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