Posted on | May 2, 2013 |
In 1971, President Richard Nixon declared a “War On Cancer”.(1) But 42 years later, it may be President Obama who declares victory. If so, it will be as much a result of Obama’s fundamental re-ordering of the war’s priorities, as to the simple passage of time and straight-line progress.
This week, the simultaneous release of two cancer genomic studies – one on endometrial cancer in Nature(2) and the other on Acute Myeloid Leukemia in the New England Journal of Medicine(3) – directly challenge the notion that cancer is a family of widely diverse and entirely separate disease entities. In fact, the findings, supported under the National Caner Institute’s “The Cancer Genome Atlas”, found common genetic markers in cancers as different as uterine, breast, ovarian and colon cancer.(2,3)
When Richard Nixon signed the National Cancer Act on December 23, 1971, the focus was on understanding the basic biology of cancer, and expanding the number of targeted cancer therapies available. Over the next three decades, there was increased focus on early diagnosis and access to treatment, but nothing close to declaring victory. Numbers were difficult to budge. For example U.S. cancer death rates adjusted for population size and age, dropped only 5 percent between 1950 to 2005(4), and cancer is expected to be the leading cause of death in the world by 2010.(5,6)
As we entered the new Millennium, there was consensus that the effort had reached a relative stall. National Cancer Institute director, Andrew von Eschenbach, sounded the alarm and challenged the scientific community “to eliminate the suffering and death from cancer, and to do so by 2015″.(7,8) The response was less then enthusiastic. Science magazine reported at the time that, “The cancer research community is abuzz over National Cancer Institute director Andrew von Eschenbach’s announcement that NCI intends to ‘eliminate death and suffering’ from cancer by 2015. Some say that however well intended, the goal is clearly impossible to reach and will undermine von Eschenbach’s credibility.”(9)
Three years later, John Niederhuber, took over as NCI director, with a focus on cancer as a global health crisis. He publicized the fact that there were nearly 13 million new cases globally in 2009 and that by 2030, if little changed, that number would increase to 27 million with 17 million deaths that year.(10)
The US Senate focused arguably more on prevention than on science. Their bill in March 2009, the 21st Century Cancer Access to Life Saving Early detection, Research and Treatment (ALERT) Act (11) had as its goal to “overhaul the 1971 National Cancer Act.”(12) It focused on patient access, prevention, and early detection. Major themes were:
1. funding for research in early detection,
In 2010, Harold Varmus took over as director of the NCI. His stated priorities included moving the dial in cancer research. The Obama administration had already signaled a green light on the effort. During the 2008 Presidential campaign, Obama promoted a science focused cancer plan that would double “federal funding of cancer research within 5 years, and provide additional funding for research on rare cancers and those without effective treatment options,the study of health disparities and evaluation of possible interventions,and efforts to better understand genetic factors that can impact cancer onset and outcomes.(13)
In 2009, the President followed up with $1 billion of a $5 billion medical research spending plan earmarked for research into the genetic causes of cancer and targeted cancer treatments.(14) In response, NIH director, Francis Collins stated,”We are about to see a quantum leap in our understanding of cancer.” Harold Varmus, concurred, saying that scientists were entering a “golden era for cancer research,” and would soon profit from advances in our understanding of the cancer genome.(15)
When President Obama announced the 2009 grants as part of the stimulus package, $175 million of the funding was to fund a collaborative effort of the NCI and the National Human Genome Research Institute titled the The Cancer Genome Atlas(TCGA). The funding was to collect comprehensive gene sequence data on 20,000 tissue samples from people with more than 20 different types of cancer . The goal? To expand our understanding of the genetic changes underlying cancer, and fuel discoveries of new targeted interventions.(14)
3 years later: The two studies reported out this week involved 100 researchers, 400 uterine tumors and 200 leukemias.(2,3) The genetic analysis of these tumors yielded some amazing results. Tumors from different organs shared genetic footprints. This means that classifications of tumors by their genetic mutations is bearing fruit. Classification by geographic site may be relatively unimportant in the future. It also means that treatments successfully used for some cancers today may prove to be useful in other currently untreatable but related cancers tomorrow. Finally, we are now entering a phase where we will finally understand what cancer fundamentally is, how it works, and how we might “win the war on cancer”.
Dr Timothy Ley, lead author on the leukemia study says, “We have the basic playbook. We finally know what the major pathways are and what all the major mutations look like. Within two or three years, risk assessment may be dramatically better. It certainly sets the stage for the next era of therapy.”(16)
There’s been a great deal of talk of late about the Obama legacy – Obamacare, immigration reform, marriage equality, gun safety legislation. But with three years to go in his second term, pundits may have missed the largest accomplishment of all. At the end of the day, President Obama may be able to say that the “War On Cancer” was won under his leadership.
For Health Commentary, I’m Mike Magee.
1.The National Cancer Act of 1971.
2.Integrated Genomic Characterization of Endometrial Carcinpoma. The Cancer Genome Atlas Research Network. Nature.May 2,2013.
3.Genomic and Epigenomic Landscapes of Adult De Novo Acute Myeloid Leukemia. The Cancer Genome Atlas Research Network. NEJM. May 1, 2013. http://www.nejm.org/doi/full/10.1056/NEJMoa1301689
4. Kolata G. As other death rates fall, cancer’s scarecly move. New York Times. April 29, 2009. http://www.nytimes.com/2009/04/24/health/research/24cancerside.html
5. Reinberg S. Cancer to surpass heart disease as world’s leading killer. HealthDay. December 9, 2008. http://www.washingtonpost.com/wp-dyn/content/article/2008/12/09/AR2008120901814.html
6. World Cancer Report 2008. WHO. http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=76&codcch=26
7. von Eschenback A. NCI Director’s Update. August 27, 2003.
8. von Eschenbach A. Eliminating the suffering and death due to cancer by 2015. Manhattan Institute Medical Progress Bulletin. September 2005. http://www.manhattan-institute.org/html/mpb_01.htm
9. Kaiser J. NCI Goal Aims for Cancer Victory by 2015. Science 28 February 2003. http://www.sciencemag.org/content/299/5611/1297.2
10. Niederhuber J. NCI Director’s Update. Global Cancer Control: An Essential Duty. October 6, 2009. http://www.cancer.gov/ncicancerbulletin/archive/2009/100609/page4
11. S.717(111th):21st Century Cancer ALERT Act. http://www.govtrack.us/congress/bills/111/s717
12. Kennedy, Hutchinson Introduce Bill To Overhaul 1971 Cancer Act. Medical News Today. March 30, 2009. http://www.medicalnewstoday.com/releases/144105.php
13. Obama B. “The Obama-Biden Plan To Combat Cancer”. Organizing for America. September 6, 2008.
14. Charles D. Obama announces $5 Billion for new medical research. Reuters. September 30, 2009. http://www.reuters.com/article/2009/09/30/us-usa-healthcare-obama-idUSTRE58T43G20090930
15. Flatow I. Harold Varmus returns to ploitics. NPR. June 16, 2012. http://www.npr.org/templates/story/story.php?storyId=128568241
16. Kolata G. Cancers share gene paterns, studies affirm. NYT. A1. May 1, 2013. http://www.nytimes.com/2013/05/02/health/dna-research-points-to-new-insight-into-cancers.html?pagewanted=all