For centuries, physician-scientists have been studying and treating cancer, yet the question persists: Why haven’t we cured it yet?

Misunderstandings about what it means to cure cancer are driven by a variety of historical and sociocultural factors that have shaped public perception over time. However, there’s an important difference between curing cancer and eradicating it—one that can reshape the idea of what conquering cancer truly means.

Otis Brawley, MD, FACP, FASCO, is a globally renowned expert on cancer screening and prevention, as well as a seasoned expert in helping the public better understand the complexities of cancer. He leads a broad, interdisciplinary research effort at the Johns Hopkins School of Medicine, the Johns Hopkins Bloomberg School of Public Health, and the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center focused on cancer health disparities. In addition to being a former chief medical and scientific officer of the American Cancer Society, Dr. Brawley is a member of Conquer Cancer’s Board of Directors and serves as editor of The Cancer History Project, a free online resource dedicated to documenting the history of cancer and its care, including those who’ve shaped our study and understanding of it.

In the following interview, Dr. Brawley discusses some of the challenges in improving public understanding of cancer, the advances necessary to continue conquering it, and how he approaches conversations about cancer and cure.

In fundraising for cancer research, the word “cure” is almost inescapable. It’s also inescapable that, despite centuries of study, cancer continues to persist globally. How do you respond when someone asks, “Why hasn’t cancer been cured yet?”
OB: The first thing I do is explain that cancer is at least 200 different types of diseases.¹ And even within those types of diseases, there are certain subtypes. Of the 200 different types of cancer out there, some are very treatable, and some are “curable” in a sense, meaning these patients can go into prolonged, complete remissions that last the rest of their lives. To a layperson, that is “a cure.” And that’s true in some leukemias, some lymphomas, and some early-detected solid tumors like breast cancer, prostate cancer, colon cancer, etc. But the answer to the question is that we are still defining what this disease is.

Today, discussions about cancer often focus on potential causes, particularly behavioral, environmental, or hereditary risk factors. However, examining the history of cancer reveals that it predates many of the causes we focus on today. Given this understanding, how do you explain causation of cancer to patients?
OB: The best way to think of cancer is that cancer is uncontrolled cell growth. All of us have cells that are undergoing daily growth. As we age, our cells are more likely to go into uncontrolled cell growth than they are to go into controlled cell growth. The natural aging process is why we have a baseline amount of cancer that we just need to accept. And then, rapidly changing environmental stimuli have contributed to the increase in the number of cancer types we have now compared to the beginning of the 20th century.

How do you answer when someone asks about current progress against cancer, or about the major challenges to cancer research and to the development of more effective treatments and cures?
OB: There are many challenges as we work to control cancer. It is fair to say that overcoming cancer is a decades-long, complex process. That said, over the past 50 years, there have been significant advances in understanding the cancer cell at a molecular level. It is fair to say we have redefined cancer, moving from a mid-19th-century definition using the biopsy, to a 21st-century definition that incorporates genomics.

This has provided us with clues into the causes of cancer and how to prevent it. It has also allowed for the development of many drugs that interfere with the molecular mechanisms of cancer. This is the basis for many treatments, some of them being very useful.

There has been progress. The number of effective drugs that the U.S. Food and Drug Administration has approved in the past decade is far greater than the number approved in the 30 years prior.² Additionally, U.S. age-adjusted cancer mortality has declined by 33% from 1991 to 2020, with the death rate of colon cancer declining by 50% and the death rate of breast cancer declining by over 40%.^3-5 

How does supporting Conquer Cancer help to address these challenges?
OB: While many scientific questions have been answered, there are still many good scientific questions that need to be addressed. This issue is evident at the National Cancer Institute (NCI), the nation’s largest funder of cancer research, which currently funds only about 10% of the grants submitted.⁶ 

This competition discourages the younger new investigators from applying for federal grants. These are the people with fresh ideas. They are the future of good research. These are the people you want to develop. Conquer Cancer focuses most of its support on these young investigators.

What advances still need to happen for us to truly conquer cancer? 
OB: While there are many basic scientific questions that need to be addressed, one of our greatest hurdles is developing easy-to-provide, relatively low-tech, inexpensive cancer prevention, screening, and diagnostic tests, and treatments.

For example, lung cancer screening of those at high risk has been shown to save lives. Currently, this is done with an expensive low-dose computerized tomography (CT) scanner using software that is even more expensive. The availability of the machine, the software, and the skilled physicians needed to use it is limited. In some centers, a screening program can actually worsen overall quality of care by making the line for the CT scanner longer for those who have illnesses that need diagnostics and treatment. A blood screening test looking at circulating DNA fragments is currently in development. It could be a game changer.

Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of several hematologic diseases. It shows promise for some solid tumors. Currently, CAR T-cell therapy is “bespoke,” meaning it’s designed for each patient. Research promises to give us an “off-the-shelf” therapy that can be useful to many. Additionally, treatment of many pediatric cancers is highly effective at controlling cancer. The challenge is to develop treatments that have fewer, or no, side effects.

Sources
1: Cancer Research UK
2: National Cancer Institute
3: CA: A Cancer Journal for Clinicians
4: American Cancer Society
5: American Cancer Society
6: ASCO