An article in the current issue of Wired Magazine nicely details how the hope of new breakthroughs in the diagnosis and treatment of cancer run headlong into the realities that inevitably occur. It also points out how perseverance and optimism—appropriately focused on the issue at hand—may take us to success as we pursue our dreams of reducing in incidence and burden of cancer.
The article, titled “The Truth About Cancer: Don’t Try to Cure It. Just Find It: Inside the Science of Early Detection” and written by Thomas Goetz (a deputy editor for Wired), outlines in large part the work of the Canary Foundation, an organization founded by Don Listwin from California to pursue the question of how we can find cancers at the earliest moment possible when the chances for cure are greatest.
Mr. Listwin’s search was inspired by the experience of his mother, who was diagnosed with advanced ovarian cancer and died from her illness a year later.
He asked the question why it took so long to diagnose the cancer until it was so far advanced and beyond hope of cure. He found out what many of us unfortunately are very familiar with: many cancers, like ovarian and pancreatic cancer, are advanced at the time of diagnosis. They are truly silent, because it is their spread that eventually produces the signs and symptoms that lead to their discovery. And then it is too late to do much about the disease.
There has been a tremendous amount of interest over the past several years in trying to find some way to make the diagnoses of these cancers earlier. Scientists have been working hard to find what we call “molecular markers” which are early signals in the blood that may say to us that a cancer is present long before it even becomes visible. (In the interests of full disclosure, the American Cancer Society and the Canary Foundation have collaborated in the funding of several of these researchers.)
We have screening tests available for some of the common cancers that have enabled us to find cancers reasonably early in their course. Screening for these cancers has resulted in real improvements in treatment and survival over the past years. Such cancers include breast cancer, colorectal cancer and cervical cancer (the jury on prostate cancer screening is still “out” until we get solid evidence that the PSA test actually makes a difference in whether men with prostate cancer have an improved outlook and survival with early detection).
But those tests are actually fairly crude, when you consider that there are probably proteins or other markers circulating in the blood that could find cancers well before they are otherwise visible with the types of machines we have today such as mammograms, CT scans and ultrasound.
The good news is that we are making progress, as reflected in the article. The bad news is that the progress is slow, moving forward in fits and starts, with some unfortunate detours along the way. For example, some tests that have been promoted as being able to diagnose ovarian cancer through blood tests have been discredited on more careful investigation.
But hope remains, and the Canary Foundation is moving that research agenda forward.
What’s unique in a very real respect is the approach used by the Foundation, which is not unlike that of a number of other “entrepreneurially directed” ventures. More and more, there are businessmen who are taking the reins of directing research programs trying to cross the void between the traditional scientific methods of research and the more disciplined, goal-directed efforts of the typical business where you scope out an opportunity and move forward, changing directions and emphasis as you go learn from your successes and your mistakes.
The article points out the dilemmas faced by the researchers engaged in trying to solve this early detection problem when it comes to figuring out whether or not the various discoveries actually are clinically relevant. That is no small matter, and sticking to the fundamental premise that proof of effectiveness is key to credibility in this field. Otherwise we may end up with some fancy technology that really doesn’t measure what it is supposed to measure.
I recently wrote a blog which questioned the value of many of these new tests and technologies that are being promoted to either screen, diagnose or otherwise aid the treatment of cancer. As I mentioned, there is a lot of hype, not infrequently little validation of these tests, and then massive marketing efforts to get a particular technology or test adopted in patient care.
The sad reality is that there is no independent professional organization that has looked carefully at the utility and value of many of these tests, leaving it to patients and doctors to make their own assessments. Unfortunately, neither are well equipped to make these judgments, relying frequently on manufacturers and promoters who create a “buzz” about a particular new test or technology.
As noted by the article’s author:
“For a disease like cancer, so often seen as a death sentence, early detection promises a trade-off. At first, it makes things more complicated. It introduces more doubt and complexity into an already complicated equation. But in return, early detection promises that this doubt can be quantified, that these new variables can be broken down into metrics, analyzed and factored into our health decisions. Early detection proposes that the result of this calculation—complicated and ambiguous as it is—will yield better results for individuals and for their families. In exchange for a modicum of doubt, it offers a maximum opportunity for hope.”
We don’t know how long it is going to take to get the benefits of research efforts into molecular markers and the very early detection of cancer. Maybe it will be five years, maybe ten years, maybe longer.
But with persistence, dedication, and commitment such as that demonstrated by the Canary Foundation, I have no doubt we are going to get there.