By Shambhavi Naik
It’s a beautiful morning, where I proceed to unlock my phone to see the various ‘good morning’ messages on my WhatsApp. Amidst a host of forwards, I spot the latest one which tells me about the ‘amazing’ anti-cancer properties of bananas bearing black spots on their skin.
These spots, the message says, contain a protein that can prevent cancers. Now, I usually ignore such forwards, but this message was scientifically illogical at so many levels that I was prompted to reply. But more importantly, it got me thinking of the reason why such forwards make rounds so frequently; against the dread of cancer, any hope of prevention or cure is welcome news indeed. Every few days we come across articles claiming that the panacea for cancer has been discovered. It is true that cutting-edge research is being carried out to find a one-stop cancer treatment, but really, how close are we to it? I started my postgraduate research in cancer in 2006 with the utopian idea of finding the cure (and hopefully, winning the Nobel Prize in the process). After a few years of active research, I realized that the notion of finding an all-out cure for cancer might be impractical.
Instead I was reposed to ask another question: do we really need a pill that would cure all cancers? We are currently spending significant amounts of effort and money trying to figure out this panacea; but is the killing of the last remnants of cancer really so essential to warrant the scope of ongoing studies? A critical point to understand here is that having cancer cells in the body does not mean a person will immediately die. (Equally important is to take into perspective the fact that not having cancer does not make one immortal).
Let us take a practical approach to this: when does a cancer become a problem to the body? Cancer is the uncontrollable growth of cells which have lost their ability to correctly function. However, it is only when essential functions start getting affected, that we may realize that something is wrong with the body. Cancer cells are formed in our body nearly everyday, but these get killed or do not grow enough to cause trouble. But only when they start overtaking the healthy cells in the lung, does our breathing get affected.
So the question is, should our research really focus on managing cancer rather than trying highly aggressive methods to kill each and every cancer cell present in the body? At the molecular level, cancer is a fairly complicated disease. Not only is each person’s cancer different, but cells within the same patient’s disease are also not the same. What this simply means is that when we treat a person with one drug, it might not kill all of the cancer cells. Hence, doctors prefer giving patients multiple drugs. A common problem with most drugs is that they cannot distinguish between normal and cancer cells and result in all sorts of side-effects. A way to tackle this issue is to give drugs that would target the underpinning cancer-causing mechanism of the cells.
This approach has yielded promising results and is reforming cancer therapy into a personalized regime where each person’s cancer is mapped and treated correspondingly. A major success story has been Novartis’ Gleevec in the treatment of a certain type of leukemia. But this is not as easy as it seems – finding the cancer-driver is like finding a needle in a hay stack. This is also complicated by the heterogeneity of cancer; that is, not all cells within the cancer will have the same driver. And if this was not enough, the property that makes a cancer really dangerous is its ability to evolve. Cancer cells follow Charles Darwin’s “Survival of the Fittest” rule to the book and show a capacity to overcome most stresses thrown at them. This explains why a cancer reappears after extensive chemotherapy – some cells adapt to survive the chemotherapy and eventually grow out even in the presence of drugs. Another way to look at this is, what comes out of an aggressive therapy regime is probably a worse cancer than its predecessor. This also feeds into why I think finding the one-stop cure for cancer is impractical. As Dr. Malcolm says, “Life, uh… finds a way”.
But then, the question remains on how do we tackle cancer? In a nutshell, cancer is a genetic disease with strong effects on physiology and social facets of an individual. However, we see that different factions of our healthcare system; the physicians, scientists and social care workers approach this disease as individual groups and rarely engage in crosstalk. For treating such a complex and evolving disease, it is essential that a more holistic approach be implemented. It is particularly important that goals of these groups be aligned: to reiterate, the goal of treatment should be to make the patient cancer-free (preferably and this now works in select types of tumors) but with minimal compromise on their standard of life post-therapy. Simply damaging a patient’s system with a host of drugs to get rid of all cancer cells cannot be a good way forward. The approach should encompass picking up the cancer at an early stage, assessing the cancer pathology and following up post treatment.
The most successful treatment for cancer is surgery, that is, to remove the tumor mass completely before it spreads. For this, it is important to catch the tumor early on – increased access to screening and an awareness of its importance are critical for identifying cancer patients at an early stage. Basic research in cancer has to focus on effective delivery of existing drugs, identifying key cancer drivers and biomarkers which can diagnose cancer before it becomes pathological. An increased co-ordination between doctors and scientists is a pivotal point in delivering expert and efficient cancer treatment. There are multiple options for treating cancer patients currently; what is needed now is a more focused and directed approach. Emphasis needs to be given to create awareness towards development in the cancer field to alleviate fear regarding cancer. A stronger role played by the media to correctly communicate developments of cancer treatments is required to prevent raising false hopes amongst the public.
Coming back to incorrect and misinterpreted information, I will conclude with what is wrong with the banana WhatsApp message. Firstly, if a protein is present in the skin of the banana, it’s not going to get into your tummy by eating the banana. Secondly, if the protein does find its way to your tummy, it will get broken down into its constituent building blocks by enzymes. So, the protein is not going to enter into your blood or reach the cancer cells at all. Thirdly (and most importantly) the protein that the WhatsApp message talks about is in fact known to do both block and cause cancer. This is true of many food products, where contradicting studies show prevention or causation of cancer. Please take these studies with a pinch of salt and let common sense prevail when making lifestyle choices. The take home message here is that instead of waiting for the perfect cure/prevention to arrive, we have to better channelize our existing knowledge to get a more effective regime to prevent and manage cancer.
Shambhavi is a Research Scholar with the Takshashila Institution