When Will We Cure Cancer?

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Talk about wishful thinking. One might as well ask if there will be a war that will end all wars, or a pill that will make us all good looking. It is also a perfectly understandable question, given that half a million Americans will die this year of a disorder that is often discussed in terms that make it seem less like a disease than an implacable enemy. What tuberculosis was to the 19th century, cancer is to the 20th: an insidious, malevolent force that frightens people beyond all reason--far more than, say, diabetes or high blood pressure.

The problem is, the "cure" for cancer is not going to show up anytime soon--almost certainly not in the next decade. In fact, there may never be a single cure, one drug that will bring every cancer patient back to glowing good health, in part because every type of cancer, from brain to breast to bowel, is different.

Now for the good news: during the next 10 years, doctors will be given tools for detecting the earliest stages of many cancers--in some cases when they are only a few cells strong--and suppressing them before they have a chance to progress to malignancy. Beyond that, nobody can make predictions with any accuracy, but there is reason to hope that within the next 25 years new drugs will be able to ameliorate most if not all cancers and maybe even cure some of them. "We are in the midst of a complete and profound change in our development of cancer treatments," says Richard Klausner, director of the National Cancer Institute. The main upshot of this change is the sheer number of drugs in development--so many that they threaten to swamp clinical researchers' capacity to test them all.

This welcome boom in cancer drugs owes its beginnings to one of this century's greatest scientific insights: that cancer is caused not by depression or miasmas or sexual repression, as people at various times have believed, but by faulty genes. Every tumor begins with just one errant cell that has been unlucky enough to suffer at least two, but sometimes several, genetic mutations. Those mutations prod the cell into replicating wildly, allowing it to escape the control that genes normally maintain over the growth of new tissue.

This realization has transformed cancer, in little more than a decade, from an utterly mysterious disease into a disorder whose molecular machinery is largely understood. Now cancer biologists are in the midst of their second epiphany: the recognition that tumors evolve, in Darwinian fashion, as each succeeding generation of cancer cells accumulates genetic mutations. "Survival of the fittest applies to cancer cells," says Richard Schilsky, associate dean for clinical research at the University of Chicago. "We now think of cancer not as a disease but as a genetic process."