Since Richard Nixon declared War on Cancer in 1971, the National Cancer Institute has poured some $90 billion into research and treatments. Yet a cure remains elusive. Experts have plenty of targets for blame, including a flawed emphasis on treatment over prevention, and Big Pharma betting on blockbuster treatments that cost billions to develop.
But a new study raises a sobering possibility: Cancer simply may be here to stay. Researchers at Kiel University, the Catholic University of Croatia and other institutions discovered that hydra — tiny, coral-like polyps that emerged hundreds of millions of years ago — form tumors similar to those found in humans. Which suggests that our cells' ability to develop cancer is "an intrinsic property" that has evolved at least since then — way, way, way before we rallied our forces to try to tackle it, said Thomas Bosch, an evolutionary biologist at Kiel University who led the study, published in Nature Communications in June.
To get ahead of cancer, he said, "you have to interfere with fundamental pathways. It's a web of interactions," he said. "It's very difficult to do." That's why cancer "will probably never be completely eradicated."
Cancer results from DNA mutations that throw a wrench into the molecular circuits that regulate the cell cycle. Unregulated, cancer cells multiply uncontrollably. They also evade a process known as apoptosis, in which cells with genetic mistakes essentially commit suicide.
Bosch and his colleagues have investigated hydra stem cells and tissue regeneration for years. In an earlier study, they showed that these pulsating polyps carry genes that can cause cancer in humans. But, they wondered, did those genes also trigger tumor growth?
Sure enough, they discovered tumor-ridden polyps from two hydra species. Oddly, the tumors ravaged only female polyps. They bred them for five years, generating several clones of each.
To unravel the tumor-causing mechanisms, the researchers observed cell division in hydra with and without tumors. They saw that stem cells programmed to turn into female sex cells, or eggs, divided uncontrollably. They accumulated in vast qualities without being naturally culled through apoptosis — resembling ovarian cancer in women. They then sequenced the tumorous hydra's DNA and discovered a gene that halts apoptosis, and the activity of which runs amok in tumor tissue. Turns out a similar gene hijacks apoptosis in humans and also spurs unbridled cell proliferation.
So we know that tumors can grow in hydra, but are hydra tumors invasive the way they are in humans? To find out, the researchers transplanted tumors into healthy polyps. The cells from tumors transplanted in the midsections of healthy polyps migrated all the way to both ends of their bodies.
All this means that cancer genes, and the mechanisms that allow tumor cells to evade death and invade healthy tissue, "have deep evolutionary roots," the researchers wrote. "Any crucial cell in your body can at any point make a mistake," and there's no way to prevent it, Bosch said.
"You carry a time bomb in your body when you're born," he said. "It can explode early in life, or middle age or later."
But, Bosch adds, "that doesn't mean that, with a patient who develops cancer, there's nothing you can do."
While our cells probably always will have the ability to make mistakes that trigger cancer, Bosch believes "medical technology will allow us at early time points ... at least in some cases, to successfully treat and clean a patient completely and forever of troublemaking cells."
One strategy might be to unleash the immune system against these cells. Yervoy, a drug that does just that, eliminated melanoma in 20 percent of clinical trial patients for up to 12 years — and counting. An infusion of Yervoy and a similar drug, nivolumab, has kept some lung cancer patients disease-free for about six years so far. "Their cancer hasn't come back yet. It might never come back," said Ben Creelan, an oncologist at Moffitt Cancer Center. "I think it's the most exciting thing in decades."
And of course, basic research on the evolution of cancer's arsenal remains crucial.
"Knowing your enemy from its origins is the best way to fight it and win many battles," Bosch said.
Our goal, then, if we can't slay the beast, is to learn enough about it that we render it harmless.
The first patients treated for Ebola on American soil will be discharged from Emory University Hospital, where they've been in an isolation ward since returning from Liberia early this month. The hospital says one of the patients, Dr. Kent Brantly, will appear at news conference today where it will discuss their release from care.
Brantly, 33, and another aid worker, Nancy Writebol, 59, were flown back to the U.S. after contracting the deadly virus in Liberia. They have been treated in a special isolation unit at Emory's hospital in Atlanta, which is also the home of the the Centers for Disease Control and Prevention.
For the pair to be released, the medical team treating them would need to have seen two clean blood tests in two days for each of them, according to CNN. In the past two weeks, their health had reportedly been improving.
Brantly, who lives in Fort Worth, Texas, and Writebol, who lives in Charlotte, N.C., had been working with Samaritan's Purse, a Christian aid group based in Boone, N.C., to treat patients with Ebola when they realized they had the virus late in July.
The Ebola outbreak has caused more than 1,350 deaths in West Africa, according to the World Health Organization. But the organization also warns that its tally might "vastly underestimate the magnitude of the outbreak." Experts tell NPR that the WHO number could be higher by at least 20 percent.
On Tuesday, I posted syllabi for the two undergraduate anthropology classes I will teach this fall: Evolutionary Perspectives on Gender and Primate Behavior. As the academic year at my college nears its start, I can't help but reflect on the extra layers of complexity involved in syllabus construction nowadays compared to when I first started out as a teacher in the 1980s.
A central question I grappled with earlier this week as I wrote and revised my syllabi was whether I should include trigger warnings.
Trigger warnings are notes on a syllabus meant to alert students that one or more books, articles or films required for class includes material that may cause emotional upset or even, on occasion — depending on students' personal experiences — post-traumatic stress disorder. Works of literature or film that describe or depict suicide, war, sexual violence and acts of racism may be prime candidates for trigger warnings.
In recent months, the use of trigger warnings in academic settings has been hotly debated in the media. I'm in sympathy with those who fear overkill, an overexcited deluge of warnings slapped onto classic literature, for example — including plays by Shakespeare or novels by Virginia Woolf. And, as seven humanities professors point out in their essay for Inside Higher Ed, any decision rule for applying trigger warnings is inherently flawed since "faculty cannot predict in advance what will be triggering for students."
In the end, though, I decided that in one specific context the benefits outweighed the costs and, so, for the first time I have included on a syllabus a trigger warning for a specific reading assignment.
Alongside the technical literature from anthropology, psychology and related fields, students in my evolution of gender class will read Abigail Tarttelin's novel Golden Boy. This work brings together, in the character of a highly likeable teenager, a number of issues central to the course, ranging from intersexuality to sexual violence. It's a beautiful fictional complement to the non-fiction science readings at the core of the course.
Near Golden Boy's start, a prolonged and graphic scene of rape occurs. It's key to the story, and I found it punishingly hard to read.
This small act, my offering of the trigger warning, feels to me the right thing to do. Should any students approach me with concerns beforehand about reading that part of the book, or discussing it in class, together we will figure out a way forward.
It's true that I can't know ahead of time that other topics we cover won't also cause concern for some of my students. What I do know is that any survivors of rape, attempted rape or other acts of sexual violence don't need to be blind-sided in my classroom by material that may cause them searing pain.