An Urban's Rural View

It's been 53 years since President Richard Nixon declared war on cancer, and while some significant battles have been won, there's no end in sight. We are fighting the second "Hundred Years War."

The first, a series of conflicts between England and France, spanned 116 years, from 1337 to 1453. The second, too, might last more -- or hopefully less -- than a century. Either way, we are likely decades away from victory.

Cancer is second to heart disease as America's leading cause of death. (https://www.cdc.gov/…) More than 600,000 Americans died of cancer last year, nearly twice as many as 53 years ago. That doesn't mean we're losing the war. Adjusted for today's much larger population, deaths are down more than a fifth. (https://www.cdc.gov/…)

When the war began, scientists believed viruses were a major cause of cancer. They were beginning to accept exposure to chemicals as another cause. They doubted a propensity for cancer could be inherited.

In the late 1960s, two young doctors at the government's National Cancer Institute, Frederic Li and Joseph Fraumeni, began a decades-long research project that would help change scientists' minds about genetic predisposition.

The catalyst for their research was a 23-year-old father and a 1-year-old son who were being treated for cancer in the same hospital. Coincidence? Maybe, but it intrigued the docs.

Searching through databases and working with physicians and hospitals across the country, they slowly documented two dozen cancer-prone families. Families with many members with cancer, some with multiple cancers, some who contracted cancer at early ages.

Lawrence Ingrassia's family wasn't one of the 24, but it could have been. Larry and his brother Paul were colleagues of mine at The Wall Street Journal, and I remember hearing in the early 1980s that Paul's 2-year-old son, Charlie, had been diagnosed with cancer.

What I didn't know was that their mother had died of cancer at 42 and one of their sisters of another cancer at 24. Later, cancer took the other sister at 32, Charlie would die of his third cancer at 39 and Paul would go on to fight four cancers before finally succumbing at 69.

Why was this happening? Larry's new book, "A Fatal Inheritance: How a Family Misfortune Revealed a Deadly Medical Mystery," (https://www.amazon.com/…) chronicles how scientists answered that question.

As one of the cover blurbs aptly puts it, the book "intertwines a deeply personal and tearful story of unbearable family loss with an inspiring story of scientific discovery that revolutionized the understanding and treatment of cancer."

Inspiring, the story is, but don't let that word fool you. The work was slow and painstaking and done by many different scientists with different skill sets. An early study boosting the inheritability theory was based on complicated math rather than laboratory experiments.

A key laboratory finding -- it won a Nobel Prize for J. Michael Bishop and Harold Varmus -- was the discovery that cancer could be caused by a mutation in a normal gene rather than being caused by a virus. Two other scientists, one in the U.S. and one in Britain, found a critical gene that seemed present in cancers without knowing that its function was not to cause cancer but to fight it.

Still other scientists worked out which gene was the culprit. And yet others uncovered where the mutation was located on this critical p53 gene.

It turned out earlier scientists were wrong in thinking most cancers were caused by viruses. Some 10% to 15% are, but the vast majority are environmental, with 5% to 10% genetic.

Still, the hundreds of millions of dollars spent trying to prove the virus theory weren't totally wasted, Ingrassia writes. Bishop and Varmus were funded out of virus-theory research money.

For all the progress scientists have made in this and other lines of cancer research, cancer is far from licked. Survival rates for many types of cancer have improved, but they're still low for others. Drugs targeted at the p53 mutation have largely disappointed, though new ones are in trials now.

Americans' trust in science has declined in recent years. Reasonable people can disagree about why. Scientists aren't always right. Even when they are, people don't always like what scientists tell them. It would be interesting to poll commercial farmers and ranchers, who depend on science more than most Americans, on their level of trust in science.

"A Fatal Inheritance" shows science at its best -- creative, collaborative, hard-working, evidence-based. The reader comes away thinking yes, cancer is much more complicated than Nixon imagined, and yes, conquering it may take a hundred years -- but someday, the scientists will win.

Urban Lehner can be reached at urbanize@gmail.com

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