Crusading politicians and activists just love declaring ‘war’ on this or that. ‘War on drugs’, ‘great war on terror’, ‘war on poverty’ and so on. We even had a ‘war to end wars’. How’d they all go?
Similarly, in 1971, Richard Nixon declared a ‘war on cancer’. There was much optimism, not to say hyperbole. Doctors talked of a cure for cancer within just a few years.
Hat tip: anyone who talks about a ‘cure for cancer’ is blowing smoke up your arse. There is no such single thing as ‘cancer’: there are cancers. More than 200 of them. While they all share the necessary condition of being a cancer – the uncontrolled growth and spread of abnormal cells in the body – each is quite different, and so are the treatments, and, indeed in some cancers, the cures.
More than half a century later, then, cancer is still with us. But was the war on cancer lost?
In fact, far from it. But, rather than a war of annihilation, the war on cancer is a war of constant attrition. The war will likely never conclusively be won, but we are winning. Often spectacularly. Childhood leukaemia used to be virtually a death sentence: now it has a five-year survival rate above 90 per cent.
Things are better than many realise. The progress is plain from the data and there is every reason to think it will continue. Cancer is related to age. If you strip out longer lifespans, it becomes clear that in the rich world the early 1990s were an inflection point. Since then, the age-adjusted death rate has been falling, slowly but steadily, year after year. In America the rate is now about a third lower than in the 1990s. The trend is similar in other developed countries.
The war on cancer is in many way analogous to the ‘great war on terror’. Eliminating Al Qaeda’s training camps in Afghanistan, or the Islamic State, didn’t defeat terrorism for good, nor did virtually making childhood leukaemia a wholly survivable disease ‘end cancer’. But both did much to eliminate the worst threats. But many other threats remain and will be the subject of ongoing campaigns.
Future gains will come from three main sources. Some will come by applying lessons from the rich world all across the globe. The overlooked success story in the fight against cancer has been prevention – perhaps because cancers that never happen are less visible than those that are cured. For example, smoking rates have plummeted in rich countries. That has probably prevented more than 3m cancer deaths since 1975 in America alone. Because smoking still causes one in five cancer deaths around the world, anti-tobacco drives in poor and middle-income countries, where smoking remains common, stand to do an enormous amount of good.
Another source of progress will be cheaper medicines and extra wealth to pay for them. Cervical cancer is one of the most common cancers in women. Almost all cases are the delayed side-effect of infection with the human papillomavirus (HPV), a bug. In 2008 Britain began offering a newly developed HPV vaccine to teenage girls. A decade and a half later, rates of cervical cancer among women in their 20s are down by 90 per cent, and British health officials talk of virtually eradicating cervical cancer by 2040. The original HPV vaccine was relatively expensive. But a cheaper version developed in India now underpins a mass-vaccination campaign in that country, too.
The next big breakthroughs will be in the developing field of genetic medicine. It’s important to remember, though, that a genetic predisposition, for instance, is not a cancer sentence. Genes only function in an environment, which is why some long-term smokers never develop cancer, while others do.
Scientists already know of genetic variants that predispose their carriers to certain kinds of cancer, such as a faulty BRCA-1 gene that raises the risk of breast or prostate cancer […]
The aim is to untangle this confusion in order to identify patients very early, when treatment is most effective.
The ‘cure for cancer’, then, is in reality a varied range of treatments for different cancers.
Some cheap drugs seem to act as cancer prophylactics. Aspirin, a painkiller, seems to cut the risk of bowel cancer in half when given to those with Lynch syndrome, a genetic disorder that predisposes sufferers to some types of cancer. Metformin, a cheap diabetes drug, cuts the risk of recurrence in women who have been treated for a particular type of breast cancer. GLP-1 receptor agonists such as Ozempic show promise, too.
Another promising treatment for some cancers will no doubt be controversial.
Alongside the mainstays of surgery, chemotherapy and radiotherapy, a new technique is emerging that harnesses the power of the immune system. The idea is to boost the body’s own ability to attack cancerous cells. Some vaccines – perhaps genetically tailored to individual patients – can target a cancer that is already established. Others, acting more like broad vaccines used against diseases such as the flu, could target pre-cancerous cells. Vaccines of this sort for breast and colon cancer are in clinical trials.
Recovering from the damage done by the hamfisted, idiotic and often brutally mis-management of the forced Covid vaccine mania is going to take years to undo. The authoritarian, dangerous, rush to force mass-use of a new class of vaccines before they had been properly evaluated did enormous damage to the reputation of other vaccines that are well-proven and safe. Worse, it gave a bully pulpit to the unhinged lunacy of the (genuine) anti-vax movement. The idiocy of politicians and health bureaucrats only enabled the greater idiocy of the anti-vaxxers. The answer to one stupidity is not an equal-and-opposite stupidity.
Governments and bureaucrats got nearly everything wrong in their Covid responses and inflicted a lasting legacy of knock-on effects. It will only compound their infamy if one of those effects is a wholly avoidable rise in cancers in years to come.
