• Michael Misialek, MD

Cancer Prevention and the Moon Shot

In President Obama’s recent State of the Union address, he unveiled his plan to cure cancer, the so called “Moon Shot”. Analogous to President Kennedy’s announcement in 1961 to land a man on the moon by the end of the decade, Obama tasked VP Biden with the lofty goal.

Heart disease is the number one killer in the US, claiming more than 600,000 lives a year. Cancer is a close second at more than 580,000. Experts predict cancer will overtake heart disease in the coming years. This will create increasing demands on an already stressed system. Cancer experts (oncologists) are in short supply across the country. With the Affordable Care Act, more patients have health care coverage and as such, are enrolled in the system. More cancer screening tests are being covered, with more cancers being found. However, many patients face barriers to access to care.

Precision medicine has revolutionized the approach to cancer care. Successes have led to more cancer survivors. This places more burdens on the system as survivors require need close follow up, being at risk for second cancers.

Escalating drug prices are another problem with some treatments costing hundreds of thousands of dollars a year. All this is coming together to create a national crisis. What if we could prevent all of this by preventing cancer?

What’s the latest in cancer prevention?

We have made great progress in precision medicine and battling cancer. Can this same technology be applied towards prevention? From the American Association for Cancer Research, the following highlights have given optimism in cancer prevention:

Genomic studies have identified a premalignant state of clonal hematopoiesis for blood cancer, driver mutations in the blood of patients with epithelial premalignant lesions, and the elusive premalignant lesion of melanocytic neoplasia.

  • Significant progress has been made in the development and implementation of HPV screening and vaccination.

  • There have been major advances in the development non-viral vaccines for colon and breast cancer, including novel vaccines for Lynch syndrome and BRCA mutation carriers.

  • The U.S. Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts who make evidence-based recommendations about clinical preventive services, recommended low-dose aspirin for colorectal cancer (CRC) prevention based on age and risk, and the first precision medicine trial was reported, beginning a new era of molecular selection in cancer prevention.

  • Studies of the biology of tumors that develop in individuals with cancer predisposition gene mutations established new chemoprevention for familial adenomatous polyposis syndrome and universal tumor screening guidelines (based on DNA mismatch repair mutations and microsatellite instability) for CRC in Lynch syndrome along with new data from a large-scale National Cancer Institute (NCI) National Clinical Trials Network study supporting expansion of this novel screening approach to endometrial cancer.

  • Remarkable technological developments in genomics, including single-cell sequencing, supporting the creation of a “Pre-Cancer Genome Atlas” or “PCGA”

  • Finally, researchers clinically validated the first genomic markers for standard early detection of colon and lung cancer. This next generation of molecular testing holds the promise to detect biologically aggressive lesions, which would be absolutely transformational.

We are entering a new and exciting time in cancer care. As we better understand the molecular and cellular events that lead to cancer, there is much hope for cancer prevention. This is a new era of precision medicine and immune-oncology in cancer prevention.

#cancer #cancerscreening #cancerprevention #moonshot

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