Cancer & Me
Most people know Bernadine Healy, U.S. News health editor, as the former head of the National Institutes of Health and the American Red Cross. They might not recall that she was diagnosed with a brain tumor eight years ago. In a new book, Healy uses her unique perspective and personal struggle with the disease to explore the state of cancer research, care, and treatment today—and tomorrow.
My brief reverie was interrupted when neurologist Hans Luders appeared over me holding my homework—a literary passage I was to read again and again during the operation. Like a third grader reading aloud in front of the class, I tried to pronounce each word perfectly, though the words seemed odd. I asked Luders if this passage made a lot of sense to him, and he laughed. To me, it seemed out of context and very flowery, not at all a passage that I would have chosen for this critical moment in my life. But, hey, who was I to be choosy? Just as I was feeling comfortable about my ability to handle this strange experience, Barnett told me he was finishing up and all was well. He had removed about half of the tumor and had plenty of tissue for further studies.
My tumor was of the less common variety, called an oligodendroglioma, a rather obscure tumor that was just starting to make a splash because of its unusual genetics. Recent studies at the University of Toronto suggested that at least one subset of this tumor, when it carried a particular genetic profile, was surprisingly responsive to therapy—including chemo.
As the tumor diagnosis sank in, I knew the life detour that my family and I now faced would not be easy and would be drawn out. In fact, that was part of the reason I had chosen cardiology as my field of specialty and not oncology. Cardiovascular treatments seemed so precise, predictable, and relatively kind to the body. And they were just so beautifully logical: If you have a coronary blockage that is limiting blood flow to the heart, bypass it with surgery or open it up with an angioplasty catheter. If blood clots are forming, administer a blood thinner. The treatments are visible, their common-sense results almost immediate. That's what I wanted as a young doctor, and it's what I longed for as a patient as well: Lay out the treatment, get rid of the problem, and let me be on my way.
This is not the case for most patients who face invasive cancer. Cancer treatment has a risk-benefit analysis all its own; the therapy is rough and toxic to an extent that seems almost to challenge the medical precept "First, do no harm." If this is going to change, it will be for one major reason: Because cancer is a disease of genes and their proteins, we must understand their networks and interactions.
Fortunately, the revolution is already underway. The Human Genome Project was a boon for accelerating our knowledge about genes, the masters of cancer's fate. As a follow-up, the Cancer Genome Atlas will put the focus on cancer treatment, sketching out blueprints for the dysfunctional molecular networks that turn a cell cancerous. And sifting through the genetic and molecular profiles of individual cancers has exposed a big secret that misled many treatments of the past: What seem to be identical tumors under the microscope can be markedly different where it really matters, in the genes and proteins. This is a crucial discovery, explaining for the first time why a tumor melts away under a particular therapy while another of the same type is barely touched, why one tumor returns in a few years yet another disappears for a lifetime. And it is a discovery that demands a rethinking of the traditional treatment approach, in which any and all cells with rapidly replicating DNA—malignant or not—are attacked as if they were known enemies of the body. The new era instead relies upon an armory of laserlike drugs, some old, some new, some yet to be devised, that specifically target deranged genetic pathways and swoop in for the kill, leaving the innocent bystanders intact.
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