1: “Our first and most obvious wish is to avoid getting cancer at all,” Peter Attia writes in his powerful book Outlive: The Science and Art of Longevity.
“But cancer prevention is tricky,” Peter notes, “because we do not yet fully understand what drives the initiation and progression of the disease with the same resolution that we have for [heart disease].”
Peter defines the four deadly diseases that will kill most of us as “The Four Horsemen:” Heart disease, cancer, diabetes, and Alzheimer’s or neurodegenerative disease.
Of these, cancer “is probably the hardest to prevent. It is probably also the one where bad luck in various forms plays the greatest role,” he writes. “The only modifiable risks that really stand out in the data are smoking, insulin resistance, and obesity (all to be avoided).
Not only that but “our treatment and prevention strategies remain far less effective than the tools that we have to address cardiovascular disease and… type 2 diabetes.”
2: Peter believes that short of a “miraculous breakthrough,” we will not “cure” cancer anytime soon.
There are, however, strategies we can utilize to combat cancer. His #1 tactic: “Early detection is our best hope for radically reducing cancer mortality,” he writes. “This remains a controversial topic, but the evidence is overwhelming that catching cancer early is almost always net beneficial.”
His recommendation: “We need to focus far more energy on early detection of cancer, to enable better targeting of specific treatments at specific cancers while they are at their most vulnerable stages.”
If the first rule of cancer is “Don’t get cancer,” the second rule is “Catch it as soon as possible.”
“Too many cancers are detected too late, after they’ve grown and spread,” he writes. “Very few treatments work against these advanced cancers; in most cases, outside of the few cancers that respond to immunotherapies, the best we can hope for is to delay death slightly.”
The data is clear. When cancers are detected early, the rate of survival goes up dramatically.
“This is partly because of simple math: these earlier-stage cancers comprise fewer total cancerous cells, with fewer mutations, and thus are more vulnerable to treatment with the drugs that we do have, including some immunotherapies,” he writes.
Exhibit one: Colon cancer.
“A patient with metastatic (advanced) colon cancer, which means the cancer has spread past their colon and adjacent lymph nodes to another part of the body, such as the liver, will typically be treated with a combination of three drugs known as the FOLFOX regimen,” Peter notes.
“This treatment yields a median survival time of about 31.5 months, meaning about half of patients live longer than this, and half do not. Regardless, virtually none of these patients will be alive in ten years.”
Compare this reality with what happens if the colon cancer is caught before it spreads so the tumor can be removed surgically.
“The follow-up care is treatment with the exact same FOLFOX treatment regimen,” Peter writes.
“But in this scenario, fully 78.5 percent of these patients will survive for another six years—more than twice as long as the median survival for the metastatic patients—and 67 percent of them will still be alive ten years after surgery. That’s an impressive difference.”
The data regarding breast cancer is similar.
“Patients with HER2-positive metastatic (advanced) breast cancer can expect a median survival time of just under five years,” he shares, “with standard treatment consisting of three chemotherapy drugs.”
What happens if the cancer is caught early enough so that the tumor can be surgically removed?
“She will have a 93 percent chance of living for at least another seven years without disease,” he notes. “It’s a numbers game: the fewer cancerous cells we have, the greater our likelihood of success.”
3: Our challenge? We aren’t very good at detecting cancer in these early stages. Yet.
“Out of dozens of different types of cancers,” Peter writes, “we have agreed-upon, reliable screening methods for only five: lung (for smokers), breast, prostate, colorectal, and cervical.”
However, one new technique in particular shows great promise: Liquid biopsies. While “this technology is still in its infancy,” Peter is hopeful about the long-term implications.
“Liquid biopsies could be viewed as having two functions,” he writes. “First, to determine cancer’s presence or absence, a binary question; and second and perhaps more important, to gain insight into the specific cancer’s biology. How dangerous is this particular cancer likely to be? The cancers that shed more cell-free DNA, it seems, also tend to be more aggressive and deadly—and are thus the cancers that we want to detect, and treat, as soon as possible.
“The implications of this, I think, are seismic: if liquid biopsies deliver on their promise, we could completely flip the time line of cancer so that we are routinely intervening early, when we have a chance of controlling or even eliminating the cancer—rather than the way we typically do it now, coming in at a late stage, when the odds are already stacked against the patient, and hoping for a miracle.”
The bottom line, according to Peter?
“More than fifty years into the War on Cancer, we can finally see a path to a world where a cancer diagnosis typically means an early detection of a treatable problem rather than a late discovery of a grim one. Thanks to better screening and more effective treatments such as immunotherapy, cancer could someday become a manageable disease, perhaps no longer even qualifying as a Horseman.”
More tomorrow!
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Reflection: Have I, a family member, or a close friend battled cancer? If so, what were the lessons I learned? How has this experience impacted me? Does anything surprise me about the metrics regarding cancer?
Action: Journal about my learnings.
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