Sparks of brilliance and pockets of hope – that's what I see when it comes to newer, more effective cancer treatments. We are shifting from a history of pretty blunt treatment options, with sometimes limited or no efficacy and pretty nasty side effects, to newer molecular understanding of certain cancers that offer far more effective and personalized treatment, often with far less toxic side effects.
With all of this exciting progress I think it's more important than ever that we don't lose focus around beating cancer in some of the biggest places where it begins – obesity and diabetes. A deeper understanding of genetic mutational drivers, how to target the cancer cells based on those mutations, and modified antibody delivery offensives really do create a future scenario where we realistically can win the war on cancer.
Inspiring use of technology like using artificial intelligence to diagnose malignant melanoma (published a week ago in Nature by Estava et al, doi:10.1038/Nature21056) is also something which will change the diagnostic landscape. Using newer techniques to look at circulating materials like tumour cells and circulating tumour DNA, allows for better treatment decisions and earlier indications of resistance.
There is a lot driving this change that begins with humanity's natural desire to live longer and healthier lives, and the curiosity of brilliant scientists and researchers around the
world. But it also wouldn't happen without the financial incentives that exist for the companies that can test for and produce breakthrough new treatments.
With all this exciting advance, it's important to not lose sight of the risk factors driving so much of the cancer incidence. Our current knowledge indicates about 40% of cancers are "preventable", and although we have tried to reduce the impact of these with things like warnings about smoking and sun exposure – we have a long way to go.
We often see alarming headlines that link certain substances to cancer. A recent example is the European Food Safety Authority that indicated, following animal studies, that acrylamide found in certain prepared foods can be potentially carcinogenic (often produced when a certain carbohydrate is exposed to high temperatures). Turns out the highest human intake ranges from 1/50th to 1/283rd of the amount required to cause a small neoplastic effect in the mice. There are bigger fish to fry – and the Cancer
Research UK has already published such a response also asserting that it's too early to tell if there is a risk. For brown toast and roast potatoes to get headline space, when almost three-quarters of the UK is obese or overweight (and is forecast to increase even further), and we know that the link to obesity and cancer is significant, is frustrating to say the least.
Studies have shown increased risk of cancer in those with a BMI over 40 to be at least 50% higher than those with normal weight (N Engl J Med 2003;348:1625-38). We know that much of this is associated with the chronic low grade inflammatory state associated with obesity. Obese people have increased levels of tumour necrosis factor, interleukin 6 and C reactive protein. There is also a link between increased insulin and certain pro-mutagenic pathways, hence those with diabetes, and prediabetes are also at increased risk, even if they are not overweight. With diabetes and prediabetes in the US, UK and recently even in China affecting over half the population, the impact on cancer is and will be significant. While celebrating all the new treatments and successes, we need a renewed focus on the key causes which are so prevalent and growing in our society : obesity and diabetes. We also need to objectively review what has worked, and what has not worked, and embrace newer thinking around the science and nutrition related to obesity and diabetes(cf. https://openminds.swissre.com/stories/1106/).
Category: Funding longer lives: Health/medicine