[danieltillett]

A important post for those of us that don't know Pieter since it reinforces that your personal attitude does not change the outcome of cancer [1]. Cancer is a horrific disease, but it is not one that bends to our will, only our science.

1. http://www.apa.org/monitor/jan08/cancer.aspx

[jimmytidey]

I think the above comment accidentally omits 'not'.

This whole story is very moving.

[melling]

What's really sad is that the state of progress in cancer treatment is extremely slow. Randy Pausch, for example, was diagnosed with pancreatic cancer about 10 years ago.

https://www.youtube.com/watch?v=ji5_MqicxSo

There are people receiving the exact same death sentence today, with the same likely outcomes.

Anyway, there's a book and a PBS series for anyone interested in learning the more about the current state of cancer research:

http://www.pbs.org/show/story-cancer-emperor-all-maladies/

[ekianjo]

> What's really sad is that the state of progress in cancer treatment is extremely slow.

This is massively false. There are great strides made for numerous cancers, while for some others (pancreatic, colorectal being among the worst) there are still not many good options. For pancreatic cancer the main issue is that it's very hard to detect in early stages and when you get the symptoms you are basically already in stage IV. Pretty much the same story for brain tumors (like GBM, usually detected very late).

We also know a lot more about how to prevent many types of cancer. If you want to reduce significantly the odds of stomach cancer, you basically need to really restrict your alcohol consumption. Even for many cancers alcohol consumption shows up as correlated with increased risks.

So, treatments are improving, prevention is improving, but of course there are still cancers with very poor outcomes. At the same time, it's a major field of investment so many companies are trying to make odds better every day.

[intrasight]

If early detection can make a big difference, then clearly that is the low hanging fruit of cancer research.

[robryk]

This would require a test that is (a) cheap (so that it can be applied to basically everyone) and (b) has extremely low false positive ratio (because a particular kind of cancer is a rare thing). Repeat for every different kind of cancer.

For these reasons I'm not sure that it'll end up being a lower hanging fruit than vastly better treatment of late detected cancer for the kinds that are usually detected very late now.

[ekianjo]

It's not that they are not trying. There are numerous studies looking for bio-markers to detect the presence of cancer, but from what I remember, it does not yield good results.

[Luc]

Strange, from what I read (including interviews with oncologists) cancer treatment is massively improving, with new treatments available and many fundamental advances in the pipeline. The future is looking bright, with cancer becoming a manageable chronic illness in the next decades.

[austinjp]

An oncologist gave a friend of mine the ridiculous opinion that there would be a cure for cancer within 5 years. That was 6 years ago.

I say ridiculous because medicine is awash with similar predictions, the vast majority of which have never come true, or materialise far far later than anticipated.

The future does indeed look bright... from the very specific perspective of the researchers. Unfortunately if you are someone actually living with lung cancer or pancreatic cancer, for example, that bright future suddenly looks a lot murkier.

Fortunately my friend remains in remission, while I remain flabbergasted at the irresponsibility of that oncologist.

[robryk]

"Cure for cancer" or "cure for that particular cancer"? First one sounds bizarre (cancer is a set of diseases that are generally similar, but very different in specifics), second is essentially already true for some kinds of cancer (e.g. testicular cancer in males).

[melling]

You're giving me anecdotal information that spans over 20-30 years? Yeah, I'm optimistic that by 2050, we'll be much better off. In the meantime, 7-10 million worldwide will die every year from cancer. We're racing to get self-driving cars to save a lot fewer people.

[karmajunkie]

Its more than anecdotal information. In the last few years 11 new treatments have been approved for stage III and IV cancers that are immune-mediated, which includes melanoma, one of the fastest growing (in terms of incidence) as well as most aggressive cancers.

But the real truth is that cancer isn't a single disease. Treatments move slowly because its a host of different diseases which all exhibit the same symptoms of unrestrained growth and cellular immortality. So yeah, a lot of people are going to die of a lot of different diseases. "Curing cancer" isn't going to happen, because "cancer" isn't one single (or even a few) things to cure.

[melling]

'cancer isn't a single disease ". That's covered in the video, and it well-known by everyone? The immunotherapy drugs are in the video too. There were certainly a few successes but it sounds like we have a bit of work. It's one of the cancer moonshot projects:

http://www.cancermoonshot2020.org

Do you have to survival rates for the various cancers. That's the benchmark, right?

[mhurron]

> I'm optimistic that by 2050, we'll be much better off. In the meantime, 7-10 million worldwide will die every year from cancer

That's sort of how progress and improvements work, they benefit those that come later.

> We're racing to get self-driving cars to save a lot fewer people

And those people working on cars are probably don't have the skills or drive to deal with medical research. That not everyone on the planet is working on what you believe they should be means nothing.

[melling]

No one said people should switch jobs. You are filling in the wrong blanks. Thinking outside the box doesn't come easy for you?

[danieltillett]

Cancer is a disease where we are making progress, but not fast enough. The immune-based approaches of the last few years are real progress, but cancers like pancreatic cancer are very hard to fight.

[melling]

Pancreatic cancer is "hard to fight" because it is seldom detected early, but at a very late stage.

I heard Craig Venter once say that the cure for cancer is early detection. Wish I could find the video.

[okket]

(a bit tangential, not directly related to the special case of pancreatic cancer, maybe in this case early detection provides better results)

Early detection is double-edged sword: It is very hard to tell in early stages if the cancer develops into harmful variants and a small false positive error can have drastic consequences, if applied on scale [1]. The result is that many undergo unnecessary therapy with 100% harmful consequences (not life threatening, but permanent damage like removed organs/sterility).

See also: "The Case Against Early Cancer Detection"

http://fivethirtyeight.com/features/the-case-against-early-c...

I'd put my money (research) rather on better treatment than earlier detection.

[1] https://www.youtube.com/watch?v=M8xlOm2wPAA

[melling]

It sounds like we need better non-invasive early detection. Tests where you can monitor the progress. Simply saying "we've got some early tests that aren't very helpful" doesn't mean we shouldn't be improving the tests.

Also, i'm not sure why we can't have both: better early detection and better treatments.

[yaakov34]

That's not really true for pancreatic cancer. It is absolutely notorious for escaping even when it's detected early, and even after a (seemingly) complete resection. This was in fact Randy Pausch's case: he had a resection with negative margin (meaning no cancer detectable on the surfaces from which the tumor was cut) and negative lymph nodes. For most cancers, his chances of survival would have been excellent, but not for pancreatic cancer. I remember at the time he wrote that it was a 50:50 proposition, but it's actually a lot worse. We don't know why this happens - it probably has to do with early metastasis by very small clumps of cells, or even individual cells.

This is one reason nobody recommends widespread screening for pancreatic cancer - apart from the inevitable false positives and so on. We currently don't have anything very wonderful to offer even to people in whom it was detected early, although it does improve the chances somewhat.

[danieltillett]

Yes you are 100% right (edited my post).