The sun rises and the sun sets. It seems like the sun rotates around the Earth. Cancer cells rise and are killed by surgery, radiation and chemotherapy. It seems like cancer is a disease. But the sun does not rotate around the Earth, and cancer is not a disease. The many kinds of cancer cells are the products of the disease neoplasia that can emerge in our bodies’ organs and tissues.
Strange as it may seem, much of the failure of the war on cancer — and more importantly, much of the potential for finally winning it — has to do with the definition of cancer. In a 2013 Time magazine article, Bill Saporito described cancer as “not just one disease; it’s hundreds, potentially thousands. And not all cancers are caused by just one agent — a virus or bacterium that can be flushed and crushed. Cancer is an intricate and potentially lethal collaboration of genes gone awry, of growth inhibitors gone missing, of hormones and epigenomes changing and rogue cells breaking free. It works as one great armed force, attacking by the equivalent of air and land and sea and stealth, and we think we’re going to take it out with what? A lab-coated sniper?” This image of cancer as a myriad of diseases makes cancer seem unconquerable.
In contrast, if we think of cancer as a complicated array of conditions arising from the dysfunctional bodily process of neoplasia, it makes it easier to organize research and treatment around preventing and stopping that process. The journal Neoplasia does this by encompassing the traditional disciplines of cancer research, as well as emerging fields and interdisciplinary investigations. Cancer remains a daunting challenge, but at least we have conceptual clarity now to guide us rather than overwhelming confusion.
To simplify the matter, killing cancer cells is like using insulin to lower the blood sugar levels in diabetes. Both cancer cells and high blood sugar are products of underlying diseases: cancer cells of neoplasia and high blood sugar of deficient insulin production by the islets of Langerhans cells of the pancreas in type 1 diabetes. Incidentally, scientists at the University of North Carolina School of Medicine and the City of Hope National Medical Center are opening the door to treating the cause of diabetes by showing that injections of certain antibodies reinvigorated the Islets of Langerhans cells and reversed the onset of type I diabetes in mice genetically bred to develop the disease. Moreover, just two injections in the North Carolina study maintained disease remission indefinitely without harming the immune system.
Although proposed in 1957 and subsequent decades, only recently has the focus of cancer research been shifting to why there is a lapse in our bodies’ natural defenses in our immune systems that ordinarily detect and destroy abnormal cells. That lapse permits cancer cells to grow and spread.
The major focus of cancer treatment has been on “search for and destroy cancer cells.” It has been on destroying cancer cells … not on preventing or stopping their formation. Tumors are identified, and surgery, radiation and/or chemotherapy are used to eliminate cancer cells. In the process, especially with radiation and chemotherapy, normal growing cells are destroyed as well, and the body’s natural defense system — the immune system — is compromised. This model relies upon the fallacy that medical interventions can cure a disease without the help of our bodies’ natural defenses. Most importantly, it focuses on the products of a disease — cancer cells — rather than on the disease itself … neoplasia.
A more realistic and productive model is based on the fact that our normal body cells are continuously changing and, if in that process do not die normally, can mutate through a process called neoplasia and become cancer cells.
Some 2,400 years ago the Greek physician Hippocrates described cancer as spreading out and grabbing on to another part of the body like “the arms of a crab,” as he elegantly put it. Similarly, a popular view is that cancer begins when the cells of an expanding tumor push through the thin membrane that separates them from other tissues. It’s a fancy way of saying that in order to become cancer, a cell has to go beyond its normal boundaries.
“Absolute nonsense!” said Michael Sporn, a professor of pharmacology and medicine at Dartmouth Medical School. He went on: “We’ve been stuck with this definition of what cancer is from 1890. It’s what I was taught in medical school: ‘It’s not cancer until there’s invasion.’ That’s like saying the barn isn’t on fire until there are bright red flames coming out of the roof.”
In fact, cancer begins much earlier than that. And therein lies the best strategy to contain it. Sporn advocates preventing cells from entering the deadly stage of becoming cancer cells in the first place. He has been struggling for many years to get fellow researchers to start thinking about cancer not as a thing but as a process, called carcinogenesis — neoplasia, a multistage process that goes through various cell transformations that can progress slowly or rapidly.
So intervention must occur earlier in the process of neoplasia. To do this, the medical community has to break away from the notion that people in an early stage of neoplasia are “healthy” and, therefore, shouldn’t be treated. People are not healthy if they’re on a path toward cancer.
If this seems radical and far-fetched, consider this. We’ve prevented millions of heart attacks and strokes by using the very same strategy. Sporn likes to point out that heart disease doesn’t start with the heart attack; it starts way earlier with dietary factors and insulin that cause arterial plaque (hardening of the arteries). So we treat those. In the same way, a stroke doesn’t start with a blood clot in the brain. It often starts with hypertension. So we treat that with both lifestyle changes and drugs. “Cardiovascular disease, of course, is nowhere near as complex as cancer is,” he admits, “but the principle is the same.” Sporn adds: “All these people who are obsessed with cures for cancer are being selfish by ignoring what could be done in terms of prevention.”
Jack C. Westman is a psychiatrist and president, Wisconsin Cares, Inc. He is the author of The Cancer Solution: Taking Charge of your Life with Cancer.