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Imagine your challenge: Hundreds of wires, tools, and engine parts are strewn across your backyard, in no particular order. Your mission? To build a car. The problem? You're not quite sure what all the parts are for.

That's how oncologist and cancer researcher Brian J. Druker, M.D., explains the job facing him and others in the cancer community.

Druker, along with pharmaceutical company Novartis, is responsible for the development of Gleevec - a molecularly targeted pill that successfully treats many cases of chronic myelogenous leukemia (CML). It is a monumental leap in the approach to cancer, and it's not the only one. Cancer experts today know more than they ever have about how cancer develops, how it can be stopped, and how to lessen its burden on people. And all this knowledge has put a pile of new tools and parts at our disposal.

The Future of Cancer Research
"New" methods of cancer prevention, detection, and treatment have their roots in research that has been going on for decades; but it's now adding up to a rapid breakthrough rate and tremendous potential for the coming years.

"Much of what we've learned is coming to fruition now," says Robert Young, M.D., national volunteer president of the American Cancer Society and president of Fox Chase Cancer Center in Philadelphia. "This accumulation of understanding has revolutionized the way we deal with this disease and how we see ourselves conquering it eventually."

Cancer genetics: Only a minority of cancers has a straightforward inherited cause; but combined with behavioral and other factors, genes can play a major part in determining who gets cancer. Individual genes have been identified that indicate susceptibility to many distinct types of cancer, as well as behaviors that lead to cancer - such as a genetic predisposition to nicotine addiction. This means scientists can predict, in many cases, who faces the highest cancer risk. But that prediction itself raises questions: Once someone at high risk has been identified, how does that person make difficult decisions about risk-reduction strategies that may come with serious side effects?

"It's like being able to see every card coming up in the deck, but not knowing how to reshuffle them," says Dr. Young. The next challenge is understanding what can be done with this knowledge.

Chemoprevention: Researchers now know that there are compounds that can intervene in the transformation of a normal cell into a cancer cell, effectively stopping cancer before it starts. These range from compounds found in nature - such as those in broccoli, soy, and tea - as well as synthetic agents such as tamoxifen for breast cancer and cox-2 inhibitors like celecoxib for colon cancer. The hope is that chemoprevention strategies can be tailored to stall the development of cancer in susceptible individuals long before invasive disease sets in.

Monoclonal antibodies: Produced in the lab, a monoclonal antibody fits like a lock and key with a protein on the cancer cell, making it capable of detecting or even killing cancer. It can be used alone or attached to a toxin, radiation source, or chemotherapy drug as a delivery vehicle. As researchers discover more cancer markers, they will be able to direct monoclonal antibodies against more and more cancers.

Rational drug design: Using information gained from decades of studying the biology of cancer cells at the molecular level, researchers are learning how to focus a drug's attack on only cancer cells. This targeted approach is typified by Gleevec and drugs like it, which leave normal cells largely unharmed. These treatments cause fewer side effects than traditional cancer therapies, showing promise for treating a wide range of cancers with high success and better quality of life.

Angiogenesis inhibitors: These drugs are designed to starve tumors by cutting off their blood supply, preventing the formation of the new blood vessels that supply tumors with oxygen and nutrients. Many scientists now believe tumors cannot grow large enough to be life-threatening without these new blood vessels. Studies continue to investigate the effectiveness, best timing, and safety of these drugs.

Cancer vaccines: Vaccines for cancer work much like traditional vaccines against infectious diseases. Unlike vaccines for infections, however, most cancer vaccines are designed for treatment rather than prevention. Containing substances derived from cancer cells, they trigger the body's immune system to respond against cancer cells already in the body. This new therapy is yet another that holds promise for being targeted, effective, and largely free of side effects. In clinical trials, dramatic results have been achieved against melanoma, and vaccines against lung, prostate, breast, and other cancers are in the pipeline.

Oncolytic viruses: These viruses have oncolytic, or cancer-killing, properties - either naturally or through laboratory manipulation. Designed to selectively infect cancer cells without harming healthy normal cells, the viruses replicate within the cancer cells, killing them. Far more remains to be understood about the potential and safety of this therapy, which is being tested on several different cancers.

Cancer survivorship: There are nearly nine million American cancer survivors alive today. Many of them, including survivors of childhood cancer, still carry lasting effects - physical and emotional - of their treatment. Research into survivorship issues is a relatively new field that examines the physical, social, psychological, emotional, and spiritual needs of cancer survivors. It could result in a better understanding of how we can maintain high quality of life long after the cancer experience is over.

Comprehensive Approach
The research is enormously promising, but it isn't the only answer to eliminating cancer as a major health problem, says Dr. Young.

"About one-third of cancer deaths in the US each year are due to nutrition and physical activity factors, including obesity," he explains. "Another third can be attributed to tobacco use. That's fully two-thirds of fatal cancers people could avoid entirely if they changed their lifestyles."

Early detection practices have a colossal impact on cancer as well. Consider the example of colorectal cancer (commonly known as "colon cancer"): Half of the roughly 148,300 annual deaths from this disease could be avoided if all Americans 50 or older got regular tests to detect colon polyps.

Understandably, people are confused about early detection. The differing opinions of doctors and stories in the news about tests from mammograms to the PSA test are enough to make anyone a little hesitant.

But while scientists search for better methods of early cancer detection, they also encourage people to take advantage of the best that's available now. That's why, for example, the American Cancer Society continues to urge women 40 and older to have annual mammograms, while also urging regular breast self-exams and clinical breast exams for all women 20 and older.

"There's a critical combination of healthy lifestyle habits and diligent early detection testing that could prevent thousands of families from having to suffer the loss of a loved one to cancer," says Dr. Young. "We just have to keep helping people know what to do."

Closer Than Ever
Experts now believe we will see a world in which cancer is a far less common, easily treatable disease. But getting to that vision will require overcoming some hurdles.

For example, the future of research depends on continued increases in government and private research funding. And all the new directions in cancer research rely on clinical trials to move forward.

In trials, patients receive either the current standard of care or investigational treatments that may be even more effective; and what's learned from these studies is crucial to improving future cancer care. (Patients looking for clinical trials can soon call the American Cancer Society at 1-800-ACS-2345 or visit www.cancer.org to take advantage of a clinical trial matching and referral system that helps people get immediate access to clinical trial opportunities across the country.)

Public support is needed too, to make sure lawmakers hear the demand for better policies that enable people to get the care they need. And organizations such as the American Cancer Society count on volunteers and donors to make progress against cancer every year.

"We're on the right track," Druker says. "We have great hope and optimism for the future. But we can't be complacent. We must seize the momentum now."

Dr. Harmon Eyre is the chief medical officer and executive vice president for research and cancer control at the American Cancer Society.

The American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from the disease through research, education, advocacy, and service.

For cancer information or volunteer opportunities - or if you'd like to learn about the Society's many support programs for cancer patients and their families - call toll-free anytime, 1-800-ACS-2345, or visit www.cancer.org.

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