, Research and Treatment (ALERT) Act
intended to "overhaul the 1971 National Cancer Act."
The bill aims to improve patient access to prevention and early detection by:
then Senators Barack Obama
and Joe Biden
published a plan to combat cancer that entailed doubling "federal funding for cancer research within 5 years, focusing on NIH and NCI
" as well as working "with Congress to increase funding for the
Food and Drug Administration
."
Their plan would provide additional funding for:
President Obama's 2009 economic stimulus package
includes $10 billion for the NIH, which funds much of the cancer research
in the U.S., and he has pledged to increase federal funding for cancer research by a third for the next two years as part of a drive to find "a cure for cancer in our time."
In a message published in the July 2009 issue of Harper's Bazaar
, President Obama described his mother's battle with ovarian cancer
and, noting the additional funding his administration has slated for cancer research, stated: "Now is the time to commit ourselves to waging a war against cancer as aggressive as the war cancer wages against us."
On 30 September 2009, Obama announced that $1 billion of a $5 billion medical research spending plan would be earmarked for research into the genetic causes of cancer and targeted cancer treatments.
Cancer-related federal spending of money from the 2009 Recovery Act
can be tracked online.
has organized a World Cancer campaign in 2009 with the theme, "I love my healthy active childhood," to promote healthy habits in children and thereby reduce their lifestyle-based cancer risk as adults.
The World Health Organization
is also promoting this campaign
and joins with the UICC in annually promoting World Cancer Day
on 4 February.
of some types of cancer (such as childhood leukemia) since the inception of the National Cancer Act of 1971, progress in reducing the overall cancer mortality rate
has been disappointing.
Many types of cancer remain incurable (such as pancreatic cancer)
and the overall death rate from cancer has not decreased appreciably since the 1970s.
The death rate for cancer in the U.S., adjusted for population size and age, dropped only 5 percent from 1950 to 2005.
Cancer is expected to surpass cardiovascular disease
as the leading cause of death in the world by 2010, according to the World Health Organization
's World Cancer Report 2008.
Yet there is evidence for progress in reducing cancer mortality.
Age-specific analysis of cancer mortality rates has indicated significant progress in reducing cancer mortality in the United States since 1955. An August 2009 study found that age-specific cancer mortality rates have been steadily declining since the early 1950s for individuals born since 1925, with the youngest age groups experiencing the steepest decline in mortality rate at 25.9 percent per decade, and the oldest age groups experiencing a 6.8 percent per decade decline.
Dr. Eric Kort, the lead author of this study, claims that public reports often focus on cancer incidence rates and underappreciate the progress that has been achieved in reduced cancer mortality rates.
The effectiveness and expansion of available therapies has seen significant improvements since the 1970s. For example, lumpectomy
replaced more invasive mastectomy
surgery for the treatment of breast cancer
.
Treatment of childhood leukemia and chronic myeloid leukemia (CML) have undergone major advances since the war on cancer began. The drug Gleevec now cures most CML patients, compared to previous therapy with interferon
, which extended life for approximately 1 year in only 20-30 percent of patients.
Dr. Steven Rosenberg
, chief of surgery at the NCI
has said that as of the year 2000, 50% of all diagnosed cases of cancer are curable
through a combination of surgery
, radiation
, and chemotherapy
.
Cancer surveillance experts have reported a 15.8 percent decrease in the age-standardized death rate from all cancers combined between 1991 and 2006 along with an approximately 1 percent annual decrease in the rate of new diagnoses between 1999 and 2006. A large portion of this decreased mortality for men was attributable to smoking cessation
efforts in the U.S..
A 2010 report from the American Cancer Society
found that death rates for all cancers combined decreased 1.3% per year from 2001 to 2006 in males and 0.5% per year from 1998 to 2006 in females, largely due to decreases in the 3 major cancer sites in men (lung, prostate, and colorectum) and 2 major cancer sites in women (breast and colorectum). Cancer death rates between 1990 and 2006 for all races combined decreased by 21.0% among men and by 12.3% among women. This reduction in the overall cancer death rates translates to the avoidance of approximately 767,000 deaths from cancer over the 16-year period. Despite these reductions, the report noted, cancer still accounts for more deaths than heart disease
in persons younger than 85 years.
An improvement in the number of cancer survivors living in the U.S. was indicated in a 2011 report by the CDC
and the NCI
, which noted that the number of cancer survivors in 2007 (11.7 million) increased by 19% from 2001 (9.8 million survivors). The number of cancer survivors in 1971 was 3 million. Breast
, prostate
, and colorectal
cancers were the most common types of cancer among survivors, accounting for 51% of diagnoses. As of January 1, 2007, an estimated 64.8% of cancer survivors had lived ≥5 years after their diagnosis of cancer, and 59.5% of survivors were aged ≥65 years.
Some of the factors that have posed challenges for the development of preventive measures and anti-cancer drugs and therapies include the following:
technologies developed during the Human Genome Project
opens up new ways to study cancer and holds the promise for the discovery of new aspects of cancer biology that could eventually lead to novel, more effective diagnostics and therapies for cancer patients.
These new technologies are capable of screening many biomolecules and genetic
variations such as SNPs
and copy number variations in a single experiment and are employed within functional genomics
and personalized medicine
studies.
Speaking on the occasion of the announcement of $1 billion in new funding for genome-based cancer research, Dr. Francis Collins
, director of the NIH claimed, "We are about to see a quantum leap in our understanding of cancer." Harold Varmus, after his appointment to be the director of the NCI
, said we are in a "golden era for cancer research," poised to profit from advances in our understanding of the cancer genome.
High-throughput DNA sequencing has been used to study the whole genome sequence of two different cancer tissues: a small-cell lung cancer metastasis
and a malignant melanoma cell line.
The sequence information provides a comprehensive catalog of approximately 90% of the somatic
mutations in the cancerous tissue, providing a more detailed molecular and genetic understanding of cancer biology than was previously possible, and offering hope for the development of new therapeutic strategies gleaned from these insights.
(TCGA), a collaborative effort between the National Cancer Institute
and the National Human Genome Research Institute
, is an example of a basic research project that is employing some of these new molecular approaches.
One TCGA publication notes the following:
In a cancer research funding announcement made by president Obama in September 2009, TCGA project is slated to receive $175 million in funding to collect comprehensive gene sequence data on 20,000 tissue samples from people with more than 20 different types of cancer, in order to help researchers understand the genetic changes underlying cancer. New, targeted therapeutic approaches are expected to arise from the insights resulting from such studies.
at the Wellcome Trust Sanger Institute
aims to identify sequence variant
s/mutation
s critical in the development of human cancer
s. The Cancer Genome Project combines knowledge of the human genome
sequence with high throughput mutation detection
techniques.
supporting cancer research, such as the NCI
's caBIG
project, promise to improve data sharing among cancer researchers and accelerate "the discovery of new approaches for the detection, diagnosis, treatment, and prevention of cancer, ultimately improving patient outcomes."
Increased participation in rigorously designed clinical trials would increase the pace of research. Currently, about 3% of people with cancer participate in clinical trials; more than half of them are patients for whom no other options are left, patients who are participating in "exploratory" trials designed to burnish the researchers' résumés or promote a drug rather than to produce meaningful information, or in trials that will not enroll enough patients to produce a statistically significant result. Recommending a clinical trial to a patient normally causes physicians and cancer centers to lose time and money while increasing their legal risks and volume of paperwork.
in order to provide a more effective, localized dose and to minimize exposure of healthy tissue in other parts of the body to the potentially adverse effects of the treatments. The accessibility of different tissues and organs to anti-tumor drugs contributes to this challenge. For example, the blood-brain barrier
blocks many drugs that may otherwise be effective against brain tumors. In November 2009, a new, experimental therapeutic approach for treating glioblastoma was published in which the anti-tumor drug Avastin was delivered to turmor site within the brain through the use of microcatheters
, along with mannitol
to temporarily open the blood-brain barrier permitting delivery of the chemotherapy into the brain.
, as well as access to support communities. Resources have been created by governmental and other organizations to provide support for cancer patients, their families and caregivers, to help them share information and find advice to guide decision making.
www.CancerProgress.Net
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
by increased research
Cancer research
Cancer research is basic research into cancer in order to identify causes and develop strategies for prevention, diagnosis, treatments and cure....
to improve the understanding of cancer biology and the development of more effective cancer treatments, such as targeted drug therapies
Targeted therapy
Targeted therapy is a type of medication that blocks the growth of cancer cells by interfering with specific targeted molecules needed for carcinogenesis and tumor growth, rather than by simply interfering with rapidly dividing cells...
. The aim of such efforts is to eradicate cancer as a major cause of death
Cause of Death
Cause of Death is a 1990 album by American death metal band Obituary. Cause of Death is considered a classic album in the history of death metal. The artwork was done by artist Michael Whelan...
. The signing of the National Cancer Act of 1971 by then U.S. President Richard Nixon
Richard Nixon
Richard Milhous Nixon was the 37th President of the United States, serving from 1969 to 1974. The only president to resign the office, Nixon had previously served as a US representative and senator from California and as the 36th Vice President of the United States from 1953 to 1961 under...
is generally viewed as the beginning of the war on cancer, though it was not described as a "war" in the legislation itself.
Despite significant progress in the treatment of certain forms of cancer (such as childhood leukemia), cancer in general remains a major cause of death nearly 40 years after this war on cancer began, leading to a perceived lack of progress and to new legislation aimed at augmenting the original National Cancer Act of 1971.
New research directions, in part based on the results of the Human Genome Project
Human Genome Project
The Human Genome Project is an international scientific research project with a primary goal of determining the sequence of chemical base pairs which make up DNA, and of identifying and mapping the approximately 20,000–25,000 genes of the human genome from both a physical and functional...
, hold promise for a better understanding of the genetic
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
factors underlying cancer, and the development of new diagnostics, therapies, preventive measures, and early detection ability. However, targeting cancer proteins can be difficult, as a protein can be undruggable
Undruggable protein
-Difficult targets:Undruggable proteins are hard for pharmaceutical researchers to target, as they do not have suitable loci that bind to small organic molecules. For instance, proteins responsible for pancreatic cancer are undruggable....
.
National Cancer Act of 1971
The war on cancer began with the National Cancer Act of 1971, a United States federal law.The act was intended "to amend the Public Health Service Act
Public Health Service Act
The Public Health Service Act is a United States federal law enacted in 1944. The full act is captured under Title 42 of the United States Code "The Public Health and Welfare", Chapter 6A "Public Health Service"....
so as to strengthen the National Cancer Institute
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
in order to more effectively carry out the national effort against cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
".
It was signed into law by then U.S. President Richard Nixon
Richard Nixon
Richard Milhous Nixon was the 37th President of the United States, serving from 1969 to 1974. The only president to resign the office, Nixon had previously served as a US representative and senator from California and as the 36th Vice President of the United States from 1953 to 1961 under...
on December 23, 1971.
NCI Director's Challenge
In 2003, Andrew von EschenbachAndrew von Eschenbach
Andrew C. von Eschenbach was the Commissioner of the United States Food and Drug Administration from 2006–2009. He became acting Commissioner on September 26, 2005, after the resignation of his predecessor Lester Crawford, and was confirmed as Commissioner by the Senate on December 7, 2006...
, the director of the National Cancer Institute
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
issued a challenge "to eliminate the suffering and death from cancer, and to do so by 2015".
This was supported by the American Association for Cancer Research
American Association for Cancer Research
The American Association for Cancer Research is the world's oldest and largest professional association to advancing cancer research. Based in Philadelphia, AACR focuses on all aspects of cancer research including basic, clinical and translational research into the etiology, prevention, diagnosis,...
in 2005
though some scientists felt this goal was impossible to reach and undermined von Eschenbach's credibility.
John E. Niederhuber
John E. Niederhuber
John E. Niederhuber, MD is the 13th director of the National Cancer Institute,succeeding Andrew von Eschenbach. A nationally renowned surgeon and researcher, Dr...
, who succeeded Andrew von Eschenbach as NCI director, noted that cancer is a global health crisis, with 12.9 million new cases diagnosed in 2009 worldwide and that by 2030, this number could rise to 27 million including 17 million deaths "unless we take more pressing action."
Harold Varmus, former director of the NIH and current director of the NCI
NCI
NCI can stand for:*National Cancer Institute*National Captioning Institute*Nordic Centre in India*National College of Ireland*Native Communications Inc - Aboriginal Public Broadcaster in Manitoba, Canada....
,
held a town hall meeting in 2010
in which he outlined his priorities for improving the cancer research program, including the following:
- reforming the clinical trials system,
- improving utilization of the NIH clinical center (Mark O. Hatfield Clinical Research Center),
- readjusting the drug approval and regulation processes,
- improving cancer treatment and prevention, and
- formulating new, more specific and science-based questions.
Renewed focus on cancer
Recent years have seen an increased perception of a lack of progress in the war on cancer, and renewed motivation to confront the disease.On July 15, 2008, the United States Senate Committee on Health, Education, Labor, and Pensions
United States Senate Committee on Health, Education, Labor, and Pensions
The United States Senate Committee on Health, Education, Labor, and Pensions generally considers matters relating to health, education, labor, and pensions...
convened a panel discussion titled, Cancer: Challenges and Opportunities in the 21st Century.
It included interviews with noted cancer survivors such as Arlen Specter
Arlen Specter
Arlen Specter is a former United States Senator from Pennsylvania. Specter is a Democrat, but was a Republican from 1965 until switching to the Democratic Party in 2009...
, Elizabeth Edwards
Elizabeth Edwards
Elizabeth Anania Edwards was an American attorney, a best-selling author and a health care activist. She was married to John Edwards, the former U.S...
and Lance Armstrong
Lance Armstrong
Lance Edward Armstrong is an American former professional road racing cyclist who won the Tour de France a record seven consecutive times, after having survived testicular cancer. He is also the founder and chairman of the Lance Armstrong Foundation for cancer research and support...
, who came out of retirement in 2008, returning to competitive cycling "to raise awareness of the global cancer burden."
Lance Armstrong Foundation
The Lance Armstrong FoundationLance Armstrong Foundation
The Lance Armstrong Foundation is a United States 501 nonprofit organization that provides support for people affected by cancer, founded in 1997 by cancer survivor and champion cyclist Lance Armstrong. The LAF states that its mission is 'to inspire and empower' cancer sufferers and their families...
(LAF) created the LIVESTRONG Global Cancer Campaign to address the burden of cancer worldwide and encourage nations to make commitments to battle the disease and provide better access to care.
In April 2009, the LAF announced that the Hashemite Kingdom of Jordan pledged $300 million to fund three important cancer control initiatives – building a cutting-edge cancer treatment and research facility, developing a national cancer control plan and creating an Office of Advocacy and Survivorship.
The LAF encourages similar commitments from other nations to combat the disease.
LIVESTRONG Day is an annual event established by the LAF to serve as "a global day of action to raise awareness about the fight against cancer." Individuals from around the world are encouraged to host cancer-oriented events in their local communities and then register their events with the LAF website.
In 2009, LIVESTRONG Day occurred on October 2.
21st Century Cancer Access to Life-Saving Early detection, Research and Treatment (ALERT) Act
The US SenateUnited States Senate
The United States Senate is the upper house of the bicameral legislature of the United States, and together with the United States House of Representatives comprises the United States Congress. The composition and powers of the Senate are established in Article One of the U.S. Constitution. Each...
on 26 March 2009 issued a new bill (S. 717), the 21st Century Cancer Access to Life-Saving Early detection, Research and Treatment (ALERT) Act
21st Century Cancer Access to Life-Saving Early detection, Research and Treatment (ALERT) Act
The 21st Century Cancer Access to Life-Saving Early detection, Research and Treatment Act is a bill to re-engage the war on cancer. The bill was introduced by Senators Edward M. Kennedy and Kay Bailey Hutchison on March 26, 2009. The bill has not yet been enacted into law....
intended to "overhaul the 1971 National Cancer Act."
The bill aims to improve patient access to prevention and early detection by:
- providing funding for research in early detection,
- supplying grants for screening and referrals for treatment, and
- increasing access to clinical trials and information.
Obama-Biden Plan to Combat Cancer
During their 2008 U.S. presidential campaignUnited States presidential election, 2008
The United States presidential election of 2008 was the 56th quadrennial presidential election. It was held on November 4, 2008. Democrat Barack Obama, then the junior United States Senator from Illinois, defeated Republican John McCain, the senior U.S. Senator from Arizona. Obama received 365...
then Senators Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...
and Joe Biden
Joe Biden
Joseph Robinette "Joe" Biden, Jr. is the 47th and current Vice President of the United States, serving under President Barack Obama...
published a plan to combat cancer that entailed doubling "federal funding for cancer research within 5 years, focusing on NIH and NCI
NCI
NCI can stand for:*National Cancer Institute*National Captioning Institute*Nordic Centre in India*National College of Ireland*Native Communications Inc - Aboriginal Public Broadcaster in Manitoba, Canada....
" as well as working "with Congress to increase funding for the
Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
."
Their plan would provide additional funding for:
- research on rare cancers and those without effective treatment options,
- the study of health disparities and evaluation of possible interventions,
- and efforts to better understand genetic factors that can impact cancer onset and outcomes.
President Obama's 2009 economic stimulus package
American Recovery and Reinvestment Act of 2009
The American Recovery and Reinvestment Act of 2009, abbreviated ARRA and commonly referred to as the Stimulus or The Recovery Act, is an economic stimulus package enacted by the 111th United States Congress in February 2009 and signed into law on February 17, 2009, by President Barack Obama.To...
includes $10 billion for the NIH, which funds much of the cancer research
Cancer research
Cancer research is basic research into cancer in order to identify causes and develop strategies for prevention, diagnosis, treatments and cure....
in the U.S., and he has pledged to increase federal funding for cancer research by a third for the next two years as part of a drive to find "a cure for cancer in our time."
In a message published in the July 2009 issue of Harper's Bazaar
Harper's Bazaar
Harper’s Bazaar is an American fashion magazine, first published in 1867. Harper’s Bazaar is published by Hearst and, as a magazine, considers itself to be the style resource for “women who are the first to buy the best, from casual to couture.”...
, President Obama described his mother's battle with ovarian cancer
Ovarian cancer
Ovarian cancer is a cancerous growth arising from the ovary. Symptoms are frequently very subtle early on and may include: bloating, pelvic pain, difficulty eating and frequent urination, and are easily confused with other illnesses....
and, noting the additional funding his administration has slated for cancer research, stated: "Now is the time to commit ourselves to waging a war against cancer as aggressive as the war cancer wages against us."
On 30 September 2009, Obama announced that $1 billion of a $5 billion medical research spending plan would be earmarked for research into the genetic causes of cancer and targeted cancer treatments.
Cancer-related federal spending of money from the 2009 Recovery Act
American Recovery and Reinvestment Act of 2009
The American Recovery and Reinvestment Act of 2009, abbreviated ARRA and commonly referred to as the Stimulus or The Recovery Act, is an economic stimulus package enacted by the 111th United States Congress in February 2009 and signed into law on February 17, 2009, by President Barack Obama.To...
can be tracked online.
World Cancer Campaign
The International Union Against Cancer (UICC)International Union Against Cancer
The International Union Against Cancer, or UICC is the only non-governmental organization dedicated exclusively to the global control of cancer. Its vision is of a world where cancer is eliminated as a major life-threatening disease for future generations...
has organized a World Cancer campaign in 2009 with the theme, "I love my healthy active childhood," to promote healthy habits in children and thereby reduce their lifestyle-based cancer risk as adults.
The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
is also promoting this campaign
and joins with the UICC in annually promoting World Cancer Day
World Cancer Day
World Cancer Day is marked on February 4 to raise awareness of cancer and to encourage its prevention, detection, and treatment. It is led by the Union for International Cancer Control, a global consortium of more than 470 cancer-fighting organisations in over 120 countries...
on 4 February.
Progress
Though there has been significant progress in the understanding of cancer biology, risk factors, treatments, and prognosisPrognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
of some types of cancer (such as childhood leukemia) since the inception of the National Cancer Act of 1971, progress in reducing the overall cancer mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
has been disappointing.
Many types of cancer remain incurable (such as pancreatic cancer)
and the overall death rate from cancer has not decreased appreciably since the 1970s.
The death rate for cancer in the U.S., adjusted for population size and age, dropped only 5 percent from 1950 to 2005.
Cancer is expected to surpass cardiovascular disease
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
as the leading cause of death in the world by 2010, according to the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
's World Cancer Report 2008.
Yet there is evidence for progress in reducing cancer mortality.
Age-specific analysis of cancer mortality rates has indicated significant progress in reducing cancer mortality in the United States since 1955. An August 2009 study found that age-specific cancer mortality rates have been steadily declining since the early 1950s for individuals born since 1925, with the youngest age groups experiencing the steepest decline in mortality rate at 25.9 percent per decade, and the oldest age groups experiencing a 6.8 percent per decade decline.
Dr. Eric Kort, the lead author of this study, claims that public reports often focus on cancer incidence rates and underappreciate the progress that has been achieved in reduced cancer mortality rates.
The effectiveness and expansion of available therapies has seen significant improvements since the 1970s. For example, lumpectomy
Lumpectomy
Lumpectomy is a common surgical procedure designed to remove a discrete lump, usually a benign tumor or breast cancer, from an affected man or woman's breast...
replaced more invasive mastectomy
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
surgery for the treatment of breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
.
Treatment of childhood leukemia and chronic myeloid leukemia (CML) have undergone major advances since the war on cancer began. The drug Gleevec now cures most CML patients, compared to previous therapy with interferon
Interferon
Interferons are proteins made and released by host cells in response to the presence of pathogens—such as viruses, bacteria, or parasites—or tumor cells. They allow communication between cells to trigger the protective defenses of the immune system that eradicate pathogens or tumors.IFNs belong to...
, which extended life for approximately 1 year in only 20-30 percent of patients.
Dr. Steven Rosenberg
Steven Rosenberg
Steven A. Rosenberg is a leading cancer researcher and surgeon. He is credited with developing the use of IL-2 and immune cells for the treatment of patients with melanoma in a procedure termed adoptive cell transfer...
, chief of surgery at the NCI
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
has said that as of the year 2000, 50% of all diagnosed cases of cancer are curable
through a combination of surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, radiation
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
, and chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
.
Cancer surveillance experts have reported a 15.8 percent decrease in the age-standardized death rate from all cancers combined between 1991 and 2006 along with an approximately 1 percent annual decrease in the rate of new diagnoses between 1999 and 2006. A large portion of this decreased mortality for men was attributable to smoking cessation
Smoking cessation
Smoking cessation is the process of discontinuing the practice of inhaling a smoked substance. This article focuses exclusively on cessation of tobacco smoking; however, the methods described may apply to cessation of smoking other substances that can be difficult to stop using due to the...
efforts in the U.S..
A 2010 report from the American Cancer Society
American Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
found that death rates for all cancers combined decreased 1.3% per year from 2001 to 2006 in males and 0.5% per year from 1998 to 2006 in females, largely due to decreases in the 3 major cancer sites in men (lung, prostate, and colorectum) and 2 major cancer sites in women (breast and colorectum). Cancer death rates between 1990 and 2006 for all races combined decreased by 21.0% among men and by 12.3% among women. This reduction in the overall cancer death rates translates to the avoidance of approximately 767,000 deaths from cancer over the 16-year period. Despite these reductions, the report noted, cancer still accounts for more deaths than heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
in persons younger than 85 years.
An improvement in the number of cancer survivors living in the U.S. was indicated in a 2011 report by the CDC
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
and the NCI
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
, which noted that the number of cancer survivors in 2007 (11.7 million) increased by 19% from 2001 (9.8 million survivors). The number of cancer survivors in 1971 was 3 million. Breast
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
, prostate
Prostate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
, and colorectal
Colorectal cancer
Colorectal cancer, commonly known as bowel cancer, is a cancer caused by uncontrolled cell growth , in the colon, rectum, or vermiform appendix. Colorectal cancer is clinically distinct from anal cancer, which affects the anus....
cancers were the most common types of cancer among survivors, accounting for 51% of diagnoses. As of January 1, 2007, an estimated 64.8% of cancer survivors had lived ≥5 years after their diagnosis of cancer, and 59.5% of survivors were aged ≥65 years.
Challenges
A multitude of factors have been cited as impeding progress in finding a cure for cancer and key areas have been identified and suggested as important to accelerate progress in cancer research.Some of the factors that have posed challenges for the development of preventive measures and anti-cancer drugs and therapies include the following:
- Inherent biological complexity of the disease:
- number of changes within a cell leading to the cancerous state
- disease heterogeneity due to different tissues of origin
- contribution of numerous genetic and environmental risk factorsRisk factorsA risk factor is a concept in finance theory such as the CAPM, APT and other theories that use pricing kernels. In these models, the rate of return of an asset is a random variable whose realization in any time period is a linear combination of other random variables plus a disturbance term or...
- complexity of cellular interactionsCell-cell interactionCell–cell interaction refers to the direct interactions between cells that play a role in the development and function of multicellular organisms....
and cell signalingCell signalingCell signaling is part of a complex system of communication that governs basic cellular activities and coordinates cell actions. The ability of cells to perceive and correctly respond to their microenvironment is the basis of development, tissue repair, and immunity as well as normal tissue...
within the tumor microenvironment - suitability of model organisms for understanding human disease.
- Roadblocks to translational medicineTranslational medicineTranslational medicine is a medical practice based on interventional epidemiology. It is regarded by its proponents as a natural progression from Evidence-Based Medicine. It integrates research from the basic sciences, social sciences and political sciences with the aim of optimising patient care...
- Challenges of early detection and diagnosis
- The drug approval process
- Availability of and access to patients with suitable tumor tissue for research
- Challenges in implementing preventive measures, such as the development and use of preventive drugs and therapies
- Choropleth mapping of the changes over time, of the national incidence rate, by cancer type, relative to the population at risk, is a technical challenge.
Genome-based cancer research projects
The rise of a new class of molecularMolecular biology
Molecular biology is the branch of biology that deals with the molecular basis of biological activity. This field overlaps with other areas of biology and chemistry, particularly genetics and biochemistry...
technologies developed during the Human Genome Project
Human Genome Project
The Human Genome Project is an international scientific research project with a primary goal of determining the sequence of chemical base pairs which make up DNA, and of identifying and mapping the approximately 20,000–25,000 genes of the human genome from both a physical and functional...
opens up new ways to study cancer and holds the promise for the discovery of new aspects of cancer biology that could eventually lead to novel, more effective diagnostics and therapies for cancer patients.
These new technologies are capable of screening many biomolecules and genetic
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
variations such as SNPs
and copy number variations in a single experiment and are employed within functional genomics
Functional genomics
Functional genomics is a field of molecular biology that attempts to make use of the vast wealth of data produced by genomic projects to describe gene functions and interactions...
and personalized medicine
Personalized medicine
Personalized medicine is a medical model emphasizing in general the customization of healthcare, with all decisions and practices being tailored to individual patients in whatever ways possible...
studies.
Speaking on the occasion of the announcement of $1 billion in new funding for genome-based cancer research, Dr. Francis Collins
Francis Collins (geneticist)
Francis Sellers Collins , is an American physician-geneticist, noted for his discoveries of disease genes and his leadership of the Human Genome Project . He currently serves as Director of the National Institutes of Health in Bethesda, Maryland. Prior to being appointed Director, he founded and...
, director of the NIH claimed, "We are about to see a quantum leap in our understanding of cancer." Harold Varmus, after his appointment to be the director of the NCI
NCI
NCI can stand for:*National Cancer Institute*National Captioning Institute*Nordic Centre in India*National College of Ireland*Native Communications Inc - Aboriginal Public Broadcaster in Manitoba, Canada....
, said we are in a "golden era for cancer research," poised to profit from advances in our understanding of the cancer genome.
High-throughput DNA sequencing has been used to study the whole genome sequence of two different cancer tissues: a small-cell lung cancer metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
and a malignant melanoma cell line.
The sequence information provides a comprehensive catalog of approximately 90% of the somatic
Somatic
The term somatic means 'of the body',, relating to the body. In medicine, somatic illness is bodily, not mental, illness. The term is often used in biology to refer to the cells of the body in contrast to the germ line cells which usually give rise to the gametes...
mutations in the cancerous tissue, providing a more detailed molecular and genetic understanding of cancer biology than was previously possible, and offering hope for the development of new therapeutic strategies gleaned from these insights.
The Cancer Genome Atlas
The Cancer Genome AtlasThe Cancer Genome Atlas
The Cancer Genome Atlas is a project to catalogue genetic mutations responsible for cancer, using genome analysis techniques started in 2005...
(TCGA), a collaborative effort between the National Cancer Institute
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
and the National Human Genome Research Institute
National Human Genome Research Institute
The National Human Genome Research Institute is a division of the National Institutes of Health, located in Bethesda, Maryland.NHGRI began as the National Center for Human Genome Research , which was established in 1989 to carry out the role of the NIH in the International Human Genome Project...
, is an example of a basic research project that is employing some of these new molecular approaches.
One TCGA publication notes the following:
Here we report the interim integrative analysis of DNA copy number, gene expressionGene expressionGene expression is the process by which information from a gene is used in the synthesis of a functional gene product. These products are often proteins, but in non-protein coding genes such as ribosomal RNA , transfer RNA or small nuclear RNA genes, the product is a functional RNA...
and DNA methylationDNA methylationDNA methylation is a biochemical process that is important for normal development in higher organisms. It involves the addition of a methyl group to the 5 position of the cytosine pyrimidine ring or the number 6 nitrogen of the adenine purine ring...
aberrations in 206 glioblastomas...Together, these findings establish the feasibility and power of TCGA, demonstrating that it can rapidly expand knowledge of the molecular basis of cancer.
In a cancer research funding announcement made by president Obama in September 2009, TCGA project is slated to receive $175 million in funding to collect comprehensive gene sequence data on 20,000 tissue samples from people with more than 20 different types of cancer, in order to help researchers understand the genetic changes underlying cancer. New, targeted therapeutic approaches are expected to arise from the insights resulting from such studies.
Cancer Genome Project
The Cancer Genome ProjectCancer Genome Project
The Cancer Genome Project, based at the Wellcome Trust Sanger Institute, aims to identify sequence variants/mutations critical in the development of human cancers...
at the Wellcome Trust Sanger Institute
Sanger Institute
The Wellcome Trust Sanger Institute is a non-profit, British genomics and genetics research institute, primarily funded by the Wellcome Trust....
aims to identify sequence variant
Genetic variation
Genetic variation, variation in alleles of genes, occurs both within and among populations. Genetic variation is important because it provides the “raw material” for natural selection. Genetic variation is brought about by mutation, a change in a chemical structure of a gene. Polyploidy is an...
s/mutation
Mutation
In molecular biology and genetics, mutations are changes in a genomic sequence: the DNA sequence of a cell's genome or the DNA or RNA sequence of a virus. They can be defined as sudden and spontaneous changes in the cell. Mutations are caused by radiation, viruses, transposons and mutagenic...
s critical in the development of human cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
s. The Cancer Genome Project combines knowledge of the human genome
Human genome
The human genome is the genome of Homo sapiens, which is stored on 23 chromosome pairs plus the small mitochondrial DNA. 22 of the 23 chromosomes are autosomal chromosome pairs, while the remaining pair is sex-determining...
sequence with high throughput mutation detection
High-throughput screening
High-throughput screening is a method for scientific experimentation especially used in drug discovery and relevant to the fields of biology and chemistry. Using robotics, data processing and control software, liquid handling devices, and sensitive detectors, High-Throughput Screening allows a...
techniques.
Cancer research supportive infrastructure
Advances in information technologyInformation technology
Information technology is the acquisition, processing, storage and dissemination of vocal, pictorial, textual and numerical information by a microelectronics-based combination of computing and telecommunications...
supporting cancer research, such as the NCI
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
's caBIG
CaBIG
The cancer Biomedical Informatics Grid is an open source, open access information network with the mission of enabling secure data exchange throughout the cancer community...
project, promise to improve data sharing among cancer researchers and accelerate "the discovery of new approaches for the detection, diagnosis, treatment, and prevention of cancer, ultimately improving patient outcomes."
Cancer clinical trials
Researchers are considering ways to improve the efficiency, cost-effectiveness, and overall success rate of cancer clinical trials.Increased participation in rigorously designed clinical trials would increase the pace of research. Currently, about 3% of people with cancer participate in clinical trials; more than half of them are patients for whom no other options are left, patients who are participating in "exploratory" trials designed to burnish the researchers' résumés or promote a drug rather than to produce meaningful information, or in trials that will not enroll enough patients to produce a statistically significant result. Recommending a clinical trial to a patient normally causes physicians and cancer centers to lose time and money while increasing their legal risks and volume of paperwork.
Targeted tumor treatment
A major challenge in cancer treatment is to find better ways to specifically target tumors with drugs and chemotherapeutic agentsChemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
in order to provide a more effective, localized dose and to minimize exposure of healthy tissue in other parts of the body to the potentially adverse effects of the treatments. The accessibility of different tissues and organs to anti-tumor drugs contributes to this challenge. For example, the blood-brain barrier
Blood-brain barrier
The blood–brain barrier is a separation of circulating blood and the brain extracellular fluid in the central nervous system . It occurs along all capillaries and consists of tight junctions around the capillaries that do not exist in normal circulation. Endothelial cells restrict the diffusion...
blocks many drugs that may otherwise be effective against brain tumors. In November 2009, a new, experimental therapeutic approach for treating glioblastoma was published in which the anti-tumor drug Avastin was delivered to turmor site within the brain through the use of microcatheters
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
, along with mannitol
Mannitol
Mannitol is a white, crystalline organic compound with the formula . This polyol is used as an osmotic diuretic agent and a weak renal vasodilator...
to temporarily open the blood-brain barrier permitting delivery of the chemotherapy into the brain.
Public education and support
An important aspect to the war on cancer is improving public access to educational and supportive resources, to provide individuals with the latest information about cancer prevention and treatmentManagement of cancer
Cancer can be treated by surgery, chemotherapy, radiation therapy, immunotherapy, monoclonal antibody therapy or other methods. The choice of therapy depends upon the location and grade of the tumor and the stage of the disease, as well as the general state of the patient...
, as well as access to support communities. Resources have been created by governmental and other organizations to provide support for cancer patients, their families and caregivers, to help them share information and find advice to guide decision making.
See also
- American Cancer SocietyAmerican Cancer SocietyThe American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
- caBIGCaBIGThe cancer Biomedical Informatics Grid is an open source, open access information network with the mission of enabling secure data exchange throughout the cancer community...
- International Agency for Research on CancerInternational Agency for Research on CancerThe International Agency for Research on Cancer is an intergovernmental agency forming part of the World Health Organisation of the United Nations....
- International Union Against CancerInternational Union Against CancerThe International Union Against Cancer, or UICC is the only non-governmental organization dedicated exclusively to the global control of cancer. Its vision is of a world where cancer is eliminated as a major life-threatening disease for future generations...
- National Cancer InstituteNational Cancer InstituteThe National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
- National Comprehensive Cancer NetworkNational Comprehensive Cancer NetworkNational Comprehensive Cancer Network is an alliance of twenty-one cancer centers in the United States, most of which are designated by the National Cancer Institute as comprehensive cancer centers...
- Stand Up to CancerStand Up To CancerStand Up To Cancer is a charitable program of the Entertainment Industry Foundation established by media, entertainment and philanthropic leaders who have been affected by cancer. SU2C aims to raise significant funds for translational cancer research through online and televised efforts...
- The Cancer Genome AtlasThe Cancer Genome AtlasThe Cancer Genome Atlas is a project to catalogue genetic mutations responsible for cancer, using genome analysis techniques started in 2005...
project
www.CancerProgress.Net
External links
- NCI Cancer Bulletin, biweekly updates on cancer research news
- Forty Years' War, a series in The New York Times examining the War on Cancer (2009)
- Why We're Losing the War on Cancer and How to Win It on CNNCNNCable News Network is a U.S. cable news channel founded in 1980 by Ted Turner. Upon its launch, CNN was the first channel to provide 24-hour television news coverage, and the first all-news television channel in the United States...
(2007) - Waging War on Cancer, documentary television show hosted by Paula Zahn