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Why we are losing war on cancer

The First Cell: And the Human Costs of… by Azra Raza, Basic Books, US $28.00, Pp 350, October 2018, ISBN 978-1541699526

Are we winning or losing war on cancer? Most people believe that we are winning the war on cancer. In fact, we are made to believe that we are winning the war on cancer by the experts, researchers, doctors, and even the media. We are told, day in and day out, that the total victory over cancer is just around the corner. In The First Cell, Azra Raza argues that we have actually lost the war on cancer. We spend more than $150 billion each year to treat the deadly disease but all we have is innovations. She says that a cancer patient is as likely to die of this disease today as one was fifty years ago. The new miracle drugs we hear of only add a few months or years to one’s life.

Azra Raza tells us that cancer is a complex disease which exists in many diseases. She says that treating cancer as one disease is like treating Africa as one country. Even in the same person, it is not the same disease at two sites or at two different points in time. Cancer is vicious and self-obsessed, it learns to grow faster and become stronger, smarter, and more dangerous with each successive division. She writes, “It is a perfect example of intelligence at a molecular level, able to perceive its environment and take actions that maximize its chances of survival. A feedback loop, using past performance to improve its efficiency, forms the basis of its seemingly purposeful behavior. It learns to divide more vigorously with time, invading new spaces, mutating to turn the expression of pertinent genes off and on, enhancing its fitness to the landscape, optimizing seed soil cooperation.” We see this metamorphosis in front of our eyes when treatment causes regression of the tumor in one area just as fresh lesions crop up in another, bearing a novel genotype, selected precisely because of their refractoriness to the administered therapy; as mini-Frankensteins, they emerge like ghosts from the machine, bent upon destroying their maker.

Cancer is fantastically complex. More fantastic is the reductionist conceit that targeting a single genetic abnormality with a single drug be curative. Azra Raza says that most common cancers have proved to be more complex, with many more biologic aberrations driving the malignant phenotype. She writes, “The trafficking of cancer cells in more labyrinthine, tangled, knotty, and impenetrably convoluted than the London Underground. The cell continually transforms itself, covering generations of its natural life span in mere hours, ditching genes and entire chromosomes, acquiring new mutations, revving organelles, deforming proteins, neutralizing death signals, forging ahead deliriously, driven by the unrelenting engine of malice, bursting its hot contents on unsuspecting organs, impregnating them with its potent malignant seed, callously moving on. Cancer rules over the host with despotic autocracy.”

However, there is still hope. Hopes of finding better drugs using the existing discovery platforms or using even more artificial systems of genetically engineered animals are as realistic as dissecting the brain and expecting to discover consciousness. Azra Raza argues, after fifty years of developing cancer drugs this way, is it time to abandon the old strategy altogether. Jeremiads alone are pointless unless a new strategy accompanies the lamentation. The new strategy is to stop chasing after the last cancer cell and focus on eliminating the first. It is still better to prevent the appearance of the first cancer cell by finding its earliest footprints. She says that we must end the beginning to begin the ending. Prevention will be the only compassionate, universally applicable cure. The new strategy must go beyond early detection as practiced currently through mammograms and other routine screening test. She writes, “The prevention I am talking about is through identification and eradication of transformed cancerous cells at their inception, before they have had a chance to organize into a bona fide malignant, incurable disease. This may seem an unattainable dream but it is achievable in a reasonable time. We are already using sophisticated technology to detect the residues of disease that linger after treatment, the last cell.”

The First Cell is a timely and necessary book that shows us where we err in handling the deadly disease. Azra Raza explores troubling subject and asks biting questions, calling for a new strategy to fight the deadly disease. She argues that the current strategy to fight cancer is to diagnose cancer at an early stage but we should try to be able to identify the transformed cancerous cells before they organize into a bona fide malignant, incurable disease. The current strategy and research are simply aimed at extending the life by a few months or maybe a few years. They don’t eradicate the disease. The First Cell will change the way we think about cancer and how to fight it. It will have a very positive impact on research in the field of cancer. That seems to be Azra Raza’s objective.

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