When I saw the NYTs article Is a Revolution in Cancer Treatment Within Reach? going viral, I could not help but to think I had seen this movie before.
Every year, sometimes multiple times, we’re promised by the media, particularly the NYTs, that a cancer breakthrough, paradigm shift, or miracle is just around the corner, if it hasn’t already happened. Or that people with cancer are living ‘longer than ever’ (even though this generally applies to certain types of cancers that are already easier to treat, such as lymphomas). Indeed, a Google search confirms my suspicions (the NYTs runs this story, and variants of it, a lot):
The article begins with the story of Carol MacKenzie, whose stage four breast cancer has been kept under control for decades thanks to new treatments:
But in the nine years since Ms. MacKenzie’s cancer reappeared, her physician, Dr. Nancy Lin, a medical oncologist at Dana-Farber Cancer Institute in Boston who specializes in treating and studying advanced breast cancer, has prescribed her a series of eight drug regimens, including three as part of clinical trials. Ms. MacKenzie, 71, of Massachusetts, switches from one medication to another when it becomes clear that a treatment doesn’t work or has stopped working because her cancer has figured out how to resist its effects. Some of these regimens have lasted only a few months, while others have kept Ms. MacKenzie’s cancer under control for longer. Of an oral type of chemotherapy she tried as her fifth line of treatment, she said: “I was excited. I got 12 months out of that one.”
The things is, breast cancer is more of an exception than the norm in terms of prolonged survival for metastatic disease. It has been known for a long time that a fairly sizable percentage of patients with stage four breast cancer can live a long time, more so than other type of cancers. This is because metastatic breast cancer tends to initially spread to the bones or the lymph nodes instead of vital organs such as the lungs or the liver, unlike most other cancers.
Stage four colon cancer, on the other hand, tends to go strait for the liver and or lungs. Hence stage four colon cancer only has a 5-15 percent 4-year survival rate–a grim statistic that has remained relatively unchanged for decades despite new treatments, and unlike breast cancer, there is no ‘thick tail’ in terms of prolonged survival for some lucky patients. Same for other solid cancers such as pancreatic, lung, kidney, and stomach cancer, which spread to viral organs quickly and cause rapid death.
Although there are plenty stories of cancer survival rates improving, it’s hard to disentangle of how much of this is due to earlier detection vs. better treatments for more advanced cancers that evade detection. This difference matters because cancer rates, especially colon cancer, seem to be rising among young people, who are below the cutoff age for routine screening, and are not diagnosed until the cancers are symptomatic and advanced.
And of course, no cancer breakthrough article is complete without the obligatory nod to immunotherapy, which for decades has held untold promise for curing cancer but never quite gets there. From the afore-linked article:
Former President Jimmy Carter, who turned 98 in October, announced in 2015 that he had metastatic melanoma that had spread to his brain. A decade ago, a patient like Mr. Carter would expect to die in less than a year, but he was treated with an immunotherapy drug called Keytruda, approved in 2014. It is one of the most successful immunotherapy treatments on the market and is useful for more than a dozen types of cancer. Mr. Carter entered hospice care earlier this year, eight years after his diagnosis of Stage IV disease.
Similarly, every year there is hype about harnessing the immune system (or gene therapy) to fight cancer (as confirmed by a similar search of NYTs headlines, with the earliest dating to 1991 “New Gene Therapy to Fight Cancer Passes First Human Test”), and nothing comes of it after the initial hype wears off:
Yeah, it worked on Jimmy Carter. Awesome, that only leaves the 608,570 or so people who die of cancer annually in the US. The immune system does many amazing things, but fighting cancer is likely not one of them.
Or hype in 2022 about a spontaneous complete remission in rectal cancer in a small study of patients, with the lead researcher proclaiming the results as “the first time it happened in the history of cancer.” I remember that article went viral, and then what?
From the above link, “It was a small trial, just 18 rectal cancer patients, every one of whom took the same drug. But the results were astonishing.” It’s always the same small, underpowered studies. There are 46,000 new cases of rectal cancer in the US every year, and you’re telling me you can only find 18 people for your study, and then not even do a follow-up on more patients if it’s so effective?
Same for mice models. One such headlines from 2006 proclaims “A Strain of Mice Appears Able to Resist Cancer Cells”. It’s like, “According to our mouse model, we induced remission on 90% of cancers.” That’s great, if only we can turn humans into mice (or into former presidents) we can cure cancer.
The FDA is often blamed for dragging its feet and hence delaying cures, but this is a common misconception. Clinical trials bypass the FDA, but very seldom yield cures or even improved survival. A ‘successful’ treatment may add a few months of life expectancy at a cost of $30,000/month–yes, this is the best that 21st century medical technology has to offer as far as prolonging survival for certain types of cancers. It’s not like people with advanced cancer are being denied experimental treatments, but the problem is for every success that gets media attention, the vast majority of these treatments do nothing or are even harmful.
My message to the NYTs: maybe try dialing back on the cancer breakthrough hype.
What we need is smarter researchers thinking outside the box, but IQ rates are dropping as conformity rises.