An incredibly simple idea for early detection of cancer.

Original author: K McGowan
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Scientists invent a new way to fight cancer by recognizing the very first signs of illness


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In 2017, cancer can be number one. It will be a disappointing victory, given that heart disease has killed more people in the US every year for almost a hundred years. But it will not be a surprise: the number of deaths from heart disease and stroke decreases, and the cancer holds its position, constantly reducing the gap between them. And if he does not become the first this year, then soon it will happen anyway.

But now there is a new idea about why we are losing the war to cancer so long: our battle strategy is wrong. We usually wait until the tumor grows large enough so that it can be felt or seen before attacking it. But because of this expectation, we often meet with the enemy, as a result of years of evolution, turned into a cunning beast, full of bizarre mutations that allow it to interfere with any medicine.

Many researchers are practicing a new approach: holding instead of war. The idea is to turn off the tumors until they become dangerous, while the cells are still in a precancerous state - they are already modified and susceptible to cancer, but still malleable and can be dealt with.

Whatever we call it - interception, active prevention, early intervention - the concept remains constant: “Is it possible to intervene early enough to influence change, to knock off something that could potentially turn into cancer?” Said oncologist Matthew Yurgelan [Matthew Yurgelun] from the Dana-Farber Cancer Institute.

In a sense, this idea is a branch of the heavily undervalued traditional method. If everyone had followed the advice and quit smoking, had an active lifestyle, would have been protected from the sun and remained thin, we would have reduced the number of cancer deaths by half. Interception is the next logical step. As Paul Limburg, a professor of medicine at the Mayo Clinic and a researcher at the Cancer Prevention Network, says, "We are at the stage that gives the best opportunity to do something innovative to prevent cancer in all 30 years of my career."

Behind these changes are two big breakthroughs. The first is a new look at the deep and complex interaction of the immune system and cancer. Researchers took a long time to realize that the cells of the immune system for some time can restrain harmful cancer until it evolves enough to overcome this resistance.

And recently, the success of drugs such as Keytruda and Yervoy showed that spurred immune response can destroy even cancer cells at a later stage. Medications work with certain types of cancer and not all people, but they prove how powerful the correct stimulated immune system can be. Now scientists can not wait to find out what she can do in the early stages of the disease.

“If you can intervene earlier and strengthen the immune response in the early stages, to prevent the tumor cells from escaping the immune system, this can be an interception point,” says Yurgelan.

One promising way to do this is to offer cancer vaccines. Despite a series of setbacks, a recent study reports 1,200 projects looking for cancer vaccines, both preventive and for people with precancerous lesions in the intestines. The Nora Disis group at the University of Washington is finishing the first stage of a vaccine that it hopes to use against breast cancer in women.

The new generation of vaccines should be more effective than their predecessors. By applying a mathematical analysis to the decoded genomes, the researchers hope to predict what unusual changes in tumor cells can serve as good targets for vaccines, and mix them together into a cocktail that is suitable for heating the immune system. Searches for the best of these "neoantigens" are conducted in many groups. In December, the project of the new Shawn Parker Institute was announced, which more than 30 research groups and companies are working on, looking for such target cells in formed tumors. Spring is expected the first draft list.

In the future, it may look like this: a person with a high risk of cancer, judging by the genetics or the presence of precancerous formations (maybe a former smoker), donates tissue for analysis for suitable purposes - mutations or other incorrectly behaving proteins. He receives a vaccine designed for his type of tumor, or made to order specifically for him. He also receives immunotherapy medications that stimulate certain parts of the immune system and keep others. And if all this works, he may not have a tumor at all.

The second big discovery is the idea that cancer develops over time and that it is necessary to gain knowledge about how precancerous cell transformations turn into a threat. As Limburg says, “the disease is not cancer, but carcinogenesis.” If you know all about the stages of development, you can figure out how to stop them.

Good old aspirin effectively prevents intestinal cancer if taken long enough. It reduces the risk by 30% when taken daily for 10 years. But for a long time no one knew why, and since it was not known who he would help and who would not, they did not give broad recommendations for its use. Now that there is a better understanding of its action and the ability to check what types of tumors it prevents, it is possible to organize “accurate prevention”, which predicts who should be and who should not take aspirin. Moreover, in 2017 two large-scale studies on aspirin should be published, answering the question whether it reduces overall mortality rates.

Modern drugs for the treatment of emerging cancer can prevent the development of precancerous lesions. A breast cancer drug , for example, tamoxifen , for example, prevents about half of cancer cases in women at risk. Other studies are exploring whether other specific therapies designed for specific mutations can stop the development of tumors.

This year, rather than a change in treatment practices, a change in thinking will occur. In medicine, changes occur slowly, and the evidence of success in preventing disease takes painfully long time. In addition, although we know a lot about cancer, we still have a lot to learn about the mysterious life of pre-cancerous formations. What funny tumors will turn into dangerous, and what - no? Today it is difficult to say.

Liquid biopsy technology appears, analyzing blood for the presence of small pieces of DNA, which in the future can facilitate tracking what these cells are doing. It is now used to work with emerging tumors, but many technology developers hope to change the tests so that they are suitable for detection. But proof of the effectiveness of technology will take years.

Cancer researchers hope to copy the success of cardiologists, turning the disease from life threatening, requiring urgent radical treatment, into a problem that you prevent. “Cancer is slower and harder, but it will go the same way,” says Ernest Hawke, vice president of cancer prevention. "In the end, everyone will focus on preventing and treating cases that have leaked through these barriers, instead of what is happening now - when 90% of efforts are focused on treatment and 5% on prevention."

This will require a detailed understanding of the biology of cancer, new drugs and tests, and a massive campaign to change the nature of cancer in humans. And in 2017, this campaign finally begins.

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