Before looking at the current state of cancer research, let’s understand how oncologists rate cancers.
Cancer is classified according to stages, numbered as zero and I through IV. It's based on tumor size (T), regional metastases or spread to lymph nodes (N), and distant metastases (M).
The staging process is called the TNM Cancer Staging system and describes the anatomic extent of the disease. It is used to help the physician plan the patient’s treatment and estimate the prognosis of the treatment.
Stage 0: The cancer is still in situ, present only in the layer of cells where it began.
Stages I - III: The higher the stage number, the more extensive the disease. Increasingly greater tumor size, and/or spread of the cancer to nearby lymph nodes or organs adjacent to the primary tumor.
Stage IV: The cancer has spread to another organ or organs.
In conjunction to the TNM staging system, there is a histologic grading system numbered 1 through 4. It is a biologic, not anatomic, system performed by a pathologist looking at the cancer tissue through a microscope.
The check points are the degree of differentiation, degree of cellular pleiomorphism that assesses how much the cells have degraded to differing sizes and shapes, the nuclear grade that subjectively describes how ugly the cell nucleus looks, the number of mitoses (cell divisions) and degree of lymphatic and vascular invasion.
A cursory look at a graph showing five year survival rates as a percentage for people diagnosed in each of the four stages show that the survival rate drops off dramatically at each successive stage.
For example, lung cancer patients diagnosed in stage I have a 60% to 100% of surviving five years.
A Stage II diagnosis gives a 40% to 60% chance, by stage III it's down to 20% to 40% and a stage IV diagnosis gives a zero to 10% chance of surviving five years.
Lung cancer is problematic in that many of its malignancies are detected in stage IV where the survival rate is lowest.
The graph is extremely bleak for pancreatic cancer since 80% to 100% of all cases are only detected in Stage IV.
Due to more frequent and better screening technology, most prostate cancers are found in the first three stages and survival rates remain high, but that is due to the slow growth rate of prostate cancers. In stage IV diagnoses, the survival rate drops off quickly.
The survival graph of ovarian cancer patients shows a steady decline as the diagnosis moves through the stages. Between 75% and 100% of all ovarian cancers are found in stage IV where the five year survival rate is 20% or less.
The result of all these late stage diagnoses is that the bulk of cancer research funds go to finding late stage cures where only 10% of patients will survive.
Stage I cancers are the most difficult to detect and late stages are the easiest. By stage III and certainly in stage IV, the patient has started to exhibit the signs and symptoms of their cancer even though the cancer may have been growing for decades.
One of the best ways to assess the state and focus of any scientific research is to examine the publications of its representative associations.
Want to know what's going on in neurology...visit the American Neurological Association. How about Astronomy? Check out what the American Astronomical Society is doing.
The following paragraphs highlight the publications of many associations and organizations devoted to researching and reporting on this dreaded disease. Also scattered about this section are several books about cancer research selected from Amazon.com. To look any of them over, just click on the books cover.
The AACR website shows that numerous medical journals are published by the association that cover all aspects of cancer research.
A quick review of their publications gave an incredible insight into the amount and type of work being done to beat this dreaded disease once and for all.
The Journal,"Cancer Research", is published twice a month and reports on significant original papers according to topical research areas. These include cell and tumor biology, clinical research, endocrinology, epidemiology, experimental therapeutics, molecular targets and chemical biology, immunology, molecular biology, pathobiology and genetics.
"Molecular Cancer Research", is also published monthly and covers basic research that has implications for cancer therapeutics in:
The Journal, "Clinical Cancer Research", issued bi-monthly, publishes original articles describing clinical research on cellular and molecular characterization, prevention, diagnosis, and therapy. Its focus is on innovative clinical research and translational research which bridges the laboratory and the clinic.
"Cancer Epidemiology Biomarkers and Prevention" which publishes monthly details original peer-reviewed research on cancer causes, mechanisms of carcinogenesis, prevention, and survival outlook.
Topics include descriptive, analytical, biochemical, and molecular epidemiology; the use of biomarkers to study the neoplastic and preneoplastic processes in humans; chemoprevention and other types of prevention trials; and the role of behavioral factors in cancer etiology (study of why diseases occur) and prevention.
"Cancer Prevention Research", is published monthly and focuses exclusively on cancer prevention.
It carries important original studies, reviews, and perspectives within the major topic areas of oncogenesis, risk factors and risk assessment, early detection research, and chemopreventive and other interventions, including the basic science behind them.
It also deals with preclinical, clinical and translational research, with special attention given to molecular discoveries and an emphasis on building a translational bridge between the basic and clinical sciences. Maybe it's there but no mention is made of the natural, whole food, nutritional approach to prevention.
It is apparent that a huge amount of effort is going into cancer research and much of it now being properly focused on prevention and early detection.
The question is whether or not prevention and early detection will be able to attract adequate funding in the face of competition for money that is flowing into research for new drug development and late stage cures. With that we dovetail nicely into the funding question.
The National Cancer Institute (NCI), a component of the National Institutes of Health, is the Nation’s principal agency for cancer research.
As a Federal Government research agency, the Institute receives its funds from the U.S. Congress and uses the money to support research at the Institute’s headquarters in Bethesda, Maryland and in labs and medical centers throughout the U.S.
The Institute coordinates a national research program on cancer causes and prevention, detection and diagnosis, and treatment through various research projects and clinical trials.
The NCI’s total budget for fiscal year 2005 was $4.83 billion, $4.79 billion for fiscal 2006 and $4.75 billion for fiscal year 2007. Why is the budget trending down? Ask you congressman.
<p>According to an article on cancer in Wired Magazine, the NCI spent 8% of its 2007 budget, less than $400 million, on detection and diagnostic research. NCI has a 2009 budget of $6.028 billion and if the same percentage for detection and prevention holds, they will spend about $482 million in this area.
Other Federal agencies, state and local governments, voluntary organizations, industry, and private institutions also spend money on cancer-related research and services, although their efforts pale in comparison to the drug companies.
The pharmaceutical industry spends $8 billion on cancer research, most on drug development and late stage treatments, according to the International Union Against Cancer. This is about 33% more than the entire NCI budget for 2009.
Do we think the pharmaceutical industry is interested in curing cancer and preventing future cases? Not likely! In the next page on cancer treatments, we will see what the pharmaceutical industry makes
off of cancer patients and their insurers.
In comparison, the Susan G. Komen Breast Cancer Foundation spent $180 million on cures in 2007 and the Michael Milken Prostate Cancer Foundation spends $14 million a year chasing a cure for prostate cancer.
Both are noble causes but much more funding is needed and, for real progress, the focus should be on finding a way to keep people from getting breast cancer and prostate cancer in the first place.
There are numerous charitable services funds set up under IRS provision 501(c)3 to raise money for research or assistance to people with catastrophic illnesses.
The 501(c)3 provision applies to corporations, funds, or foundations, organized and operated exclusively for religious, charitable, scientific, testing for public safety, literary, or educational purposes.
AIDS, heart disease, diabetes and the like have all fostered the formation of such organizations. One representative 501(c)3 specifically set up to fight cancer is SU2C.
Stand Up To Cancer (SU2C) was established by the Entertainment Industry Foundation to speed up cancer research by raising philanthropic dollars and developing unique mechanisms to utilize these funds.
The end result is intended to be more rapid advances in the treatment of patients and the prevention of cancer in those individuals who are at risk.
SU2C funds will support research projects conducted by interdisciplinary, multi-institutional translational and clinical research Dream Teams and high-risk Innovative research grants from which ideas for new Dream Teams may arise.
The funds will be administered through the American Association for Cancer Research (mentioned above), since they have the existing infrastructure to focus on every aspect of high-quality, innovative cancer research.
In the January 2009 issue of Wired Magazine, is an article by Thomas Goetz, Deputy Editor, titled "Cancer and the New Science of Early Detection". It is an eye-opening story of how Don Listwin, a top executive at Cisco Systems, was moved to set up the Canary Foundation in 2004.
The Foundation is a 501(c)3 non-profit dedicated to the goal of identifying cancer early through a simple blood test and then isolating it with imaging.
Its research programs span multiple disciplines and institutions and 100% of donations go to early detection research activities.
From the Canary Foundation website, we learn that Mr Listwin lost his mother to a misdiagnosed ovarian cancer.
His epiphany came when he learned that..."almost $10 billion is spent annually on cancer research in the U.S. but the vast majority is allocated to developing new cancer treatments and caring for patients."
He was "surprised at how little funding is available to researchers investigating new ways to detect cancer it at its earliest, curable stages."
"Don made a commitment to use his time, energy, expertise, enthusiasm, professional network, and his own family foundation's resources to build a non-profit organization that will succeed at the creation of an early warning system for cancer."
"His ongoing passion is to build the foundation that connects the very best cancer researchers with entrepreneurs and venture capitalists so that their breakthroughs will have the best chances of saving lives."
SU2C is an example of an industry getting on board the fight against cancer while The Canary Foundation is an example of how one determined individual can make a difference; both making use of the same IRS tax exempt provision.
There are many, many companies that have commercialized their cancer research by bringing new early detection products to market.
Many spring from university research seeded by venture capitalists; others from medical practitioners in a specific field who found a better way; and yet others being born from R&D budgets of large established firms.
For illustration, two fledgling companies active in early detection of breast cancer, using two vastly different approaches, are briefly discussed below.
The first is a public company, the second is still private as of this writing. The descriptive text is largely taken from each companies website.
Imaging Diagnostic Systems Inc.
Imaging Diagnostic Systems, Inc.(IMDS) has developed a revolutionary new imaging device to aid in the detection and management of breast cancer.
The Computed Tomography Laser Mammography (CTLM®) system uses lasers to image the breast in a non-invasive procedure.
Unlike x-ray mammography, CTLM images blood hemoglobin and the process of neoangiogenesis or new vessel formation which is often associated with breast cancer.
IMDS has approval to market their system internationally and is using several sites abroad to gather information needed to complete the FDA pre-market approval process.
Unfortunately, IMDS went into bankruptcy and will likely be dissolved and cease to exist. It had a great product and had sold several units abroad but due to extended delays by the FDA in granting approval to market its machine in the U.S. it ran out of money and could not find an angel investor to carry it through. We will be watching the remains of IMDS to see if there may be a resurrection in its future.
HALO Healthcare, Inc.
HALO Healthcare based in Irvine, CA, acquired the assets or NeoMatrix LLC and now develops innovative devices that allow women and their doctors to promote optimal breast health. It is woman-owned and operated company with deep ties to the silicon valley venture capital crowd.
The company's premier product, the HALO™ Breast Pap Test, is the only fully automated, noninvasive breast disease screening device designed for use in the Primary Care setting as part of an annual well-woman visit.
The HALO is a device for collecting "aspirate fluid" via the nipple of each breast and examining the fluid for ductal cancer cells. The collected fluid is used in the determination and/or differentiation of normal versus pre-malignant versus malignant cells.
If you have the time, watch this 5 minute video on the technology and process of the HALO system.
The firm claims that its device can detect developing breast cancer a full eight years sooner that any other technology on the market.
Certainly these are only two of possibly hundreds of start-up and/or young companies coming to market with the next big product to detect pre-cancerous or in-situ or stage 1 cancers. Let's hope such innovation continues to thrive and grow.
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