What is a Cure?

As our knowledge of cancer grows, our vocabulary for dealing with the disease grows with it.
By Richard Saltus

Thirty years ago, half of cancer patients survived five years or more; today, the rate is more than two-thirds.

Not so long ago, cancer was so feared that many dared not say its name: "The Big C," they called it. These days, people speak much more openly and the disease has lost some of its stigma and death-sentence aura. Treatments are better, mortality rates are falling, and incidence rates for some forms of cancer are declining.

Now another "C" word bubbles up often in the cancer community – "the cure." It's hardly a new word, of course: A "cure for cancer" has long been near the top of humankind's wish list. The earliest documented case of cancer, recorded on papyrus in about 1,500 BC in Egypt, was treated by burning with a hot iron. The ancient physicians opined that the disease was not curable. But with the explosion of knowledge about cancer beginning in the mid-20th century, optimism surged. In the 1970s, for example, the American Cancer Society (ACS) used a slogan, "We want to wipe out cancer in your lifetime."

Today, "For the Cure" is a frequent rallying cry in the names of organizations and fundraising events. At Dana-Farber and other cancer centers, health care providers will tell you that being part of this mission is what brings them to work every day.

After all, the reasoning goes, science and technology have defeated polio and smallpox, sent people to the moon, unlocked the code of the human genome. Why should biomedicine not eradicate the scourge of cancer?

But with increasing knowledge of cancer's many faces and its ability to outwit medical attacks, the definition of the term "cure" grows more ambiguous. As researchers delve ever deeper into the genetic jungle of the cancer cell, their vision of an outright cure – especially a single, cancer-eliminating solution – is giving way to other "c" words, such as conquer, control, and making cancer a chronic disease: a successful long-term campaign rather than a knockout blow.

"Cure is a word that I don't use a great deal; it is promising something that may or may not be possible," says Robert J. Mayer, MD, a senior cancer researcher at Dana-Farber and physician at Dana-Farber/Brigham and Women's Cancer Center. "Instead I say to patients, 'You will be alive and well, and in 20 years we'll look back at this and have a chuckle.'"

"People tend to forget where we were and where we are now – our progress is incremental, but our progress is real."

– Len Lichtenfeld, MD

Certainly, some cancers can be cured today, and others will be in the future. Cancer is an umbrella term for several hundred different diseases all caused by damaged DNA that spurs cells to grow uncontrollably, invade tissues and organs, and spread menacingly to distant parts of the body. Further complicating matters, cancer cells aren't derailed by a lone defect, but often have an array of abnormalities that enable them to survive the body's cellular self-destruct mechanisms. They are also quite adept at evading even the most powerful and toxic cancer drugs. Few scientists today envision one all-powerful key that would solve the puzzle.

"Will we have the magic bullet that will cure all cancer? The answer is no, but we will increasingly be able to keep this disease under control – people will live a long time with it," says Len Lichtenfeld, MD, deputy chief medical officer for the ACS. "People tend to forget where we were and where we are now – our progress is incremental, but our progress is real."