“What’s the point of funding cancer research?”

After reading through the comments on the kidney cancer/NICE post, one question crops up again and again – “What is the point of donating money to cancer research if the resulting drugs are too expensive to give to patients?”

This is a very good question, and one that’s clearly rumbling around the public consciousness at the moment. So here are some very good answers as to why giving to cancer research charities is very definitely a great investment.
‘Treatment’ is not just about drugs
Firstly, improving cancer treatment is emphatically not just about developing and testing better cancer drugs. Certainly, drug discovery is a vital part of what we – and others – do. But it’s a huge oversimplification to think that the story begins and ends with drugs.

For a start, cancer treatment almost always involves either radiotherapy or surgery – both areas of intensive research that aren’t so attractive to commercial funders. To this end, we’ve recently made a big investment in a new radiobiology research institute in Oxford.

But cancer also needs to be diagnosed, and treatment needs monitoring – so there are huge efforts underway to improve and speed up cancer diagnosis and to find ways to monitor the success – or failure – of treatment.

For example, almost every week we see a new paper that finds a new potential biomarker to detect cancer, and all of these need to be followed up in larger research studies. (Some examples here, here and here).

Screening is another important aspect to beating cancer – the earlier you can detect cancer, the greater the chance of a successful outcome. So we’re investing in a number of projects looking at cancer screening, including UKCTOCS – a study to test the benefits of ovarian cancer screening in 200,000 women.

Cancer research is not just about improving treatment and detection
Understanding what causes cancer, who gets it, and why, is a huge area of research. For example, we know that our diet is very important in determining our risk of cancer – yet we’re still very much in the dark as to how. Huge studies are going on across the world looking at how diet and other lifestyle choices can affect our risk of the disease. For example, we’re funding the two UK arms of EPIC – the largest study of diet and cancer ever undertaken.

And no consideration of ‘cancer research’ is complete without mentioning the worldwide hunt for new cancer genes. Gene hunters have had notable successes, finding ‘strong’ predisposition gene faults like those in BRCA genes – but now they’re trawling the net wider to find the small genetic variations linked to cancer risk. And this research is time consuming, expensive and slow-paced, yet fundamental to our understanding of who gets cancer and how to treat them. Over the past year or so we’ve seen the discovery of new genes linked to breast, prostate, bowel and lung cancer – and many of these studies were funded by Cancer Research UK.

A lot of science fails
But, thinking back to the lab – in its purest form, science is a slow, methodical process of testing theories and finding out which ones work. For every medical breakthrough, for every Herceptin, there were hundreds of blind alleys and failed ideas – that’s the nature of science.

If a researcher could be sure that an experiment would work at the outset, it wouldn’t tell him or her anything new, and would be a waste of time and money. It can be a frustrating, lonely process – in the lab, there’s as much luck as there is judgement. Thankfully, even a ‘failed’ result adds to the sum total of human knowledge – if the failure is noted and communicated, no-one else will make that mistake again.

Science is cumulative
Moreover, each scientist’s work builds on the work of their predecessors. No breakthrough, no discovery, no progress, would be possible without the years of research that lays down the groundwork.

In the early stages, much of this groundwork might be viewed as ‘blue skies’ research – not profitable for pharma companies to fund, so it falls into the hands of the research charities or Government-funded scientists. A good case in point here is Herceptin – although much of the later development work was done by Genentech, Cancer Research UK scientists and others around the world put in years of painstaking background research, enabling us to understand the role of the molecule (HER2/ErbB2) targeted by the drug.

Cancer research charities don’t just do research
It’s also worth pointing out that the money given to cancer charities goes a lot further than just funding scientists and doctors to do research.

Indeed, without the concerted efforts of several medical research organisations, and others, the UK smoking ban may not have happened – something that will help save thousands of lives every year. Another good example is the introduction of the bowel screening programme – pressure from cancer charities, not to mention a few uncomfortable news headlines, helped to make it a reality.

It’s easy to feel a sense of futility when NICE turns down yet another cancer drug, or when we hear the latest horror stories about the NHS. But in fact charity supporters should feel empowered. For example, more than a million people are regular supporters of Cancer Research UK – and that’s a big voice. We’ve run a number of political campaigns over recent years, including the highly successful Cancer2020. With the help of our supporters we can really make the Government sit up and listen.

And in some cases, things are changing. We’re starting to see the introduction of what is known as ‘risk sharing’ schemes for expensive drugs. A recent example of this is the agreement reached over the use of the drug Velcade, which is used to treat a type of blood cancer called multiple myeloma.

Here, the Government agreed that they would only give manufacturers money for the drug where patients showed improvement after treatment (in this case measured by a certain level of tumour shrinkage) and not for those who didn’t. Although they’ve not yet been widely adopted, many people think that such schemes could help to provide greater access to pricey drugs for people who will benefit from them. (There’s a pdf file with more information about the Velcade scheme here.)

To sum up
Not all cancer research is ‘sexy’. A single discovery can take decades. Sometimes it throws up new questions that, in turn, can take a decade to answer. Cancer’s a complex question, and there are no easy answers. It’s vital that the efforts of medical researchers around the world are supported with continued funding.

And finally, let’s not forget the vital lobbying role that charities, and their supporters, can take to make change happen. As we say in our vision statement – together we will beat cancer.

Henry and Kat