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Deposing the ‘Emperor of All Maladies’ will take a diverse toolkit, not a single moonshot.
On the campaign trail, President-elect Joe Biden repeatedly promised that as president he’d lead America to a massive healthcare victory — not over COVID, but over cancer. “I promise you if I’m elected president, you’re going to see the single most important thing that changes America,” he said. “We’re gonna cure cancer.”
That promise drew fire from oncologists, who rightly pointed out that cancer isn’t a single disease — and that in fact, we’re already curing cancers every single day. That’s not to detract from the importance of Biden’s commitment to tackling cancer. But to achieve results, we’ll need to think bigger — not by shooting for the moon, but by using every tool at our disposal to diagnose and treat cancers more effectively.
When people talk about curing cancer, they usually imagine the equivalent of some kind of magic pill — a wonder drug that can be prescribed to people who have cancer, and quickly leave them miraculously cancer-free.
Unfortunately, the reality of cancer treatment is far messier than that. There are more than 100 different kinds of cancer, forming a constellation of illnesses of varying lethality and prevalence. The idea that any single intervention could cure all those different diseases is about as realistic as the idea of a single governmental policy definitively solving everything that’s wrong with modern society.
That’s not to knock the breakthroughs that have been made. Thanks to pharmaceutical and surgical innovations, we’re able to cure some kinds of cancer, and dramatically improve the prognosis for many others. But such efforts will only ever be one pillar of our fight against cancer. To achieve real results, we’ll need a more holistic approach.
Historically, though, efforts to deliver a cancer moonshot have been marred by an excessive focus on developing lucrative therapeutics that help small populations, but don’t ultimately do much to bring down overall cancer survival rates. In order to do better, we need a more coordinated push to leverage not just narrow pharmaceutical interventions, but also broad-spectrum public health measures and new diagnostic technologies.
One key area that we’ll need to embrace if we’re to defeat cancer is the power of preventive public health measures. Educating the public about risky behaviors is a good first step, but bolder action is needed. Eliminating the use of nicotine products would save around 8.5 million lives by the end of the century, for instance. Sharply reducing air pollution, which is directly to blame for more than 14% of lung cancer deaths, would also have a big impact.
Even without major policy shifts, we can also reduce the impact of cancers by increasing access to healthcare. We’re blessed to now have an effective vaccine against HPV, which puts us within striking distance of eradicating a disease that causes 9% of cancers in women and 1% of cancers in men — but it will only work if we ensure that both girls and boys get vaccinated at the right ages. The Hep B vaccine, similarly, gives us a vital tool in the battle against liver cancer, but only if people have easy and affordable access to the healthcare they need.
Of course, not all risks can be eliminated, so increased awareness and better diagnostics are also key. In fact, early screening and diagnosis is arguably the single biggest tool in our belt as we try to tackle cancer. Cervical cancer, for instance, has a 92% five-year survival rate if detected early, versus 15% if detected late.
It’s in this area that the biggest breakthroughs are currently being made. Genetic counseling, for instance, can help to identify people at heightened risk of cancer, allowing them to look out for warning signs and get regular checks. Some blood tests have the potential to flag the markers for cancers even in pre-symptomatic patients, enabling treatments to begin earlier than ever.
Advanced 3D mammograms are also giving doctors important new tools to detect breast cancer early. And full-body advanced multi-parametric MRI scans that can deliver the accuracy of PET/CT but without any radiation are now commercially available, allowing people who believe they are at high risk — or who simply want reassurance — to spot very early-stage tumors before they run the risk of metastasizing.
Some of these technologies don’t come cheap — but when the alternative is dealing with advanced cancers, the economics of investing in screening and diagnostics are extremely attractive. According to one recent study, the net cost-savings from making early cancer diagnosis more widely accessible would total at least $26 billion a year, and potentially far more. Beyond financial savings, early detection leads to better and quicker health outcomes for patients as they can often be treated by a simple surgical procedure to remove the tumor rather than months of chemotherapy or radiation therapy.
The bottom line is that while few oncologists believe they’ll cure cancer on Biden’s watch, we do have a better chance than ever before of beating this horrifying constellation of diseases into something close to submission. To do so, however, we’ll need to use every tool in the box — including headline-grabbing pharmaceutical and surgical innovations, yes, but also better public health initiatives and smarter monitoring and diagnostic technologies.
Recent advances in genetic screening, imaging, monitoring, and treatment have given us the tools we need to chip away at the toll taken by cancer. But victory will come slowly — not through a single silver bullet, but through a long campaign and a lasting commitment to broad-gauge healthcare innovation. If President Biden wants to defeat cancer, he needs to look beyond investing in potential “cures,” and find ways to support and expand the entire medical and diagnostic ecosystem.
Andrew Lacy is CEO and founder of Prenuvo, a Chicago-based medical technology company.