Provocative Questions

Provocative Questions

Anees B. Chagpar, MD, MPH

May 08, 2011

A few nights ago, I was invited to speak to the Board of Directors and Major Donors of the Breast Cancer Alliance. A hush came over the crowd as I described the real advances we are making in breast cancer research and treatment – how we are now able to sequence the human genome, determine genes that are turned on or off in cancer, concoct drugs to specific targets and spearhead clinical trials to eliminate the offending cells in a personalized fashion. We talked about all of the research we have ongoing from prevention to survivorship and how each piece of this complicated puzzle is moving us closer to making our patients cancer-free . . .

And then the question-and-answer period came and there were two questions that stumped me. The first was “Where should we spend our money to have the greatest impact?” Clearly, understanding the molecular basis of this disease is critical, and the translation of such research into clinical practice will revolutionize our current paradigms of care. Equally important, however, is work to try to prevent cancer in the first place, to treat it in the most cost-effective and efficacious manner, and to improve the quality and quantity of life in our burgeoning population of cancer survivors. Vaccines, nanotechnology, stem cells . . . all highly innovative, potentially groundbreaking areas of research. I was glad to see that I wasn’t alone in my struggle to find the singular silver bullet meritorious for funding when the NCI recently released its series of “Provocative Questions”, which they defined as important controversies and paradoxes in cancer research that have received insufficient attention.

The second question, equally perplexing, was “What are the barriers to finding the answer to cancer?” – we made it to the moon, we knocked out polio and smallpox, so why can’t we figure out cancer and stop it? Are we inhibited by a lack of time, money, and/or ideas? Or is there a preponderance of governmental regulation and bureaucracy that stands in our way? Certainly, there are many brilliant people around the world who have dedicated their lives to working on this complicated problem, each approaching it from a different angle. It will take time, energy, and effort, not to mention significant funding to move this work ahead. However, with strong collaboration between clinicians and researchers from across disciplines, institutions, and indeed borders, I am confident we will get there someday, and likely sooner than I would have thought a few years ago . . . perhaps, as Coolidge said, we must simply 'press on'.


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