The ongoing impetus for change in the cancer field is described

Where Do We Go from Here?

The ongoing impetus for change in the cancer field is described.

One of the basic tenets of clinical medicine is to do no harm. This presumes that the role of physicians is to aid the natural, life-sustaining forces of our bodies and minds in dealing with illnesses and injuries that impair our health. As examples, surgeons rely upon our bodies’ capacities to heal, and primary care physicians rely upon our bodies’ capacities to fend off infections after antibiotics have reduced the number of offending bacteria.

If we lose the capacity to heal naturally because our immune systems are overwhelmed, such as by drug-resistant viruses, bacteria, cancer or AIDS, we die. In other words, physicians do not cure any disease or fix any injury without relying upon our bodies’ natural defenses. The “search for cancer and destroy it” model of oncology is not based on this fact and actually harms the body’s natural defenses.

This is the fundamental flaw in the conventional approach to cancer as if it is a disease in itself…get rid of cancer cells, and you cure cancer.

In order to think clearly about the way health care should work, the field of public health employs the concepts of primary, secondary and tertiary prevention. Primary prevention is preventing a disease or harm from occurring in the first place.

Secondary prevention is treating a disease or harm. Tertiary prevention is minimizing the disability from a disease or harm.

In applying the public health approach to cancer, oncology employs primary prevention by identifying genetic and environmental factors that contribute to developing cancer, such as smoking, air pollution and toxic food contents (prevent neoplasia). Secondary prevention is employed in treatments that aim to cure cancer (stop neoplasia). Tertiary prevention is managing the course of cancer (slowing down neoplasia and palliative care).

Clinical oncologists are largely engaged in tertiary prevention because there is no cure for cancer as such. For example, the surgical removal of a tumor does not ensure that cancer will not recur. Chemotherapy aims to prolong survival from cancer. As an example, Vemurafenib was one of the first treatments for melanoma. It can cause tumors to shrivel within weeks. Unfortunately, continual mutation of the tumor creates resistant cancer cells, and most tumors rebound between six and nine
months later.

Paradoxically, according to Meghna Das Thakur of the Novartis Institutes for Biomedical Research, in Emeryville, California, if cancer cells evolve with resistance to the chemotherapy being used to treat it, withdrawing that drug can sometimes stop the cancer in its tracks as effectively as the chemotherapy did in the first place.1 This is because stopping the drug also stops suppressing the immune system, which then can destroy the newly mutated cancer cells that are unable to evade it as did the original cancer cells. In fact, this is the explanation for long-term remissions after chemotherapy…the immune system takes over and stops or restrains neoplasia. Believing that the chemotherapy drug did it all by itself is a dangerous fantasy.

Unfortunately, the many forms and the refractory nature of cancer have made it difficult to think clearly about principles to guide research that will have a significant impact. Fortunately, progress has been made in primary prevention that actually is the main reason for the decreases in cancer rates. Examples are smoking cessation programs that have reduced lung cancer and human papillomavirus vaccination that has reduced cervical cancer in women and oropharyngeal cancers in men. However, the knowledge that we have about how cancer cells develop and spread through neoplasia has not been given a high enough priority in secondary prevention clinical practice.