Biologically, cancer represents an abnormal growth of cells that have overcome inhibitory checkpoints owing to sequential accumulation of defects in their DNA [1, 2]; and, by virtue of this inseparable association with our genome, cancer as a disease could probably be as old as our own existence as a species: first documented cases being recorded in Egyptian papyri (2500 BC), which described surface tumours that had ‘no treatment’ available back then. However, much of what we know now about cancer is incredibly recent: as late as 19th century, it was erroneously believed to be a localized manifestation of excessive black bile, caused by melancholia, and was treated by clinicians and quacks alike through bizarre and grotesque ‘remedies’– fire drills, chiselling with knives and scalpels, goat dung, crab paste, frog’s blood, purging, bloodletting and probably worse. Even during most of the twentieth century, available treatment options reflected a fatalistic mindset against cancer; for example, radical surgeries (greatly popularized by William Halsted and his disciples) were aimed at extirpating as much of the diseased organ and its vicinity as possible, and egregious mega-dose chemotherapies were aimed at annihilating any proliferating cell in the body. Unsurprisingly, therefore, during the world-war era, when war was at the heart of most human efforts and effects, the use of military metaphors to describe cancer became a commonality: cancer was thought to be an enemy that ought to be engaged militarily and fought mercilessly. However, there was no official ‘war on cancer’ until 1971 when, yielding to a relentless campaigning by health activists, the US president Richard Nixon signed the National Cancer Act (NCA) that promised the National Cancer Institute (NCI) an unprecedented financial support on a long-term basis . The legislation was initially opposed by many members of the scientific community owing to apprehensions that such an approach, carried out in a constant blaze of publicity, would end up promoting the obvious short-term projects of limited significance at the cost of truly original programmes of basic sciences with no superficial link to cancer . However, although the merits of that legislation have been debated forever, there is no denying the fact that it went a long way in bridging the gap that existed between cancer research and patient care, making sure that the advances in the understanding of cancer were quickly translated into survival benefit for the cancer patients [4, 5]. Nevertheless, it took almost a generation after signing of the legislation before its fruits started appearing in the 1990s in form of a slow but steady decline in cancer mortality in the United States [6–8]. Despite being a national legislation, it affected lives far and beyond the US borders and placed cancer at the forefront of mankind’s struggle against diseases. However, the current US and global cancer statistics that reflect the rising cancer burden worldwide are a stark reminder of the enormity of the task ahead to confront cancer (Fig. 1) [7–11].
Figure 1. Trends in cancer incidence and mortality in the U.S. over past four decades. For about two decades after signing of the National Cancer Act in 1971, no significant improvement was noted in overall cancer mortality rates, albeit situation seemed to have slightly deteriorated, as was by highlighted by John Bailar in 1986 . However, since the early 1990s, the overall cancer death rates have shown consistent statistically significant decreasing trends, and have continued to decrease afterwards, especially for cancers where effective prevention strategies have been implemented [6,7,8]. For example, the cancer death rates for cervical, colorectal and stomach cancers fell by about 60%, 40% and 55% in the U.S. respectively, largely due preventive measures (screening in case of cervical and colorectal cancer, and improved sanitation and effective treatment of H. pylori infection in case of stomach cancer), as opposed to the overall cancer death rates that fell only by about 11% during the same period [7,8]. However, mortality from pancreatic cancer has remained virtually unchanged; that from hepatocellular and intrahepatic bile duct carcinoma has sharply increased; and the incidence of melanoma of skin has more than tripled during past four decades. Unfortunately, the prospects look worse in developing countries [9,10]. However, it’s important to bear in mind that there has been a significant increase in the prevalence of several cancer risk-factors such as obesity, AIDS, hepatitis B and C infections and aging populations during this period; and our improved understanding of their links with cancer and preventive measures against some of them (such as anti-HBV vaccination and anti-retroviral therapy) have definitely prevented several cancers and eventual deaths. Nevertheless, according to the World Health Organization (WHO) estimates based upon current trends, by 2030, there will be 21 million new cancer cases and 13 million cancer deaths each year worldwide, consuming trillions of dollars in patient-care alone ;clearly, by hook or by crook, cancer still remains undefeated.
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