Reaching for the Moonshot goal: Where will the journey lead?
Do you ever wonder what cancer incidence and death rates will be 20 to 30 years from now?
In reigniting the Cancer Moonshot, President Joe Biden wants to reduce the cancer death rate by at least 50% over the next 25 years.
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You are probably saying I have more important issues to think about right now and, frankly, if you are my age, you may think it doesn’t matter because you probably won’t be on the planet 25 years from now. If that’s the case for you, forget about the rest of this commentary.
For the rest of you, read on.
A changing landscape
In a cross-sectional study, Rahib and colleagues estimated that melanoma incidence and liver cancer and pancreatic cancer deaths would increase by 2040, whereas prostate cancer incidence and breast cancer deaths would decrease. As the authors stated, the estimates can be important to guide both clinical and translational research, as well as health care and health policy efforts. Also, they highlight the importance of cancer screening, early detection and prevention.
According to the study, the most common cancer in 2040 will be breast (364,000 cases), with melanoma (219,000 cases) increasing to become the second most common cancer. Lung cancer will be the third most common cancer, at 208,000 cases, with colorectal cancer remaining fourth at 147,000 cases. Believe it or not, the estimates showed prostate cancer dropping to the 14th most common cancer (66,000 cases).
Unfortunately, lung cancer will remain the leading cause of cancer-related death in 2040, according to the estimates, with 63,000 deaths projected. Pancreatic cancer (46,000 deaths) and liver/intrahepatic bile duct cancer (41,000 deaths) will surpass colorectal cancer (34,000 deaths) to become the second and third most common causes of cancer deaths. Breast cancer would drop to the fifth most common cause.
It's all very encouraging information, but the results are certainly not exponential. However, I guess it depends on your perspective in life.
Reasons for great hope
There are limitations to the study, which the authors discuss. One, in particular, is that these estimates do not take into consideration the progress that will be made in prevention and treatment of cancer over the next 20 to 30 years. We certainly have seen major advances in lung cancer and melanoma treatment in the era of immunotherapy. Add that to the potential of Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR), which is becoming a reality and gives us all great hope.
CRISPR — together with progress in genomics, proteomics and serial blood biomarkers such as circulating tumor DNA — can only lead to further progress in cancer treatment and prevention. Technologies and innovations like artificial intelligence, telehealth, cryo-electron microscopy, the next generation of robotic surgery and the Infinium assay will continue to help accelerate the progress against cancer. The Infinium assay (Illumina) provides extensive levels of multiplexing for genome-wide and targeted genotyping applications with a manual or automated workflow.
Personalized vaccines, cellular therapy and microbiome treatments will also change the way cancer is treated. Of course, we must overcome the barrier and difficulty of targeting cancer stem cells, drug-resistance properties of cancer stem cells that make them immune to anticancer drugs, and lack of cancer epigenetic profiling and specificity of existing epigenetic drugs. All of this leads to going beyond what are considered the three pillars of cancer treatment: surgical therapy, radiation and drug therapy.
There are other challenges, such as lack of social support, insurance/financial concerns as treatment costs skyrocket, and problems with health care communication, that will not disappear easily over the next 20 to 30 years. And let us not forget the environment as a key determinant of human health. As we all know, the fight against cancer is a major challenge for patients and their families/friends, the physicians and the scientists devoting their lives to cancer research. Hence, accepting all help available seems only logical.
It seems like a never-ending list, but our only choice is to continue the journey, stay on the cutting edge and learn from our failures. I’m reminded of the quote from Ralph Waldo Emerson: “The greatest glory in living lies not in never falling, but in rising every time we fall.”
Stay safe.
References:
- Fact sheet: President Biden reignites Cancer Moonshot to end cancer as we know it. Available at: https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/02/fact-sheet-president-biden-reignites-cancer-moonshot-to-end-cancer-as-we-know-it/. Published Feb. 2, 2022. Accessed May 4, 2023.
- Rahib L, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.4708.
For more information:
Nicholas J. Petrelli, MD, FACS, is Bank of America endowed medical director of ChristianaCare’s Helen F. Graham Cancer Center & Research Institute and associate director of translational research at Wistar Cancer Institute. He also serves as Associate Editor of Surgical Oncology for HemOnc Today. He can be reached at npetrelli@christianacare.org.
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Fact sheet: President Biden reignites Cancer Moonshot to end cancer as we know it. Available at: https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/02/fact-sheet-president-biden-reignites-cancer-moonshot-to-end-cancer-as-we-know-it/. Published Feb. 2, 2022. Accessed May 4, 2023.
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