By Azra Raza (WSJ)
I have been studying and treating cancer for 35 years, and here’s what I know about the progress made in that time: There has been far less than it appears. Despite some advances, the treatments for most kinds of cancer continue to be too painful, too damaging, too expensive and too ineffective. The same three methods—surgery, chemotherapy and radiotherapy—have prevailed for a half-century. Consider acute myeloid leukemia, the bone-marrow malignancy that is my specialty. AML accounts for a third of all leukemia cases. Currently, the average age of diagnosis is 68; roughly 11,000 individuals die annually from the disease. The five-year survival rate for diagnosed adults is 24%, and a bone-marrow transplant increases the odds to 50% at best.
These figures have hardly budged since the 1970s. The overall rate of cancer deaths in the U.S. has fallen by a quarter since its peak in 1991, translating to 2.4 million lives saved—but improved treatments are not the primary reason. Rather, a reduction in smoking and improvements in screening have led to 36% fewer deaths for some of the most common cancers—lung, colorectal, breast and prostate. And for all those gains, overall cancer death rates are not dramatically different from what they were in the 1930s, before they rose along with cigarette use. Meanwhile, cancer drug costs are spiraling out of control, projected to exceed $150 billion by next year. With the newest immunotherapies costing millions, the current cancer-treatment paradigm is fast becoming unsupportable.
What we need now is a paradigm shift. Today, the newest methods generating the most research and expense tend to be focused on treating the worst cases—chasing after the last cancer cells in end-stage patients whose prognoses are the worst. We need instead to commit to anticipating, finding and destroying the first cancer cells. We must reliably detect the faint footprints of cancer at the beginning and stop it in its tracks. Such prevention represents the cheapest, fastest and safest alternative to the terrible, longstanding treatment trio of slash, poison and burn. It’s the most universally applicable way to save lives, and the estimated cost savings from early diagnosis add up to over $26 billion a year, more than any other new approach can promise.
Earlier detectio n is also the most humane way to improve cancer outcome s. Status quo treatments—the combination of surgery, chemotherapy and radiation for solid tumors, or chemo and bone marrow transplants for liquid ones—can be brutal and indiscriminate killers. Treatments often leave patients in agony, while providing mere months of added survival. The new immunotherapies can be even more dangerous and harsh. Patients have to be treated in intensive care units, and entire industries are sprouting up just to control the deadly side eﬀects.
I’ve experienced the pain of this situation from the other side of the hospital bed. My own husband, a leading oncologist himself, survived one cancer at the age of 34 and became convinced that he was destined to die young, suspecting every stray blemish of beingmalignant. When a swollen lymph node appeared in his neck in February 1998, he suspected the worse. At ﬁrst, we were relieved to ﬁnd it was only a lymphoma and not a much more terrifying metastatic appearance of his previous cancer.
But the treatments we gave him caused his immune system to collapse. His weight went down to a mere 139 pounds from 210, and his face became disﬁgured by lesions and paralysis. At our daughter’s eighth birthday party, I found him hiding in a bedroom. “What’s wrong?” I asked?