When former U.S. Vice-President Joe Biden announced that Project Cancer Moonshot’s goal was to “eliminate cancer as we know it,” he lit a spark of hope around the world — and churned up an ocean of controversy.
“A lot of people reacted negatively to that, saying it’s just not possible,” says Dr. Jon Meddings, dean of UCalgary’s Cumming School of Medicine. “But in 50 years? I’m not sure that what he said won’t be true.” Indeed, as Meddings puts it, “the future of medicine is health — that is, the absence of disease. By 2067, we’ll be closer to that goal.”
Certainly, if anything’s going to get us there, it’s the advent of precision medicine.
Replacing the previous decades’ focus on “evidence-based medicine,” which was marked by the randomized controlled clinical trial, precision medicine treats individuals. “It’s about precisely understanding the diagnoses of an individual and why they have that disease,” says Meddings. “Why is breast cancer aggressive in one person and not another? What is it about an individual’s genes, their environment, their diet, their stress level — what has gone wrong that has been expressed as a disease?”
The upshot of precision medicine is the ability — thanks to our increasing capacity to harness big data for DNA analysis — to match the therapy to the specific cause of an individual’s disease. One big dream for medicine, says Meddings, is that someday we’ll visit our family doctors not because we’re ill, but to learn about our inherent susceptibility to certain diseases. “Your doctor would look at your genomic profile and environmental exposures reflected in your epigenome, as well as at other factors in your microbiome (see above), all of which could lead to disease.” You might find out, for instance, that you shouldn’t live so close to Highway 1 because you’re genetically susceptible to asthma.
Related to that aspiration is the hope — expectation, even — that many diseases will be eliminated in 50 years. “Research has helped us understand smallpox and polio, as well as childhood leukemia, which has basically been cured with drugs,” says Meddings. “In another 50 years, we could potentially eliminate inflammation-related diseases such as arthritis, depression, Crohn's, schizophrenia.”
Overall, Meddings would like a future that sees our health care system turned on its head. “The most expensive system is one that treats disease, and the least expensive is the one that prevents disease and maintains health,” he says.
Dr. Greg Cairncross is director of the Charbonneau Cancer Institute at the Cumming School of Medicine; here are few of his 50-year hopes and expectations based on UCalgary's focus of current cancer research:
- I can imagine that, one day, we’ll have tools to detect and treat nascent cancer on the pancreas, for instance, before it would be obvious in a CT scan.
- We’re testing the idea of a low-dose CT scan of the lungs to detect lung cancers early in people.
- I like to imagine that a day will come when you could take a tablet to eliminate your susceptibility for a genetic disease. Rather than undergo a double mastectomy, for instance, you would negate an inherent risk of developing breast cancer by taking a daily tablet, just as you would take medication for high cholesterol or diabetes.
- The dream for brain cancers in infants, children and adolescents would be to learn what might put them at risk during fetal development. I’ve often wondered if it’s some subtle maternal exposure — something in the environment, the diet, some incidental illness. If we could learn what it was, we could prevent it — just as spinal abnormalities are prevented by taking folic acid during pregnancy. What if we could prevent brain cancer in the same way?