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Why haven't we cured cancer yet?

sciencebasedmedicine.org

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Re: Why haven't we cured cancer yet?

#71
because 99% of money raised to "fight" cancer is spent on finding a "cure" whereas only 1% of money raised is spent on prevention. 0% is spent looking at environmental factors:

- nuclear waste alone: bomb testing in the 60's and 70's, uranium mining, Chernobyl, bullets tipped with depleted uranium used in recent wars, Fukushima Daiichi

- systematic poisoning of the industrial food supply: genetically modified food, petrochemicals, drugs that are put in food

- systematic poisoning of the environment, water, air, and land.

Re: Why haven't we cured cancer yet?

#72

Because, like AI, molecular biology is complicated and there are no quick hacks . Some things are meant to take time and be right. First time. Survival rates are spectacularly better than they were fifteen or twenty years ago and they are getting better all the time. Also there is no one type of lung cancer, brain tumour or bladder or bowel cancer either. There are many different types. Half the battle is identifying…

Do you have a reference for survival rates? Note that there are many confounding factors - lung cancer incidence has dropped a lot although lung cancer itself remains intractable to average cancer survival rates may have improved.

Small cell, granuloma, take your pick. The data is available world-wide. The fact is that lung cancer is one from which there is never a good prognosis regardless of type. People can expect 4-5 years on average (although I know people who have gone past ten and have a good quality of life).

It also is one where heredity and genetics plays an enormous role (as opposed to purely environmental conditions).

Like I said, molecular biology is something we've only just noticed far less got a handle on.

Ars Longa Vita Brevis.

Re: Why haven't we cured cancer yet?

#73
One angle I feel is often missed in the whole cancer discussion is that it's a multidimensional problem.

1) Developing drugs which can damage cancer cells selectively.

Like selecting a few needles in a haystack, cancer cells typically "look" the same as healthy cells, which makes selectively destroying them very difficult. Some cancers (such as CML) have a specific driver mutant proteins which allows for a pinpoint attack (Gleevec), but if this target protein mutates and Gleevec can no longer bind then that drug instantly becomes totally ineffective.

2) Identifying malignant tissue

Surgery is still one of the most important tools against many forms of cancer, yet being able to identify malignant tissue vs. healthy stuff has always been a problem. In the first half of the 20th century the radical mastectomy was all the rage, but in reality provided little benefit. I was lucky enough to see Roger Tsein speak a few years ago (Nobel prize for GFP) who is pioneering a way to fluorescent tag malignant tissue which can be viewed in real time to give surgeons an augmented reality overview of a tumour to maximize the chance of getting all the malignant cells.[http://en.wikipedia.org/wiki/Roger_Y._Tsien#Fluorescence-ass...].

3) Stopping metastasis

Even if a patient presents with a tumour and that tumour is removed, it's impossible to tell if any of the maligant cells have managed to escape to other parts of the body, where they slowly start to regroup before launching a subsequent attack. This is the primary reason why cancer survivors have 5Y and 10Y survival rates as opposed to, "You're cured". The mechanism and time in a cancer at which this happens depends on so many factors its currently almost impossible the predict.

4) Drug delivery

The tumour micro environment is so foreign compared to the normal stromal environment, and moreover so heterogeneous between tumour types (which in turn depends both on a cancer's underlying genotype and its associated tissue, vascularization and a wide range of additional factors) that creating drugs which can just survive long enough to act on their target can be difficult. This, combined with the fact that tumours are, compared to normal tissue, often poorly vascularized, means just getting drugs in can be a major challenge. I remember reading how often the vascularization of a tumour can be proportional to rate of growth and inversely proportional to chemotherapeutic efficacy (although don't quote me because I can't find the reference) meaning smaller, slower growing tumours often represent those most difficult to treat while larger, more aggressive ones may respond better, if caught in time.

5) Cancer is effectively microscale evolution

Perhaps the biggest problem is that once cancer cells begin to acquire some initial mutations (and lie in a pre-cancerous form) they're often more susceptible to further mutations. In a way, this allows them to employ a sort of bet-hedging strategy, such as that seen by yeast or other single celled organisms. No longer can we treat the cancer cells as part of our multicellular body, but as a separate, single celled population. This means that even if certain drugs are effective, there will be a small population of cancer cells who may have mutated in such a way that they are resistant, so even if a treatment gets 99% of the cells, that final 1% can restart and the same bet-hedging strategy is re-employed to create another, diverse set of cells. This is totally analogous to antibiotic resistance. The range of this diversity varies significantly between cancers, but as we "pick out" the easier ones with an obvious target, this will become an every increasing issue.

These are just a few points - there are more, but I've tried to focus on ones not yet brought up in discussion. This is an area I have some experience with, and if anything is unclear let me know and I'll do my best to explain.

[EDIT]: This is not meant to be quite as, "we're all doomed" as it appeared. I think Dn_Ab's post summarizes how I feel more accurately. The development in a range of different areas has been staggering (childhood leakemia, CML, Her2+ BC etc), and the reason this is such a daunting task is because the magnitude has only reared its large, complex head in the last 10-15 years or so. Despite the challenges, it is a very exciting time to be a cancer biologist.

Re: Why haven't we cured cancer yet?

#74
post #19

Earlier quoted context omitted.

Also, plenty of biological evolution can happen in the absence of mutation.

I'm not sure why you're being downvoted. Evolution is simply the changing of allele frequencies over time, which can certainly happen in the absence of mutation. Although, I don't know that I would say "plenty" of evolution can happen without mutations, but I guess that depends on what you think "plenty" is.

Only changing allele frequencies is proven to result in a stable state. You need mutation for evolution.

Re: Why haven't we cured cancer yet?

#75

Earlier quoted context omitted.

Heh.. Perhaps you might use an apple computer to help cure cancer and you probably wouldn't use a football? >who gets to decide what spending is "right" and what's "wrong?" None. Noone. Perhaps not wrong. Interesting though. Sorry guys, guess I kind of ran this one right off the rails. We underspend on medical research proportionally. That was all. I just tried to pick something a little more interesting than the TSA…

Picking a few billion that sports makes rather than the lots more billion that tech makes feels a little like pandering to the crowd, though (we're geeks, stereotypically don't like sports and "jocks"). A more edgy question, given the audience, would be to ask why our priorities are such that we pump much more money into web startups than cancer research.

Or, hell, why we pump more money into web startups than computer science research!

Re: Why haven't we cured cancer yet?

#77

Fascinating paper on returns on cancer research out of the NBER argues that for about $300 billion in cancer research expenditures from 1988 to 2000 the US created 23 million life-years worth, in aggregate, about $1.9 trillion [1]. That comes to about a 52% smoothed return. Pretty good given that the S&P 500 grew at about 14.6% over the same period (though if similarly smoothed yielded about 42%). [1] http://www.nber…

If creating life-years is the goal, paying poor people in 3rd-world countries to have kids will be at least 10 times as efficient as cancer research.

Re: Why haven't we cured cancer yet?

#78
post #20

Earlier quoted context omitted.

A minority of NFL revenues come from ticket sales & merchandising combined. Much of it comes from advertising. If you're an effective channel for mass attention, it stands to reason that you're going to be poised to capture huge amounts of money, simply because there's huge amounts of commerce happening. The NFL's revenue is not really a reflection on our priorities. A better comparison would be to other discretionar…

> The NFL's revenue is not really a reflection on our priorities. Isn't it reasonable to assume that, if costumers had different priorities and seek for science research news more often. Then advertisers would, maybe, consider investing in science research instead of football? If we could, somehow, teach and get people interested in science. Then having your brand name associated with the cure of cancer could be more…

People aren't buying football advertising to associate their brand with football. They're buying advertising because during football games, millions of people are paying attention to a specific TV or radio station.

Re: Why haven't we cured cancer yet?

#79
What I got from this:

- Cancer is complex, its profile is not that of 1 disease but many hundreds of diseases

- Sequencing Cancers and attempting to find a match to suggest a treatment will not work, each cancer is unique and itself made up of a diverse population

- Cancer is mutiny combined with the greed of evil dictators. A bunch of cells give up the chain of command and start co-opting resources to feed their opulent lifestyles. What this means is that no simple cure is going to work, cancer effectively exists to solve the problem of maximizing its growth or survival rate. Treatments are just another constraint that increase the dimensionality of the cancers' search space.

- Tumorous cell lines are invaders even if they originate from the body and evolve at a breakneck pace. This is why many treatments fail to work - not that the ideas behind them are wrong but the system has outsmarted it. Cancer is dynamic not static.

I found this inspiring and positive. While some may despair from a lack of a cure what I see is progress. We've gone from the boundless optimism that comes from ignorance to the sober determination that comes from an awareness of the extent of our ignorance. So now maybe the real work can begin.

He says tackling the evolutionary aspect of cancer will be key. I wonder if game theory will inform future treatments. Or if there will be things people will take to reduce mutations or lend better error correction - outside immune and optionally germ cells. Or ubiquity of sensors allowing one to cluster features which determine the onset of cancer and forming tests to pinpoint and drugs to eradicate before the cancer stage. I wish I was not so ignorant.

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