Winning the War on Cancer

A blitz of medical breakthroughs may end this deadly disease once and for all.

Making Progress

As a nurse, Ginger Empey knew how grim her prognosis was when, at 50, she was diagnosed with breast cancer that had already spread to other parts of her body. She had a mastectomy, but when chemotherapy failed to touch the golf-ball-sized tumors on her liver, the doctors told her to "get her affairs in order."

"I couldn't believe that three months into the disease, there was nothing available to me," Empey recalls. Fortunately for her, UCLA's Dennis J. Slamon, MD, a pioneer in the use of the next generation of cancer treatments, was about to begin recruiting patients for the final stage of a study to test a new breast cancer drug. Herceptin, which targets the gene defect that is responsible for about a quarter of all breast cancer cases, would supposedly fix the biological problem at the root of Empey's disease. It worked. Today, little evidence can be found of the aggressive cancer that led doctors to give Empey a death sentence 11 years ago. "My recovery was miraculous," she says.

As researchers probe the genetic roots of cancer, they are gaining an unprecedented understanding of how the disease develops. And this new insight into the biology of cancer promises to lead to better diagnosis and many more treatment options. In fact, significant advances in targeted anticancer therapies are being made "on an almost week-to-week, if not day-to-day, basis," according to National Cancer Institute director Andrew von Eschenbach, MD. Does this mean that an end to cancer is now within reach? We're not on the brink of eliminating the disease completely -- lung cancer, for example, continues to be a huge challenge -- but most experts agree that cancer is, as epidemiologist Philip Cole, MD, puts it, "on the run, in retreat." There are now almost 10 million cancer survivors, compared with about 3 million in 1971. And the cancer mortality rate has been dropping slowly but steadily, about 1 percent a year, for the past 12 years. (Cancer has surpassed heart disease as the No. 1 killer of people under 85, largely because the mortality rate for heart disease is declining more rapidly.)

What is within reach, according to Dr. von Eschenbach, "is an end to the suffering and deaths associated with cancer." He predicts that ten years from now, when patients hear the words "You have cancer," they will no longer hear "You will therefore suffer and die." Instead, he says, cancer will come to be seen as a manageable chronic disease like diabetes or arthritis. Empey, for one, says the dose of Herceptin she takes every three weeks to keep her cancer under control is a small price to pay for the privilege of being alive to dance at her youngest daughter's wedding.

A Better Understanding
Decades of research into the biology of cancer have significantly improved scientists' understanding of how it develops and what drives its growth. Though only 5 to 10 percent of cancers are believed to be inherited, all cancer is genetic; that is, it develops because something in a cell's genes has gone awry. "Every time a cell in your body divides, it has to copy the entire blueprint of you," explains Dr. Slamon, chief of hematology/oncology at UCLA's Jonsson Cancer Center, "and there are mistakes frequently made when the body's machinery is copying this blueprint. We have mechanisms that repair these mistakes, but they get less efficient with age." Thus, the longer you live, the more you are at risk of developing cancer. In about 25 percent of all breast cancers, for example, a mutation occurs in which cells produce excess copies of a particular gene that results in the overproduction of growth factor receptors, which are like antennas on the surface of a cell that receive signals telling the cell to divide. "You get an overload of growth signals in the breast tissue," says Dr. Slamon, "and you are off to the races with the cells growing." In other cancers, the molecules that regulate cell growth, turning on and off to keep the number of cells in the body constant, get stuck in the on position, so to speak, and cancer cells multiply like rabbits. Here, too, it is a gene defect that causes the molecules to misbehave.

• • Colon Cancer
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