Editor's note: This is the second installment of a 2-part series. Part 1, which featured additional perspectives on the barriers to the fight against cancer, appeared in the May 1 issue of CancerScope.
Nobel Prize laureate James Watson, PhD's critique of the conservative nature of cancer research in the journal Open Biology prompted CancerScope to talk with leaders in the field for their perspectives.1
A Collaborative Approach
Margaret Cuomo, MD, a radiologist and author of the book A World Without Cancer, agrees with Dr. Watson that progress against the disease has been slow. 2 “We are still relying on surgery, chemotherapy, and other anticancer drugs and radiation, just as we did 40 years ago,” she writes in her book. She adds that although those techniques have been perfected to better treat the disease and extend lives, the goal of actually preventing the disease in the first place has fallen short.
Although the American Cancer Society stresses the importance of prevention, and the National Cancer Institute (NCI) has a Division of Cancer Prevention, only about 2% of the NCI's total annual budget of $5 billion is dedicated to prevention, says Dr. Cuomo. This is despite the NCI stating in its 2012 budget request that much of the progress against cancer in the past decade can be attributed to prevention and control efforts. “They acknowledge the effectiveness of prevention, but we're just not devoting enough of the financial and intellectual resources to it,” she says. “The model of medical treatment in this country is that we are trained to fix what is broken—we're not trained as physicians in the preventive or integrative model.”
She points to the March 4, 2013 Time cover story by Steven Brill titled, “Bitter Pill: Why Medical Bills are Killing Us,” which suggests that physicians be rewarded for keeping patients healthy rather than encouraging services and tests to prove an illness. “It's simpler than focusing on a lot of ‘breakthrough’ cures that have been proven ineffective or that extend lives by a minimal amount with multiple side effects,” she says.
In her book, Dr. Cuomo proposes a transdisciplinary, collaborative approach to prevention-in essence, team science that would involve experts in fields such as epidemiology, oncology, immunology, microbiology, pharmaceuticals, engineering, and even urban planning. Many of the strategies for preventing cancer also would help prevent other major diseases such as heart disease and diabetes, she adds.
She proposes establishing a National Cancer Prevention Institute that would gather experts from these and other fields to focus on the most effective prevention strategies for the disease. According to Dr. Cuomo, more than 50% of cancers are preventable by applying known strategies, including diet, exercise, sun protection, eliminating alcohol and tobacco use, and reducing toxins in cleaning and personal care products.
Her idea for funding such an institute would be to create a budget from funds used to support more than a dozen agencies and departments that currently receive funding for cancer research, ranging from the NCI to the Centers for Disease Control and Prevention to the Departments of Energy and Defense. “Our health care will become so burdensome on all of us that we can't afford to do otherwise,” says Dr. Cuomo, who cites statistics in her book that in 2010, total medical costs for expenditures associated with cancer were an estimated $124.6 billion. That figure is expected to increase from $158 billion to $207 billion by 2020.
Dr. Cuomo concedes that conducting cancer prevention studies is expensive and time-consuming. In her book, she quotes Larry Norton, MD, a proponent of cancer prevention and medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center in New York, as saying, “You can see activity [against cancer] faster in treatment than in prevention.”
Still, she believes that uncertainty shouldn't discourage prevention research. Minimizing environmental risks, such as toxins in personal care products, is crucial, she says, citing a report released February 19, 2013 by the World Health Organization warning that chemicals in household and industrial products that disrupt the human hormone system are linked to high global rates of breast, ovarian, prostate, testicular, and thyroid cancers.3 The report, “State of the Science of Endocrine Disrupting Chemicals–2012,” calls for more research to understand fully the associations between endocrine-disrupting chemicals and specific diseases and disorders.
Similarly, the 2008–2009 President's Cancer Panel report, “Reducing Environmental Cancer Risk,” concluded that “our nation still has much work ahead to identify the many existing but unrecognized environmental carcinogens and eliminate those that are known from our workplaces, schools, and homes.”4
Dr. Cuomo laments the fact that although the Safe Chemicals Act of 2011, sponsored by U.S. Sen. Frank Lautenberg (D-NJ), passed in the Senate last year, it did not pass in the House of Representatives. The law would have required the burden of proof to be placed on chemical companies to perform tests and prove a chemical is safe before it can be used, rather than the current scenario in which the Environmental Protection Agency has to prove a chemical is unsafe before it can be banned. Still, she commends companies such as Johnson & Johnson, which announced in August 2012 that they would remove all carcinogenic and other potentially harmful chemicals from their products by 2015. She hopes that other personal care product companies will follow suit.
Education about healthy eating and activities, particularly among young people, is key, because cancer takes years to develop, she adds. At the same time, physicians should be trained in prevention while in medical school, and later, they should be rewarded for keeping people healthy. “We have the power, tools, and resources to change this paradigm, and we have a moral obligation to do so,” Dr. Cuomo says.
Innovation and Impact
Meanwhile, in an effort to encourage new ideas in cancer research, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James) in Columbus has launched its own funding initiative known as the Pelotonia Intramural Research Program. These multiyear “idea grants” present innovative approaches to understanding and curing cancer and are supported primarily by funds raised through Pelotonia, a grassroots bicycle tour established in 2009 to raise money for cancer research at Ohio State University. Since the event's inception, a total of 29 idea grants have been awarded at an investment approaching $5 million.
Programs such as Pelotonia are important, but eventually, researchers still will need to enter the more conservative research system, says Peter Shields, MD, deputy director of OSUCCC. “Faculty are evaluated on whether they have grants, and you're not going to get grants unless you become conservative by nature,” he says. “I think there's a wide consensus that we're too conservative and too slow, and we're all frustrated.”
Dr. Shields believes that substantial progress has been made in cancer research but that the current lack of government funding forces researchers to be conservative. Yet, he questions whether there would have been as much progress made over the past 40 years if research funds had been put into “lots of high-risk projects.”
“Unless you've got a billion dollars, you're never going to bring anything to fruition,” he says. “People want to use money in the wisest way. The NIH wants results, and when you submit a grant you're going to submit what has the best likelihood of succeeding.”
In the intramural program at the NCI, where investigators do not have to write grants, investigators still tend to be conservative. One reason, he says, is because even if someone were to come up with a brilliant idea, it takes a long time to develop the work and, initially, they may not be able to produce a lot of high-profile publications.
Although the NIH tried to change the scoring for its grant evaluations a few years ago to include “innovation and impact,” it still hasn't made a huge difference because researchers need to show feasibility through preliminary data, says Dr. Shields. He adds, “There are a lot of good ideas that never pan out, and the government doesn't have enough money to fund all of them.”
As scientists learn more about cancer, they have more avenues they need to pursue. But, at the same time, the field does not have enough people working on the problem, Dr. Shields says. Still, important discoveries continue to occur. “As we have better technologies and get smarter about cancer, it may be that this will fix itself because the projects will get better,” he says. “Right now, all we can do is hope it gets better.”