To date, there is no satisfactory explanation for cancer initiation. Does cancer start in one cell because a handful of its genes malfunctioned, or because thousands of its genes have gone haywire simultaneously? Maybe it has nothing to do with genes. Or even the cell. What if the organ itself is diseased, pushing a cell to take off on a tangent? Maybe all of the above or none of the above?
Whatever the proponents of a given theory claim, progress in treating metastatic cancer is basically a flat line for the last century. The fact that advanced cancers continue to kill at the same rate today as they did back in 1931 means the theory is less than adequate. Current models may have clarified the biology of cancer but they are, by and large, not helping patients. Something has to change. Attitudes, for one. [...]
The Covid19 lockdown provided me with an unexpected opportunity to invest a year into reviewing the existing literature regarding carcinogenesis thoroughly. As expected, the exercise ended up with more questions than answers. It was sobering to realize that it is not just my education that is lacking but the field itself is shockingly clueless. More shocking is the cluelessness about its own cluelessness. Which makes for a kind of confidence in ignorance that is dangerous and costing millions of lives a year. [...]
Since my careful re-examination of the scientific literature led to startling insights, it was a productive exercise after all. For one thing, a surprising number of anomalies in the existing cancer models seem to have simply been ignored or tossed aside through implausible explanations (confirmation bias much?). For another, few researchers seem interested in the steps leading to transformation. There is a serious dearth of effort directed at understanding the happenings in and around The First Cell prior to the actual transformation. Of course, one reason so little is known about the genesis of cancer is that cancer is a silent killer. Even the tiniest recognizable tumors contain hundreds of thousands of malignant cells. How does one go about looking for The First Cell when the disease is already so advanced even at Stage I? Another problem is that the research community has been seduced by the promise of molecular biology since the 1970s. Using this newfound tool to interrogate DNA, researchers became overconfident in their ability to reduce the complex cancer problem down to a few genes whose abnormal proteins could then be targeted through Magic Bullets to achieve cures. Unfortunately, the problem turned out to be far more complex. Of the two hundred or so cancers that have been catalogued systematically, this one-cancer-one-mutation-one-drug strategy has successfully cured exactly two.
As always, there is more at the link.
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