Cancer is among the least understood of human ailments, and with good reason: its biology is incredibly complex, its ability to cause death (or even illness) highly variable, and reporting on the topic has been inconsistent to say the least. In this series of “Mythbuster” articles, I hope to set the record straight on some commonly-held and demonstrably false beliefs. Although I am a board-certified oncologist practicing at a large east coast cancer program (and an assistant professor of medicine at Drexel University), I don’t expect you to take my word for anything stated here, and will provide references via links to back up my statements.
Let the debunking begin!
Myth #1: There is now (or will be in the future) a “cure for cancer.”
Whenever the various media sources report on a new treatment that promises to cure cancer, oncologists worldwide collectively roll our eyes*. Unfortunately, those of us who have been doing this for a while have seen this cycle of hope and disappointment play out many times, almost always in a similar, predictable pattern.
A recent example of this phenomenon started with a 2019 article in the Jerusalem Post with the relatively modest headline “A cure for cancer? Israeli scientists may have found one”. Unfortunately, the humility quickly gave way to hype, as the non-scientist, non-physician chair of the profiled company’s board rattled off a list of weirdly-specific pie-in-the-sky claims, including (and I quote directly):
“cure will be effective from day one” (not exactly sure what this means—will the tumor instantaneously evaporate?)
“no or minimal side-effects”
“at a much lower cost than most other treatments on the market”
He even makes the rookie fraudster mistake of giving a timeline. “We believe we will offer in a year’s time a complete cure for cancer”, he asserts, in a statement reminiscent of the earlier, portentous claims of one Dr. Alice Krippin:
The rest of the article contains literally no data at all—not even a single integer. Within days, fact-checking journalists quickly reported that not only had the company never conducted a clinical trial in humans, they had published nary a single line of data from their self-described rat studies. Given that three years later, the company’s website returns mostly error messages (and also that cancer still seems to be happening), it seems reasonable to conclude that the entire claim was a not-so-clever, over-the-top fabrication.
Unfortunately, “not-so-clever” turned out to be clever enough, as the article and its non-reality-based claims made it to no fewer than 700 reported stories including television news segments on affiliates of three of the four major U.S. networks (FOX, CBS, and ABC). By the time the dust settled, the spiderweb of misinformation looked like this (hat tip, healthfeedback.org):
These articles were shared on facebook and elsewhere more than 4 million times, including to some of my patients, of whom roughly a dozen asked me about it. I seriously thought about handing each of them a copy of the classic xkcd strip, which has sadly been relevant at least annually throughout my 17-year career:
But there is another reason oncologists and other healthcare professionals roll our eyes at the mention of a cancer cure, and this one has nothing to do with our own cynicism or even with media sensationalism, and everything to do with the nature of the beast. In ancient Mesopotamia, cancer was thought to be related to demons and spirits—just get rid of those and you’ll be fine. For much of the first two-thirds of the 20th century, a “germ theory” was so popular among cancer researchers that it made the cover of mainstream magazines. Other theories have waxed and waned in popularity, including defective genes for programmed cell death, simple DNA mutations, and loss of innate cancer surveillance systems. In fact, other than the demons, all of the above theories are verifiably true in certain instances and demonstrably false in others—and that is the point. Cancer, as it turns out, is not one disease but one-thousand, each with slightly—or in some cases radically—different causes and potential treatments. In fact, even the basic sites of cancer (for instance, lung) yield various diseases which are fundamentally biologically different: lung cancer in a young, female Asian non-smoker is likely to harbor different DNA mutations and respond to an entirely different treatment than the lung cancer of a 75 year-old lifelong tobacco user.
So when I am asked by well-meaning friends, relatives, and patients when we will have a cure for cancer, it feels similar to being asked “When will we cure infections?” It is intuitive to most of us that a urinary tract infection requires different treatment than a bacterial pneumonia, which itself requires a completely different therapeutic approach than a viral pneumonia like COVID-19, and so on. There will never be a single magic pill which fixes all bacterial, viral, fungal, and parasitic infections (and let’s not even talk about the prions). Like infectious organisms, no two cancers behave exactly alike.
Which leads me to the promised “good news” portion of Mythbuster #1:
Although, there will never be a universal medication that cures all cancers, we have made tremendous headway in figuring out how to treat nearly all malignancies. In my own practice, I often see patients with a blood cancer called myeloma, which in the absence of treatment eats away at the bones, damages the kidneys, and makes the patient susceptible to life-threatening infection. At the time that I was initially board-certified in 2005, myeloma had a life-expectancy of 3-5 years—and they weren’t very good years since the unfortunate patients required a lot of chemotherapy to stay alive. 17 years later, we use far gentler, non-chemo-based therapies, and a sizable majority of patients are still going strong at that five year point and beyond. Some myeloma patients in my clinic even appear to have been cured (defined as having no detectable cancer on the most sensitive testing after five years off of all treatments).
A very incomplete list of cancers which are routinely cured in 2022:
testicular cancer (even when metastatic to critical organs)
most of the aggressive lymphomas (e.g., Hodgkin’s Disease)
breast cancer (86% cure when not metastatic)
prostate cancer
colon cancer
thyroid cancer
I could write another long list of cancers which, though technically incurable, are no longer deadly with current treatments, among them some of the most dreaded like the leukemias.
It is of course true that we still have a long way to go: many of the GI cancers, for instance, have proven to be formidable adversaries (particularly stomach, pancreas, and liver). But even in those areas progress has been made and life expectancies improved, and this trend has continued unabated since the 1970s. In the 20 years from 2001 to 2020, cancer death rates went down 27%, from 196.5 to 144.1 deaths per 100,000 population. Of course, we’d like to get that number to zero, and are steadily (albeit admittedly too slowly) moving in that direction—even without a Magic Cancer Bullet.
*Pre-emptive note to wise guys: Contrary to the belief of a few loud conspiracy theorists, oncologists do not have a stake in avoiding cures of the disease. Like most cancer specialists, I am also board certified in internal medicine and hematology (blood disorders), and would be able to make a fine living in a post-cancer world, thank you very much.
Thank you for this, Erik.