Got cancer? It's all the rage. Actress Christina Applegate, Senator Ted Kennedy, Olympic swimmer Eric Shanteau, columnist Robert Novak are just the highest profile of the 1.4 million Americans who will get a diagnosis of cancer this year. Walk into the oncology waiting room of a hospital and you'll find it hard not to notice the crowd--or the balding heads, the yellow faces, that gaunt prisoner-of-war look of those who are well into their chemotherapy. You stare blankly across the room at the others staring blankly back, everyone silently asking the question: Am I going to make it? When you're facing that kind of primal question, you say to yourself, "Well, at least I'm not alone." And that is precisely the problem. You are not.
Although it's uplifting to talk about living with cancer, dying with cancer is the more honest reality. Cancer is overtaking heart disease as the No. 1 killer in the U.S.: An estimated 565,650 Americans will die from it this year alone, according to the American Cancer Society. Because the incidence of cancer increases with age, the nearly 80 million baby boomers now crossing into their 60s will probably drive the number even higher. At current rates, 1 in 2 men and 1 in 3 women will eventually have some form of cancer diagnosed. (Why the gender disparity? Men smoke more.) For the record, the cancer community includes me; five years ago, I was treated with chemotherapy and major surgery.
For an increasing number of cancer activists, researchers and patients, there is too much death and too much waiting for new drugs and therapies. They want a greater sense of urgency, a new approach that emphasizes translational research over basic research--turning knowledge into therapies and getting them to patients pronto. The problem is, that's not the way our sclerotic research paradigm--principally administered by the National Institutes of Health and the National Cancer Institute (NIH/NCI)--is set up. "The fact that we jump up and down when cancer deaths go from 562,000 to 561,000, that's ridiculous. That's not enough," says Lance Armstrong, 36, the cyclist and cancer survivor turned activist through his Lance Armstrong Foundation (LAF).
A new and more radical approach is being taken by groups like the newly formed Stand Up to Cancer (SU2C), which plans to finance research designed to deliver big leaps and home runs rather than the incremental improvements that are more typical of mainstream science. The new focus for funding grants, said Dr. Eric Winer, chief scientific adviser to the Susan G. Komen Breast Cancer Foundation, in a conference address, is results: "What we want to see is research that is going to change the number of women that are diagnosed with, or more importantly, die of, breast cancer within the foreseeable future." Others, like the Multiple Myeloma Research Foundation (MMRF), are trying a no-nonsense business model to speed drug development.
Doctors and scientists understand the frustration and the fear, and they don't necessarily mind the nudge. "We do need to change. Something needs to be done differently," says Tyler Jacks, director of the David H. Koch Institute for Integrative Cancer Research at MIT. "We have a lot of new insight, and we need to have a whole new collection of drugs, a new armamentarium."
Some Advances, Much Pain
Aren't we making a lot of progress? Absolutely. In a lot of places. When you adjust for age (since cancer is over-represented in the elderly), fewer people are getting cancer, and those who get it are surviving longer. We are benefiting from improved surgical techniques as well as more refined chemotherapies and radiation strategies that use lasers and robots to target cancer cells. Cracking the genomic code is leading to new drugs, geared to individual dna, that disrupt the very mechanism of cancer. "The rate of discovery has been phenomenal," says Dr. Harold Varmus, CEO of Memorial Sloan Kettering Hospital in New York City, a former NIH director and a Nobel-winning researcher in lung cancer. "We feel we understand some of the basic principles. We understand the tissue environment."
Some of the latest weapons in Big Pharma's arsenal result from that understanding. Gleevec, for instance, treats one form of leukemia by zeroing in on the Philadelphia (Ph) chromosome, that part of the genome that directs bone marrow to keep making abnormal white blood cells. Because of drugs like Gleevec and therapies such as bone-marrow and stem-cell transplants, there are 12 million people walking around today who are classified as survivors.
But cancer isn't one disease; it's dozens of them, each with different mechanisms that make the fight diabolically difficult. The most pernicious forms of cancer--among them, pancreatic, lung and brain--are still nearly invincible. Survival rates in rare forms of cancer aren't budging much, either. And the cancer arsenal is still heavy on the blunderbuss--blasting the body with harsh chemotherapy and radiation that take a huge toll on healthy as well as diseased tissue. Nor has the national health-care system done a great job of prevention and early detection. Worst of all, many people don't have access to care. Overall, the death rate from cancer dropped just 5% from 1950 to 2005, the latest available data. During the same period of time, deaths from heart disease dropped 64%.
The Problems with Research
It's not that cancer research funded by NIH/NCI or Big Pharma is somehow second-rate. "The last 30 or so years of concerted effort have led to a tremendously rich understanding. This is not a waste of time," says Jacks of MIT.
The long-standing criticism, though, is that NIH/NCI is necessarily structured for caution, for limited returns based on individual scientists grinding it out in their labs--the three-yards-and-a-cloud-of-dust mentality. To get funding, individual researchers typically have to write grant proposals that demonstrate a reasonable expectation of success. "You have to have already done some of the stuff and then propose it, before they're going to believe it's the right thing to do," says Dr. Ray DuBois, executive vice president of M.D. Anderson Cancer Center and a cancer researcher. A proposal can take months to write, so a rejection means the loss of a scientist's productivity as well.
It can also mean that "lesser" cancers don't get as much attention. M.D. Anderson has a project to map the entire bladder-cancer genome. "It's not something that NIH is interested in because it's a little less common than other cancers," says DuBois. Using other funds, researchers identified a gene defect that correlates smoking and bladder cancer. "If you have that defect and you smoke, there's a 100% chance you'll get cancer," says DuBois. But the hospital is more likely to get support for work on lung cancer, a much bigger problem. So call it research triage.