One of the nation’s leading killers has gotten some sky-high attention in recent days. But what to make of President Obama’s proposal for a “moon shot” initiative, led by Vice President Biden, to beat cancer? What to think of some big investors’ promoting their companies’ pushes to improve cancer’s detection and treatment? And what takeaways might there be in researchers’ underscoring their controversial guidelines for average-risk women and mammography to detect breast cancer, the most common female cancer?
In brief, skepticism and caution provide sound guides when examining all discussions of cancer. Although major advances have occurred — cancer for many has become a chronic, challenging condition — yet cancer remains a killer. It recently overtook heart disease as the leading cause of death in 22 states, including Virginia. Death rates from the disease are on a slow decline, particularly with federal and state efforts to get Americans to stop smoking.
But the American Cancer Society estimates that 1.685 million Americans will be diagnosed this year with the disease and almost 600,000 will die from it. Medical experts now see cancer not as a singular disease but an array of them, “characterized by the uncontrolled growth and spread of abnormal cells.” Diagnoses and therapies for each, as well as an overall understanding of the disease, has progressed significantly. It’s still complex. That reality may have gotten blurred in recent events.
The President’s moon shot
With his presidency in its waning months and in his final State of the Union address, Obama called for a major push by the federal government to defeat cancer. His choice of Biden to lead it was emotional and symbolic, since the vice president’s son Beau died of brain cancer last year. Biden also played a big role in winning a major boost in federal support for health care as part of a year-end budget deal with Republicans on Capitol Hill.
The brevity of Obama’s remarks on cancer, as well as the absence of specifics and funding for this anti-cancer effort, which the President said would be as robust as the national campaign to get American astronauts to the moon, quickly raised questions as to what might be accomplished. Skeptics noted that, dating to the Nixon presidency, past administrations had tried similar cancer-fighting “wars.” Leading researchers also found themselves caught off-guard by the President’s proposal and then divided in their reactions to it.
Biden has said he will listen a lot to see where he and the federal government can make a difference in cancer combating research. But his own tragic experiences with his son’s disease already has raised its own worries. Some researchers fret about the vice president’s ties with Patrick Soon-Shiong, a wealthy and sometimes flashy physician-researcher and Los Angeles medical entrepreneur. Soon-Shiong has amassed a personal fortune estimated at $12 billion from his founding of two drug companies and his invention of Abraxane, which has become a go-to medication to treat pancreatic cancer. The part-owner of the Los Angeles Lakers heads NantWorks, a company that seeks to leverage patient health data with genetic information to improve care.
Big money, big talk
Call it the East Coast and West Coast cancer offensives: Within days of Obama’s moon shot proposal, moguls were proposing disease-related projects of their own.
Soon-Shiong announced that a consortium of drug companies, including Southern California biotech giant Amgen and global pharma company Celgene, would join in large-scale testing of their anti-cancer therapies in hopes of finding mixes or cocktails tailored to and effective against specific cancers. Soon-Shiong dubbed the project Cancer MoonShot2020. Some researchers said they were intrigued by its proposed scope, with plans to advance cancer immunotherapy — treatments in which the body itself battles the disease — by conducting dozens of small-scale clinical trials with as many as 20,000 patients over the next three years, followed by larger-scale trials.
In the East, a company called Grail captured a lot of media attention by announcing plans to create a simple blood test to detect any kind of cancer at early stages. This so-called “Holy Grail” liquid biopsy seeks to discover the disease early when it might be easier to fight. The firm has Memorial Sloan Kettering Cancer Center’s physician-in-chief heading its medical advisory board and financial support from the likes of Microsoft co-founder Bill Gates and Amazon-Washington Post chief Jeff Bezos.
Even with the powerful personages attached to both these projects, there were issues. It was unclear whether Soon-Shiong’s project really had the scope he announced, and whether other Big Pharma firms, including Pfizer, Merck, and GlaxoSmithKline, has signed on. His initiative’s relationship with the federal National Cancer Institute also was muddy.
As for Grail, its announced plan to detect any cancer and with a simple test aroused immediate doubts. Liquid biopsy products exist already and have been helpful in those already diagnosed with cancer. But the complexity of a creating sweeping, accurate, useful, affordable, and blood-based diagnostic tool as the New York Times described it is nothing less than “daunting.”
Further, Americans have already grown wiser about cancer diagnoses and therapies, and, as one expert told The Times: “Patients ought to be hesitant until there is really good data that this actually helps people, and they should remember that it could harm people.”
Lest anyone doubt the difficulties and complexities of defeating cancer, look no further than the long, tough battle against breast cancer. More than 230,000 American women will be diagnosed with the disease each year and it will kill 40,000 women, most dying in the 55 to 64 age group. A key component in the battle against breast cancer has been screening and early detection. But the Times offers these age-based breakdowns about this approach, with new findings from an influential, expert panel:
For every 10,000 women screened repeatedly over 10 years, four lives are saved in women 40 to 49; eight in women 50 to 59; 21 in women 60 to 69; and 13 in women 70 to 74
As I’ve written before, even physicians are struggling to get it in their heads that mammograms can be over-used and problematic in themselves as a means of detection, resulting in false positives and needless, costly, and painful follow-up procedures. The new goal is to get away from urging women at average or low risk and at different ages from repeatedly taking a test without clear beneficial outcomes. At the same time, how do experts encourage women at high risk, many of whom may find mammograms a pricey, hard to access procedure, to get a test that could be life-saving? How do physicians effectively convey to women that their breast cancer risk is correlated to age?
Researchers are only beginning to understand which forms of breast cancer are relatively benign and require less intervention, in contrast with their aggressive, deadly counterparts. They also are skeptically examining this dilemma: What are the relationships among improved breast cancer therapies, extensive screening, and women’s outcomes? The nuanced reply from one new modeling study: “Advances in systemic therapies for breast cancer have not substantively reduced the relative benefits of screening but have likely reduced the absolute benefits because of their positive effect on breast cancer survival.”
We’ve got a far ways to go before we can claim we’ve defeated cancer. It’s good to know the disease is getting lots of attention. But we always need to be clear-eyed and -minded about how we detect and treat this killer, always also aiming to ensure that the best options are effective, available, and affordable for all.