Misinformation May 4,
2013
By Leonard Zwelling
Do you read the daily
External Communications email? I do, every day. It focuses attention on
mentions of MD Anderson in the print media for the most part. The one May 2 was a true microcosm of the world of competing forces in which
we live and which characterizes the cancer community at-large.
There were several
stories questioning the value of genetic testing in cancer patients. It seemed
to be of limited benefit as a predictor of the cancer of origin in patients
diagnosed with unknown primary cancers. These genetic aberrancies seem yet to
be nailed down as landmarks in the quest to unearth the very etiology of
various malignant diseases.
Of course, we couldn’t go a day
without a mention of the morass that is still CPRIT. Will the monies be freed
for science? How about for commercial development? How will the system be
overseen to prevent a recurrence of the debacle that was the first three years
of the program? Will the leader of the program retain any real power? Is the
only criterion for bad behavior in research that it reach the level of criminality?
Finally, we are
learning, once again, that even cancer from a single anatomic site may have
more in common with cancers from other sites than from cancers in the same site
from other people.
The quote from Marissa
Fessenden’s Scientific American article says it all: “Cancer is a disease of
misinformation”. Unfortunately misinformation also clouds the manner in which
we cancer professionals talk about the disease.
So let’s clear a few
things up:
The cure for cancer, if such a thing exists, is not
around the corner. Even if it turns out that it is, we should not spread false
hope that this is the case for we simply do not know where the answer will be
found or how.
Genomics of normal human populations MAY
identify risk factors for developing cancer within tested individuals which MAY
allow preventative intervention. This has been demonstrated in only a limited
number of diseases and in people with cancer-associated genetic mutations
(e.g., brca1 and 2). The only current intervention for these women is more
frequent screening or actual prophylactic mastectomy.
Genomic studies of human cancers are even less
predictive as suggested by the story on Medicare’s evaluation of such testing
to trace the origin of cancers of unknown primary site.
Genetic testing is NOT a part of most routine
cancer care. Insurance companies should not be expected to cover it. It is
research.
What this all says to me is that
cancer care and cancer research have not fully coalesced yet and it is vitally
important in our interactions with individual patients and with the media that
we make it clear what we really know and what is still in the realm of don’t
know, requiring additional research.
There have been several high
profile instances of major figures in oncology promising cures. It actually
dates all the way back to President Nixon’s 1971 State of the Union message
when he compared the conquest of cancer to the race to the moon. These two
worthy scientific endeavors differ in every way. The moon shot was an extension
of American foreign policy aimed at defeating the Soviet Union. President
Kennedy and then President Johnson were willing to spend as much as needed to
beat the Russians, as recently released audio tapes have revealed. The
scientific principles needed to get us to the moon were all known, probably by
Sir Isaac Newton.
The War on Cancer started at the
end of the year of President Nixon’s address on December 23, 1971 with the
signing of the National Cancer Act. Here we are over 40 years later, with a
great deal of wonderful science to show for our money and effort, but only a
scratch on the scourge of this dreaded disease. Despite our huge expenditures
on cancer research, we still don’t know what cancer is, how and why it arises,
and why it afflicts some but not others with seemingly similar risk factors.
There is only one rational response
to the current state of cancer research and knowledge. That is humility. We
probably still have a ways to go. Let’s own up to that so that we don’t lose the
support of the public because we continually over-promise and under-deliver.
