Can the NBCC End Breast Cancer by 2020?

They think  so.

The National Breast Cancer Coalition (NBCC) is setting a deadline: End breast cancer by 2020. Breast Cancer Deadline 2020. It is time.

Taking a “just do it” approach, the NBCC has decided that by setting a deadline, they can make it happen.

In setting this ambitious goal, the NBCC criticizes the incremental advances in oncologic research that may take a drug to market but not actually impact long term survival from cancer or prevent it in the first place. (For example, Avastin, which is making billions for its manufacturer while not saving a single life from breast cancer to date.)

Researchers and the media often celebrate small accomplishments. We have been conditioned to believe that a drug that may extend life a few months is a breakthrough, that a 2% reduction in mortality is promising, that tumor regression or stabilization are cause for celebration, even though at that point there is no way to determine if anyone’s life was actually prolonged. We have settled for these limited, incremental changes along with the platitude “early detection saves lives” for too long.

While not doubting the integrity, sincerity and dedication of researchers, the NBCC appears to have lost patience with the system that creates and supports them and the industries that benefit from their discoveries.

More than 40 years and billions of dollars have not ended breast cancer. It has, however, created a robust cancer industry that thrives on raising awareness and producing drugs, screening devices and genetic tests. It has also created an academic system that generates hundreds of thousands of articles about breast cancer and builds careers for thousands. Although there is no doubt individual researchers sincerely want to end breast cancer, every system is perfectly designed to achieve the results it gets. The current system is perfectly designed to be lucrative, cautious and incremental.

They appear to be looking for an “outside the box” approach to breast cancer prevention and treatment that bypasses the conventional research and pharmaceutical industrial complex, and focuses solely on the eradication of breast cancer in a decade.

Their first initiative is the development of a breast cancer vaccine.

As our first project in the campaign we are currently working with a diverse group of stakeholders to create a five-year strategic plan to catalyze the development of a preventive breast cancer vaccine that could revolutionize breast cancer prevention.

My take

While I sympathize with the NBCC’s frustration with the research and pharmaceutical infrastructure, and with the lack of significant progress towards a cure for breast cancer, this 10 year goal is looking a bit pie in the sky to me.

They make comparisons with the eradication of polio. But they forget that we knew what caused polio – a single virus. We don’t even know yet what causes breast cancer –  so developing a vaccine against it seems premature. Even if we were to develop a vaccine, the long lead time to development of breast cancer mandates much longer than a 5-10 year project to prove efficacy. And let’s not forget subject safety – we can’t throw caution to the winds here, folks, or we risk losing even more lives to the race for the cure.

They recall John F Kennedy’s race to the moon – a goal that was clearly defined and visible in the night time sky to any child, and the path to which could practically be drawn with one’s hand. But the multi-factorial nature of breast cancer means that there are dozens of moons, in solar systems we cannot even see, with hundreds of possible paths to get there, and thousands of dead ends on the way.

We just may not be close enough to get there in 10 years.

I am reminded…

The NBCC ultimatum reminds me of two women I know who gave their longtime live-in boyfriends a deadline of New Year’s Eve to propose or get out.  That first one gave her ultimatum over 25 year ago, and it worked – they are still married today. The other gave hers just last year, and well, you can guess the outcome – he moved out.

While a 10 year deadline may have worked years ago – when science was simpler and the problems less complex –  such an approach may be a bit outdated today. After all, we have pretty much tackled the simple stuff and are on to the complicated things like cancer, drug resistant infections, HIV and the multi-factorial problems of hypertension, obesity and dementia.

If we knew how to do it, we would have done it by now.

All of this could change, by the way

A deadline would work, by the way, if we were to find a single necessary cause for all breast cancers – in the same way  we now know that the HPV virus causes cervical cancer.

If this were to happen, then yes, we could eradicate breast cancer – maybe not in 10 years,  but certainly in my children’s lifetime.

That same potential now exists to eradicate cervical cancer – if we could develop a vaccine that targets all the cervical cancer causing strains. Instead, we are vaccinating girls right and left with a vaccine that will certainly prevent some cervical cancers, but will never eradicate cervical cancer because it does not target the entire range of viral strains that cause cervical cancer.  It has, however, brought millions of dollars to the pharmaceutical companies that have developed it.

In this sense, I share the frustration of the members of the NBCC, who see profit-driven goals impeding the long term goal of disease eradication.

So I guess I’ll just wish them all the best in their efforts.

And send them a check.