Cancer Revisited: Our Evolving Thinking, And Where’s The Cure?

Cancer — and our evolving knowledge about its nuances and complexity — is in the news this week, three decades after the so-called War On Cancer began.

A highly publicized piece in The Journal of the American Medical Association earlier this week that addresses cancer overdiagnosis and overtreatment begins by charting some failures:

Tara, a cancer patient at San Francisco's Henna Lounge, who helped inspire "Henna Heals"(Henna: Henna Lounge; Model: Tara; Photography by: Frances Darwin)

Tara, a cancer patient at San Francisco’s Henna Lounge, who helped inspire “Henna Heals”(Henna: Henna Lounge; Model: Tara; Photography by: Frances Darwin)

Over the past 30 years, awareness and screening have led to an emphasis on early diagnosis of cancer. Although the goals of these efforts were to reduce the rate of late-stage disease and decrease cancer mortality, secular trends and clinical trials suggest that these goals have not been met; national data demonstrate significant increases in early-stage disease, without a proportional decline in later-stage disease. What has emerged has been an appreciation of the complexity of the pathologic condition called cancer. The word “cancer” often invokes the specter of an inexorably lethal process; however, cancers are heterogeneous and can follow multiple paths, not all of which progress to metastases and death, and include indolent disease that causes no harm during the patient’s lifetime. Better biology alone can explain better outcomes. Although this complexity complicates the goal of early diagnosis, its recognition provides an opportunity to adapt cancer screening with a focus on identifying and treating those conditions most likely associated with morbidity and mortality.

WBUR’s On Point today continues the conversation, offering this thoughtful segment on why a cure for cancer remains elusive and how to improve treatment.

Also, in an excellent Cognescenti post, journalist and risk expert David Ropeik examines our outsized fears of cancer and explores how we assess risk when the “C” word is uttered. “Cancer is a powerful word,” he writes, “a frightening word and as dreadful as many types of cancer truly are, the word itself can do harm too.”

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