The roots of the National Cancer Act | Hacker News Reader

The roots of the National Cancer Act

npr.org

80 pointsnoodlesUK68 comments

All: Please don't pick the most provocative thing in an article and rush to the thread to complain about it. Find something interesting to comment about instead.

That's a new addition to the site guidelines and relevant in a case like this. I've changed the title (to the first sentence of the article) to try to cut down on the flamebait, but it shouldn't be appearing here in the first place. It's not what this site is supposed to be for.

https://news.ycombinator.com/newsguidelines.html

Jim Allison - Breakthrough: https://www.youtube.com/watch?v=MapggZMbCaI

Dr. Allison recently was awarded the Nobel Prize in Medicine for his persistent decades-long pursuit of using our own immune system to combat cancer. I was diagnosed with Stage 4 melanoma in early 2017, and I have been cancer-free for almost five years. Thank you, Jim.

Only about 10% of cancer patients respond to immunotherapy at the moment. While it's great when it works, we have a very long way to go in improving outcomes.

Whilst this might be true in general melanoma does respond particularly well to immunotherapy with 5 year survival rates in excess of 50% for advanced (metastatic) disease and a subset of patients effectively cured.

I wonder how much of this rate is affected by patients who try immunotherapies have failed frontline treatments and then try an immunotherapy later.

I'm just a layperson in this and could be wrong here, but my understanding is that cancer tends to survive by accumulating complementary pathogenic properties that individually are of little threat to the body. One of these properties is increased expression of ‘programmed death ligand 1’ (PD-L1), a surface protein on the cancer cell that binds with ‘programmed death protein 1’, a person on the surface of T-cells that, when bound, inhibit the T-cell response. I could be wrong here as well, but most immunotherapies today are of the 'checkpoint inhibitor' variety, which interfere with this binding process in one way or another.

To me this is similar to removing an invisibility cloak from the cancer cells. Now the immune system gets a shot at these cells b/c there's nothing indicating otherwise. In the case of some cancers, like melanomas and some lung cancers they may look sufficiently broken that the immune system just kills them naturally. But if the cancer cells still resemble healthy tissue, it's not super clear to me what is going to provoke a kill response.

I do think it's likely we will ultimately have customized therapies in which cancer cells are extracted, unique features are identified and custom mRNA packages created to emulate those features sufficiently to provoke the immune system to kill them. That, in combination with checkpoint inhibitors, would likely create an effective response.

The treatment of melanoma is a true 21st century medical miracle.

When I was going through med school 2010-2013 metastatic melanoma had a 5 year survival of basically 0%. By the time I graduated, it was a chronic disease for a proportion of patients and getting better.

Ken Burns documentary “Cancer: Emperor of Maladies” does an incredible job opening with some of this history.

It aired on PBS 6 years ago: https://www.pbs.org/show/story-cancer-emperor-all-maladies/

For those interested it’s still on Amazon: https://www.amazon.com/Cancer-Emperor-All-Maladies/dp/B00UGD...

The book that documentary is based on is one of my favorites, second only to the making of the atomic bomb.

https://www.amazon.com/Making-Atomic-Bomb-Richard-Rhodes/dp/...

Richard Rhodes

He has a new book on EO Wilson

https://www.amazon.com/Scientist-Wilson-Life-Nature/dp/03855...

I read a lot of medical research. A lot has something to do with cancer and the research can be summed up as "We found a new way to kill cells. This may work better on cancer cells than normal cells. Hooray! More study is needed." or "This gene or habit or whatever may have some correlation to cancer."

Kind of wish they would try something different. The book "Tripping Over the Truth" was a good expose of the failed approaches to cancer research over the years.

There is a lot of money to be made if someone comes up with a game changing cancer treatment - so the incentive is there.

It is impossible to treat cancer without killing cancer cells, so I'm not sure why this is troubling to see

Not all treatments are equally profitable. I’m close colleagues with the cancer research dept here in Oxford and there’s more than a little cynicism about what types of pursuits get funding amongst grad students.

Diet change, for example, is generally undervalued I’m told.

Not all treatments are equally likely as well. Given how good dietary science is outside of cancer, less optimistic at rigorous studies in this area.

I think it is important to delineate treatment from prevention. I would agree that prevention may be undervalued relative to treatment.

My understanding is that dietary effects on treatment have small effects on the margin. They might bump your survival a few percent, but are not going to reverse your stage 4 cancer.

Dietary research is probably good ROI, but is unlikely to yield groundbreaking treatments or silver bullets, like you mentioned in the OP.

>It is impossible to treat cancer without killing cancer cells

best treatment would be to find root cause and prevent cancer cells from growing in the first place, I'd imagine gene therapy will one day be used to help with this.

Early detection would also drastically improve outcomes

That's the problem: there's no single root cause to cancer. Every cancer type has an additional dozen subtypes with different causes. It's a mess.

I find this video [1] interesting as it pertains to the root cause of cancer. Compelling theories anyway.

[1] - https://www.youtube.com/watch?v=06e-PwhmSq8 [video]

Prevention /= treatment, but I agree prevention is good too. The HPV vaccine is a great example of this, reducing one's chance of cervical cancer by up to 99%, depending on the source

What else would you do with those cells? Keep them alive?

Our immune system is probably strong enough to whack most cancers before they become a macroscopic problem. Most hopeful treatments of today are in direction of engaging the immune system against cancer cells.

If I had to guess, the ultimate solution would be resolving immunosenescence. Our immune systems are getting worse over time, so the chance of a runaway malignity grows with age. But we might be able to prevent or reverse this loss of function.

> Our immune system is probably strong enough to whack most cancers before they become a macroscopic problem.

Cancer cells are your cells. And this is the heart of the problem, the majority of the time the immune system is a-ok with what cancer cells are doing. It's not rare at all to find cancers so big that they have had a major effect on the bloodflow to healthy cells around them simply because they consume that much in terms of resources. They can get so large that they will quite literally rearrange your organs and disrupt their functioning. And all the while not a peep from your immune system. Of course this doesn't hold for all cancers, in all situations, your immune system can and does detect certain types of cancer, sometimes in an early enough stage that it is able to eliminate the threat.

Good read (a bit old, 2002):

https://jlb.onlinelibrary.wiley.com/doi/10.1189/jlb.71.6.907

The majority of the time, it seems that the immune system does it's job. 'The majority of the time _that it has already become a macroscopic problem_ the immune system didn't do it's job' is sort of a tautology.

That's a fair criticism, but those are the cases that people are worried about, not the ones where the immune system generates the appropriate response. Just like we don't really care about regular moderate rain but we do care about rain that overwhelms our ability to deal with it. I'm not even sure what the stats are on the cases where a cancer got nipped in the bud at the single or just a few cells stage, but now I'm interested and I'm going to try to find out if this has been researched or not, that has to be a tricky problem to determine the answer to.

"the majority of the time the immune system is a-ok with what cancer cells are doing"

This is survivorship bias. Of course we do not detect cancers that were killed early on, much like we aren't aware of all the pathogens that were neutralized before they could cause visible symptoms. We only know about those that escaped the immune system patrol.

The good news is that the immune system can be augmented/instructed from the outside, and new cancer therapies do precisely that.

If cancer cells didn't occasionally manage to evade detection by the immune system then we wouldn't be having this conversation in the first place so those are the cancers that are in focus because they are the ones that people end up dying from (or needing treatment or surgery with all of the associated risks).

True, but as I already mentioned, immune systems can be trained against those cancers as well, they only need external help.

For example, BioNTech was actually founded as a cancer vaccine research lab, its Covid vaccine is "only" a (very welcome) serendipity.

There's also Cuba's lung cancer vaccine that's unfortunately illegal here in the states because of the embargo.

https://pulitzercenter.org/stories/cuba-has-lung-cancer-vacc...

That's a very weird thing that Cuban embargo, I never really got what's so terrible about Cuba that you couldn't travel there. And in this context it is terrible assuming that that stuff really works.

> the majority of the time the immune system is a-ok with what cancer cells are doing

Ok, no. The majority of the time the immune system prevents tumor formation. Immune surveillance is not really debated [1]. Animals where the immune system is shut down and immunosuppressed patients have a much higher chance to develop cancer.

The paper you cite even underlines the point that immune evasion is a failure and not the rule.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857231/

That's the third comment that says the exact same thing.

Obviously, we are within the 'war on cancer' talking about the remainder, not the ones that the immune system dealt with successfully.

This is a shifting standard, though.

Our immune systems are much worse in our 70s than in our 20s, and we suffer from many more cancers in our old age. This correlation probably isn't completely random.

I am cautiously optimistic about potential rejuvenation of immune systems in older adults. There already were successful experiments (google TRIIM and TRIIM-X by Dr. Greg Fahy) that restored function of the thymus in older people (people, not mice!).

Active thymus likely translates into a better function of T-lymphocytes, vital soldiers in the immune army.

Part of that is simply that the cumulative copy errors of cells several generations old incurs a higher chance of cancer as well as the higher chance of those cancers not being detected by the aging immune system. So there is degradation on multiple axis at once (and probably others that I'm not even aware of).

> I am cautiously optimistic about potential rejuvenation of immune systems in older adults.

That's a worthy goal.

Random errors in DNA are part of the picture, but we have error-correction mechanisms as well. It is possible that those mechanisms go haywire as we age, too.

It is interesting that short-lived animals like mice tend to suffer from cancer a lot, while huge, long-lived beasts such as whales and elephants seem to be very resistant to cancer, even though they have a lot of cells that can go wrong. Their anticancer mechanisms are obviously much better than ours.

We might yet learn something from them.

That might be the other way around though: in order to become a large beast you really need that error correction.

Similar with viruses: small viruses are typically RNA because they don't need that error correction as much as their larger counterparts which are typically DNA based giving much better resilience against mutation (and hence a much lower mutation rate).

Sorry, I was getting riled up about the "majority" part of your statement and trying to find some references with quantitative estimates (which you were also wondering about in your response to a sibling comment). The other comments snuck in meanwhile...

Yes, I should have been more careful in wording that, obviously if the early stage stuff gets snuffed out we won't know about it. But the numerical angle is an interesting one and the ratio between the cancers that are caught versus the ones that aren't (and maybe per age cohort) could be quite insightful.

Amazing to me how many commenters here are looking at a successful government initiative that’s massively improved survival rates for a number of diseases, and the takeaway they can’t wait to share with the world is, but the name is dumb.

It's a general attitude. Not restricted to some agency or initiative.

We live in an age of miracles.

I just don't get it. All the complaining about our society's lack of progress. Wut?

Maybe it's corporate media; cynicism, fear, outrage. Maybe it's growing inequity; hard to appreciative living hand-to-mouth. Maybe people will settle down after we reach the next plateau; Society always freaks out for a few decades when technological progress shakes the ant farm.

It's too bad.

My one prescription for people (individuals) getting an (positive) attitude adjustment is go find the Milky Way.

Mountain top, away from city lights, cold clear night, no moon. The entire night illuminated by star light alone.

It's hard to not have an overwhelming sense of awe while looking up at the Milky Way.

It's hard to believe we have all the answers when you're just hanging out with the stars.

Fifty years of loudly covering up for profitable carcinogens.

I share your concern that we (as a society) seem more focused on treating cancer than in addressing whatever environmental factors increase the risk.

I'm curious about how much this stems from the U.S. legal system's approach to liability.

IIUC, a company can contaminate the air/land/water to shocking degrees, but will only be held liable if the government chooses to enforce environmental regulations or an individual can prove that that particular source of contamination caused a particular harm to that individual.

So, for example, if I were to dump 1000 gallons of dioxin in some aquifer, and a few more people got prostate cancer than one would statistically expect, I may end up paying only the cost of defending a law suit. Despite the myriad of evidence that I should have known that it was taking a major gamble with the lives of current and future people.

And if I or my company was found guilty, in all likelihood I'd only have to pay for the harm to the particular persons who sued me. Which, with "proper" incorporation, I could walk away from with most of my personal wealth intact.

If I'm correct about this, it seems very far from true justice to me. Nor does it seem like an effective deterrent. My current view (which I hold lightly) is that a more just policy would be that (1) such crimes carry the same legal penalties as attempted mass murder or attempted terrorism; (2) all corporate veils are ignored; and (3) there is no limitation of liability for stockholders, even for publicly traded stocks.

Is (3) either implementable or necessary (for the former case, are you liable the if you hold stock the moment the decision is made? What if the decision is kept secret from public stockholders?)?

Agreed, though, that quality of life would be higher if decisions that materially degrade the quality of life for members of a society were judged as crimes against society, with antediluvian punishments (lifetime imprisonment at least, and stripping of all assets from the family) for all culpable corporate officers. Of course this also runs into problems, chief of which is: when does something materially degrade quality of life? How many tons of carbon emissions is permissible, for example? Once something is known to be bad, does a public oversight panel determine how much is to be allowed for a given company? And if so, how do you avoid (1) dramatically slowing innovation (which would be fine except we're still in competition with other countries) and (2) corruption of such processes over time?

I think most carcinogens we are exposed to aren't even from corporate pollution, although it's also a big source, and connected to the products we use, but from products we buy and use voluntarily without doing adequate research.

In ancient Egypt they tried to treat breast cancer with rudimentary methods around 3000 BC:

Our oldest description of cancer (although the word cancer was not used) was discovered in Egypt and dates back to about 3000 BC. It’s called the Edwin Smith Papyrus and is a copy of part of an ancient Egyptian textbook on trauma surgery. It describes 8 cases of tumors or ulcers of the breast that were removed by cauterization with a tool called the fire drill. The writing says about the disease, “There is no treatment.”

https://www.cancer.org/cancer/cancer-basics/history-of-cance...

"After adjusting for cancer stage, the mortality improvement in expansion states from the periods before and after expansion was no longer evident (HR, 1.00; 95% CI, 0.98-1.02; P = .94), nor was the difference between expansion vs nonexpansion states (DID HR, 1.00; 95% CI, 0.98-1.02; P = .84)."

I'm going to assume your point is "Expansion of Medicaid/Medicare did not have as much of an impact as most think, and the results in my quote provide some evidence." Please correct me if I'm wrong.

Stage at diagnosis is not independent from healthcare coverage, so adjusting for it loses some information. If people can catch cancers at earlier stages because they gained access to affordable screening, that's a good thing attributable to the expansion.

If you'd like to make another point with the stage-adjusted rates, please state it and cite the source.

I wonder if the Americans "war on X"-phrase washed out the word "war". Is it still as powerful as it should be?

As empty as "renewable revolution" or "space race"

I think you're onto something there. We've come to think of war — endless war — as a normal part of life in the US. Even our actual wars are now the War on Terror, not the war in Afghanistan or Iraq. We may defeat one enemy (or more likely declare victory and ditch), but there's no expectation that we'll defeat Terror, or Obesity, or Hate.

It would be hard to tell, since it goes back over 100 years: https://www.uky.edu/~eushe2/Pajares/moral.html

It's a bit odd to see an article on the efforts to reduce cancer incidence that doesn't include the terms 'carcinogen' or 'mutagen' anywhere in its body, or that doesn't reference Rachel Carson's significant role in the understanding that many pesticides and herbicides have carcinogenic properties, and doesn't even reference the well-studied linkages between tobacco and lung cancer.

Obviously, the industries involved in producing agricultural and industrial chemicals have an interest in suppressing this aspect of the cancer story, but entirely ignoring it is pretty ridiculous on the part of NPR. Clearly there are a wide variety of both naturally occurring and synthetic chemicals that can damage DNA and otherwise cause the cell cycle to go out of control, which is thought to be the fundamental process leading to cancers. A major part of the reduction in the incidence of cancer has been the removal of such substances from the water and food supply, right? The recent judgment against Bayer/Monstanto over the carcinogenic properties of their Roundup-Ready formulation wrt non-Hodgkins Lymphoma is one such example. (Note there that it's the surfactants causing the problem most likely, not the glyphosate itself, although without the surfactants the plants don't absorb the glyphosate).

As far as the 'war on cancer' theme, one of the most curious books on the topic is about the German 'war on cancer' in the Nazi era, a period when the science of carcinogens (and toxicology in general) was making a lot of advances. It's a bit disturbing as well [1]

[1] https://press.princeton.edu/books/paperback/9780691070513/th...

I can't help thinking that NPR's silence on this rather fundamental feature of cancer, i.e. the role of environmental carcinogens, is in some way related to the money they take from their advertisers in the fossil fuel / pharmaceutical sector.

>I can't help thinking that NPR's silence on this rather fundamental feature of cancer, i.e. the role of environmental carcinogens, is in some way related to the money they take from their advertisers in the fossil fuel / pharmaceutical sector.

I think their "silence" is related to the small proportion of cases linked to environmental contaminants or carcinogens besides alcohol and tobacco. I work with my state's cancer prevention program, and cancer incidence and mortality rates are heavily and undeniably correlated to behaviors and social determinants: alcohol consumption, smoking rates, exercise, access to healthcare, poverty. The only environmental causes worth any money or time are radon gas and sun exposure. In a morbid way, we'd love a localized environmental cause. That'd be easy to fix compared to convincing people to exercise and get colonoscopies.

It's just that "hot spots" are almost always statistical anomalies that occur about as often as expected. Usually in communities near industrial zones, because they're high poverty (so already prone to high incidence), low population (better chance of deviating far from the mean rate), and have been convinced that all unknown chemicals are highly carcinogenic. There are so many of these communities, it would be surprising to not see one or two a year with a very high number of similar cancer diagnoses.

And, please believe me, I have never seen a dime from anyone besides the state government. I've never been told to avoid any topics when combing through data for any patterns. And I have never gotten the sense anyone I work with, especially the epidemiologists who interview communities when a cancer cluster is feared, are on the take. It is incredibly unlikely that major news media, cancer researchers, practicing oncologists, and all public health experts working on cancer are corrupt.

What's a good breakdown of the relationship between exercise and the likelihood of cancer? On the extreme end, I'd imagine that if you're very muscular your chance of getting a tumor would increase, simply because your body has more cells, but I'm not sure what effect exercise would have for the average human.

Obesity is a major risk factor for cancer. Exercise itself didn't fight cancer cells, it's just what we encourage to combat obesity.

Well, if it’s had anywhere near the success as the “War on Drugs” …

great comment. super smart.

Americans are always going to proverbial war on stuff. It seems bad enough that something inanimate is trying to kill you. To imagine an enemy with malign intent on top of that doesn’t seem very helpful to me.

...not forgetting that some other countries do the same. Allies/ sheep? Sometimes it's a fine line.

Ok, but please don't take HN threads on predictable generic tangents. Especially not nationalistic ones. On HN, what's interesting are the diffs (i.e. the new information) in a story—not the old saws.

https://news.ycombinator.com/newsguidelines.html

I suggest a different name next time. The US is not known for winning wars

(edit: whoa didn't realize this was flamebait, i think it is a common journalistic trope, e.g. https://www.theatlantic.com/international/archive/2015/06/am...

https://www.vox.com/2018/2/15/17007678/syria-trump-war-win-i...

https://www.americanprogress.org/article/real-reasons-u-s-ca...

nothing to do with nationalism)

Actually, that suggests an even better idea: Abandon our bodies and let someone else clean up the mess. I mean... it's worked before. :D

Flamebait will get you banned here. No more of this, please.

https://news.ycombinator.com/newsguidelines.html

All these “War on” political grandstanding does is kill a lot of people, increase a lot of taxes and inflate the poor into destitution.

War on Drugs. War on Terror. War on Cancer.

Same pig but different shades of lipstick.

US govt has become unbelievably bloated and overreaches every aspect of life today.

Slogans like these help them keep expanding and hurting the people.

> War on Drugs. War on Terror. War on Cancer.

One of these is not like the others.

Please don't take HN threads on generic ideological tangents. They're repetitive and tedious. More here: https://news.ycombinator.com/item?id=29666852.

https://news.ycombinator.com/newsguidelines.html

Edit: you've unfortunately been posting a ton like this (unsubstantive flamebait and name-calling). Please don't! We're trying for a different sort of forum.

It’s not a tangent. It’s how these things turn out.

If you want to silence people speaking their minds and instead of humming along and cheer your neo-communist vision of the future.

Then by all means go ahead and cancel me.

Keep your precious silicon valley socialist/totalitarian club to yourself.

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