Lessons from 50 Years of the War on Cancer, Looking Ahead to the War on Aging

Today I'll point out a high quality commentary on what we might take away from the War on Cancer, launched 50 years ago. In the longevity advocacy community, the notable past success in building a cancer research community, as well as in persuading the public to support large-scale efforts to bring an end to cancer, are viewed as an aspirational goal. Over the years there has been talk of attempting to reproduce these successes in order to engineer public support for a War on Aging. There were many moving parts to the War on Cancer: decades of preliminary patient advocacy and lobbying; the evolution of public attitudes towards cancer and cancer research; progress in science and funding; the challenges inherent in the growth of a truly massive research community; the creation of a funding ecosystem to power that broad range of research. Much might be learned from an examination of each.

There are other lessons we might learn here, however, such as the modes of failure that emerge from focusing on diseases of aging, such as cancer, rather than on aging itself. Or that the wrong approach to a problem can absorb any amount of funding to produce only incremental progress. Diseases of aging are caused by the mechanisms of aging, yet little to no work made the deliberate effort to target those mechanisms until comparatively recently. Attempting to treat the disease, rather than its cause, inevitably has limited utility. As the author points out here, the War on Cancer was set up in a way that limits the scope of benefits to health that can result. Prevention is a noble goal, but cancer cannot be entirely (or even largely) prevented by lifestyle choices, as one cannot choose not to age.

50 years of the "war on cancer": lessons for public health and geroscience

Reflecting on the realities of the past 50 years of the "war on cancer", and the reality of the prevalence of comorbidity for populations surviving to the upper limits of the human lifespan, we cannot continue on the same course originally plotted out by the National Cancer Act of 1971. Today cancer is still the second leading cause of death in America. The project of behaviour control has not successfully altered this outcome, in large part because it does not alter the most significant risk factor for cancer - age.

I am not suggesting that public health should concede the battle and abandon the important preventative measures of smoking cessation and a physically active lifestyle. Of course not. But we should have the humility to recognize that doubling down on these efforts for the next half a century is unlikely to yield a significant health dividend for today's ageing populations. Strategic innovation in preventative medicine will be required. The strategy of behaviour control must be supplemented with the strategy of rate control. In order to unify the aspirations to "save people" from cancer mortality while also ensuring they live longer and better lives, the inborn ageing process must also be targeted. To fixate on disease elimination without also aspiring to alter the rate of ageing will prove costly with diminishing health returns because it does not increase the healthspan.

The public health lessons of the 50-year campaign to defeat cancer in the USA ought to inform global public health more generally. The European Commission, for example, has recently identified cancer as a "mission area". A House of Lords "Science and Technology Select Committee" UK report was released, the catalyst of which an assessment of the feasibility of the government's Ageing Society Grand Challenge mission. Chapter 6 of this report is entitled "The Ageing Society Grand Challenge", and it sets the goal of increasing healthy life expectancy by 5 years by 2035. The World Health Organization dedicated the decade 2021-2030 as the decade of "healthy ageing". The campaign identifies four main areas of action-age-friendly environments, combating ageism, integrated care and long-term care. These are all morally laudable, but incomplete, prescriptions.

Like the EU report on defeating cancer, what is missing from the World Health Organization's action plan is undertaking the committed action to develop an applied gerontological intervention to increase the human healthspan. Geroscience is an integral element of public health for today's ageing populations. Redressing the imbalance between the research funding invested in tackling specific chronic diseases vs the most significant risk factor for chronic diseases is critical. The past half a century war on cancer reveals the limitations of continuing on the path of disease elimination for populations that are approaching the upper limits of the human lifespan.

Strategic innovations in preventative medicine are required if we hope to improve the healthspan of today's ageing populations. To make serious headway in cancer prevention, we must target the most significant risk factor - biological ageing. Despite the limits facing behaviour control, there is good reason for optimism that the development of an applied gerontological intervention could help us achieve the important goal of rate control. Age retardation would ensure we improve the quality of life for older people vs simply preventing death by helping older populations manage multi-morbidity.

When President Nixon declared a "war on cancer" nearly 50 years ago, the success of the war was equated with disease elimination. That is a noble but unrealistic goal. Waging a war against an unrealistic goal is harmful for two reasons. Firstly, it means that large investments of public funds are invested into something that is not attainable (of the 200+ types of cancer, none have been cured or eliminated). Secondly, and more importantly, that investment in disease elimination imposed a hefty opportunity cost. Had those same funds been invested elsewhere, for example, targeting the ageing process itself, it could have yielded the population a much more significant health dividend. The primary challenge for today's ageing populations is not to eradicate cancer mortality but rather to increase the human healthspan.

Comments

Not sure if I agree that curing cancer won't be achieved. Yes it's been 50 years. But it's only been 20 years since the genome project, 10 years since RNA seq, and just a year since they figured out the CRISPR on/off thing. Plus we have AI coming along at a rapid clip to make sense of all the new information.

I think we are just starting to scratch the surface of how cells work. We can crack both cancer and possibly aging. I say possibly aging because aging really does seen to be everything heading towards entropy.. so.. can entropy be beaten? I don't know.

Posted by: Matt Pease at April 27th, 2021 4:26 PM

Just my anecdotal evidence:

Telling people I'm interested in "research to fight aging" has never been a good way to put it. "Research to increase healthspan" or "new forward/bold thinking on approaches to cure cancer, heart disease, alzheimers, etc" are much more palatable and accepted terms of phrase.

"The WAR on Aging" just seems a little tactless to me, if we are talking about a national campaign and if you really want to convince the average person to support this research.

Posted by: greg schulte at April 27th, 2021 5:09 PM

This reminds me of a TED talk in 2015 or so how in only a couple of years ahead we all would be able to spot cancer simply in the blood.
Well, six years later these blood tests still have a couple of years ahead of being market ready.
It's my personal prime example of a reminder not to understimate that available therapies will probably take much longer than you'd hope for.

Btw shouldn't the combination of early detection of cancer via blood test and a new set of immunotherapies in the near future (5-10 years) make cancer much much more treatable than it is now? Maybe to a point that it's even not a top cause of mortality anymore?

Posted by: Mark at April 27th, 2021 5:57 PM

I had a boss once whose favorite buzz-word was "defensible data". By that I mean it is allot easier to get government funding for conservative preventative measures that won't seem controversial to a government bean-counter type. More radical strategies that while they would be more likely to produce more significant results but are inherently riskier (like epigenetic reprogramming). Not even counting political hot potatoes like fetal stem sell treatments. Imagine what someone like the late Senator Proxmire ("golden fleece award fame) would have made of a stated goal to "cure old age"? An example is re-packaging two already approved drugs like metformin and rapamycin; easier to get FDA approval for that even though the results would likely be modest at best.

Posted by: Tim at April 27th, 2021 6:04 PM

And after 50 years of said war, people are still dropping like flies with the disease. And in my opinion, aging is going to be much more difficult to solve.

Posted by: mcmp at April 27th, 2021 9:19 PM

'War'... that sounds not like the half assed struggle, stumble even, against aging that happens now.

Posted by: Jones at April 28th, 2021 12:57 AM

@Matt Pease
One big issue , apart of the obvious age correlation, is that cancer is not a single disease but rather dozens and they are quite different from each other. Some forms are very treatable and there is a cure that leads to permanent remission. Others are a death sentence within the course of a few months. We have won many battles but not the war. It is still fairing much better than the war on drugs , for example. Even without revolutionary improvements, there are new treatments coming every year and slowly more and more forms get meaningful treatments. At some point of time we will have a cure for all forms of cancer (we know today). Question is will it be in the next 30 years or 300. It all depends on the rate of progress and how hard the problem is. We might get lucky and stumble on someting like antibiotics but for cancers. That would take care for 99% of the cases. There will be still one pesky percent that is too different.

Posted by: Cuberat at April 28th, 2021 10:39 AM

@Tom
Very interesting, not a treatment but a timely detection in many cases means the difference between life and death..

Posted by: Cuberat at April 28th, 2021 10:45 AM

@cuberat yes too find cancer early is important for treatment success, the fewer cancer cells you have the lower is the chance that there a resistant colones for a given treatment.

btw, there is another very interesting early detection company out there that claims they can build an MRI machine for your pocket, but they are much earlier, it's hard to say how far this will go.

https://www.openwater.cc/technology

Posted by: Tom at April 28th, 2021 11:33 AM

@Tom
Fair enough. The last thing I read is that the British NHS is going to run a trial until 2025 and maybe then it will become routinely available.

Living in Germany I don't think this test is available at all and even in the US you need a health care provider ordering for you. For me personally I am pretty sure that I won't be able to get tested in the next couple of years. You don't happen to know how much they price their test right now?

Posted by: Mark at April 28th, 2021 12:14 PM

If we are going to end aging by 2036 then we will probably need a war on aging and the diseases of aging, and using the two different approaches to ending aging which is accumulated damage and corrupted information.

Posted by: Tj Green at April 29th, 2021 3:46 AM

@Tom: I have got a proposal for a cancer blood test by https://precura.com/pantum-detect in Germany. Any comments on that one?

Posted by: Ralf Bendzko at April 30th, 2021 12:35 AM

War on Aging is not a good metaphor. Instead of killing enemies ,as in war, it is much better to to convert enemies to be your friends. -Curing Aging.
In war on cancer by chemotherapy, radiation and surgery cancer cells were killed but also many neighboring normal cells died.
It is much better to convert abnormal cells (senescent, cancerous) to become normal - conversion therapy.

"One cannot choose not to age" - This means humans don't have Free Will.
Also one cannot choose not to be born, and one cannot choose to live for ever (perpetually)
But one can choose to stop aging by going into cold storage (cryonics)and also stop living at
the same time. Or to stop Ravages of Aging by committing suicide. Sadly, this method of conquering Aging will also kill the patient.

Posted by: Nicholas D. at May 1st, 2021 8:56 PM

"But such a dystopic future need not become a reality, especially if we make an applied gerontological intervention (like we have with COVID-19 vaccines) a public health priority for all"
Interesting the comparison. However I am much less optimistic when seeing the huge disparity in vaccination between "rich" and "poor" countries, resp. 1 in 4 against 1 in 500. If there is a lesson to be leaned is maybe we seem learning nothing!

Posted by: albedo at May 4th, 2021 2:24 AM

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