Let’s get real about cancer
Even in 2019 millions of lives every day are turned upside down by a cancer diagnosis. Cancer affects almost everyone at some stage in their lives. Whether they’re one of the estimated 1 in 2 people worldwide diagnosed with some form of the disease during their lifetime, or one of those forced to watch a much-loved friend or family member fight it.
As Chief Executive of Worldwide Cancer Research and a scientist by trade - she has a Ph.D in Molecular Biology from the University of York and was a Postdoctoral Research Fellow at Imperial College London - Dr Helen Rippon knows first hand how important it is to fund the discoveries that underpin life-saving tests and treatments for cancer. But with regular media attention focusing on breakthroughs and cures, there is an understanding for some people that cancer is on the brink of extinction. So, is cancer nearing elimination or are we in danger of giving false hope?
To mark #WorldCancerDay, Dr Helen Rippon reveals the truth and says it's time to get real about cancer.
The burning question on everyone's lips: "why haven't we cured cancer?".
I don’t think cancer will ever be eliminated. Which seems an odd thing for a CEO of a cancer charity to say. I don’t mean we won’t learn to contain it, live with it, cure many types and even prevent a lot. But a future without cancer completely? I just don’t see it. I know that sounds bleak but let me explain why.
We see messages every day about beating cancer and constant news reports of breakthroughs. Sometimes I wonder if it might lead people to think cancer is on the brink of extinction. A word our great-grandchildren respond to with as little comprehension as my seven year old does upon seeing a cassette tape.
But this is the inconvenient truth: cancer is hardwired into us as an inevitable biological consequence of the way we are built.
What do I mean by that? It has been said that everything in biology should be viewed through the lens of evolution; through evolutionary pressures we were built, honing our reproductive fitness to be just good enough to pass on our genes onto offspring just often enough that the species has a fighting chance of survival.
Do I mean that we have evolved to develop cancer? Not at all. What I mean is that to evolve at all, mistakes must be made.
Evolutionary science tells us that everything living in this world – you, me, your pet cat, the trees outside the window, the bacteria on the kitchen sponge – is a product of a single line of cell division from the very first living organisms on earth 3.8 billion years ago. The only way that happened was that there was change. Change at the genetic level. And we know from evolutionary biology that genetic change doesn’t happen by design or intent, but by error. Simple mistakes made, say, when DNA is copied, when damaged DNA is repaired, or when chromosomes are pulled apart into new cells.
Cells get it wrong every now and then and gradually, ever so slowly, and over many imprecisely reproducing generations, there is change. Without those mistakes, humans would not exist.
Our cells make mistakes and this forms the slow mechanism of evolution. This also means that the machinery that copies and repairs and manipulates our chromosomes is not foolproof; it has an error rate. What happens if those accidental mistakes hit something important, like a gene that helps control cell division? Or if it clobbers a gene responsible for repairing other damaged genes?
Cancer is so often portrayed as a modern-day disease caused by our calorie-laden, industrially produced food, our sofa-lounging lifestyles and the drip-drip-drip exposure to environmental insults like cigarette smoke. Sure, none of those things help, but if we look for the facts, we see there was cancer in ancient humans – clean-eating, athletic humans living in an utterly unpolluted environment. Going even further back, fossils reveal that even some dinosaurs suffered from cancer. And if we define cancer as being a state of uncontrolled cell division that causes a mass of tissue where there shouldn’t be one, then even plants get tumours too.
Nowadays we humans live long enough to see cancer more often. In developed countries most of us are fortunate not to die of preventable infectious disease or in childbirth or of malnutrition. Hand-in-hand with that, our lifestyles and modern inventions like cigarettes have increased our cancer risk. The mechanisms at work here are not all understood, but the most clear-cut case, tobacco smoking, increases the speed at which cellular mistakes accumulate.
There is more cancer about than there used to be. But cancer itself isn’t new: it is an ancient disease, and the capacity for it is part of life itself. It is literally in our DNA.
The logical consequence of these facts is that to wipe out the disease so that nobody ever gets cancer again would mean engineering cellular infallibility into our bodies.
To faithfully copy all genetic and associated information from parent cell to daughter cell every time without error, or to continuously and without fail stop error-strewn cells from causing chaos. In doing this we might draw inspiration from animals that seem to have unusually low cancer rates. Elephants, for instance, with their extra copies of the cancer-preventing gene p53. Or naked mole rats, one of nature’s most curious creatures, that prevent cells forming tumorous masses by filling their tissues with a gooey, high density sugar.
But even if that advanced technology existed it would be a profound and artificial alteration to human biology, with all the incumbent ethical questions, not to mention uncertain consequences. From today’s perspective, it is hard to see how cancer can become a relic of the past, or at least not without - to paraphrase Arthur C. Clarke - ‘technology indistinguishable from magic’.
None of that means death from cancer can’t be fixed. If you are diagnosed with cancer today, you are already much less likely to die of it than you were forty years ago and there’s no reason to think that trend won’t continue.
We can reduce our own cancer risk by leading healthier lives. We can take up offers of cancer screening; screening programmes that we know save lives by improving the chances of early diagnosis. We have cancer treatments now that are better targeted and more effective than those of the past, designed according to what scientific research has uncovered about the disease. And we can all keep funding the pioneering research that will, without doubt, lead to future generations seeing fewer lives cut short.
Eliminate cancer? Maybe not. Eliminate the fear of cancer? A resounding yes.
We have to be realistic about what science can achieve, but we shouldn’t stop hoping and we mustn’t stop trying.