Can­cer Won’t Be the Last of Our Prob­lems

Science Illustrated - - CONTENTS - Anthony Ford­ham aford­ham@next­media.com.au

For the last few decades at least, the phrase “a cure for can­cer” has, in many ways, stood for more than just end­ing this ter­ri­ble side-ef­fect of be­ing a mul­ti­celled organism.

In some re­spects, “cure for can­cer” is code for hu­mans gain­ing fi­nal and ul­ti­mate con­trol over our own bi­ol­ogy. In the sense of us de­feat­ing the last great killer.

We beat the beasts. We beat the el­e­ments. We beat the bac­te­ria and the viruses. To a large ex­tent, we’ve even beaten those loaded ge­netic dice that lead to ter­ri­ble con­gen­i­tal con­di­tions.

And in the years ahead, if the lat­est re­search and tests go well, we’ll have beaten our own cells’ propen­sity to oc­ca­sion­ally go nuts and repli­cate out of con­trol.

Un­for­tu­nately, this list of achieve­ments makes some­thing re­ally clear. Ev­ery time we “win” against some­thing that kills us, some­thing newer and even harder adds it­self to the top of the list.

It’s hard to imag­ine, but for peo­ple liv­ing any­thing more than about 100 years ago, can­cer was barely a thing.

Sure, peo­ple died of it. But you had to sur­vive bac­te­rial and vi­ral in­fec­tion first. And war, of course. Mal­nu­tri­tion. And all the other things that con­trib­uted to the vastly lower life ex­pectancy of the past.

And if you did man­age to live to 83 in, say, 1876 and then died of can­cer, you were still cel­e­brated as some­one who lived a no­tably long life. Dy­ing of can­cer at 83 was an achieve­ment, not a tragedy.

Each time we de­feat a whole class of killer - mi­cro-or­gan­isms be­ing the clas­sic ex­am­ple - we ex­tend our life ex­pectancy, and al­low harder and more in­sid­i­ous dis­eases a chance to be­come “the big­gest killer” in turn.

In the mid- to late-20th-cen­tury we be­came so good at medicine that peo­ple started be­ing able to die of “life­style dis­eases”. For thou­sands of years, death from com­pli­ca­tions due to obe­sity used to be some­thing that could only kill a king. Half of the re­ally bad drugs only ex­ist be­cause med­i­cal re­search in­vented them. Type II Di­a­betes? How many peo­ple liv­ing in 18th cen­tury ru­ral Europe could even find the calo­ries nec­es­sary to de­velop such a con­di­tion?

The cur­ing of can­cer - or rather, the un­der­stand­ing and man­age­ment of the wide range of con­di­tions that cause cell repli­ca­tion to go hay­wire - is al­ready well un­der­way. Many can­cers are al­ready down­graded to some­thing you live with, rather than die from. Sur­vival rates for child­hood can­cers are in­cred­i­ble, from al­most-cer­tain-death in 1900 to al­most-cer­tain­re­cov­ery in 2000.

So what gets us next? Cur­ing can­cer in the young will be a good thing, just as erad­i­cat­ing small­pox and cre­at­ing re­li­able de­fences (many not even med­i­cal) against most other dis­eases has been key to cre­at­ing the world we take for granted.

But if re­duc­ing all forms of can­cer to a health con­di­tion no more se­ri­ous than a bad in­fec­tion dou­bles our life-ex­pectancy again - as an­tibi­otics, sew­er­age, and nu­tri­tion did over the last 200 years - we’re go­ing to have to face a fact that’s been star­ing us down for a while now.

At 80 years old, your “life­time risk” of de­vel­op­ing Alzheimer’s is 14%. At 85 years old it’s 19.3%. At 90, it’s 30.8%. And if you live to 95, there’s a 50% chance you have some form of Alzheimer’s. That’s a flip of a coin.

The cause and pathol­ogy of Alzheimer’s and de­men­tia isn’t yet fully un­der­stood, but given how much harder “cur­ing can­cer” has been com­pared to, say, de­vel­op­ing an­tibi­otics... the next war against dis­ease isn’t go­ing to be straight­for­ward, or short.

But we’ll still win.

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