Cancer prevention must become the cornerstone of our strategy

Cancer Crisis

I frequently face two common questions: “Why did you choose this specialty?” and “Why is the number of cancer patients increasing?” My answer to the latter is: “More of us live longer—increasing age, smoking, alcohol, sedentary lifestyles, and urbanization or western lifestyles all contribute.” Often, I add, “We really do not know.”

In front of me sat a young woman in her early twenties, who had recently completed treatment for breast cancer. Her treatment involved breast-conserving surgery, removing only the diseased part of the breast. While one might expect her primary focus to be on her recovery, her thoughts were instead consumed by the potential reaction of her future in-laws to her diagnosis as her marriage approached. Survival, surprisingly, was not her foremost concern. Survival was nowhere in her thoughts. She was the fifth breast cancer patient under 30 years of age had seen that week.

It has been more than 50 years since the declaration of the “War on Cancer” and the passing of the National Cancer Act in the USA, which transformed the fight against cancer. Since then remarkable progress has been achieved. The identification of cancer genes and cytogenetic abnormalities in the 1980s was followed by the Human Genome Project (1990-2003) and the launch of the Cancer Genome Atlas in 2005. Our understanding of cancer biology, the discovery of its hallmarks, the identification of mutations in cancer cells, the immunological environment of cancer, and the development of effective therapies have all made headlines.

Hence precision medicine, driven by genomic profiling, has enabled tailored therapies targeting specific molecular abnormalities in tumors. For instance, genomic profiling allows oncologists to identify unique mutations or genetic markers in a patient’s cancer cells, enabling the selection of therapies most likely to be effective. This approach is exemplified in the treatment of non-small cell lung cancer, where specific genetic mutations like EGFR or ALK can guide the use of targeted drugs, significantly improving patient outcomes. Immunotherapy, including immune checkpoint inhibitors and CAR-T cell therapy, has revolutionized the treatment of several cancers, offering durable responses in once untreatable cases. Advances in minimally invasive surgical techniques, targeted radiotherapy, and artificial intelligence in diagnostics have enhanced precision and outcomes while reducing side effects. Additionally, improved supportive care and novel drug developments have significantly boosted survival rates and although some advanced cancers have seen therapeutic improvements, many new treatments offer only marginal survival benefits, often measured in mere days or weeks. Compounding this challenge is the skyrocketing economic burden of these innovations, which severely limits access for economically disadvantaged........

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