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The dark side of being alive

The way to tackle cancer lies in recognising that the notion of a “cure” is too simplistic

Medical science is making huge advances in treating cancer. Figures released in February by Cancer Research UK showed that, since 2003, the chances of dying from the disease have fallen by 10 per cent. Increases in screening for the disease along with improved treatments mean that thousands of people in Britain have been saved from an early death.

But cancer is a disease like no other. It isn’t caused by a lone pathogen or genetic defect, so there is no single obvious point of attack in treating it. Unlike that other major killer, cardiovascular disease, it is not confined to any particular organ or tissue. In general, it has both genetic and environmental triggers.

These are some of the reasons why cancer is so hard to combat, and why the approaches are so diverse. But there is a growing sense that cancer is not so much a disease or even a malfunction— it is the dark side of being alive, a hazard lurking in the molecular mechanisms of our cells much as road networks harbour the potential for traffic jams. That’s one reason why it makes little sense to speak of a “war on cancer”: military metaphors, almost impossible to avoid in discussing the treatment of disease, seem particularly inappropriate when the target is not, say, a virus or bacterium, but our own biology. The scale of the problem has been reflected in Cancer Research UK’s (CRUK) call last October for research that will meet seven “Grand Challenges” (see box on p67). Some of the targets are specific—for example, to eradicate cancers caused by the Epstein-Barr virus, which triggers 200,000 new cases and claims 140,000 lives worldwide each year. Others— to discover how unusual patterns of mutation are induced by different cancer-causing events, for example—reveal our ignorance by their very breadth.

But these grand challenges highlight only a part of what remains unknown. As Gerard Evan, a biochemist at the University of Cambridge, recently wrote in Nature, “despite 45 years of insight into the molecular processes of cancers, we still do not really know how therapies exploit the vulnerabilities of different cancers, or even why such vulnerabilities exist.” In other words, even though we have drugs and other therapies, we don’t actually know why they work. CRUK’s challenges are valid and important, but no one imagines that they will “solve” the problems of cancer.

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In Prospect’s March issue: Peter Pomerantsev describes the situation in Eastern Europe as the governments of Hungary and Poland turn right. Simon Tilford, from the Centre for European Reform, questions the substance of David Cameron’s EU deal and Philip Collins argues that Jeremy Corbyn is not fit for purpose. Also in this issue: Peter Kellner shows us that we are feeling more optimistic than during the last stages of the last Labour government and Jessica Abrahams explores the sexism of Valentine’s Day. Plus Justice Malala on South Africa and the Prospect Duel asks: "Should all immigrants learn English?"