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May 17, 2012

Cancer treatment advances reduce mortality, researcher says

Nancy Davidson

Nancy Davidson

Government funding and a better understanding of genomics have led to advances in cancer research and treatment that have, in turn, reduced cancer incidence rates and mortality in the United States, said breast cancer researcher Nancy E. Davidson.

Davidson, professor of medicine, associate vice chancellor for cancer research and director of the University of Pittsburgh Cancer Institute, marked her appointment as Hillman Chair in Oncology in the Department of Medicine with a May 10 lecture in Scaife Hall.

In her talk, “The War on Cancer: The Next 40 Years,” part of the Provost’s Inaugural Lecture series, Davidson outlined advances in the 40 years since President Richard M. Nixon signed the National Cancer Act of 1971.

While there are 12 million cancer survivors in the United States, statistics show that one of every two men and one in three women in America will be diagnosed with cancer in their lifetime, Davidson said. That equates to 1.6 million new cases this year, leading to 600,000 deaths.

Better understanding

Over 40 years, there have been amazing leaps in the understanding of the hallmarks of cancer, which bring with them the possibility of taking advantage therapeutically of what is known about the disease, Davidson said.

Researchers in molecular cancer medicine today aim to identify the causes and estimate the risks of developing cancer and find ways to prevent or delay its onset and detect it early. They also seek ways to gauge prognosis and diagnosis, identify new targets for therapy and predict patients’ response to therapies, and provide supportive care.

Thanks to better understanding of the human genome and of cancers themselves, treatments are becoming more tailored to the individual. One size doesn’t fit all. To maximize efficacy and minimize side effects and costs, doctors now aim to give the right treatment to the right person at the right time.

While much has changed, some of the aphorisms she was taught as a medical student in the 1970s still hold, Davidson said.

Then, as now, an ounce of prevention is worth a pound of cure, she said.

Then, common wisdom was that “a chance to cut is a chance to cure,” she said, noting that surgery remains a mainstay of cancer treatment. The value of tissue diagnosis, which also was emphasized in her schooling, remains. “Today, that’s even more important,” she said.

The idea that more is better when it comes to treatments has changed somewhat, but she noted that while the field is moving more and more toward biologically based therapies, that doesn’t mean that they are not toxic.

Trends reversing

Past trends are being reversed. In 1987, cancer incidence was rising 1.2 percent per year and mortality was rising 0.5 percent; by 2001, incidence was declining 1.7 percent per year and mortality was declining 1.8 percent, she said.

At the same time, the cost of care doubled from $24.7 billion to $48.1 billion, although the percentage of medical costs related to cancer care remained steady at about 5 percent of the nation’s total medical expenditures.

Breast cancer

In the case of breast cancer, early detection and advances in mammography have helped reduce both incidence and mortality for U.S. women in recent years, Davidson said.

Although mammography remains a contentious issue, with disagreement over who should get mammograms and how often they should be performed, she said there’s no question that mammography has been valuable in reducing cancer rates.

Advances in breast cancer surgery — moving from radical mastectomies toward less-drastic lumpectomies — and the use of radiotherapy likewise have had an impact.

One study that compiled data from 17 research trials that spanned 25 years and included 10,000 women found that surgery and radiotherapy reduce the risk of recurrence by half and the risk of dying by one-sixth, she said.

The recognition that breast cancer actually is not one but a number of diseases with a variety of molecular diagnoses has helped improve treatments that target specific types of breast cancers, Davidson said.

The future

She said better understanding of genomics — both of the patient and of his or her cancer — will aid in developing treatment plans.

The field will move rapidly and speedy dissemination and uniform application of what is known will be important, she said.

She sees a push for very early therapy, strategic use of screening and a true commitment to prevention as crucial elements in future progress.

By 2050, news headlines may declare cancer conquered, cancers cured or cancer controlled and considered a chronic disease, Davidson said.

The hope is that “advances of the last 40 years will translate into even more advances over the next 40 years.”

—Kimberly K. Barlow


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