Can we conquer cancer in the twenty-first century?
The twentieth century recorded the greatest advance in the control of human disease. From the beginning of recorded time, the human life-span changed little until the twentieth century. In the USA, it increased from 47.3 years in 1900 to 76.4 years in 2000. The answer to the question of "Can we cure cancer in the twenty-first century?" requires an appreciation of the contemporary nature of our knowledge. At the beginning of the twentieth century, major problems were nutrition and infection. By 1950, the major causes of mortality and morbidity were still infectious diseases, such as syphilis, tuberculosis, poliomyelitis, and influenza. The 1950s and 1960s were the golden age of control of infectious diseases, while cancer, because of the aging of the population and the strong association between cancer and age, has become the major healthcare problem of the twenty-first century. Until 1960, no one had proposed or demonstrated that a systemic or metastatic form of cancer could be cured. In only 35-40 years not only have techniques for the early detection, prevention, and surgical and radiation therapy treatments improved, but at least 15-20% of patients with systemic/metastatic cancers can be cured with our current primitive systemic treatments. Prior to 1943, there was no chemotherapy. Prior to 1948, no one had described complete regression of a systemic cancer. There were no multi-institution, randomized clinical trials prior to 1949. Additionally, combination chemotherapy, new drugs, bone marrow transplantation, broad-spectrum antibiotics to control infections, and platelets to control hemorrhage have been added in the past 50 years. The pace of progress extrapolates to a prediction of cancer control in the twenty-first century. The human genome has been sequenced, and it will be possible to identify expression profiles not only for malignant cells but for their normal counterparts. It is certain that interventions specific for control of the malignant transformation will be identified. An example of gene-directed therapy is in acute promyelocytic leukemia where trans-retinoic acid is effective and contributes to cure. The signal transduction inhibitors, small molecules bioavailable orally and specific for interfering with signals resulting from ligand-receptor interactions, are a dramatic advance. Because cancer is a genetic disorder, the expanding field of genomics will certainly accelerate our progress toward the control of cancer. Finally, the twenty-first century will be an era of enhanced communication. The computer has given us the internet. Our communication in cyberspace is not only universal but instantaneous. Increases in the speed at which knowledge can be exchanged and the enormous capacity for storing new knowledge in cyberspace ensure that the pace of progress that we saw in the twentieth century will accelerate in the twenty-first. To address the question in the title of this paper, I believe that it is not a question of whether, but only of when.
Freireich
E J
EJ
Adult Leukemia Research Program, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
D000367:Age Factors; D005544:Forecasting; D006801:Humans; D008495:Medical Oncology / Q000639:trends*; D009369:Neoplasms / Q000235:genetics / Q000517:prevention & control / Q000628:therapy*