A victory against the terror cells

Oct 7th 2005
From The Economist Global Agenda

Merck has announced a big breakthrough in the treatment of cervical cancer. Despite the good news, cancer is becoming an increasing health risk around the world. Is comprehensive victory against the disease conceivable?

WHEN an American president declares war on an ill that pervades society, the expectation should be for a long and drawn-out struggle where small gains may be made without any foreseeable hope of outright victory. The lesson can be drawn as much from Richard Nixon’s declaration of “war on cancer” in 1971 as from George Bush’s “war on terror”. But this week Merck, an American drug company, announced what should amount to a significant advance in the battle against cervical cancer.

Cancer, the result of an uncontrolled multiplication of mutant cells in the body, claims some 7m lives around the world each year, according to the World Health Organisation (WHO), and about 10m new cases are diagnosed. Some 300,000 deaths a year are attributable to cervical cancer. But the results of a clinical trial of Merck’s Gardasil vaccine showed that it was 100% effective against the two strains of human papillomavirus, a sexually transmitted virus, that cause 70% of cervical cancer cases. Versions of the vaccine for both men and women could be commercially available within a year. Future improvements to the treatment could make it effective against 87% of cervical cancers, according to the study’s leaders.

This is not the only battle being won. Improvements in the diagnosis and treatment of many cancers have led some to suggest that the illness may, in time, become no worse an affliction than diseases like diabetes, which, while unpleasant, is no longer terminal. Early diagnosis, the key to successful treatment, has been helped by numerous public-health campaigns around the world urging the public to check themselves for the early signs of, for instance, breast and testicular cancer. Better screening programmes for those at risk of breast, bowel and other cancers have also improved detection rates, as have improvements in body-scanning technology.

Better pharmaceuticals are also helping. The first wave of “targeted” drugs is currently hitting the market, and more are being developed. These attack cancerous cells only, rather than all rapidly dividing cells in the body, most of which are normal. These new therapies will help to diminish the unpleasant side-effects of current cancer drugs, such as nausea and a weakened immune system. But cancers often comprise a clutch of different cell mutations so a combination of drugs may be required for effective treatment—and some drug companies are reluctant to test products alongside those of their competitors.

“Gene chip” technology is also assisting with the better diagnosis of cancers that these targeted drugs require. This technology allows scientists to monitor thousands of genes and determine which ones are producing cancer-causing mutations. Last month, researchers in London announced that they had identified a key gene in the development of skin cancer using gene-chip technology.

And now the bad news

Despite the many bits of good news from the front, the broad statistics of the war on cancer still make bleak reading. Cancer is the world’s second-biggest killer after heart disease and the number of people dying from the illness is growing. More than half the deaths occur in poor countries, where the prospects for diagnosis and treatment are generally woeful. The WHO expects the number of people with cancer to grow by 50% between now and 2020, with three-quarters of new cases in poor countries.

While poverty and disease wreak havoc in the developing world, the battle against cancer in rich countries is hardly an unmitigated success. America’s National Cancer Institute (NCI) has received over $70 billion from public coffers since Nixon opened hostilities. Many billions more have been spent by drug companies, charities and other governments in the fight against the disease. It is true that death rates for cancer have declined in America of late, but they are still significantly higher than in 1971.

In part, this apparent lack of success is a result of ever lengthening life spans. Mortality rates for the other big killer, heart disease, have fallen since 1971 but, as populations age as a result of success in tackling other potentially fatal conditions, the chances of developing breast or prostate cancer increase. These and other cancers are far more likely to strike the elderly. On the other hand, fewer people are smoking. The ever more doom-laden health warnings on cigarette packets, combined with smoking bans, have led to a rapid fall in the incidence of lung cancer in men—though the trend in lung-cancer rates among women, who are less likely to quit, is unclear.

Cancer has a variety of causes. As well as a genetic predisposition to the disease, the chances of getting it are connected to diet, lifestyle and other social and economic factors. Americans and others in rich countries are increasingly sedentary, which has contributed to steady growth in the number of overweight and obese adults. Apart from heightening the risk of heart disease, high blood pressure and diabetes, obesity is thought to increase the likelihood of developing certain types of cancer.

Although the war on cancer is proving a hard and costly slog, it is hoped that the drive to uncover useful new technologies will mean that improvements in treatments outweigh the setbacks in the coming years. With more announcements like Merck’s, something approaching comprehensive victory may one day be imaginable.

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