The First Cell - Why We Aren't Curing Cancer

     Twenty-one years ago, I graduated from medical school. I learned a lot of things, including a bunch of things about cancer. Cancer scared me before I understood what it was, because it took my grandmother away from me. Cancer scared me even more when I learned about it in medical school, because it is a sinister, brilliant  disease. I learned the names of toxic drugs and cell receptors and various terms that I rarely thought about in the subsequent 21 years while I practiced emergency medicine. 

    Then I was diagnosed with breast cancer. Almost 2 years ago exactly. Surely something - anything - had changed in those intervening years. My screening mammogram had failed to diagnose my invisible tumor, and we still don't have any better screening to find it, but OK, surely at least the treatments were better? Surely leaps and bounds had been made in understanding cancer biology and disease? 

    I was horrified to learn that the more I read, the more I felt like a second year medical student with Harrison's Internal Medicine textbook open on my lap. There had been very few breakthroughs in understanding tumor biology. The same drugs we were using twenty years ago, we were still using now. My "other" type of breast cancer, invasive lobular cancer, despite representing 15% of all breast cancers, accounts for less than 0.5% of breast cancer research. 

    And yet -  how many BILLIONS of dollars have been poured into cancer research in those 20 years? (NCI alone spends $6.4 billion per year.) We measure success in the extension of lives by weeks or months - instead of stopping malignant cells from becoming cancerous tumors in the first place. We implant human tumors into mice and expect them to act like they do in humans. We focus on "battling" cancer once it has presented itself, but for the people living in Purgatory like me, we cross our fingers and hope for the best. No one cares if I have circulating tumor cells, because if we found them "it wouldn't prolong life anyway". Maybe not. But an 18 month lead time on the beginning of the end would be a big gift - a gift of time before decisions are made about treatments. Time to travel, to quit a toxic job, to reunite with loved ones. To experience what remains of good physical health, whatever it looks like now.

    Today I finished reading "The First Cell" by Azra Raza. She is a hematologist/oncologist who put into words and verified all the things I feared: we really haven't made much progress in understanding cancer. Imagine if there was a pill I could take, like antivirals that prevent HIV from becoming AIDS, that would prevent rogue cancer cells from becoming tumors. We have turned HIV into a chronic, manageable disease within my lifetime - I took care of men dying of AIDS in the 1980's in New York, when we knew nothing about it. Cancer has existed as long as there have been cellular organisms - for all of humanity's lifetime, anyway - and we haven't made truly meaningful progress outside of screening. Billions of dollars. If you want to understand how that's possible, I highly recommend this book. It was vindicating as a physician, but terrifying as a cancer patient.