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."
This new view has sparked innovations that will manage the
process and keep it from killing large numbers of people. "We
are going to see a real shift from diagnosis and treatment to
prediction and prevention," declares California surgeon Susan
Love, author of Dr. Susan Love's Breast Book. Indeed, if all
goes well with current clinical trials, women at high risk for
breast cancer will soon be able to be screened with a device
that removes a sample of breast cells through the nipple. If any
cells show signs of the early mutations that lead to cancer,
doctors can suggest the drug tamoxifen, which is believed to
reduce the risk of breast cancer by suppressing precancerous
cells. Drugs with fewer side effects that can also prevent
breast cancer are already in the pipeline.
Within five years, early detection will be available for many
other types of cancer as well. A stool sample will be all that
is needed to search for colon-cancer cells on their way to
becoming tumors, and drugs like the new COX-2 inhibitors, which
are improved versions of pain killers, can prevent those
precancerous cells from progressing. By the end of the next
decade, a simple blood test could alert doctors to a wide
variety of cancer precursors.
Treatments for more advanced cancers, however, are farther over
the horizon than anybody can see. What is clear is that
oncologists must take a page from aids treatment and use a
cocktail of drugs with very different modes of action to outsmart
tumors that have already begun to spread or metastasize.
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