Cancer Research: Progress, Challenges, and OpportunitiesMay 27, 2014
Thousands of doctors and researchers throughout the United States are working every day to find new and better ways to treat and prevent cancer. In recognition of the importance of this work, the U.S. Congress declared May National Cancer Research Month.
In this interview, American Cancer Society Chief Medical Officer Otis Brawley, M.D., provides high-level insights into the progress cancer researchers have made as well as the challenges and opportunities that lie ahead.
Q. There has been a tremendous amount of cancer research conducted by doctors and scientists since the early 1900s – what do you think some of the biggest breakthroughs have been in the past 100 years?
A. The answer to that question can be volumes long. The first big breakthrough in therapy was probably radiation therapy treatment of localized (only in one part of the body) lymphoma. But there have been so many clinical and basic achievements. Let’s review some of the major achievements:
- A new standard for cancer treatment: The cure of some leukemias and lymphomas with combination chemotherapy was probably the greatest oncologic achievement of the past century. It set the standard for therapeutic approaches for other cancers.
- First tumor to be cured by chemo: The cure of testicular cancer with cisplatin was another major breakthrough. It was the first solid tumor that could be cured with chemotherapy.
- Refining the mastectomy: In breast cancer, we refined how it is treated surgically by going from the Halsted mastectomy, first described in 1894, to the simple mastectomy in the early 1970's and the lumpectomy and radiation in the 1980's.
- Invention of hormonal therapy: In the case of prostate cancer, the discovery of the effect of androgens and androgen deprivation therapy (a treatment to reduce the level of hormones in a man’s body to help stop or slow prostate cancer) won a Nobel Prize in 1966. This work, done by Charles Huggins, a researcher supported by the American Cancer Society, showed prostate cancer is a hormonally-driven disease. Huggins’s work led to the understanding that breast cancer is also a hormonally-driven disease, which in turn led to the creation of tamoxifen treatment for breast cancer as well as much more work that is all around the role of hormonal receptors. The development of hormonal therapy is directly related to our increasing understanding of the cancer cell, including the discovery of molecular targets for cancer treatments such as estrogen receptor and HER2 receptor.
- The first cancer screening test: The Pap smear (a test to find pre-cancers) was a significant development. It was the first screening test.
- Development of mammography and colon cancer screenings: I believe mammography was also a major development, as has been the colon cancer screening tests to include stool blood testing and colonoscopy.
Q. What cutting-edge cancer research are scientists currently conducting that you think could lead to the next big breakthrough?
A. I see genomic identification of tumors as the next great breakthrough. We have used a mid-19th century definition of cancer using histology (what cells look like under a microscope) and we are moving into a 21st definition that takes into account both histology and genomics (how DNA and genes work in a cell).
There are tumors that appear cancerous under the microscope but are not malignant in behavior. We are developing ways of predicting biologic behavior and clinical significance of tumors. This will save some people the problems related to treatment and improve our ability to assess our therapies. Today we cure some people who do not need to be cured.
Q. The American Cancer Society funds a wide spectrum of cancer research – from studying the inner working of the cell to developing new models for reducing cancer disparities – why is it important to continue to conduct research across so many different areas?
A. The control of cancer is only going to be brought about through concerted efforts in treatment and prevention. Treatment requires an understanding of the disease at a molecular and cellular level. Development of drugs that affect specific targets in the cell is also important, as are clinical studies to validate the efficacy of these drugs.
Q. What are the biggest barriers to moving cancer research forward faster?
A. By far our greatest barrier is the lack of money and resources going into research. Many research ideas or grants that should be funded do not get funded due to a lack of money. A second major issue is the lack of adults participating in cancer clinical treatment trials.