The 2013 Edge Question: What *Should* We Be Worried About? Xeni's essay: "Cancer."

Photo: "Clematis 2013" Copyright © 2013 by Katinka Matson. View larger size.

Each year, literary über-agent and big idea wrangler John Brockman of poses a new question to an assortment of scientists, writers, and creative minds, and publishes a selection of the responding essays. This year's question, which came from George Dyson, is "What *Should* We Be Worried About?"

We worry because we are built to anticipate the future. Nothing can stop us from worrying, but science can teach us how to worry better, and when to stop worrying.
Many people more interesting than me responded—here are the 2013 contributors, and the list includes some amazing minds: Brian Eno, Daniel Dennett, Esther Dyson, George Dyson, David Gelernter, Danny Hillis, Arianna Huffington, Kevin Kelly, Tim O'Reilly, Martin Rees, Bruce Schneier, Bruce Sterling, Sherry Turkle, and Craig Venter, to name just some. And here's an index of all the essays this year.

Following is the full text of my contribution, "Science Has Not Brought Us Closer To Understanding Cancer."

"Cancer cells," a medical illustration by BioMedical, via Shutterstock.

We should be worried that science has not yet brought us closer to understanding cancer.

In December, 1971, President Nixon signed the National Cancer Act, launching America's "War on Cancer." Forty-odd years later, like the costly wars on drugs and terror, the war on cancer has not been won.

According to the National Cancer Institute, about 227,000 women were diagnosed with breast cancer in the US in 2012. And rates are rising. More women in America have died of breast cancer in the last two decades than the total number of Americans killed in World War I, World War II, the Korean War and the Vietnam War, combined.

But military metaphors are not appropriate to describe the experience of having, treating, or trying to cure the disease. Science isn't war. What will lead us to progress with cancer aren't better metaphors, but better advances in science.

Why, 40 years after this war was declared, has science not led us to a cure? Or to a clearer understanding of causes, prevention? Or to simply more effective and less horrific forms of treatment?

Even so, now is the best time ever to be diagnosed with cancer. Consider the progress made in breast cancer. A generation ago, women diagnosed with breast cancer would have had a prognosis that entailed a much greater likelihood of an earlier death, of more disfigurement, and a much lower quality of life during and after treatment.

Treatment-related side effects such as "chemobrain" are only just now being recognized as a scientifically valid phenomenon. A generation ago, breast cancer patients were told the cognitive impairment they experienced during and after chemotherapy was "all in their heads," if you will.

Sure, there has been progress. But how much, really? The best that evidence-based medicine can offer for women in 2013 is still poison, cut, burn, then poison some more. A typical regimen for hormone-receptive breast cancer might be chemotherapy, mastectomy and reconstruction, radiation, at least 5 years of a daily anti-estrogen drug, and a few more little bonus surgeries for good measure.

There are still no guarantees in cancer treatment. The only certainties we may receive from our doctors are the kind no one wants. After hearing "we don't really know" from surgeons and oncologists countless times as they weigh treatment options, cancer patients eventually get the point. They really don't know.

We're still using the same brutal chemo drugs, the same barbaric surgeries, the same radiation blasts as our mothers and grandmothers endured decades ago—with no substantially greater ability to predict who will benefit, and no cure in sight. The cancer authorities can't even agree on screening and diagnostic recommendations: should women get annual mammograms starting at 40? 50? Or no mammograms at all? You've come a long way, baby.

Maybe to get at the bottom of our worries, we should just "follow the money." Because the profit to be made in cancer is in producing cancer treatment drugs, machines, surgery techniques; not in finding a cure, or new ways to look at causation. There is likely no profit in figuring out the links to environmental causes; how what we eat or breathe as a child may cause our cells to mutate, how exposure to radiation or man-made chemicals may affect our risk factors.

What can make you even more cynical is looking at how much money there is to be made in poisoning us. Do the dominant corporations in fast food, chemicals, agri-business, want us to explore how their products impact cancer rates? Isn't it cheaper for them to simply pinkwash "for the cause" every October?

And for all the nauseating pink-ribbon feel-good charity hype (an industry in and of itself!), few breast cancer charities are focused on determining causation, or funneling a substantial portion of donations to actual research and science innovation.

Genome-focused research holds great promise, but funding for this science at our government labs, NIH and NCI, is harder than ever for scientists to secure. Why hasn't the Cancer Genome Atlas yielded more advances that can be translated now into more effective therapies?

Has the profit motive that drives our free-market society skewed our science? If we were to reboot the "War on Cancer" today, with all we now know, how and where would we begin?

The research and science that will cure cancer will not necessarily be done by big-name cancer hospitals or by big pharma. It requires a new way of thinking about illness, health, and science itself. We owe this to the millions or people who are living with cancer—or more to the point, trying very hard not to die from it. I know, I am one of them.

—Xeni Jardin, January, 2013, for


  1. There is infinitely more money in “researching” and “treating” cancer than there is in curing it.

    You need to envision big pharma as munitions manufacturers – why would a bullet maker EVER want a war to end?

    1.  the point of the treatment is to cure you of cancer.

      I’m not sure exactly how you think cancer can be cured when it’s a genetic disorder caused by mutation. You can certainly try and prevent it but with so many external forces causing mutation it seems impossible to prevent them all.

      As you get older the odds just get cumulative.

      1. The pharma industry already is effectively paid on a contingency basis.  If the FDA doesn’t determine that their products are safe and effective, they can’t bring them to market and they don’t get paid for the research they did.

    2. Any company that develops a cure for any of the more prevalent cancers will have created a license to print money. It will be much more profitable than any treatment. Treatments have to compete with other treatments: a cure transforms that pharma from being a player in a market to OWNING that market. If given the choice between having some repeat customers (possibility of revenue tomorrow) or ALL of the customers (guaranteed revenue today), you know which one they would pick. 
      Plus it probably wouldn’t just be the cure for just one type of cancer – that company would patent related cures for related cancers and be incredibly profitable for 20 or 30 years. They would also be able to name their price  – until someone develops a competing cure. The real limiting factor is that it’s a lot harder to develop cures than treatments. Imagine that your car is rusting and you want to cure it, not treat it. Rust proofing is a treatment that has to be renewed, as are all of the other coatings. Replacing a rusty part is certainly a cure for that part -but consider the analogy for people. You could buy a new car made from stainless steel – but that won’t cure the car you already have. So you’re left with looking for a way to “cure” iron’s chemical tendency to oxidize. Oh, and it will need to be something you can pour in the gas tank or just spray on the car: this is analogy to people remember, and we don’t take well to being turned off let alone disassembled and dipped in vats. Maybe if we get truly proficient with gene therapy we’ll start to see more cures, but til then we’re looking at treatments.

  2.  I thought this was probably the worst question of recent years. Not only do the answers start out with a lot of bogus-seeming evolutionary psychologists who I don’t really want to read anything by, but I feel like the question brought out the worst kind of reactionary old-fogeyism in a lot of the respondents and as a result many of the answers are semantically indistinguishable from “we should be worried about kids these days and their new-fangled internets and their rap music”. There were still some good replies in there, though, it wasn’t a total loss.

  3. Well, this confuses me.  According to the National Cancer Institute, overall cancer death rates have been in decline since the 90’s and “Between 2000 and 2009, overall cancer incidence rates decreased by 0.6 percent per year among men, were stable among women, and increased by 0.6 percent per year among children (ages 0 to 14 years).”

    Obviously, there’s an unimaginable amount of work left to do, but don’t decreases in rates of cancer and cancer deaths indicate that science actually has brought us closer to understanding the disease, at least a little?

    1. Closer, as I say right there in the piece. But, as a cancer patient who’s slogged through the hell that is treatment, and the lack of closure that the end of treatment brings, I say: not close enough.

      1. Sorry, Xeni, I see what you’re saying.  I was too fixated on the title, which is less ambivalent in its assertion.  While I believe science has provided us with a deeper understanding of the disease since the early 70’s, I think everyone would agree that no improvement is “enough,” until we wipe it out entirely.

        The questions you ask in your piece are essential ones.

  4. No, there is no cure. Treatment options are in the same broad categories as before. But it’s not fair to say that it hasn’t moved forward. Many forms of cancer have seen their treatment success rate (reaching remission and long-term monitoring rather than active treatment) improve enormously over that time period (leukemia just for example, was under 50% survival 40 years ago – now it’s well over 90%). In the last decade there has been enormous basic progress with biologics and classes of drugs that simply did not exist prior to the turn of the millennium (e.g. EGFR inhibitors and drugs like Erlotinib).

    “The research and science that will cure cancer will not necessarily be done by big-name cancer hospitals or by big pharma.”

    Then who? Are you hoping for the one-in-a-billion genius researcher working alone? I understand you’re bitter that cancer hasn’t been “won”, but those are the groups that have moved treatment forward, whether you like them or not.

    I know, I’m living with cancer too. Every time I feel an odd pain on the left side of my head I wonder if anything has returned, and will the rest of my life.

    1. Joshua,

      I don’t know if you read my essay in entirety, but I do not argue that ” it hasn’t moved forward.”

      I argue it hasn’t moved forward enough.

      I can empathize with what you described; survivor life can be tough. And not all cancers are equal, nor are all experiences of treatment equal.

      Is it “bitter” to outline the shortcomings in science? I don’t think so. The word makes me wince, as it’s so often reflexively used when women in particular state a critical opinion, or anger. Anger, frustration, a lack of satisfaction with the status quo, isn’t always a bad thing.

      I feel overwhelming gratitude to be alive. I feel overwhelming gratitude to the researchers and oncology professionals who are responsible for the (so far!) effective treatment I’ve received.

      Wishing you long remission.

  5. Hmm.  My answer would have been: “The same as every other year: that we die without having lived…”

    Daniel Dennett answer is so wonderfully geeky!  (All scraped and in my Nexis, for later perusal.)

  6. We declared war on cancer 30 years before we sequenced the human genome. The promise was gobs and gobs of money resulting in a cure in 5 years. The problem isn’t nebulous accusations of foot dragging by big pharma,  the problem is wanting a particular outcome  and making big proclamations before you have fully understood the problem.

  7. Joshua – yes, treatment success rates have improved, and new drugs have improved treatments for certain cancers.  But I feel as Xeni does, that the work that’s being done often seems to be happening at a glacially slow pace, and precious little of it is directed at anything truly paradigm-changing.

    Xeni’s treatment options for breast cancer over the past year are essentially the same as I had 14 years ago.  Surgical options – identical.  Chemotherapy drugs – identical.  Her chemo dosing schedule was a little different, and there’s less invasive screening of lymph nodes to evaluate local spread during surgery, and that’s about all that’s improved.

    1. Yes, but you say that as if molecular biology is an easy thing to work with. The majority of molecular functions in something as common as mitosis are not known to this day and a simple signaling cascade is a massive series of molecular interactions, the slightest change to which may kill the cancer or kill the patient.
      It’s like trying to debug Windows with a sledgehammer.

      And Paradigm changing solutions have been made already. Many of them, hence why Cancer survival is much higher now then it was 10 years ago.
      New drugs and new methods of fighting cancer appear regularly, but if you’re expecting that any day now a pill will appear that can kill any Cancer in any patient, then you might as well be praying to god for help, or an alien race to show up with a universal cure, either is about as likely or physically possible.

      1. It’s like trying to debug Windows with a sledgehammer.

        You must be an Apple user, because violently striking the computer is the correct way to debug Windows.

        1. Not quite Windows but for a while a co-founder of Intel (Andy Grove) was bashing Pharmas for not making more progress. He thought they should use the methods engineering companies like Intel use to routinely make better and faster IC chips. He got a bit quieter after people extended his analogies and asked questions like “OK, how would you propose to “cure” the problems in a population of 40 year old IBM PCs. Their Intel processors seem to be getting a bit dodgy. Feel free to poke around in them, but you can’t power them down (restarting is iffy), replace the CPUs or other components, load a different OS, or even stop any of the programs that are running.”

      2. No, Dan I’m not expecting that pill.  I’m well aware of the difficulties in presented in understanding the mechanisms of cancer, and of the inherent complexity of the subject, that reba summarizes so succinctly.

        My sister and I, and both of our paternal aunts had breast cancer, which I think at least argues to a genetic component of some sort.  But whatever it is, it’s not BRCA-1 or BRCA-2 (we’ve been tested), the two known breast-cancer related genes. Two, out of how many millions of single genes, gene combinations, combinations with epigenetic factors thrown in?  I’ve come to think of cancer as simply an inherent flaw in the animal machinery – the price we pay for being able to evolve at all.  Who knows, maybe in another hundred thousand years, we’ll have evolved some of it out of us.

        Just sayin’, though, that when you are the patient, that even though those treatment methods and techniques have been refined and refined again, they are still overwhelmingly slash, burn and poison, and you want to know why things can’t move faster.  Some cancers have novel new treatments that work well, and don’t make you so sick, and some cancers seem sadly impervious to any kind of treatment, or even adequate early detection. 

    2. I was kind of surprised that Xeni was getting the same drugs that we were using when I worked in the hospital in the 1980s. Zofran was the big new miracle drug for nausea, but even that came out in 1991.

      1. And Zofran was still the big new miracle drug for nausea in 1999, when I had chemo.  My insurance company would only pay for 9 pills (3 days worth, for the uninitiated) every 7 days, in an effort to get oncs to prescribe less expensive (but less effective) anti-nausea meds.  I had to buy them out of pocket to get enough for the first two weeks of chemo, and they were $27 per pill.  After that, I had to hoard them, and my onc gave me samples, to try to get though, because I couldn’t afford to keep laying out $300+ a week for them.

  8. I usually love Xeni’s writing, and I was very disappointed by this piece. Starting with the title – are we really not closer to understanding cancer?  I don’t think so. I think new understandings and discoveries are happening everyday, but cancer is incredibly complex, and like many things, the more you study it, the more complexities you uncover. Just because the initiative was introduced with our usual simple metaphor (“War on…..!”) that makes us think victory will come quickly, is not cause to think it is actually reasonable for all or even most of the answers to be found in 40 years.

    What is dismissed as “How much progress, really?” actually pooh-poohs an enormous amount of refinement in surgical, medical and radiation techniques that have improved survival rates while reducing morbidity from treatment.  No, there are no guarantees with cancer treatment, but that is true throughout the medical field.  How well will someone do with MS, IBD, a stroke, heart failure, infertility – it’s always a game of probability and test-of-treatment.

    Following the money may be valid to some extent. But most of the baseline research – especially into screening, causation etc – is not funded on a profit model. This is most frequently government or foundation research (think NIH, Cancer Society, etc) done by academics.  Plenty of people are interested in this stuff, researching it, and getting funding.  Even the early work on drugs, treatment, and genetic causation and certainly attempts at new surgical techniques – is born from academic centers where the funding is not mainly corporate.  (The theft perpetuated when a company comes along an monetizes, justifying cost by claiming “R&D costs” is a discussion for another time.)  Science dollars are being slashed all the time, and that is going to choke off more research than focusing on money motivations of for-profit companies.

    Even the phrase “cure cancer” is so upsetting. Cancer is a huge umbrella for a an incredible number of diseases found in every single organ system of the body which we are constantly learning have a huge number of underlying causes, from viral infection to environmental exposure to genetic mutation.  Crying out for scientists to “cure cancer” is such an over-simplification of an incredibly broad field.  Its like asking for us to “cure infections” or “cure pain”.   How can you be surprised that we haven’t gotten there in 40 years?

  9. Interestingly, here’s another article in the same series from a cancer researcher’s point of view: I thought it made a good companion piece, saying a lot of the same things from a different perspective.

  10. National Cancer Institute:
    “Studies in mice and rats have shown that cannabinoids may inhibit tumor growth by causing cell death, blocking cell growth, and blocking the development of blood vessels needed by tumors to grow. Laboratory and animal studies have shown that cannabinoids may be able to kill cancer cells while protecting normal cells.”
     I’m not a cannabis activist,,or user, and regularly criticize some who make claims that it is the solution to all our ills,but this is pretty interesting

  11. I’m disappointed to see 15 physicists, 6 biologists, yet no chemists.  I’m sure chemists can provide quite a few things to worry about, more-so maybe than even physicists!

    1. Xeni, I must say that it hurt reading the second half of your essay.  As a scientist working a “big-name cancer hospital”, I assure you that we are trying our best.  Come by at 3am sometimes, you’ll be surprised how many people you see working 100 hour weeks for a salary that is hardly enough to live on (I have colleagues with children who have to send them to their parents because they can’t afford them, financially or timewise).

      Cancer is impossibly complicated, as I’m sure you know.  We had been pursuing a cure, but as has been stated elsewhere in the comments, but that is now seen as impractical.  It is much more realistic to pursue treatments; I myself am pursuing a genome-based silver bullet for hormone-responsive cancers.  It is highly unlikely to work, but it’s my best idea, and I’m going to give it my best.  Research for earlier detection is being pursued in the field, and is an important part of our long term cancer strategy.

      As far as your mention of environmental factors, I have a suggestion for you: diagram a research plan that studies the relationship between what a child ate, the chemicals they are exposed to, air pollutants in their vicinity, and likelihood of cancer occurance.  Write the proposal, and submit it (why not?)  It would require such a large sample size, a lifetime of data collection, a biodome of children raised in a controlled environment as a control… See what I’m getting at?  Finding a population with low incidence of a certain cancer is simple, PROVING that the low occurrence is linked to a certain factor with statistical significance and not simple genetics is extremely difficult.  Money isn’t the problem, we just think we have better avenues to distribute it.  Keep in mind, tumors have been even found in mummies, prior to the invention of teflon.  Suggesting we retroactively try to determine the data set is pseudoscience at best.

      I also disagree with your statement that genome-based strategies are finding it more difficult to secure funding.  Sure, funding levels of NIH and NCI grants are decreasing every year OVERALL, but there are also more labs looking for funding in less rewarding research areas (I come from one of those labs, my PhD research certainly didn’t change the world and shouldn’t/wouldn’t be funded in today’s research climate).  As a researcher, I would guess that a proposal with a novel genome-based strategy and the institutional resources to reasonably accomplish the proposed strategy would have increasing funding rates.  But I don’t think anyone has the historical data on funding rates broken down into subfield, so it’s purely conjecture.  Your claim is misleading at worst and purely conjecture at best.

      It is correct that we need to worry about cancer, and you nailed the reason: unfathomable complexity.  But I disagree and/or am offended by the remainder of your essay.

    2. This chemist worries about: cardiovascular disease, cancer, and Republicans. If you would like chemical things to worry about I highly recommend “Things I Won’t Work With”, a series of blog articles by Derek Lowe at In The Pipeline.  Search for FOOF.  I’ve worked with several of the “Things I Won’t Work With” but nothing like that.

  12. My two cents…

    Cancer is hard, because it’s not even vaguely one disease. It’s hundreds of diseases, on the edge of thousands, and we’re still studying genomics across large sets of patients and across tumor sets within a given patient. In many cases we’re finding that it’s not even the same disease in the same person, that it’s multiplied into many different ones from the same root.

    For some of these specific mutation/diseases we’re finding silver bullets; single drug or combo vulnerabilities that just work.

    For the rest, in particular when a given patient’s tumors start mutating in diverging ways, we’re not going to find easy solutions.

    For most things that can go wrong, we can fight immunologically, because no matter what bacteria or virus, it’s “the other” and never will do more than passingly resemble self. Immunology plus drugs (drug/antibody and antibody/radioactive tracer combos, etc) are opening further avenues. But cancer is “the self”. Unless the particular mutation expresses something at the cell wall we can’t tell cancer from self.

  13. Is nobody else bugged by the nonsensical quote at the top of the page?

    “Nothing can stop us worrying … when to stop worrying.”


  14. At least the war on the environment is going well.  Cancer-causing polluters have broad bi-partisan support!

    1. I read two articles, started to skim then scroll. Then I went back and started to count. Then I went back and started to count articles submitted by people outside western based academia…

  15. Why doesn’t Brian Peskin’s research in this area get more press?

    Just starve the cancer cells with dietary ketosis.

    1. I am not familiar with Peskin (thanks for the link!) but his research is unlikely to get press attention unless he establishes an contagious emotional meme devoid of scientific content.

      Keep in mind that William B. Coley cured several forms of cancer in the 1890s, but because the medical “authorities” decided that his methods were “unscientific” we have allowed millions of people to die rather than use that treatment.  You can see this pattern in many fields (LENR anyone?) but it’s particularly egregious in the field of medicine, where most people’s beliefs are astoundingly free from logic or reason (look at anti-vaxxers) and most doctors will let people suffer or die rather than use a method that contradicts their dominant meme.

      Article on Coley –

  16. Okay, you linked a colophon, a challenge, a hagiography of responders, the responses by index, then included something inline; you are not -about- to let the big C do SEO on; or this is some other kind of cyber attack. It feels more like the rewards in the Practical Oncology Supplement videogames are found wanting… 

    Peskin doesn’t get more press because ketosis induces some scarier mutations, often (not to say things are not sorted in clinical treatment by now.)

  17. Fortisquince, sorry that I’m not a “person of color”, but “people of color” have just as much of a right to post here as anyone else, and last time I checked, they get cancer too.  So why is it that this blog and subject does not seem to interest people of color?   I’d suggest that it is not Xeni’s fault which is an undercurrrent of your comment.

    So my white guy of 70 years comment…

    I’m a prostate cancer survivor, and for me, the astounding thing upon my diagnosis was to realize that while I’m very aware of the biological purpose of breasts, I was really not aware of the role of the prostate in male anatomy.   A quick informal survey of a number of my male and female friends found the same lack of knowledge.  

    My treatment was swift and decisive: prostatectomy via DaVinci robotic surgery.   Two days and nights in the hospital, no need for radiation or chemo follow-up, and nearly two years since first diagnosis, so far so good.  But I’ll never stop wondering…   And the treatment was not without it’s permanent price…a major change in how I work sexually.   I’m lucky to have an incredibly great girlfriend; I do enjoy sex in mostly “normal” ways; I’ve already fathered four wonderful kids; so I’m lucky to have been diagnosed and treated when I was.

    But what comes to my mind is how much money each and every tax payer is shelling out for the technology of dealing death…these days mostly in the Middle East, Western Asia, and now in Africa.   It costs one million bucks to train and send one soldier there for their first year of deployment.   How much does it cost to kill each Taliban fighter?   How much better could all that money be spent here at home on permanent good for us here and then the betterment of humanity.

    There is plenty of money to throw at wars that kill.   How about money for wars that save lives?

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