"Curing?"

How much suffering would you be willing to endure to extend your life by a few weeks? You may be confronted with the question if you become a cancer patient. If a chemo agent shows the ability to lengthen your life by only a 2.5 month average, the FDA will approve the drug. That’s an average. The individual patient may benefit only a couple weeks. Others who are not in a fortunate subgroup will not benefit at all, and some people may actually be harmed by the new drug.

Dr. Azra Raza, oncologist and Professor of Medicine, paints a grim picture even of the 5% of the drugs that do meet the low bar in prolonging life. She says of the approved drugs, they “might as well have failed; once they are administered in non-trial settings, the results are no better than those that were not approved.” She blames failure on the fact that experimental protocols select individuals in fairly good physical shape. Most cancer patients are weak with other comorbidities. Therefore, the drugs usually show no advantage. In the last two decades, of all the approved chemo drugs, 70% turned out to have shown zero improvement in survival rates! “Between 30 and 70% of the drugs may actually be harmful to the patient.” [1] Notable exceptions to these statistics are the effective drugs for childhood cancers and Hodgkin’s lymphoma.

Certainly my oncologist did not tell me these facts, and I did not know to ask. I assumed I was trading hair loss, fatigue, lasting neuropathy, and the risk of heart problems for the promise of healing with a chemotherapy regimen. In order to make informed decisions, we need facts to balance risks and benefits for ourselves. Nutrition expert Dr. Robert Greger writes that the “war” waged on cancer, though lasting decades, is not being won. Greger faults the medical system for not admitting that the entire approach is flawed. [2] These conclusions are similar to those of Raza. She advocates a complete overhaul to the system which uses mice for experiments because positive results typically do not transfer to humans. Raza wants money spent and energy focused on strategies for detecting cancer at its “first cell.” [3] Perhaps this could be achieved with liquid biopsies or other yet-to-be invented methods. Currently, oncology methods typically tackle cancer at its last stages, when success is rare.

Greger shares some statistics which I find disturbing. For “the most common cancers—colon, lung, breast, and prostate—success rate [with chemotherapy] is [improved by] only about 1%.” I read the pharmaceutical company’s pages of fine-print warnings about the chemo agent used on me; it did not include this fact. To put real numbers to these statistics, it means that out of 14,000 colon cancer patients, chemotherapy made a difference in 146 patients’ five-year survival outcome.[4] (Note: Five-year survival rates for localized colorectal cancer are 90%; if spread to surrounding tissues, 71%; if cancer has spread to distant parts of the body, the survival rate drops to 14%.) [5] However, all chemo agents are not created equally. Some drugs do prove effective for some types of cancer. That is why it is important to differentiate among cancers and understand which therapy should be tried. Blanket statements are not accurate and contribute to a misinformation campaign. The key is for both patients and their providers to ask questions to find the targeted treatment which likely is most effective.

Questions should include ones such as the following in order to cull helpful information. With my stage and type of cancer, which chemo agent is advised? Should a genetic test be done to learn more? Additionally, what are the expected rates of recurrence (in percentages), and what are the average survival rates? What are the potential drawbacks in terms of side effects and which are most probable to occur? Once you are forearmed with information, you will be able to make the best decision for you! The important aspect is not to be persuaded by terms such as, “first line therapy” or “FDA approved” as if that is a stamp of approval for your particular case.

Unfortunately, a new drug is often heralded as a major break-through. The hyperbolic ads offer hope and hope sells. What is not advertised is when the drug is later retracted as ineffective or even detrimental. Perhaps some small sub-group of people received a minor benefit, but nothing like the publicity led us to believe. Everyone wants a cure for cancer, so understandably, newscasters and journalists alike report the newly touted claims with enthusiasm rather than skepticism.   

If new chemo agents are not always the answer, what does help? Preventing cancer in the first place! It is an astounding fact that most cancers are actually preventable. However, lowering cancer risks requires major lifestyle changes in terms of diet and exercise. People seem more willing to spend thousands of dollars on a body-damaging drug than they are to eat broccoli and take a walk. (Granted, I over-simplify for dramatic effect.) We know that about 10% of cancers are genetically caused. The other 90% can be traced to diet. How did researchers come up with these numbers? By studying the “enormous differences in the incidence of [different] forms of cancer” from around the world, whose rates then change when people move from one place to another” and adopt eating habits similar to those of Americans. [6]

Both doctors Greger and Raza hope to see changes to the entire way cancer is approached. They want to “win the war” on cancer by prevention. Obviously, it is better to prevent cancer in the first place, and it also has the advantage of being good for your body. The only drawback of changing your eating habits might be dessert withdrawal! “On the other hand, cancer treatment, even when successful, often exposes the patient to much suffering, both physical and psychological. Indeed, some cancer treatments are considered worse than the disease.” [7] Raza refers to the current measures as “draconian.” She asks how we can think of treatments as solutions “if we constantly have to ask ourselves whether the cancer or the treatment we prescribe will kill the patient?” She likens trying to cure cancer by using chemotherapy to “beating the dog with a baseball bat to get rid of its fleas.” [8]

Raza claims we don’t need a slightly better way of doing things, but one “quantum leaps better.” If means were employed to detect early biomarkers of malignancy such as cancer-specific metabolites in plasma or other body fluids, cancer could be caught extremely early and eradicated. Simply by looking for cancer-derived DNA in Pap smears, cancer deaths could drop dramatically in gynecologic cancers. [9]

In other fields, failed practices are discontinued when they don’t succeed; they are not simply altered slightly. Raza sums up our current medical research practices with a fitting analogy: “If we’d kept trying to improve upon the typewriter, we would never have invented the word processor. The cancer problem requires a radically different approach.” [10] Oncology research seems to have lost its way at a terrible cost to patients.

However, now there is hope for finding our way back to the right path of early detection. Radical change is on the horizon as researchers respond to the need for developing accurate tools for early cancer detection. One promising screening uses saliva. Molecules found in the blood are also found in saliva such as DNAs, RNAs, metabolites and others. Therefore, salivary diagnostics is an effective method of detecting specific biomarkers. The advantages of using saliva include the simplicity of collection and its cost-effective and precise results.[11] “Biological sensors provide a reliable early diagnosis of cancer, which results in faster therapeutic outcomes with in-depth fundamental understanding of the disease progression.” [12] Research is also on-going using biological samples in sweat, urine, and tears to find the first indications of disease. Other non-invasive experiments are being conducted using wearable devices for cancer detection. These methods are indeed revolutionary.

I can easily imagine a smartphone-based bio-sensor which detects cancer years before it can progress to a visible tumor. I turn to my smartphone to get answers, locate a restaurant, and get directions, why couldn’t it be used as a bio-sensor? Perhaps in the near future, our smartphones will give us directions to the cancer-cure road!

1 Azra Raza, The First Cell (New York: Basic Books, 2019) 29-30.

2 Michael Greger, “How to Win the War on Cancer,” NutritionFacts.org, July 18, 2018, https://nutritionfacts.org/video/how-to-win-the-war-on-cancer/.

3 Raza, 13

4 Greger

5 “Colorectal Cancer: Statistics,” Cancer.Net, accessed Sept. 25, 2020, https://www.cancer.net/cancer-types/colorectal-cancer/statistics

6 Greger

7 Greger

8 Raza, 13

9 Raza, 14

10 Raza, 47

11 X. Wang, K.E. Kaczor-Urbanowicz, and D.T. Wong, “Salivary biomarkers in cancer detection” Med Oncol. 2017 Jan;34(1):7. doi: 10.1007/s12032-016-0863-4. Epub 2016 Dec 10. PMID: 27943101; PMCID: PMC5534214.

12 A. Takke, P. Shende, “Non-invasive Biodiversified Sensors: A Modernized Screening Technology for Cancer.” Curr Pharm Des. 2019;25(38):4108-4120. doi: 10.2174/1381612825666191022162232. PMID: 31642768.