tag:theconversation.com,2011:/id/topics/cancer-cures-15260/articlesCancer cures – The Conversation2022-10-05T12:19:56Ztag:theconversation.com,2011:article/1908772022-10-05T12:19:56Z2022-10-05T12:19:56ZBreast cancer awareness campaigns too often overlook those with metastatic breast cancer – here’s how they can do better<figure><img src="https://images.theconversation.com/files/487963/original/file-20221004-26-x590oy.jpg?ixlib=rb-1.1.0&rect=64%2C32%2C4217%2C2811&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many stage 4 breast cancer patients say that they don't relate with the pink ribbon.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pink-breast-cancer-awareness-ribbon-with-copy-space-royalty-free-image/183579195?adppopup=true">AnthiaCumming/E+ via Getty Images</a></span></figcaption></figure><p>Is there anyone who isn’t aware of breast cancer? </p>
<p>Since 1985, cancer-related nonprofits, along with pharmaceutical firms and other businesses, have sponsored an international campaign to <a href="https://web.archive.org/web/20110716123431/http://www.nbcam.org/about_faq.cfm">observe October as “Breast Cancer Awareness Month</a>.” During these weeks, the public is bombarded with awareness and education messaging featuring the campaign’s symbol, a pink ribbon. </p>
<p>A wave of pink products typically appears, too, including clothing – think about <a href="https://greatnonprofits.org/org/save-the-ta-tas-foundation">the “Save the Ta-Tas” shirts</a> – as well as events like marches and walkathons. This onslaught has led some to term the <a href="https://www.fredhutch.org/en/news/center-news/2014/10/Pinktober-breast-cancer-awareness-month-patients.html">campaign “Pinktober</a>.” </p>
<p>These efforts often focus on encouraging women to get screened with mammograms to increase the possibility that the cancer will be detected early. Breast cancer patients are celebrated for “beating” cancer, “winning” the battle, having survived and being cured. But these messages overlook the experiences of millions of breast cancer patients. </p>
<p>I am a <a href="https://www.bsu.edu/academics/collegesanddepartments/sociology/about/faculty-staff/krausrachel">sociology professor</a> who specializes in studying gender as well as how having a serious illness affects identity. These themes also hit close to home for me: In 2009, I was diagnosed with metastatic breast cancer – also referred to as stage 4 on a scale from 0 to 4 – which means a cancer that has spread beyond the breasts to other parts of the body. Since that time, I have participated in face-to-face and online support groups, joined retreats and met myriad health professionals who specialize in oncology while also continuing my research. </p>
<p>In 2019, I began a nationwide study to examine the experiences of women with stage 4 breast cancer. The first of my papers on religion’s role in coping with metastatic breast cancer <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/jssr.12771">was recently published</a> in the Journal for the Scientific Study of Religion. I am now working on research that examines metastatic breast cancer and a range of spiritual experiences. </p>
<p>The seriousness of metastatic breast cancer, which is the only breast cancer that kills, is rarely discussed. This leaves people with this diagnosis feeling ignored and angry – and largely invisible to most of the organizations focused on breast cancer. </p>
<h2>A need for inclusion</h2>
<p>Breast cancer is <a href="https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html#">the second most common cancer in women</a> in the U.S. after skin cancer. <a href="https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html#">One in 8 American women</a> will be diagnosed with breast cancer at some point in her life. </p>
<p>Although <a href="https://doi.org/10.1007%2F978-3-030-20301-6_3">women of color</a> are less likely to get breast cancer, they are more likely to die from it. <a href="https://www.cancer.gov/types/breast/patient/male-breast-treatment-pdq">Male breast cancer</a> makes up less than 1% of all cases of breast cancer. </p>
<p>Nearly <a href="https://www.breastcancer.org/symptoms/types/recur_metast">30% of people with early stages breast cancer</a> will see their cancer metastasize to stage 4, which kills <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf">about 44,000 American women and men</a> each year. </p>
<figure class="align-center ">
<img alt="Georgia Bulldogs football team displays the slogan 'Save The Ta-Tas!' on their backs." src="https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=319&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=319&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=319&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=401&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=401&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=401&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Breast Cancer Awareness Month events, like this display by Georgia Bulldogs football fans, often aim to encourage women to get mammograms, which can detect the disease in its early stages.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/georgia-bulldogs-fans-supper-breast-cancer-awareness-month-news-photo/184230633?adppopup=true">Kevin C. Cox/Getty Images Sport via Getty Images North America</a></span>
</figcaption>
</figure>
<p>To find participants with stage 4 breast cancer for my survey, in 2019 I sent out requests through online support groups, cancer organizations and societies, and word of mouth. Ultimately 310 women completed a questionnaire about their experiences with metastatic breast cancer, such as perceived support, feelings about breast cancer organizations and the pink ribbon, and ways of coping. </p>
<p>I selected 33 of those women to participate in in-depth interviews to provide additional information about some of their survey answers.</p>
<h2>Recognizing people with metastatic disease</h2>
<p>I’m a member of several metastatic breast cancer social media groups. For the purpose of this article, I asked people in these groups to share their thoughts about Breast Cancer Awareness Month and specifically the term “survivor.” Most people who responded aren’t overly excited about October: They don’t find terms like survivor and related language relevant. Nor do they feel the pink ribbon represents them. </p>
<p>Of the women who took my original survey, the majority – at least 70% – felt that pink-ribbon events tend to minimize the seriousness of metastatic breast cancer and tend to ignore stage 4 altogether. They also believe that pink-ribbon campaigns focus too much on breasts and selling products and services, <a href="https://www.bcaction.org/pink-ribbon-marketing-culture/what-is-pinkwashing">a practice known as “pinkwashing</a>.” </p>
<p>As one respondent in a social media group wrote, “I don’t like the term survivor. That and October are aimed at early stage cancer, not at supporting people who have Stage 4 cancer. We won’t survive. We aren’t going to be cured. Early detection didn’t save many of us. Removing boobs didn’t save us. All the pinkwashing does nothing to help us.” </p>
<p>Asking women to rate their preferences on a scale of 1 to 4, from “not at all” to “a great deal,” I found that far more metastatic people prefer “patient” and “a person who has cancer” over the term “survivor.”</p>
<p>On average, many participants also say there isn’t much recognition that those with metastatic disease have a different treatment plan. Often, stage 1 to 3 patients can look forward to a treatment end date after they finish radiation, surgery – mastectomy or lumpectomy – and what are called systemic therapies, such as chemotherapy. The vast majority of metastatic patients will be in treatment for the rest of their lives. </p>
<p>For stage 4 breast cancer, <a href="https://www.cochrane.org/CD011276/BREASTCA_breast-surgery-metastatic-breast-cancer">there is some debate</a> as to whether lumpectomy or mastectomy are effective options. The effectiveness of radiation treatment <a href="https://moffitt.org/cancers/metastatic-breast-cancer/radiation/#">is also debatable</a>. So metastatic patients more typically receive chemotherapy and – more recently – immunotherapy, with no surgery.</p>
<p>I also learned that many stage 4 breast cancer patients find it necessary to manage the diagnosis in ways that don’t apply to those with earlier stages. Metastatic patients must go into treatment simultaneously hoping the drugs will calm the cancer and confronting potential end-of-life issues. They may worry about leaving their families. Some may set milestones, such as seeing their children or grandchildren graduate from school or get married. </p>
<p>They may also be contending with issues like how many possible treatment options are left, or maximizing both quantity and quality of life amid a range of side effects. </p>
<h2>Overturning worn-out narratives</h2>
<p>I surveyed participants about the degree to which they feel excluded from breast cancer organizations, and why. They firmly indicated feeling a recognition gap among breast cancer organizations and awareness campaigns. So many seem to emphasize early detection and survivorship, and leave out the concerns and needs of metastatic patients.</p>
<p>One respondent talked about the “early detection mantra.” Another referred to the “ringing of the bell,” a common celebratory ritual when one is done with chemotherapy or radiation. I’ve been known to use the phrase “that damn bell” to express frustration that I will always be on treatment and won’t get to ring that bell. </p>
<p>People echoed these same sentiments when I posed my question in social media groups. One woman wrote, “I am not going to ever be a survivor. Feels like we are the under belly. … No ‘you got this.’ … There is no stage 4 fanfare.” </p>
<p>Many women with stage 4 breast cancer also feel like little is being done to showcase the less optimistic and more frightening aspects of metastatic disease. </p>
<p>Several organizations are starting to fill these gaps. Some are devoting themselves to funding research for breast cancer, while others are now paying more attention to stage 4 patients – or at least moving in that direction. <a href="https://www.metavivor.org/">Metavivor is one organization</a> focused exclusively on serving the metastatic breast cancer community. The Susan G. Komen organization has also begun offering resources and <a href="https://www.komen.org/breast-cancer/metastatic/">information about metastatic breast cancer</a>. </p>
<p>I see hopeful signs that some of these efforts are making a difference. Just the other day, I stopped by my cancer center’s gift shop to buy some mastectomy bras and saw that they were handing out pink-ribbon bracelets. So I asked the woman running the shop if they could get bracelets representing metastatic breast cancer. I was encouraged that – without hesitation – she said it shouldn’t be a problem. </p>
<p><em>This is an updated version of an article <a href="https://theconversation.com/breast-cancer-awareness-campaigns-can-do-a-better-job-supporting-women-whove-received-a-stage-4-diagnosis-instead-of-focusing-only-on-early-detection-and-beating-cancer-168628">originally published on Oct. 29, 2021</a>.</em></p><img src="https://counter.theconversation.com/content/190877/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Kraus receives funding from the Society for the Scientific Study of Religion and the Louisville Institute. </span></em></p>October is awash in seas of pink T-shirts, balloons and ribbons in honor of Breast Cancer Awareness Month. But this messaging fails to recognize people who are not cured of the disease.Rachel Kraus, Professor of Sociology, Ball State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1686282021-10-29T12:38:17Z2021-10-29T12:38:17ZBreast cancer awareness campaigns can do a better job supporting women who’ve received a stage 4 diagnosis, instead of focusing only on early detection and ‘beating cancer’<figure><img src="https://images.theconversation.com/files/426985/original/file-20211018-17-5ni4iu.jpg?ixlib=rb-1.1.0&rect=48%2C8%2C5318%2C3604&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many women with metastatic breast cancer feel left out of annual 'Pinktober' awareness drives because these campaigns tend to focus on earlier, more curable stages of the disease.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/multi-ethnic-women-with-breast-cancer-awareness-royalty-free-image/1170994066?adppopup=true">kali9/E+ via Getty Images</a></span></figcaption></figure><p>Since 1985, cancer-related nonprofits, along with pharmaceutical firms and other businesses, have sponsored an international campaign to <a href="https://web.archive.org/web/20110716123431/http://www.nbcam.org/about_faq.cfm">observe October as “Breast Cancer Awareness Month</a>.” During these weeks, the public is bombarded with public health messages featuring the campaign’s symbol, a pink ribbon. </p>
<p>A wave of pink products typically appears, too, including clothing – think about <a href="https://greatnonprofits.org/org/save-the-ta-tas-foundation">the “Save the Ta-Tas” shirts</a> – as well as events like marches and walkathons. This onslaught has led some to term the <a href="https://www.fredhutch.org/en/news/center-news/2014/10/Pinktober-breast-cancer-awareness-month-patients.html">campaign “Pinktober</a>.” </p>
<p>These efforts often focus on encouraging women to get screened with mammograms to increase the possibility that the cancer will be detected early. Breast cancer patients are celebrated for “beating” cancer, “winning” the battle, having survived and being cured. But these messages overlook the experiences of millions of breast cancer patients. </p>
<p>I am a sociology professor who specializes in studying gender identity as well as how having a serious illness affects identity. These themes also hit close to home for me: I was diagnosed with metastatic breast cancer in 2009 – also referred to as stage 4 on a scale from 0 to 4 – which means a cancer that has spread beyond the breasts to other parts of the body. Since that time, I have participated in face-to-face and online support groups, joined retreats and met myriad health professionals who specialize in oncology while also continuing my research. </p>
<p>In 2019, I began a nationwide study to examine the experiences of women with stage 4 breast cancer. The first of my papers on religion’s role in coping with metastatic breast cancer will be published in the <a href="https://sssreligion.org/journal/">Journal for the Scientific Study of Religion</a>. I am now working on research that examines metastatic breast cancer and identity. </p>
<p>The seriousness of metastatic breast cancer, which is the only breast cancer that kills, is rarely discussed. This leaves people with this diagnosis feeling ignored and angry – and largely invisible to most of the organizations focused on breast cancer. </p>
<h2>A need for inclusion</h2>
<p>Breast cancer is <a href="https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html#:%7E:text=Breast%20cancer%20is%20the%20most%20common%20cancer%20in,8%20chance%20she%20will%20never%20have%20the%20disease">nearly the most common cancer in women</a> in the United States, second only to skin cancer. <a href="https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html#:%7E:text=Breast%20cancer%20is%20the%20most%20common%20cancer%20in,8%20chance%20she%20will%20never%20have%20the%20disease">One in 8 American women</a> will be diagnosed with breast cancer at some point in her life. Although <a href="https://doi.org/10.1007%2F978-3-030-20301-6_3">women of color</a> are less likely to get breast cancer, they are more likely to die from it. <a href="https://www.cancer.gov/types/breast/patient/male-breast-treatment-pdq">Male breast cancer</a> makes up less than 1% of all cases of breast cancer. </p>
<p>Nearly <a href="https://www.breastcancer.org/symptoms/types/recur_metast">30% of people with early stages</a> of breast cancer will see their cancer metastasize to stage 4, which kills <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf">about 44,000 American women and men</a> each year. </p>
<p>To find participants with stage 4 breast cancer for my survey, I sent out requests through online support groups, cancer organizations and societies, and word of mouth. Ultimately 310 women completed a questionnaire about their experiences with metastatic breast cancer, such as perceived support, feelings about breast cancer organizations and the pink ribbon, and ways of coping. </p>
<p>I selected 33 of those women to participate in in-depth interviews to provide additional information about some of their survey answers. </p>
<figure class="align-center ">
<img alt="Georgia Bulldogs football team displays the slogan 'Save The Ta-Tas!' on their backs." src="https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=319&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=319&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=319&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=401&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=401&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426994/original/file-20211018-13-bn7bpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=401&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Breast Cancer Awareness Month events, like this display by Georgia Bulldogs football fans, often aim to encourage women to get mammograms, which can detect the disease in its early stages.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/georgia-bulldogs-fans-supper-breast-cancer-awareness-month-news-photo/184230633?adppopup=true">Kevin C. Cox/Getty Images Sport via Getty Images North America</a></span>
</figcaption>
</figure>
<p>According to my research, these patients generally do not feel like they fit the “survivor” mantra associated with pictures often seen in the media of women who are cured of breast cancer, happy and getting on with their lives.</p>
<p>Further, many of these women do not believe that breast cancer organizations, including pink ribbon groups, do a good job of including metastatic patients in their campaigns. They feel like they are left out of public discussions on breast cancer and that little is being done to showcase the less optimistic and more frightening aspects of metastatic disease. </p>
<p>Asking women to rate their preferences on a scale of 1 to 4, from “not at all” to “a great deal,” I found that more metastatic people prefer the term “patient” – which scored an average of 3.1 – and “a person who has cancer” – which scored a 3.3 – rather the term “survivor,” which rated an average of 2.3. </p>
<p>On average, many participants also say there isn’t much recognition that those with metastatic disease may face somewhat different treatment outcomes. </p>
<p>Often, stage 1 to 3 patients can look forward to a treatment end date. The vast majority of metastatic patients will be in treatment for the rest of their lives. </p>
<p>Earlier stages of breast cancer typically have more than one treatment option, including radiation, surgery – mastectomy or lumpectomy – and what are called systemic therapies, such as chemotherapy. </p>
<p>For stage 4 breast cancer, <a href="https://www.cochrane.org/CD011276/BREASTCA_breast-surgery-metastatic-breast-cancer">there is some debate</a> as to whether lumpectomy or mastectomy are effective options. The effectiveness of radiation treatment <a href="https://moffitt.org/cancers/metastatic-breast-cancer/radiation/#:%7E:text=Radiation%20therapy%20is%20often%20used%20to%20treat%20breast,metastasized%20%28spread%20to%20other%20parts%20of%20the%20body%29">is also debatable</a>. So metastatic patients more typically receive chemotherapy and – more recently – immunotherapy, with no surgery.</p>
<p>I also learned that many stage 4 breast cancer patients find it necessary to manage the diagnosis in ways that don’t apply to those with earlier stages. Metastatic patients must go into treatment simultaneously hoping the drugs will calm the cancer and confronting potential end-of-life issues. They may worry about leaving their families. Some may set milestones, such as seeing their children or grandchildren graduate from school or get married. </p>
<p>They may also be contending with issues like how many possible treatment options are left, or maximizing both quantity and quality of life amid a range of side effects. </p>
<h2>Overturning worn-out narratives</h2>
<p>I surveyed participants about the degree to which they feel excluded from breast cancer organizations, and why. They firmly indicated feeling a recognition gap among breast cancer organizations and awareness campaigns. So many seem to emphasize early detection and survivorship, and leave out the concerns and needs of metastatic patients.</p>
<p>One respondent talked about the “early detection mantra.” Another referred to the “ringing of the bell,” a common celebratory ritual when one is done with treatment. I’ve been known to use the phrase “that damn bell” to express frustration that I will always be on treatment and won’t get to ring that bell.</p>
<p>After completing one of my several radiation therapies, a nurse harmlessly asked me if I would like to ring the bell. I thought, “There is a lot more beyond this one course of therapy” and, not knowing what to say, I simply started crying. Thankfully they had a little guardian angel pin they gave me instead. </p>
<p>Several organizations are starting to fill these gaps. Some are devoting themselves to funding research for breast cancer, while others are now paying more attention to stage 4 patients – or at least moving in that direction. <a href="https://www.metavivor.org/">Metavivor is one organization</a> focused exclusively on serving the metastatic breast cancer community. </p>
<p>My own experiences, and that of so many others with metastatic breast cancer, make it clear that public campaigns and breast cancer organizations can do much more for these patients.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/168628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Kraus received funding from The Louisville Institute and the Society for the Scientific Study of Religion.</span></em></p>A diagnosis of metastatic breast cancer means having cancer for the rest of one’s life – a situation with very different needs and concerns compared to earlier stages of the disease.Rachel Kraus, Professor of Sociology, Ball State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1109212019-02-04T12:30:28Z2019-02-04T12:30:28ZCancer growth in the body could originate from a single cell – target it to revolutionise treatment<figure><img src="https://images.theconversation.com/files/257009/original/file-20190204-193213-1tzdd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/cancer-cells-3d-illustration-574815085?src=Bz5qM75AljUdBvqrlw6Bfg-1-3">Andrii Vodolazhskyi/Shutterstock</a></span></figcaption></figure><p>Cancer remains a frightening and largely incurable disease. The toxic side effects of chemotherapy and radiation make the cure often seem as bad as the ailment, and there is also the threat of recurrence and tumour spread.</p>
<p>Cancer treatment still follows a practically medieval method of cut, burn or poison. If the growth can’t be cut out through surgery, it may be burnt away with radiation or poisoned by chemotherapy. As a result, cancer therapy remains a daunting diagnosis for patients and treatment options seem limited for a disease which causes <a href="https://www.who.int/news-room/fact-sheets/detail/cancer">one in six deaths globally</a>.</p>
<p>The failure to innovate in cancer treatment may lie in the very poor success rate of clinical trials. Approximately 95%-98% of new anti-cancer drugs <a href="https://academic.oup.com/biostatistics/advance-article/doi/10.1093/biostatistics/kxx069/4817524">actually fail phase III clinical trials</a>, the phase in which <a href="https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/what-clinical-trials-are/phases-of-clinical-trials#phase3">new treatments are compared</a> with existing therapy options. This is a staggering statistic. No other business could possibly survive with such an abysmal success rate.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257011/original/file-20190204-193213-reh2xh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257011/original/file-20190204-193213-reh2xh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257011/original/file-20190204-193213-reh2xh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257011/original/file-20190204-193213-reh2xh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257011/original/file-20190204-193213-reh2xh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257011/original/file-20190204-193213-reh2xh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257011/original/file-20190204-193213-reh2xh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Chemotherapy and radiotherapy are broad-based treatments which attack the bulk of cancer cells but also damage healthy tissue.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cancer-patients-receiving-chemotherapy-treatment-hospital-529109200?src=PhgS1fo7VEItjr0JsbMkcQ-1-0">Napocska/Shutterstock</a></span>
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<p>Most drugs are made to target “bulk” cancer cells, but not the root cause: the cancer stem cell. Cancer stem cells, also known as “tumour-initiating cells”, are the only cells in the tumour <a href="https://www.nature.com/articles/nature09781">that can make a new tumour</a>. New therapies that specifically target and eradicate these cancer stem cells are needed to prevent tumours growing and spreading, but for that there needs to be more clarity around the target.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5941316/">Our new research</a> may have discovered such a target. We have identified and isolated cells within different cancerous growths which we call the “cell of origin”. Our experiments on cancer cells derived from a human breast tumour found that stem cells – representing 0.2% of the cancer cell population – have special characteristics.</p>
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Read more:
<a href="https://theconversation.com/drug-resistant-cancers-kill-millions-heres-how-were-tackling-them-78208">Drug-resistant cancers kill millions – here's how we're tackling them</a>
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<p>They generate <a href="https://www.frontiersin.org/articles/10.3389/fonc.2018.00677/abstract">vast amounts of energy and proliferate rapidly</a>. We believe that they resemble the cancer cell of origin that has escaped senescence – the natural process of cell ageing and “death” which concludes a healthy cell life cycle. These are thought to be the first cancer cells which start the process of uncontrolled cell multiplication and cause tumours to form.</p>
<p>These cancer stem cells undergo anchorage-independent growth, also known as growth in suspension, without any tissue attachment. This is how metastasis occurs – spreading via the blood vessels and lymphatic vessels. These features put them front and centre as a new target for anti-cancer therapy.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257018/original/file-20190204-193195-10koi98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257018/original/file-20190204-193195-10koi98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257018/original/file-20190204-193195-10koi98.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257018/original/file-20190204-193195-10koi98.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257018/original/file-20190204-193195-10koi98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257018/original/file-20190204-193195-10koi98.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257018/original/file-20190204-193195-10koi98.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Cancer stem cells grow in suspension in the bloodstream and spread throughout the body.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendering-red-blood-cells-vein-517874557?src=BvKWjBwOSlhDO4joRgHq1g-1-5">Phonlamai Photo/Shutterstock</a></span>
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<p>With astonishing luck, these energetic cancer stem cells are colour-coded which means they have a natural phosphorescent glow, making them easy to identify and target.</p>
<p>Now that we have found them and we know how they behave, it should be relatively simple to find drugs to target cancer stem cells. <a href="https://www.frontiersin.org/articles/10.3389/fonc.2018.00677/abstract">In our new paper</a> we have already shown that they are easily targeted with a mitochondrial inhibitor or a cell cycle inhibitor <a href="https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/going-through-breast-cancer-treatment/targeted-therapy/ribociclib-kisqali">such as Ribociclib</a>, an FDA-approved drug in the US which would prevent their proliferation. </p>
<p>Ultimately, this means that if we focus on energetic cancer stem cells, we may be able to directly hit the target. We might be able to turn cancer into a manageable chronic disease, like diabetes. We believe that we have arrived at the start of a new, more fruitful, road in cancer therapy. As a consequence, “big pharma” drug screening should actually focus on cancer stem cells and their relevant targets.</p><img src="https://counter.theconversation.com/content/110921/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael P. Lisanti holds a minority interest in Lunella Biotech, Inc.
</span></em></p>Cancer treatment could be revolutionised by the discovery of the origin cells which divide first.Michael P. Lisanti, Professor of Translational Medicine, University of SalfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/636272016-08-10T22:20:49Z2016-08-10T22:20:49ZWhat can a 1.7-million-year-old hominid fossil teach us about cancer?<figure><img src="https://images.theconversation.com/files/133391/original/image-20160808-18010-8sjngf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Volume rendered image of the external morphology of the foot bone shows the extent of expansion of the primary bone cancer beyond the surface of the bone.</span> <span class="attribution"><a class="source" href="http://www.eurekalert.org/multimedia/pub/120746.php?from=334527">Patrick Randolph-Quinney (UCLAN)</a></span></figcaption></figure><p>In late July, <a href="http://doi.org/10.17159/sajs.2016/20150471">an international team of researchers</a> announced that they had identified evidence of cancer in the fossilized remains of a biological relative of human beings who lived about 1.7 million years ago.</p>
<p>It is rare to find fossils from the hominid family tree. Finding one with such well-preserved evidence of a tumor is rarer still.</p>
<p>It seems that cancer has been with us for quite some time, and this finding highlights one of the most fascinating questions about it: why cancer exists in the first place.</p>
<p>Cancer is a deadly disease and would have been particularly lethal before the recent development of effective treatments. So why didn’t it – or our susceptibility to it – die out long ago? </p>
<p>To put the question somewhat differently, why should organisms, including human beings, carry within our DNA the instruments of our own destruction – tumor suppressor genes and oncogenes just waiting for environmental insults before they kill their carriers? Shouldn’t organisms with such genes be selected against in the evolutionary competition to survive and reproduce?</p>
<h2>An ancient osteosarcoma</h2>
<p>Before addressing that question, let’s go back to the 1.7-million-year-old tumor.</p>
<p>The researchers found the cancer in a metatarsal, one of the long bones of the foot found just behind the toes. The researchers examined the specimen with high-resolution x-rays, revealing the lesion in greater detail and producing a three-dimensional image, which revealed an “irregular spongy woven bone texture with a cauliflower-like external appearance.” In other words, the cells of the tumor had grown in a disorganized fashion and were ballooning out from the shaft of the bone – features of a malignancy. They concluded that it was a bone cancer, probably an osteosarcoma. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/133393/original/image-20160808-18010-hcwokh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/133393/original/image-20160808-18010-hcwokh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133393/original/image-20160808-18010-hcwokh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133393/original/image-20160808-18010-hcwokh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133393/original/image-20160808-18010-hcwokh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133393/original/image-20160808-18010-hcwokh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133393/original/image-20160808-18010-hcwokh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A different view of the tumor in the metatarsal bone.</span>
<span class="attribution"><a class="source" href="http://www.eurekalert.org/multimedia/pub/120747.php?from=334527">Edward Odes/University of the Witwatersrand</a></span>
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<p>As a radiologist working in a children’s hospital, I regularly see x-ray, CT and MRI scans of patients with osteosarcomas. They account for a fraction of all primary bone cancers, and are most often diagnosed in adolescence and young adulthood. One unusual feature of the South African report is the location of the tumor – the leg and arm are much more common sites than the foot.</p>
<p>Osteosarcomas arise from abnormal bone-producing cells. In fact, the name osteosarcoma comes from Greek roots meaning “bone” and “fleshy growth.” </p>
<p>Osteosarcomas aren’t just found in humans. They represent the most <a href="http://wearethecure.org/learn-more-about-canince-cancer/canine-cancer-library/osteosarcoma/">common bone malignancy found in dogs</a> <a href="http://www.vcahospitals.com/main/pet-health-information/article/animal-health/osteosarcoma-in-cats/316">and cats</a>. In fact, osteosarcomas are <a href="http://dx.doi.org/10.1093/ilar/ilu009">more common in dogs than people</a>, <a href="http://www.vet.upenn.edu/docs/default-source/ryan/oncology-handouts/bone-tumors-in-dogs_ek-ks.pdf?sfvrsn=4">especially in large species</a> such as <a href="http://rrcus.org/rhodesianridgebackhealth/Documents-PDFs/Osteosarcoma.pdf">greyhounds and great danes</a>. </p>
<p>Cancer has been around for much longer than 1.7 million years. In Indianapolis, our <a href="https://www.childrensmuseum.org/blog/meet-the-gorgosaur-v2">Children’s Museum</a> features the fossilized skull of a Gorgosaurus, a relative of Tyrannosaurus rex which lived during the Cretaceous period about 70 million years ago. It shows clear evidence of a golf-ball-sized mass inside the skull cavity. </p>
<h2>Cancer isn’t a single disease</h2>
<p>One challenge in attempting to understand the causes of cancer is the fact that cancer is not a single disease. </p>
<p>There are many different types of cancer, which can be categorized according to the organ in which they originate – lung cancer, colon cancer, breast cancer and so on. Better yet, they can be categorized by the type of tissue they represent. For example, carcinomas arise from epithelial or lining cells, sarcomas from connective cells, and leukemias from blood-forming cells.</p>
<p>What we call cancer really represents a family of disorders, all of which can be lumped together because of a common feature – disrupted regulation of cell growth.</p>
<p>For example, genes that normally suppress cell growth may be damaged, leading to uncontrolled proliferation. An indication that all cancers are not the same is the fact that they have very different prognoses and treatments.</p>
<p>Today evidence suggests that many cancers can be traced to environmental exposures, such as tobacco, dietary carcinogens, infections, and air and water pollution. It seems unlikely that tobacco or air pollution could have caused cancer millions of years ago, but it’s possible that some dietary and infectious agents may have been more common in the remote past. </p>
<h2>Chromosomes and oxygen</h2>
<p>One of the first explanations for how cancer could result from chromosomal damage was provided by a medical school professor of mine at the University of Chicago, <a href="https://news.uchicago.edu/article/2013/12/17/janet-rowley-cancer-genetics-pioneer-1925-2013">Janet Rowley, M.D</a>. In the 1970s, Dr. Rowley showed that in many patients with a type of leukemia, CML, <a href="http://www.nature.com/nature/journal/v243/n5405/abs/243290a0.html">portions of chromosomes 9 and 22 had been exchanged</a>, proving that changes in DNA could lead to cancer.</p>
<p>Part of the blame for cancer may be placed on a rather unexpected culprit, a molecule without which human life would be utterly impossible – oxygen. Oxygen is necessary for our cells to convert food to energy. This is one of the reasons that the human body is equipped with over 60,000 miles of blood vessels, which enable red blood cells to carry oxygen to each of our 75 trillion cells.</p>
<p>But oxygen is not an entirely benign molecule. In fact, it is highly reactive and even toxic in high concentrations. And early in Earth’s history, oxygen levels began to rise dramatically, as plants capable of photosynthesis – a process that produces oxygen – proliferated. More oxygen permitted the development of multicellular organisms capable of transporting oxygen to all of their cells. </p>
<p>Oxygen becomes problematic when <a href="http://dx.doi.org/10.3109/10715761003667554">superreactive forms</a> of it are formed. For example, when ionizing radiation strikes a cell, it can form superoxides that react avidly with nearby molecules. When one of the nearby molecules is DNA, damage to genes occurs, producing mutations that can be carried from one generation of cells to another. In some cases, a transformation to cancer may result. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133385/original/image-20160808-18053-slt6xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133385/original/image-20160808-18053-slt6xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133385/original/image-20160808-18053-slt6xy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133385/original/image-20160808-18053-slt6xy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133385/original/image-20160808-18053-slt6xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133385/original/image-20160808-18053-slt6xy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133385/original/image-20160808-18053-slt6xy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Human malignant osteosarcoma (bone cancer) cells from a leg mass.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Osteosarcoma_(bone_cancer).jpg">National Cancer Institute via Wikimedia Commons</a></span>
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<h2>Will cancer always be with us?</h2>
<p>Another reason that cancer has persisted is the fact that it tends to be a disease of older organisms. Only <a href="http://www.cancer.org/cancer/cancerinchildren/detailedguide/cancer-in-children-key-statistics">1 percent of the cancers</a> diagnosed each year in the U.S. occur in children. So for most of our biological history, when life expectancy was shorter, hominids reproduced and died of other causes long before cancer had a chance to develop.</p>
<p>In advanced countries today, mortality rates due to other diseases, such as infections, <a href="http://dx.doi.org/10.1001/jama.2015.12319">heart disease and stroke</a>, have fallen so far that many more people are living to advanced ages, by which point the series of mutations necessary to induce cancer have had sufficient time to occur. In effect, rising cancer rates are in part a sign of general good health and longevity.</p>
<p>Can we make cancer disappear? The fundamental problem with cancer cells is that they do not know when to stop growing and die, and as a result, they keep proliferating in an uncontrolled fashion. While this is highly injurious to the organism, the existence of genes that promote cell growth is obviously crucial for organisms to grow and survive in the first place.</p>
<p>Consider an automobile. Just two weeks ago, the brakes on my car failed, a dangerous situation. We might wish that cars were built so that the brakes could never fail, but the only way to eliminate the possibility of brake failure would be to do away with the brake system altogether, a far more hazardous proposition.</p>
<p>The same thing can be said about cancer. We might wish that we were built without genes that can contribute to the development of cancer, but normal growth and development – and yes, even death – might not be possible without them. When it comes to life, we must take the bad as well as the good, though this is not to say that we cannot make strides in preventing and curing cancer.</p>
<p>The finding of cancer in the bone of a 1.7-million-year-old human relative isn’t just a biological oddity – it is a reminder of what it means to be both alive and human. Life is fraught with hazards. Thriving biologically (and biographically) does not mean eliminating all risks but managing the ones we can, both to reduce harm and promote a full life.</p><img src="https://counter.theconversation.com/content/63627/count.gif" alt="The Conversation" width="1" height="1" />
Cancer is a deadly disease and would have been particularly lethal before the recent development of effective treatments. So why didn’t it – or our susceptibility to it – die out long ago?Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/532842016-01-18T19:27:08Z2016-01-18T19:27:08ZResolving to ‘cure cancer’, Obama promises the impossible<p>In his 2016 <a href="https://en.wikipedia.org/wiki/State_of_the_Union">State of the Union</a> address last week, United States President Barack Obama <a href="http://www.abc.net.au/news/2016-01-13/barack-obama-delivers-state-of-the-union-2016/7085682">declared he wanted America</a> to be the country that “cures cancer once and for all”. </p>
<p>Obama’s goal is unrealistic, too simplistic and not achievable by the United States, or any other country. Cancer is not just one but a group of more than 100 different diseases, for which no <em>single</em> cure will ever be effective.</p>
<p>Finding better drugs to treat cancer effectively and with fewer side effects will certainly help reduce the number of people who die from the disease. But instead of romantic hopes for cancer “cures”, countries need to invest more to find better methods for early detection and awareness campaigns to promote healthier lifestyles.</p>
<h2>What do we mean by cure?</h2>
<p>Firstly, something this important can’t be solved by one country. Cancer knows no national boundaries as it affects families across the world. We need a globally coordinated program to find better treatments so research and costs are not duplicated. </p>
<p>Next, the phrase “a cure for cancer” is empty because few people, if any, know what it actually means. It could mean total eradication of the disease. That is, preventing it from developing in the first place, like the way the world <a href="http://www.who.int/features/2010/smallpox/en/">eradicated smallpox</a>. </p>
<p>It might also mean finding a single drug that, when given to any cancer patient, will effectively cure them of the disease without need for surgery or radiotherapy. </p>
<p>Both definitions are unrealistic. And when it comes to cancer, there is no such thing as a “cured” patient, in the way that a patient can be cured of other diseases, such as infections. After treatment, there can be some leftover cancer cells, which may redevelop into cancer. </p>
<p>Sadly, a patient may also develop entirely new cancers or, worse, get a new cancer that is actually <a href="http://www.cancer.org/cancer/cancercauses/othercarcinogens/medicaltreatments/secondcancerscausedbycancertreatment/second-cancers-caused-by-cancer-treatment-toc">caused by the chemotherapy</a> treatment they received for the initial disease. </p>
<p>Doctors don’t use words like “cure”. Instead they talk in terms of five-year survival rates. That is, the percentage of patients who live for five years post-cancer diagnosis for a given treatment.</p>
<p>We’ve seen some real progress in this area in the last few decades. Compared to around 30% in the 1970s, <a href="https://theconversation.com/the-fourth-pillar-how-were-arming-the-immune-system-to-help-fight-cancer-48152">today around 70% of people</a> will live for five years after diagnosis. So what we’re looking for, when we say we’re looking for a cure, is really getting that long-term survival rate as close to 100% as possible.</p>
<h2>Why we can’t cure cancer</h2>
<p>Our understanding of cancer has improved remarkably from a hundred years ago when we thought it was caused by trauma and was infectious. </p>
<p>Now we have some certainties in our cancer knowledge. We know that <a href="http://www.who.int/mediacentre/factsheets/fs380/en/">the human papillomavirus causes</a> causes most cervical cancers and that smoking causes most lung cancer. We know that <a href="https://theconversation.com/more-than-one-third-of-cancers-can-be-avoided-if-australians-modify-their-lifestyle-48581">being overweight and having a poor diet</a> increase the risk of bowel and bladder cancer.</p>
<p>Most importantly, we’ve discovered that many types of cancers we thought were identical are actually completely different. Typically, doctors classify cancers based on the region of the body in which they are found. Patients are routinely told they have breast cancer or lung cancer, for instance.</p>
<p>But now we know <a href="https://theconversation.com/how-cancer-doctors-use-personalised-medicine-to-target-variations-unique-to-each-tumour-47349">this is a poor method</a> of diagnosing and treating cancer. Many cancers originating in the same organ can be reclassified into different subgroups, each needing a different cocktail of drugs to treat them. </p>
<p>The best example of this is breast cancer. Doctors now routinely biopsy breast cancers to look for three specific markers. The presence or absence of these markers categorises a patient with one of eight different types of breast cancer. Drugs are then <a href="http://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/biomarkers-guide-treatment-metastatic-breast-cancer">specifically selected</a> based on these markers.</p>
<p>There will never be one vaccine or drug that will be effective for all the different cancer types. At best we will continue to develop more vaccines and drugs, but these will be effective for only specific cancer subgroups.</p>
<p>So if we aren’t ever to find a cure for cancer, how can we make real progress?</p>
<h2>Early detection</h2>
<p>The biggest factor when it comes to long-term cancer survival isn’t the treatment, but how early the cancer is found. Practically any cancer is treatable if caught early and before it has spread to other locations in the body.</p>
<p>So while we must continue looking for better drugs, it is just as important that we get better at preventing and detecting cancers. Close to <a href="https://theconversation.com/10-3-simple-ways-to-reduce-your-cancer-risk-37185">30% of all cancers are lifestyle related</a> and simple changes can significantly reduce the number of people diagnosed with cancer. </p>
<p>This includes better diets and more exercise, drinking less alcohol, not smoking, and protecting ourselves from the sun’s damaging effects.</p>
<p>We must ensure more people are checking themselves for the early signs of cancer, such as <a href="http://www.cancer.org.au/preventing-cancer/sun-protection/check-for-signs-of-skin-cancer.html">moles on the skin</a>, lumps in the breasts or testes, or unexplained bleeding, pain or coughing.</p>
<p>We must combine established methods of detection, such as a <a href="https://www.google.com.au/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=blood+test+cancer+prostate">blood test to detect prostate cancer</a>, with new ones, such as <a href="http://www.dailymail.co.uk/health/article-183291/Breath-test-detects-breast-cancer.html">breath tests</a> that can detect breast cancer. </p>
<p>In this way, we are more likely to catch the cancers at a stage when current (and new) treatments will be effective.</p><img src="https://counter.theconversation.com/content/53284/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible and the Scottish Universities Life Sciences Alliance for research into platinum drugs. Dr Wheate is a named inventor on two international patents dealing with the drug delivery of platinum drugs.</span></em></p>Obama’s goal of “curing” cancer is unrealistic, simplistic and not achievable. Cancer is a group of more than 100 different diseases for which no single cure will ever be effective.Nial Wheate, Senior Lecturer in Pharmaceutics, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/520222015-12-15T13:36:15Z2015-12-15T13:36:15ZWhat do we mean when we say a person’s cancer has been cured?<p>Until fairly lately, it was unusual to see the words “cancer” and “cured” used in the same sentence. Now, it’s much more common. Reports that toddler <a href="http://www.mirror.co.uk/news/uk-news/how-miracle-leukaemia-cure-works-6776752">Layla Richards</a> had been cured of what was thought to be an incurable form of leukaemia were followed with news that former US president <a href="http://www.theguardian.com/science/2015/dec/06/immunotherapy-drug-jimmy-carters-cancer-cure">Jimmy Carter</a> was cured of brain cancer – a melanoma that had spread from his liver. </p>
<p>In both these cases the most up-to-date <a href="https://theconversation.com/explainer-what-is-cancer-immunotherapy-24476">immunotherapies</a> were used to treat cancers that normally have poor survival rates. These new treatments use the body’s own immune system to identify and kill the cancer and their success in difficult to treat cancers has led to them being hailed as a cure. But is “cured” the right word?</p>
<h2>When is a cure not a cure?</h2>
<p>The <a href="http://www.oxforddictionaries.com/definition/english/cure">dictionary definition</a> of cured is: to relieve (a person or animal) of the symptoms of a disease or condition; or eliminate (a disease or condition) with medical treatment. These definitions, then, are open to interpretation. </p>
<p>With infections, a cure is the point at which the invading pathogen is removed from the body – using antibiotics, say – so that it is undetectable and the patient is returned to a healthy state. But a cure is not always achieved despite it seeming so, as some infections and viruses can hide and lay dormant even when someone appears in good health. One high profile example was the <a href="http://www.bbc.co.uk/news/world-us-canada-21651225">HIV infected baby</a> who was reportedly cured in 2013 after treatment with antiretroviral drugs. The absence of detectable virus led to the belief that the baby was free of the virus. However, when the drugs were stopped the <a href="https://theconversation.com/sad-tale-of-hiv-return-in-cured-baby-comes-as-new-study-suggests-virus-seeds-early-29433">virus returned</a>.</p>
<p>When it comes to cancer, successful therapy is generally described by professionals as being either in “partial remission” (the cancer has shrunk or stopped growing) or “complete remission” (the cancer is undetectable). Even when patients are in complete remission this does not represent a cure because it is almost impossible to say that all the cancer cells have been destroyed and do not exist in another part of the body. Indeed, if a cancer does return it usually does so <a href="http://www.cancer.gov/about-cancer/diagnosis-staging/prognosis">within five years of remission</a>.</p>
<h2>The future’s bright</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/105489/original/image-20151211-8326-zb0zbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/105489/original/image-20151211-8326-zb0zbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/105489/original/image-20151211-8326-zb0zbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/105489/original/image-20151211-8326-zb0zbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/105489/original/image-20151211-8326-zb0zbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/105489/original/image-20151211-8326-zb0zbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/105489/original/image-20151211-8326-zb0zbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Immune cells attacking a cancer cell.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=tkrFIQTZ9flvePWNZxWv0Q&searchterm=t-cells%20&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=313800764">www.shutterstock.com</a></span>
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<p>Immunotherapy has one very important advantage over conventional <a href="http://www.nhs.uk/Conditions/chemotherapy/Pages/Definition.aspx">chemotherapy</a> and <a href="http://www.nhs.uk/conditions/Radiotherapy/Pages/Introduction.aspx">radiotherapy</a>. Once an immune response to the cancer has been initiated it will target the cancer at the site in which it originated, as with conventional therapy. But with immunotherapy the responding immune cells are able to create a <a href="http://www.cancerresearch.org/cancer-immunotherapy">memory of the cancer</a>, which can persist for many years, allowing detection and killing of any further cancer cells that may have spread from the original site. It is this important property that has led to the argument that patients that have undergone successful immunotherapy have been “cured” of their cancer when no cancer is detectable. </p>
<p>The ability to treat “incurable” cancers and improve cancer survival is an exciting prospect, but the use of “cure” to describe the status of these patients is premature. Immunotherapies are still in their infancy and we have to be careful not to overstate the claims until the results of long-term studies of patients undergoing this treatment are available. Despite this, the early evidence of strong anticancer immune responses is very encouraging and compelling, and gives a great deal of hope to cancer patients that one day they will really be rid of the disease once and for all.</p><img src="https://counter.theconversation.com/content/52022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edd James receives funding from Cancer Research UK. </span></em></p>Jimmy Carter is now cancer-free, but is it right to say that he’s been cured?Edd James, Associate Professor in Cancer Immunology, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/479062015-09-23T16:36:52Z2015-09-23T16:36:52ZStarving cancer cells of sugar could be the key to future treatment<figure><img src="https://images.theconversation.com/files/95882/original/image-20150923-2617-1frwddr.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C736%2C547&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is sugar the answer for tackling cancer cells?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/wellcomeimages/5814247339/">Flickr/Wellcome Images</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>All the cells in our bodies are programmed to die. As they get older, our cells accumulate toxic molecules that make them sick. In response, they eventually break down, clearing the way for new, healthy cells to grow. This “<a href="http://www.ncbi.nlm.nih.gov/books/NBK26873/">programmed cell death</a>” is a natural and essential part of our wellbeing. Every day, billions of cells die like this in order for the whole organism to continue functioning as it is supposed to.</p>
<p>But as with any programme, errors can occur and injured cells that are supposed to die continue to grow and divide. These damaged cells can eventually become malignant and generate tumours. In order to <a href="http://www.ncbi.nlm.nih.gov/pubmed/19351640">avoid their programmed cell death</a> in this way, cancer cells reorganise their metabolism so they can cheat death and proliferate indefinitely.</p>
<p>Cancer researchers have <a href="http://www.ncbi.nlm.nih.gov/pubmed/19460998">known for decades</a> that tumours use a faster metabolism than normal cells in our body. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19029908">One classic example</a> of this is that cancer cells increase their consumption of glucose to fuel their rapid growth and strike against programmed cell death. This means that limiting glucose consumption in cancer cells is becoming an <a href="http://www.ncbi.nlm.nih.gov/pubmed/16892078">attractive tool</a> for cancer treatments.</p>
<h2>A new hope?</h2>
<p>You may have seen <a href="http://www.dailymail.co.uk/home/you/article-1025497/The-anti-cancer-diet--introducing-healthy-new-way-life.html">articles</a> or <a href="http://www.canceractive.com/cancer-active-page-link.aspx?n=3087">websites advocating</a> that starving patients of sugar is crucial for getting rid of tumours or that eating less sugar reduces the risk of cancer. The story is not that simple. Cancer cells always <a href="http://www.ncbi.nlm.nih.gov/pubmed/23177934">find alternatives</a> to fuel their tank of glucose, no matter how little sugar we ingest. There is not a direct connection between eating sugar and getting cancer and it is always advisable to talk to your doctor if you have doubt about your diet. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Chemotherapy – the most common cancer treatment.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=iewo8m4xx7g4rclor3&searchterm=chemotherapy&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=218458957">www.shutterstock.com</a></span>
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<p>Researchers <a href="http://www.ncbi.nlm.nih.gov/pubmed/19270154">have demonstrated</a> that cancer cells use glucose to generate the building blocks of the cellular compounds needed for rapid tumour growth. They also use it to <a href="http://www.ncbi.nlm.nih.gov/pubmed/19029908">generate molecules</a> that guard against the toxic accumulation of reactive oxygen species, the cell-damaging molecules that activate programmed cell death. This means that glucose serves as a master protector against cell death.</p>
<p>If the amount of sugar we eat doesn’t affect this process, the question we need to answer is how the cancer cells are instructed to consume more glucose. Who is filling the fuel tank? We have discovered that what allows tumours to evade their natural cause of death in this way is a protein that is overproduced in virtually every human cancer but not in normal cells.</p>
<h2>Turbocharged growth</h2>
<p>In a <a href="http://www.nature.com/ncomms/2015/150810/ncomms8882/full/ncomms8882.html">recent study</a> published in Nature Communications we showed that cancer cells stimulate the over-production of the protein known as PARP14, enabling them to use glucose to turbocharge their growth and override the natural check of cell death. Using a combination of genetic and molecular biology approaches, we have also demonstrated that inhibiting or reducing levels of PARP14 in cancer cells starves them to death.</p>
<p>The best news is that by comparing cancer tissues (biopsies) from patients that has survived cancer and those that have died, we have found that levels of PARP14 were significantly higher in those patients that have died. This means that levels of PARP14 in cancer tissues could also predict how aggressive the cancer would be and what the chances are of a patient’s survival.</p>
<p>This means that a treatment which could block the protein could represent a significant revolution in the future of cancer treatment. What’s more, unlike traditional chemotherapy and radiotherapy, the use of PARP14 inhibitors would only kill cancer cells and not healthy ones. The next step is to design and generate new drugs that can block this protein and work out how to use them safely in patients.</p><img src="https://counter.theconversation.com/content/47906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Concetta Bubici receives funding from Key Kendall Leukaemia Fund. </span></em></p><p class="fine-print"><em><span>Salvatore Papa receives funding from Foundation for Liver Research and AMMF-Cholangiocarcinoma Charity</span></em></p>Eating less sugar isn’t enough to stop glucose-hungry cancer cells but new research points the way to how we might starve them to death.Concetta Bubici, Lecturer in biomedical science, Brunel University LondonSalvatore Papa, Senior scientist, Institute of Hepatology, Birkbeck, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/383422015-03-05T11:31:58Z2015-03-05T11:31:58ZWhat cures may lie within Kew Gardens? Give it the financial freedom to find them<figure><img src="https://images.theconversation.com/files/73839/original/image-20150304-15267-b67ii3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kew is home to plants from across the globe.</span> <span class="attribution"><a class="source" href="http://de.wikipedia.org/wiki/Royal_Botanic_Gardens_(Kew)#mediaviewer/File:Kew_Gardens_Waterlily_House_-_Sept_2008.jpg">Diliff</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>To the casual visitor, the World Heritage Site that is the Royal Botanic Gardens at Kew might appear to be merely a green and pleasant land, a tranquil oasis amid the hustle and bustle of London – but it is under threat. A <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/science-and-technology-committee/news/kew-gardens-report/">new report by a committee of MPs</a> calls for greater financial freedom for this venerable institution. </p>
<p>Beneath the peaceful, verdant veneer of manicured gardens and innovative architecture that houses botanical curiosities and vegetable wonders from around the globe, a bitter battle is being fought. At stake is no less a prize than the survival of Kew as a world-class botanical research organisation.</p>
<p>Founded in the 18th century, when Britain’s imperial ambitions were being realised, Kew was envisioned as an exhibition of the botanical riches of the British empire so that they could be studied, understood, and exploited, for the benefit of the mother country. But Kew is much more than our nation’s greenhouse. For all its rich history, its present-day activities are very much about our future as a species on this planet.</p>
<p>Strong stuff. So, what does Kew do? What is it for? Is it just a “living museum”?</p>
<p>There are approximately <a href="http://www.kew.org/science-conservation/plants-fungi/environment/how-many-flowering-plants-are-there-world">352,000 species of flowering plants</a> in the world. We have little idea how useful the great majority might be, and many of them are endangered in the wild. Appropriately, a major part of Kew’s activities is recording plant diversity, understanding it as an invaluable natural resource from which we can all benefit, and helping to conserve it. But why? </p>
<p>Simply put, plants provide us with food (whether directly for vegetarians or indirectly via the plant-eating animals that we consume), fibres (for clothing), pharmaceuticals (to cure much of what ails us), and much more besides. Oh, and plants also provide that essential life-sustaining gas: oxygen.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/73841/original/image-20150304-15291-nrs9fq.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/73841/original/image-20150304-15291-nrs9fq.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/73841/original/image-20150304-15291-nrs9fq.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/73841/original/image-20150304-15291-nrs9fq.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/73841/original/image-20150304-15291-nrs9fq.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/73841/original/image-20150304-15291-nrs9fq.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/73841/original/image-20150304-15291-nrs9fq.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Powerful in pink: the Madagascar Periwinkle has provided a treatment for leukaemia.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:Catharanthus_(Madagascar_Periwinkle)_BN3Q9553.JPG">Devilal</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>It is an oft-repeated cliché that we don’t know where the next cure for cancer might come from. Well, we don’t, but it’s likely to be from plants, which have already provided us with effective treatments for leukaemia (<a href="http://news.nationalgeographic.com/news/2001/03/0314_plantsheal.html">from the Madagascar periwinkle</a>), and for breast cancer (<a href="http://dtp.nci.nih.gov/timeline/flash/success_stories/S2_taxol.htm">from the Pacific yew tree</a>). And innovative solutions to the pressing problems of future climate change and food security are likely to be found amongst the botanical diversity of our planet.</p>
<h2>Botany is serious business</h2>
<p>So, plants (and fungi) are Kew’s business. And like all businesses it needs income to allow it to operate, and a plan of what it’s going to do with that money. Kew’s <a href="http://www.kew.org/sites/default/files/Kew%20Science%20Strategy%202015-2020%20Single%20pages.pdf">Science Strategy for 2015-2020</a> clearly shows it has vision and plans for the next several years at least. </p>
<p>In terms of funding, the recent parliamentary report was sparked by Kew’s announcement of a £5 million <a href="http://www.kew.org/about/press-media/press-releases/financial-challenges-kew-update">“hole” in its 2014/15 budget</a>. Alongside its own income-generating activities, 45% of Kew’s total funding comes from public money distributed by the Department for Enivronment, Food & Rural Affairs. However, this amount is not guaranteed and has to be negotiated each year, and large portions of the money are tied to particular expenditure. This compares poorly to the Natural History Museum, 96% of whose government <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/science-and-technology-committee/news/kew-gardens-report/">funding is unrestricted</a>, meaning that the museum decides how best to deploy those sums.</p>
<p>If you have ever wondered whether a parliamentary committee has any independence from the influence of the ruling government, then you may be pleasantly surprised to learn that its main conclusion was that current government funding arrangements for Kew were a “recipe for failure”. In particular, there is an urgent need for Kew to be given more freedom in how it manages its budget, and to be given a better indication of funding in the longer term.</p>
<p>This is all well and good, but a new government might not implement the findings of the committee, and we might be facing another series of crisis talks concerning Kew’s funding in the very near future. But, let’s be optimistic, and hope that the next government – of whatever hue – is at least sufficiently green to put into effect the conclusions of this committee: to allow Kew to decide how best to spend its income and to secure its future funding.</p>
<p>In a world where our future as a species is more than ever tied up with our relationship to and exploitation of the planet’s botanical bounty, shouldn’t Kew be given the security of funding to maintain its world-class status, and the wherewithal to manage its own budget?</p><img src="https://counter.theconversation.com/content/38342/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nigel Chaffey is an External Examiner for Kew's Diploma in Horticulture. But this role does not influence what he has to say. His comments/views/opinions are those of a botanist who is concerned for the future of botanical research in the UK.</span></em></p>A new report by MPs recommends greater independence for financial decisions, and a secure funding strategy.Nigel Chaffey, Botanist, Bath Spa UniversityLicensed as Creative Commons – attribution, no derivatives.