Helpless to Prevent Cancer? Actually, Quite a Bit Is in Your Control

For the tl;dr crowd:

- written by a physician

- people often think that heart disease is controllable by our actions whereas they feel that cancer is not

- > people can’t change many risk factors of heart disease like age, race and family genetics

- > A more recent study published in Nature argues that there is a lot we can do. [about cancer]

- > Using sophisticated modeling techniques, the researchers argued that less than 30 percent of the lifetime risk of getting cancer was because of intrinsic risk factors, or the “bad luck.”

- > [another study] identified four domains that are often noted to be related to disease prevention: smoking, drinking, obesity and exercise

- if you limit that stuff, and not meaning 0 smoking, but "having quit within the last 5 years", no more than 1 drink a day (women) or 2 drinks a day (men), your BMI is >= 18.5 and HOWever:

> No study is perfect, and this is no exception. These cohorts are overwhelmingly white and consist of health professionals, who are not necessarily like the population at large. But the checks against the national data showed that if anything, these results might be underestimating how much cancer is preventable by healthy behaviors.

[...]

Optimistic conclusion, for a skeptical cheapskate like myself,

> As we talk about cancer “moonshots” that will most likely cost billions of dollars and might not achieve results, it’s worth considering that — as in many cases — prevention is not only the cheapest course, but also the most effective.

Hard to fault this article. I'm glad you posted it, thank you.

Science ended up printing a follow-up actually clarify things, perhaps feeling themselves that the interpretation by the public at large got out of hand a little bit[2].

[1] https://www.youtube.com/watch?v=iiH4m7NvV98

[2] http://www.sciencemag.org/news/2015/01/bad-luck-and-cancer-s...

Why economic transformation in cancer research? The cancer research community suffers from a high level strategy problem: the majority of treatments are only applicable to a small number of cancer types, out of the hundreds of known types, and the majority of new technology platforms under development will be just as expensive to adapt to a different type of cancer as to build in the first place. A much more efficient approach is needed, as there are only so many researchers and only so much funding in the world.

This is much on my mind because I'm helping to raise funds for one such project right now. It involves taking on the less well-supported but still necessary part of building a universal cancer treatment platform, one that can target all cancers. This could be built for about the same cost as one of today's highly specific single-cancer treatments. Obviously that is an immensely better path forward.

The approach is to block telomere lengthening: all cancers must lengthen their telomeres in order to grow, and abuse a small number of target mechanisms in order to do so. These mechanisms, telomerase and alternative lengthening of telomeres (ALT), are very fundamental to cellular biochemistry. If they are turned off, it is expected that there is no way for a cancer to evolve around that dead end. Many of today's cancer therapies, in addition to being very specific, also leave room for a cancer cells to evolve a different way of conducting business that renders them immune.

A number of research groups are working on sabotage of telomerase, but next to no-one is working on ALT. It is known that telomerase cancers can turn into ALT cancers, so it is probably the case that both doors have to be slammed shut to have a truly effective universal cancer therapy. So I'm helping a fundraiser to use an ALT assay to scan the standard drug candidate library for compounds that act to suppress ALT, something that should greatly advance that part of the field, both by identifying more lines of investigation, and by finding potential therapies for ALT cancers. Since ALT doesn't happen in normal cells, completely suppressing ALT should be a pretty safe treatment if an approach with limited side-effects can be identified. The telomerase blocking will need more work on compensating or targeting for other effects, since stem cells require it. But that is still a lot less work than producing one therapy per cancer type.

After two paragraphs about how the only way to save yourself is to give generously? Ya don't say...