The Big Question…

Let's continue the numbers theme from the last post just a little bit further.

In my travels, I think that the two most frequently asked questions have been, "Are we really making any progress?" and "Are we ever going to find a cure for cancer?"

My answer to the second question, which is really the main question on most everyone's mind, is as swift as it is equivocal: "Yes… and No".

The reason for my hedging is not because I'm afraid of commitment :-) Rather, it's because the question "Are we going to ever find a cure for cancer?" is the wrong question to ask. The correct question is "Are we ever going to find cureS for cancerS?".This may seem a little bit like splitting hairs, but I assure you that these questions are vastly different.

One must keep in mind that the word "cancer" is an umbrella term, not the definition of a specific disease. If you think of “infectious diseases", there are undoubtedly thousands of types of infections, all of them different. They can range in severity from the mild but annoying common cold all the way through to an infection with a deadly agent such as the Ebola virus. We would never confuse the two of those, yet we would consider both of those broadly to be "infections" of one sort or the other. And so it is with cancers.

By current estimates, there are perhaps as many as 200 to 300 different cancers. While they all share some common characteristics, some of them are as different as night and day. A tiny solid tumour in your thyroid for example may bear very little resemblance to a leukemia that affects all the white blood cells circulating through your bloodstream. To think of these two very different types of cancer as being the same thing is equivalent to thinking that two different types of infection are the same thing.

Thus, it is my sad duty to have to say that I do not believe we are ever going to find A cure for cancer. There will not be, in my opinion, a single "magic bullet" that we can ever hail as “the” cure.

But one should not despair. Just because we will not find a single magic bullet cure for "cancer", doesn’t mean that we can’t cure many cancers right now. Depending on how you define ‘cure’ (most commonly used statistic is 5-year survival, although less commonly 10-year survival is sometimes quoted), I contend that we can cure many cancers right now.

Consider the table below, for example. It is taken from the latest version of the Canadian Cancer Society's annual publication: Canadian Cancer Statistics 2011, published by the Canadian Cancer Society's Steering Committee on Cancer Statistics; Toronto, ON, 2011. In this table, at the top, you can see the five-year relative survival rates for someone newly diagnosed with any cancer. This is the 62% survival rate I referred to in the previous post.

But on this table you can also see some very high five-year survival rates for a number of cancers, survival rates that far exceed the average. Thyroid cancer, with its survival rate of approximately 98% is what I consider to be a very curable cancer. Not shown on the table is testicular cancer which boasts a similar survival rate of approximately 95%. It may surprise you to see prostate cancer on the list with a survival rate of approximately 95%. This attests to the fact that most men will die WITH prostate cancer as opposed to dying FROM prostate cancer.

Look also at breast cancer on the list. I would be the last person to stand up and claim that breast cancer is now a totally “curable" disease. But consider the fact that any woman diagnosed today with breast cancer, at any stage, has approximately an 88% probability of surviving that diagnosis. And if the cancer is caught early, at Stage I, where the tumour has not left the breast, that survival rate climbs to something on the order of 96 or 97%.

Obviously, with both breast and prostate cancers, even very high 5-year survival rates do not tell the whole story. Although the percentage of patients who do not currently survive is getting smaller and smaller, the absolute number still represents a lot of individuals. The last thing I wish to do therefore is to trivialize in any way a diagnosis of breast cancer or prostate cancer but I do want to put it into perspective: both of these cancers have very, very high survival rates today, largely due to advances in research, early detection and treatment.

Even colorectal cancer, the cancer that killed my own father, deserves mention. You will see on the table that the overall five-year survival from colorectal cancer is only about 63%. But again that is the average and takes in all colorectal cancers diagnosed at any stage. Colorectal cancer when detected early is, for all intents and purposes, a totally curable disease. The number of people dying from colorectal cancer would be hugely reduced if more people would avail themselves of current screening methodologies, and if research can help us develop even better early detection screens.

Of course all the news isn't as good. One only has to look at one or two of the cancers at the bottom of the list, notably lung cancer and pancreatic cancer to show how much farther we have to go to deal with these very deadly forms of cancer. These are but 2 kinds of cancer where research has a great opportunity to make significant new impacts over the coming years.

Will we continue to find ways to cure more and more cancers? Without any doubt in my mind whatsoever! Is it possible that we may never find cures for some cancers? I think that is not only possible but perhaps even likely.

My own belief is that with continued research and better treatments we will indeed cure more and more cancers, but those that we cannot cure outright we will increasingly transform from diseases that one dies from into diseases that one lives with...