This past December was a hard month. Bigelow lab where I work, lost our director, Graham Shimmield to colon cancer, and we lost a trustee to cancer, I lost a cousin to ovarian cancer, and a colleague lost her mother, also to cancer. Everyone has their stories with this disease. It’s a killing field that looks you squarely in the eyes before slowly sucking your life away. It leaves loved ones and all else who care in a relentless continuum from fear, to anger, to deep sadness, to resignation.
My mom died of ovarian cancer in the early ‘90s. At that time there was ovarian cancer, lung cancer, bladder cancer, leukemia, and lymphoma, to name but a few. Twenty years after Richard Nixon declared a ‘war on cancer’, in the 1970s, we were just coming to terms with the fact each of these types of cancer was unique. Cancer was not this monolithic disease that had a single source, and if we could just figure out what it was, we could ‘cure cancer’. We now know even that view was far too simplistic. Not only is every type of cancer unique, but even within any particular type of cancer there’s a lot of variation. Each cancer can have its own progression, with its own start based on a whole range of causes from environmental pollution to viruses to genetics, but unfortunately, a lot of the time it’s just plain bad luck. Once it starts, the progression of each cancer within an individual may track its own course based on a host of factors, including some that remain unknown unknowns. It’s probably useful to think about every cancer as its own malicious ecosystem, and we only have glimmerings of what the rules are that control any one particular ecosystem.
Science and scientists are on the frontlines in wars on cancer, or cancer moonshots, as they are for most diseases, and a whole host of other things for that matter. It’s hard not to feel a sense of futility, whether its cancer, or climate change, or making water cleaner. It’s an odd time-warp we inhabit, for as a scientist, day to day life in the trenches often seems ploddingly slow, but when you stop for a longer view over a few years, it is astounding how rapidly things move. Yet, on things like cancer and other really big problems, it’s often frustrating to see how slowly the needle changes over years and decades. It’s a reminder of what a complex place the world is, especially the biological world, where cancer lives.
I’m fortunate to work in my own little scientific outpost, where nearly anything we discover is new, and leads somewhere; although, nowhere near a cure for cancer. I have colleagues who will spend their entire careers seeking the answers to how a certain cell type becomes cancerous and how a particular receptor on a cell surface might be tricked into taking up a drug that would turn the cancer off. It’s painstaking work that requires a lot of knowledge and skill. Still, the likelihood of ultimate success can seem vanishingly small. Let’s just say that even for very successful scientists a batting average for making substantial breakthroughs that effect patient outcomes would never be close to making it in the major leagues. Of course, there are still many consequential steps along the way; the battle is joined with contributions to the greater effort that will eventually yield important answers towards how we deal with this disease.
My hunch is that big data, essentially sequencing the genome of every cancer type in thousands of patients, together with collecting data on cell metabolism and other factors, that are then integrated into really large databases and analyzed using machine learning, or artificial intelligence, will eventually allow us to define the progression of most cancers. We will at last understand the rules of individual cancer ecosystems. This will lead to new drug discovery and treatments. For patients, it will lead to significantly higher percentages of people who can get immediate treatment and a cure, but probably in a lot more cases, it will simply mean better disease management, quality of life, and improved life expectancy. It’s also possible, even likely that aided with some technological breakthroughs it will be possible to remove the mutations that cause certain, and perhaps a lot of different types of cancer. In science, the future always seems limitless, but no matter how clever or creative you are, watching people you care about succumb to this disease leaves you with a feeling of futility.