“Mom, why don’t we have a total cure for cancer yet?” That’s what my 13-year-old daughter asked me a few nights ago as I walked into her room to kiss her good night. She was 9 and 10 when I was going through active cancer treatment and didn’t say much about it at the time. Her musings about cancer now come out in dribs and drabs.
“Well,” I said, getting ready to put on my science geek hat. “The main reason that we don’t have a ‘cure’ for cancer is that cancer is not one thing. As researchers learn more and more about the genetics of cancer, we’re finding that breast cancer may be dozens of different diseases caused by dozens, if not hundreds, of different things. That’s also true of other cancers. So we’re not looking for one cure; we’re looking for hundreds of cures.”
I was going to go on. As my daughter says, this is one of my “rant” topics. But I could see her eyes starting to glaze over. So I stopped. But here’s what I’m going to tell her, eventually, in bits and pieces, as she gives me the openings to do so:
We don’t have a cure for cancer because:
• Scientists are just figuring out the genetic code, the “genomics,” of different cancers. That’s making us reevaluate lots of things. For instance, where your cancer started doesn’t seem to be as important as how your cancer functions.
• Even as we’re figuring out the different genetic codes of cancer, we’re just beginning to figure out how that cancer code is translated into instructions, just beginning to understand how those instructions turn into the proteins that both sustain life and fuel cancer.
• There’s still a ton of work to be done to understand how our environment influences cancer. Sometimes, a patient may have a gene that might cause cancer, but it doesn’t go into action until something in the environment “triggers” that gene to “express” itself, making proteins that fuel cancer.
• There’s still a massive amount of work that needs to be done regarding cancer prevention. We don’t talk nearly enough about prevention. But to be fair, to really prevent cancer, you have to understand exactly what causes it. And except for general advice like “exercise, eat right, and reduce stress” — or in clear cases like the connection between smoking or asbestos and lung cancer — we just don’t know exactly what steps we can take that will definitively prevent cancer.
• Researchers are finding that cancer is so varied that we need to rethink how we research cancer. We need to develop new ways of doing studies that will result in proven treatments more quickly. We need ways of accessing data from more patients.
Of course, work is going on in all these areas and more, by scientists who are far more knowledgeable than I am.
Yet when you’re a cancer patient, it feels like a massive betrayal when you learn how much we still need to know about cancer. “What do you mean, ‘We don’t know’? I need a cure NOW.”
Just remember, the puzzle of cancer is almost more complicated than we can imagine. Thousands of doctors and research biologists are working on these questions. But I doubt we’ll ever have a “total cure” for cancer because we’re always changing. The environment is always changing. Cancer is always changing.
What do you think? Does it upset you when your doctor says, “We don’t know”? Do you think a “total cure” for cancer is a realistic goal?