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Why Early Detection Is the Best Way to Beat Cancer Pointlessly NSFW… - Elena's Journal
Why Early Detection Is the Best Way to Beat Cancer

Pointlessly NSFW image at the beginning of the article, just FYI.

When the first cell in one of Brenda Rosenthal's ovaries mutated and turned cancerous, she felt no symptoms. The telltale pains or lumps that signal cancer were still months, if not years, away. But there were signs, sparks thrown off by the tumor that had begun to smolder in her belly. As more cells were conscripted from the original task coded in their DNA and assigned a new, malignant mission, they produced proteins that leaked into Rosenthal's bloodstream. Had an effort been made to see these molecules, had there been a strategy for detecting them, the 69-year-old wouldn't face such long odds today.

Certainly, there were statistical red flags, if only Rosenthal had known to look for them. Twenty years before, she had survived a bout of breast cancer, increasing her risk for ovarian cancer in the future. That risk was exacerbated by a mutation in her BRCA2 gene that's been associated with much higher rates of breast and ovarian cancers.

Going purely by the numbers, Rosenthal, a New York City native now living in Delray Beach, Florida, was a prime candidate for ovarian cancer. But even after the link between the BRCA2 gene and breast and ovarian cancer was discovered in 1995, Rosenthal didn't think to get tested. "It didn't even register," she says. "I went on with my life, and I didn't think about cancer." It wasn't until 2005, when she first noticed a physical symptom—"this huge lump in my stomach area"—that Rosenthal learned she was once again a cancer patient.

Ovarian cancer, like most cancers, is measured in four stages. Stage I is early, when the disease is contained in the ovaries. In stage II, it may be present in the fallopian tubes or elsewhere in the pelvis. By stage III, it has migrated into the abdomen or lymph nodes. And by stage IV, the malignancy has spread, or metastasized, into major organs like the liver or uterus. (The first three stages are further subdivided into A, B, and C levels.) For ovarian tumors discovered in stage I or II, the survival rate 10 years after diagnosis is reassuringly high—almost 90 percent—because treatment is straightforward: surgery, perhaps followed by low doses of radiation. But survival rates drop precipitously as the diagnosis shifts to stage III or IV, when the cancer is well established and spreading. Here, the survival rate falls to 20 percent and then to 10 percent. Unfortunately, more than two-thirds of ovarian cancers aren't found until these later stages. That was true in Rosenthal's case: By the time she noticed her lump, the disease had spread and progressed to stage IIIC.

Four years later, after two rounds of chemotherapy, Rosenthal's cancer is in remission. But she remains vigilant. Every three months, her blood is tested for levels of CA125, a protein marker used to monitor ovarian cancer. She tracks clinical drug trials in the hope that she will qualify as a subject. Yet she'll always blame herself, if only a little bit, for missing a way to find the disease earlier. "I could live 10 or 15 years more, but I still won't have the quality of life I would've if we'd found the cancer early," she says. "I don't want anyone else to be in my position."

The survival rate for many cancers is similar to the cliff-like curve that defines ovarian malignancies. Find the disease early, thanks to a stray blob on an x-ray or an early symptom, and the odds of survival approach 90 percent. Treatment—surgery—is typically low risk. But find it late, after the tumor has metastasized, and treatment requires infusions of toxic chemicals and blasts of brutal radiation. And here the prognosis is as miserable as the experience.

This reality would seem to make a plain case for shifting research and resources toward patients with a 90 percent, rather than a 10 or 20 percent, chance of survival. But these are largely hypothetical patients. Cancer may be present, but since it hasn't been detected, as a practical matter these cases don't yet exist. People with full-blown cancer, however, are very real. They are our fathers and mothers, our children and friends. They're right in front of us. These are the 566,000 Americans who will die of cancer this year.

The US spends billions of dollars to save these late-stage patients, trying to devise better drugs and chemotherapies that might kill a cancer at its strongest. This cure-driven approach has dominated the research since Richard Nixon declared war on the disease in 1971. But it has yielded meager results: The overall cancer mortality rate in the US has fallen by a scant 8 percent since 1975. (Heart disease deaths, by comparison, have dropped by nearly 60 percent in that period.) We are so consumed by the quest to save the 566,000 that we overlook the far more staggering statistic at the other side of the survival curve: More than a third of all Americans—some 120 million people—will be diagnosed with cancer sometime in their lives. Their illness may be invisible now, but it's out there. And that presents a great, and largely unexamined, opportunity: Find and treat their cancers early and that 566,000 figure will shrink.

Cancer, in other words, has a perception problem. We lack the ability to see what's going on inside the body, to gaze through our too-solid flesh and glean information on a molecular level. Conventional medical technologies—blood tests, x-rays, MRIs—can serve as proxies for proximity, but the picture they offer is often incomplete and obscured. Without a way to positively identify illness early, to detect that first spark, medicine will continue to be a last resort.

But new technologies for the early detection of cancer are now at hand. Researchers are refining sophisticated protein tests that can pick up molecular whispers in the bloodstream and are testing next-generation imaging techniques that can identify and isolate a tumor within the body. These technologies build on screening methods already proven to reveal cancer—the Pap smear (cervical), the antibody blood test (prostate), the mammogram (breast)—but go further and deeper so that even stubbornly covert cancers might become visible.

This new approach treats diagnosis as an algorithm, a sequence of calculations that can detect or predict cancer years before it betrays symptoms. It starts with a statistical screening to identify people, like Rosenthal, who have a genetically greater risk for disease. A regular blood test follows, one primed to look for telltale proteins, or biomarkers, correlated to specific cancers. A positive result prompts an imaging test to eliminate false positives or isolate a tumor. The process is methodical, mathematical, and much more likely to find cancer than current diagnostic procedures.

This is the potential of early detection: To use data instead of drugs, to reveal a cancer before it reveals itself, and to leave the miracles for the patients who really need them.

Don Listwin learned about the 90/10 survival curve after his mother, Grace, was diagnosed with ovarian cancer in 2000. Doctors had diagnosed her—twice—with a bladder infection and prescribed antibiotics. Not surprisingly, that treatment didn't work. By the time her doctor established that she had ovarian cancer, she was stage IV and 12 months from her death.

Listwin, a onetime heir apparent to CEO John Chambers at Cisco Systems, says his impulse was to sue the doctor, the hospital, and anyone else who looked culpable. "I thought their incompetence had killed my mother," he says now. "But then I started staring at this 90 percent and this 10 percent, and I realized that if she had just been over here at 90, she'd be alive today." An electrical engineer by training, Listwin started to ask questions. Why does survival drop off so steeply? What happens in later stage cancers that make them so lethal? And most obviously, why can't we find the killer cancers early? "This looked like an emergent systems engineering problem, a systems biology problem," he says. "And it looked like an opportunity to engineer solutions."

Listwin, who says he was at Cisco during "the right 10 years," left the company in 2000 at age 41 with $100 million in the bank. Typically, people like Listwin—wealthy, philanthropic, and touched by cancer's ruthlessness—get on the cure bandwagon. But after looking at the numbers, Listwin was drawn to the problem of early detection. In 2004, he created the Canary Foundation, a research group with the single goal of bringing a battery of screening tests to patients and their doctors by 2015, starting with ovarian cancer and moving on to pancreatic, lung, and prostate. Listwin likes to explain the Canary approach with PowerPoint, and every presentation starts with a slide of the survival curve for cancer. Pointing to the 90 percent, he makes this simple observation: When we see cancer early, we have a chance to fight it.

In fact, much of the meager increase in cancer survival rates over the past 30 years can be attributed not to new chemotherapies or treatments but to early detection. Deaths from skin cancer, which is the most obvious to diagnose and treat, have fallen 10 percent. Since the Pap smear—a simple swab of the cervix for precancerous and cancerous cells—became part of routine care in the US in the 1950s, cancer incidence and mortality rates due to cervical cancer have fallen by 67 percent. Five-year survival rates for breast cancer have likewise improved as mammography and MRI screening have increased. There are tests for these diseases not because they are biologically different from other cancers but because they occur in accessible parts of the body. It's neither difficult nor prohibitively expensive nor dangerous to swab a cervix or perform a mammogram. Other areas of the body, though—the lungs, the pancreas—are less accessible and harder to monitor. Consequently, their malignancies are far more deadly.

Despite this proven model, early detection is an afterthought in cancer research. The pharmaceutical industry spends nearly $8 billion annually on cancer research, according to the International Union Against Cancer, most of it steered toward drug development and late-stage treatments. The major cancer foundations spend lavishly on cure-based research: The Susan G. Komen Breast Cancer Foundation spent $180 million on cures in 2007; the Michael Millken Prostate Cancer Foundation spends about $14 million annually pursuing a cure for prostate cancer; the National Cancer Institute spent just 8 percent of its 2007 budget, less than $400 million, on detection and diagnosis research. Compared to these sums, Canary's $5 million annual budget scarcely registers. Yet Canary stands out in the cancer research community because its focus is on early detection rather than treatment.

Then start on page 3: http://www.wired.com/medtech/health/magazine/17-01/ff_cancer?currentPage=3


1 comment or Leave a comment
banditess From: banditess Date: March 25th, 2009 12:46 am (UTC) (Link)
i couldn't agree more with this article. my grandmother had ovarian cancer when i was a little girl, and because it was detected early she survived. my best friend's father passed away last year from a stage IV melanoma that he refused to get checked out until it was far, FAR too late. early detection really can mean the difference between life and death!
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