There have been mixed responses to the recent no makeup selfie trend, and the more ridiculous ‘cock in a sock’ trend. Photogenic people are posting supposedly embarrassing photos of themselves for cancer awareness. Does linking the ‘bravery’ of no makeup belittle the very real struggle of cancer sufferers? Is this a sad moment for feminism and cancer patients? These are important questions, but unfortunately not what is most worrying. There is growing frustration directed towards cancer researchers; why, after so much funding and talk, is there still no cure? These voices are getting louder and more impatient, perhaps spurred on by exasperation over the selfie farce. They use rhetoric like ‘cancer industry’, implying that monetary profit is prioritized over finding a cure. This is an absurd notion, but disturbingly, one that is becoming more popular. In its extreme form, it seeks to discredit scientists by discouraging funding, believing a simple cure is being withheld from the public.
This perception stems from the lack of any substantial news on cancer research. Progress is not well publicized beyond the scientific and medical community. The silence leads to the assumption that nothing has happened. Social media has proved itself again as a great tool for quickly spreading a short message, but proper information is harder to find on our newsfeeds. Everyone knows cancer is bad and scary, but how many of us really know how to effectively self-examine for breast or testicular cancer? Or do you know about new methods of treatment such as scalp cooling? One good thing the selfie trend has achieved is to highlight the illogical gap between what research has discovered and how much the public knows about it.
Often the information available is difficult to understand without a solid grasp of biology. A paradox arises: the complexity of the content means the real information stays in journal articles, while the public hears only oversimplified catchphrases, like ‘cancer is complex’. This can certainly be frustrating when it is the only answer repeatedly given for the absence of a cure. As an aspiring researcher, I want to address this with a biological explanation of cancer in layman’s terms. I hope that by understanding the biological basis of cancer two things can be achieved: recognition of the enormity of the task, and an appreciation for the discoveries made so far.
Benign or Malignant?
The first recorded description of cancer has been dated back to 2500BC. Before it was known what cancer actually was, doctors approached it in the only logical way: excision. Sometimes it worked, but sometimes the cancer would come back, often in a totally different area of the body. Doctors were baffled for centuries – imagine trying to prove surgery was an effective treatment, as sometimes it is, when success was so inconsistent. It was concluded that some of the cancer had been left behind and would spread outwards. Surgeries became extremely aggressive, widening the removal area to often fatal levels. Ribs and collarbones were snapped off, huge chunks of organs sliced away. They were partially correct, as we now know that some cancer cells have the ability to migrate beyond their original site of formation. Cancer cells capable of movement are defined as malignant, and as benign when they cannot move. This realization was crucial. We now have tests to determine if cancer tissue is benign or malignant, and have introduced the concept of staging tumours. This energized researchers in the recognition that more effective treatment options for malignant cancers were needed, and has saved many people from unnecessary and exhausting treatment.
Growth: Cancer’s enigma
Apart from these two fundamental differences in cancer, the actual causes of cancers vary hugely. This is why it is often easier, but not straightforward, to shorten a description of cancer to ‘complex’. ‘Cancer’ itself is an umbrella term for many different types, each with their own idiosyncrasies in origin and responses to treatment. What they all have in common is the end result: when cells that aren’t meant to keep dividing, proliferate. These cells alter their path, previously programmed to become a specific tissue type, say a skin cell. They now form a growing mass of unprogrammed cells with no other purpose than to reproduce. When this mass interrupts vital organs from functioning, it becomes the menacing cancer that is heart-breakingly familiar to us all.
An ideal and simple cure would target this common denominator in all cancers – their energetic cell divisions. But cancer is a disease characterised by frustrating paradoxes. No treatment with as generic a target as growth can be perfect, because, as demonstrated by the side effects of chemo and radiotherapy, inevitably non-cancerous cells suffer. Growth is important for cancer, but also inherent to sustain life. The aim of these treatments is to be too toxic for the cancer cells and cause too many mutations in them that they give up and die. But paradoxically, it is the introduction of mutations that causes cancer, and so inherent in such treatment is the risk of secondary cancer.
An important point is the idea of mutations. It took scientists until the early 20th century to identify that cancer’s principal cause lay in abnormalities in our DNA, that is, mutations in our genes. To become cancerous, with a loss in growth control and of the cell’s identity, is a multistep process. It requires layer upon layer of mutations, which in combination changes a cell. There are two types of mutations. A normal cell has genes that stop it from becoming cancerous – growth suppressors, death triggers, mutation repair mechanisms. Mutations that switch off these genes lead to cancer, whether via UV rays, smoking, our body’s own mistakes, a virus, or an unknown mechanism. Then there are genes that when produced at a higher level than normal cause cancer. For example, genes for growth signals and cell movement. To add to this large number of possibilities, imagine that every gene has its own switchboard, with a circuit of other gene switches that lead to it being turned on or off. There are literally hundreds of genes that have the potential to cause cancer, and for each gene there are different ways in which it can mutate and become detrimental. There is a lot to research.
Thus every cell has all the ingredients in it to become cancerous, it just needs the right recipe of switches to activate or remove such ingredients. Every cancer formed will have its own combination of mutations. This is why developing a drug is so difficult, because each person will have unique manifestations of cancer. And even if there are drugs made to target specific mutations, cancer employs evolutionary tactics. Every time a cancerous cell divides, the chance of another mutation advantageous to the cancer increases. Growth makes cancer stronger. Drugs will kill the weakest cancer cells, inadvertently selecting for the best cancerous cells to survive. If a drug switches off one thing, the cancer cell simply switches on another. The end result is that the cancer returns with more force and hostility. This is also why cancer evades our immune system. Our immune system is very good at detecting and evaluating the threat of a foreign object, like the flu virus, but it is more cautious when the threat comes from our own cells. Caution is important in avoiding autoimmune diseases like diabetes and arthritis. Cancer survives by taking advantage of this cautious side of our immune system, and again the only cancerous cells that survive are those that are very good at surviving.
Progress: Tricks to target the tricks
Although the enormity of genes involved makes it seem hopeless, with emerging technologies in DNA sequencing and data analysis, all these genes can be identified and patterns found. Genes commonly mutated in all cancers, genes that are crucial in the switch from benign to malignant – these are important areas for research. If these can be targeted, the triggers that cause a cancer to go from manageable to fatal can be stopped. Personal DNA sequencing may mean that soon we will all have a tailored treatment plan for prevention and cure. We are already seeing this in its preliminary form with Angelina Jolie’s preventative double mastectomy upon learning her genetic makeup gave her a high chance of breast cancer. It also means different responses by patients in clinical trials to new drugs can be better understood, by looking at the differences in each patient’s DNA. Research into other techniques is also progressing, particularly on easier and earlier detection methods and ways to help our immune system attack cancer. It is remarkable that such progress has been made when it has only been a hundred years since the discovery that cancer emerges from our own DNA.
The cancer issue is of course more convoluted than its biological hurdle. There is no doubt that cancer has an industrial side. Insurance and pharmaceutical companies, law, technology and marketing are also part of the cancer experience. Each sector has their own motivations, but my point is that the biology of cancer is the biggest obstacle in finding a cure, and researchers have no agenda other than finding a way to overcome it. It is so important for donations to keep coming from unbiased sources so that research can be performed without pressure. Many discoveries were based on a backlog of general observations that needed a missing piece to link together. When public funding goes down, researchers have no choice but to turn to privately funded avenues that are interested in low-risk, economically favourable options for research. With no encouragement for novel and creative exploration, research would stagnate. The same ideas would simply be recycled, ideas that have led us to the biological understanding we now have, but that cannot alone take us beyond it. The current Australian government’s shift in attitude, removing science from its own independent domain to be placed under the industry portfolio, is therefore very concerning.
The bottom line is that I’m really happy about anything that aims to increase cancer awareness, but I want to see it in an appropriate and informative form. I believe the current distrust stems from a lack of understanding. My aim is to attenuate this negativity. Please don’t join the climate change and vaccination skeptics to hinder the future of public health. The last thing we (cancer patients, researchers and those who benefit from it, i.e. everyone) need is apathy towards research and doubt over the credibility of researchers. Cancer wins when we give up.