Hope in Cancer War

By Mike Tenszen

     Doctor Barbara Whylie, one of Canada's leading advocates for cancer control, is a busy woman.
    Several appointments with the outspoken CEO of both the Canadian Cancer Society and National Cancer Institute of Canada had to be cancelled at the last minute. But Dr. Whylie eventually found time for the one-on-one interview with Toronto Times and also to set down her detailed answers to some of the questions:

Dr. Barbara Whylie is CEO of the Canadian Cancer Society and the National Cancer Institute of Canada. She says we are making extensive progress in the cancer war-but there may never be a “silver bullet” found to eradicate the deadly disease. She calls for a national cancer strategy for the nation that will save much money and many lives in the long run.

Toronto Times question 1:

How many people die of cancer in Canada each year?

1 One in three Canadians will develop some form of cancer in his/her lifetime.
2 An estimated 145,500 new cases of cancer were diagnosed in 2004 and an estimated 68,300 people died from the disease.
3 Given current trends, as a result of our growing and aging population, the number of new cancer cases will increase by an estimated 60 per cent over the next 20 years.

(b) How many are under treatment now?

In 2003, 443,756 people aged 12 and over reported that they had doctor-diagnosed cancer.

(c) Are we diagnosing more people than we did 10 years ago?

Yes, we are diagnosing more people today than we were 10 years ago. Much of this is due increasing screening for cancer: ie: PSA (prostate) testing, mass mammography and more frequent cervical cancer testing, just to name a few.
However, the cancer rate is also increasing because of our aging and growing population.

d) What is our success rate in prolonging life and how has that been made better over the last years?

1        More than half the people diagnosed with cancer today survive.

2        Death rates for childhood cancers have fallen by more than 50% since the 1950's.

3        Overall death rates for all cancers declined by 12% in men between 1988 and 2000.

4        Overall death rates for women, with the exception of lung cancer, have declined by 15% since 1974.

5        Incidence rates for breast cancer have stabilized and death rates have declined steadily since 1990.

6        Death rates for prostate cancer in Canada fell by almost 15% between 1991 and 2000.

Question 2:

What are the three most common forms of cancer in Canada for men/women?
1        The three leading cancers among men were lung, colorectal and prostate.
2        The three leading cancers for women were lung, breast and colorectal.

Question 3:

What are the most important tactics to be carried out now, in Canada, in the battle against cancer? Is it just a matter of throwing money at the problem or must our money be redirected?

Prevention is the single largest thing we can do to control cancer. We know that almost 50% of all cancers can be prevented through healthy lifestyles, refraining from smoking, avoiding sun damage, protected sexual exposure, eating a high-fibre, low-fat diet, having regular Pap smears and breast exams.
A second is the implementation of the Canadian Strategy for Cancer Control. The Strategy, by making more effective use of resources in the system, will lead us towards a future where:
1        Effective prevention will enable more Canadians to enjoy cancer-free lives;
2        Screening for common cancers will be a regular part of our healthcare activities;
3        Should a person develop cancer, it will be detected early, the person will have access to high-quality treatment and care throughout the course of his or her illness and will receive support and rehabilitation when needed, wherever in Canada that person lives.
4        At the time when a person is most vulnerable, confused and scared, a dedicated guide will assist the person through his or her treatment and care, ensuring that needs are heard and met;
5        When cancer cannot be cured, or held in remission and a person is destined to die from it, he or she will do so without enduring unnecessary pain or discomfort and close to family and friends.
Question 4:

In your view is there any possibility that we will ever find a cure for cancer? How soon?

In many ways, we have already cured some cancers. There are many cancers that have high survival rates and low levels of re-occurrence and are considered effectively controlled, such as testicular cancer, Hodgkin's disease and thyroid cancer.
As well, our investments in cancer research over the last 20 years have yielded many remarkable insights into how cancer develops, and has greatly improved our ability to detect and treat the disease. As a result, cancer death rates for both men and women have dropped in the last 15 years and death rates for childhood cancers have fallen by more than 50 per cent since the 1950s.
Almost every day newspapers and television report new and exciting advances, some of which have been spearheaded by researchers funded by the Canadian Cancer Society. Clearly, there is a sense of optimism in the scientific community that progress is being made in unravelling the intricate genetics and molecular biology of cancer cells.
That said, cancer is at least 200 different diseases and it may never be possible to have one single universal treatment or cure. Although basic cancer research has contributed answers to many of the pieces of the cancer puzzle, a sudden breakthrough for one type of cancer is unlikely to also provide a solution to all other cancers. So, what works for testicular cancer or childhood leukemia cancers - where we have made tremendous headway in treatment - does not necessarily work for breast, prostate, lung or other cancers.

If the last 20 years have yielded so many remarkable insights into how cancers develop, the possibilities for the next 10 or 20 years are tremendously exciting. We are moving towards the day when some cancers will be controlled, as are conditions such as diabetes or asthma. Other cancers may be eliminated. But, there is still so much work to be done.

Question 5:

What gives you the most hope in the fight against cancer?
Research results are showing that our work is making a significant impact on the fight against cancer. There are also many cancers that have high survival rates and that are considered effectively controlled - testicular cancer, Hodgkin's disease and thyroid cancer all have an 85% survival ratio.

Also, we have hope in that we know there are many things we can do to control cancer:
1        Prevention: we know that almost 50% of cancers can be prevented through a healthy lifestyle.
2        Co-ordinate a national strategy for cancer control which will be rolled out as a national model.

The Canadian Cancer Society will continue to fight cancer on many fronts to improve the lives of Canadians. We will continue to fund excellent research throughout Canada; inform and help people living with cancer and those who support them; provide up-to-date information on the most effective ways to prevent cancer and advocate for public policy changes wherever they are needed.

Question 6:

What causes you the most concern in your positions with the cancer society and cancer institute?

What concerns me most is that we are not doing all that we can to control cancer. We have the knowledge and the tools; our next step is to work together and receive the funding for a national strategy. We need to have better systems in place to effectively apply all the new knowledge and discovery coming on line about cancer. Right now, we are lagging behind other developed countries in this area. We believe that the adoption of a national strategy is the key to meeting this challenge.

Question 7:

(a) What are the hottest areas of cancer research?
There has been a veritable explosion of knowledge about cancer over the past two decades thanks to cancer research. A rapidly expanding knowledge base is giving us the ability to ask, and answer, questions we could not even have conceptualized 10-20 years ago.

Here are just some of the promising research trends that are leading us forward in our attempts to make cancer history:

1        Starving tumours by cutting off their blood supply
Until quite recently, the only ways to remove or shrink a tumour were via surgery, radiation or chemotherapy. But several years ago, researchers realized that there might be another - and probably better - approach. It's based on the fact that tumours can't survive without a continuous supply of blood to provide oxygen and other nutrients. In fact, cancer cells seem to have the ability to recruit new blood vessels - a process known as angiogenesis. If scientists could develop drugs to block this process, they might be able to kill cancers before they had a chance to grow and spread.  Some anti-angiogenesis research is already finding that combinations of blood vessel-inhibiting drugs and standard chemotherapy drugs are more effective against some cancers than either therapy alone. Anti-angiogenesis compounds are currently being tested in patients with a variety of cancers.

Leading Canadian Cancer Society researchers currently working in this area are Dr. Robert Kerbel in Toronto and Dr. Shoukat Dedhar in Vancouver.

2        Helping the body's defences destroy cancer cells
New insights into how the body's immune system defends itself against cancer have generated renewed interest in a kind of cancer treatment called "immunotherapy". This approach is based on finding ways to stimulate or enhance the immune system so that it recognizes foreign invaders like cancer.

Leading Canadian Cancer Society researchers currently working in this area are Dr. John Dick in Toronto and Dr. Yves Fradet in Quebec.

1        Using viruses to treat cancer
Even though viruses cause a variety of human ailments, some viruses seem to be effective cancer killers. For example, recent studies have found that the common reovirus, which typically produces nothing worse than mild flu-like symptoms, is especially lethal to cancer cells. Once inside the cancer cell, the reovirus multiplies rapidly, invading and destroying its host.

The reovirus has already been tested and found effective on human cancers grown in mice, including brain tumours, lymphoma, and cancers of the colon, breast, ovary, prostate and pancreas. Clinical trials of the reovirus in people with brain cancer are now underway.

Leading Canadian Cancer Society researchers working in this area are Dr. Patrick Lee in Halifax and Dr. Peter Forsyth in Calgary.

3        Designing drugs that target malignant cells
Over the years, many chemical compounds have been tested for their ability to control or cure cancer. In the past, potential new cancer drugs were tested by exposing tumour cells to them and observing the effects. Unfortunately, in many cases, such cancer drugs attacked normal, healthy cells along with malignant ones, causing all kinds of unwanted side effects.

Now researchers are developing "designer" cancer drugs which specifically target tiny components of each cancer cell - for example, certain mutated genes or the proteins they produce. The goal: to kill cancer cells without harming healthy ones, or even to transform malignant cells back into normal one.

A leading Canadian Cancer Society researcher working in this area is Dr. Marcel Bally in Vancouver.

4        Understanding - and changing - risky behaviours
The risk for developing certain cancers has already been linked to particular habits and behaviours. These include diet, exercise, smoking, certain kinds of sexual activity and exposure to ultraviolet radiation.

An important and growing area of cancer research is aimed at trying to understand more about the cancer-behaviour link. For example, what makes some teenagers move from experimenting with tobacco use to becoming regular and heavy smokers, which predisposes them to many cancers, particularly lung cancer?

The ultimate goal of such research is to identify high-risk groups or individuals, and then target them with effective strategies or treatments that will change these unhealthy behaviours or even stop people from starting them in the first place.

A leading Canadian Cancer Society researcher in this area is Dr. Jennifer O'Loughlin in Montreal.

Question 7 (con't)

(b) Where are we making progress?
Here are a few other examples of cancer research in Canada that are getting a lot of attention right now:

5        Clinical trials
Cancer clinical trials are making a significant impact on cancer care, especially in Canada. We have a world-class clinical trial facility here in Canada that is funded by the Society - the NCIC Clinical Trials Group (CTG). Founded in 1971, the CTG conducts national and international trials of new cancer therapies, supportive care and anti-cancer drugs. No other disease in Canada has such a nationally coordinated effort for clinical trials.

One of the exciting areas the CTG is currently running trials in are on "aromotase inhibitors" - a relatively new class of hormone-based drugs that could become the new alternative to tamoxifen for women with breast cancer. This class of drugs has shown great promise in reducing the recurrence of breast cancer in comparison to tamoxifen (the current standard) and is now being tested to see if it can also be a first line treatment.

6        Genetic research
This is an exciting area because genetic information could help us better identify people at risk of developing cancer, and also because it has the potential to help us tailor treatments to individual patients. In other words, by knowing more about the detailed genetic makeup of a person's disease, we would be better able to provide a specific treatment for that particular disease, resulting in better cure rates with fewer side effects. Leading researchers working in this area are Drs. David Hogg and Steven Gallinger in Ontario.

An exciting tool new being used by genetic cancer researchers is the microarray. It allows scientists to quickly and efficiently compare genes in a normal cell to those in a tumour cell. This tool enables doctors to better predict how a tumour is likely to behave, allowing them to tailor therapies to individual patients. Ontario's Dr. Linda Penn is leading in this area of research.
Question 8:
We all fear cancer. Give us some advice, young and old, men, women, children, what we can do to lessen the chance of getting cancer.
We now know that up to 50% of cancers can be prevented. And, although there is no single cause of cancer but some factors appear to increase the risk of developing it. These are known as risk factors. Although you cannot control all risk factors, there are some risk factors related to everyday choices that you can change. You can choose to:
7        Be a non-smoker and avoid tobacco smoke.
8        Eat a healthy diet.
9        Be physically active every day.
10        Stay at a healthy weight.
11        Limit alcohol use.
12        Reduce your exposure to UV (ultraviolet) rays from the sun or tanning beds.
13        Know your body and report any changes to your doctor or dentist.
14        Follow health and safety instructions when using hazardous materials at home and at work.
The Canadian Cancer Society is committed to providing information about how to prevent or reduce the risk of cancer.

Question 9:

A lot of people believe that once you get the "Big C," as John Wayne and other victims called and call this disease, you are history. Dead. How do you look at it?

We know Canadians are concerned about cancer and we know this disease takes a huge toll on patients and their families. However, we are making progress. More than half the people diagnosed with cancer today survive. More and more, cancer is becoming a disease that you live with rather than a disease you die from, much like diabetes and asthma are now manageable diseases. Our mission is to ensure no Canadian fears dying from cancer. Each year we are moving closer to achieving this goal, but we know there is much more we need to do.
Question 10:
What is your message to the public, to governments, about what has to be done TODAY in the fight against cancer and in enhancing research and treatment and diagnosis?
As Canadians we take great pride in our health care system, yet Canada lags behind much of the developed world in controlling cancer. With the implementation of a national strategy, Canada has the opportunity to lead cancer control.
There are ways that cancer can be controlled. We currently have the knowledge and potential to control cancer but are not fully applying it. For example:
2        About half of all cancers in Canada are preventable. Certain cancers can be prevented through lifestyle choices and diet, yet the major funding agencies allocate only 10 per cent of their budgets to cancer prevention research.
3        Eight women die from cervical cancer every week in Canada, more than 400 every year; yet this type of cancer is almost entirely preventable. This is unacceptable when a known standard exists for proper screening.
4        Although trials have demonstrated screening can reduce colon cancer mortality by 20 per cent, there has been limited adoption by the public and no province has initiated a population-based screening program.
5        Symptoms and side-effects of cancer and cancer treatment are devastating, yet more than one-third of patients don't get recommended and proven supportive therapies.
We need Canadians to join us in demanding a new response to control cancer - one that effectively uses the knowledge we currently have to prevent, detect and treat cancer, and sets out to learn the things we know we need to learn.