Are we winning the war on cancer?

US Vice President Joe Biden issued a call to action at Davos in January. The world needs to step up its game in the fight against cancer, he said, and it needs to start now.

"Our goal," he said, "is to make a decade's worth of advances in five years ... and eventually end cancer as we know it." Today, World Cancer Day, is a chance to reflect on a disease that claims over 8 million lives annually, and take steps towards the dream of ending it.

What is cancer?

The cells in your body are reproducing constantly. In a healthy human being, those cells grow and divide into new cells as the body needs them. As these grow damaged or old, they die out and are replaced with healthy new ones.

So far, so good. But there are trillions of cells in your body, and with that much replication, sometimes things don't go according to plan. A mutation occurs when the DNA of a cell has a "typo", or error in the code. When the faulty cell then begins to replicate itself, it replicates the error as well.

Your body is actually really good at recognizing this problem and dealing with it. It's possible that we contract cancer every day but our immune system simply deals with it before it becomes a problem. Your T cells identify and destroy cancer cells all the time. You can watch it happen in the video below.

In a session called Decoding Cancer, at the Forum’s Annual Meeting of the New Champions last year, NHS director Francis Collins said that we now know it takes more than one glitch (or, as he put it, “spelling error”) for a cell to go from healthy to malignant.

When we think of cancer, we often think of it in terms of parts of the body: breast cancer, skin cancer, lung cancer and so on. But understanding these "spelling errors" has brought about a shift in focus from which organ has cancer to which kind of mutation has occurred. This leads doctors away from traditional one-size-fits-all solutions such as chemotherapy, and towards the development of “smart bombs” in treatment.

Why is it taking so long to find a cure?

In one word: complexity.

Cancer has been a problem throughout human history. A medical papyrus dating back to 3000 BC describes attempts to remove breast cancer. You would think that 5,000 years later we might have found a cure.

But cancer remains one of the world’s biggest killers, with approximately 14 million new cases and 8.2 million deaths a year. In Europe alone, cancer is responsible for one in four deaths.

One of the major hurdles we have yet to overcomes is understanding what exactly causes cancer. There is still a great deal of debate to what degree lifestyle choices play a part, versus other environmental factors and even just sheer bad luck.

Two studies published within a year of each other in Nature Magazine, for example, seem to contradict each other on this question. That isn't to say the jury is out on all lifestyle choices. We know, for example, that smoking is a major factor in causing lung cancer. Tobacco use alone is responsible for 20% of all cancer deaths.

The older you get, the higher the risk of getting cancer. As the world population is living longer as a whole, we have seen a rapid rise in cases.

How are we fighting back?

We might not have found a cure, but we have come a long way from 3,000 BC. Breakthroughs in the understanding of DNA and genetic links to cancer, screening programmes, less invasive surgical techniques have all contributed to reducing the death toll. In the United Kingdom, for example, survival rates have doubled in the past 40 years.

3D modelling has helped scientists and doctors to study tumours in ways that would have been impossible only a few years ago. Martin Nowak, director of the Program for Evolutionary Dynamics and a professor of mathematics and of biology at Harvard, developed a model of solid tumors that reflects both their three-dimensional shape and genetic evolution.

“Previously, we and others have mostly used non-spatial models to study cancer evolution,” Nowak said. “But those models do not describe the spatial characteristics of solid tumours. Now, for the first time, we have a computational model that can do that.”

There is even evidence that vaccines could play a role in the battle.

A global initiative

Of the 8 million cancer deaths a year, 5 million of those will be in low and middle-income nations. Many of the cancers in those countries are preventable. Tobacco-related cancers continue to be the fastest growing types in these countries, followed by cancers preventable by vaccines such as liver cancer (caused by the hepatitis B virus) and cervical cancer (caused by the human papillomavirus).

Treatment remains another hurdle. Many still do not have access to surgery, radiotherapy, chemotherapy, endocrine therapy and other measures that could help save lives.

As Joe Biden says, there's no silver bullet when it comes to curing cancer, but a difference can be made in the incidence and management of the disease, even in the poorer countries of the world, if the right people – scientists, business leaders, politicians, data analysts – work together.

Have you read?
Are we neglecting global cancer care?
How genome sequencing is getting us closer to curing cancer
What causes cancer - bad luck or lifestyle choices?