Open Access
Issue
4open
Volume 1, 2018
Article Number 2
Number of page(s) 2
Section Life Sciences - Medicine
DOI https://doi.org/10.1051/fopen/2018002
Published online 29 June 2018

Cancer is the one of the most important public health problems in recent years [1]. It is only over the past 40 years since the passing of the national Cancer Act in 1971 in the US and the spending of hundreds of billions dollars, that the mortality rate of many cancers is at a level similar to that in 1930 (even when corrected for age) or somewhat declining [13]. Declining is largely a result of earlier detection (cancer of the cervix, breast and colorectal cancer). Similarly, recent changes in mortality from lung cancer are certainly due to decreases in smoking patterns over the past few decades. The observed trends may largely reflect changing incidence or earlier detection, rather than improved therapy [4].

In the last half a century, some topics have become fashionable in cancer research, and most cancer research resources are directed to these topics. First, the fashion was on “oncogenes” [5]. This, after a long delay, was displaced by tumor-suppressor genes. The mentioned trends of cancer fashion was followed by others such as cell cycle gene mutation, apoptosis, aneuploidy, angiogenesis [4] and lastly “bad luck” [57].

According to WHO, early detection of cancer greatly increases the chances for successful treatment [8]. Recognizing possible warning signs of cancer and taking prompt action leads to early diagnosis and early diagnosis is particularly relevant for cancers of the breast, cervix, mouth, larynx, colon and rectum, and skin. Screening refers to the use of simple tests across a healthy population in order to identify individuals who have disease, but do not as yet have symptoms [8]. Examples include breast cancer screening using mammography and cervical cancer screening using cytology screening methods, including Pap smears [9].

A huge US project (US$100-million) to genetically profile 10,000 tumors started in 2006. In 2009, this project received an additional $275 million [3]. The Cancer Genome Atlas (TCGA) is now the biggest component of the International Cancer Genome Consortium, a collaboration of scientists from 16 nations that has discovered nearly 10 million cancer-related mutations. Complexity of the data is the first problem of the project. Other problems are the lack of common mutations among tumors and cancer cells are often quick to become resistant, typically by activating different genes to bypass driver mutations that are blocked by targeted treatment [5]. Recently it was pointed out that cancer profiling may underestimate that two cancer cell clones may look identical yet differ completely at the protein level [10] In summary, this project has not succeeded in winning the fight against cancer, despite the high amount of resources spent [11,12].

Meaning of ”pragmatic” is “Dealing with things sensibly and realistically in a way that is based on practical rather than theoretical considerations” [13]. Pragmatic thought largely developed in late 19th and early 20th century United States by the likes of C.S. Peirce, William James, John Dewey and others [14]. The key to the pragmatic method is a commitment to end-causes and outcomes of practice, rather than abstract first-causes [15]. Pragmatism has influenced the study of law, education, political and social theory, art and science [16]. Pragmatic researchers seek to determine the effectiveness of an intervention in a real-world setting to inform clinical decision making [17]. The pragmatic approach to science involves using the method which appears best suited to solve the problem. May be, the successful HIV/AIDS program serves as a global model of pragmatic medicine in operation [17].

In conclusion, we still do not have a valid hypothesis about carcinogenesis [3,5]. Because of this, accumulation of large amounts of genomic data does not work in everyday clinical practice so far [3]. As stated by Poincare “Science is built of facts the way a house is built of bricks: but an accumulation of facts is no more science than a pile of bricks is a house”. Also, the “foundation of science is trust, which is earned, not given” [18].

If we spend our effort and energy on the early detection of cancer instead of producing vast amount of genomic data [19], we can be more successful in the battle with cancer.

Conflict of interest

The author declares that he has no conflicts of interest in relation to this article.

References

  1. Braun E (2015) The unforeseen challenge: from genotype-to-phenotype in cell populations. Rep Prog Phys 78, 036602. [CrossRef] [PubMed] [Google Scholar]
  2. Bailar JC, Gornik HL (1997) Cancer undefeated. New England J Med 336, 1569–1574. [CrossRef] [Google Scholar]
  3. Brücher BL et al. (2014) Imagine a world without cancer. BMC cancer 14, 186. [CrossRef] [PubMed] [Google Scholar]
  4. Harris H (2005) A long view of fashions in cancer research. Bioessays 27, 833–838. [CrossRef] [PubMed] [Google Scholar]
  5. Brücher BL, Jamall IS (2016) Somatic mutation theory-why it's wrong for most cancers. Cellular Physiol Biochem 38, 1663–1680. [CrossRef] [PubMed] [Google Scholar]
  6. Tomasetti C, Vogelstein B (2015) Variation in cancer risk among tissues can be explained by the number of stem cell divisions. Science 347, 78–81. [CrossRef] [PubMed] [Google Scholar]
  7. Sigston EA, Williams BR (2017) An emergence framework of Carcinogenesis. Frontiers oncology 7, 198. [CrossRef] [Google Scholar]
  8. Organization WH, National cancer control programmes: policies and managerial guidelines. 2002: World Health Organization. [Google Scholar]
  9. WHO. Early detection of cancer. 2017 [cited 2017 27April]; Available from: http://www.who.int/cancer/detection/en/. [Google Scholar]
  10. Peng X, et al. (2018) A-to-I RNA Editing Contributes to Proteomic Diversity in Cancer. Cancer cell [PubMed] [Google Scholar]
  11. Ledford H (2015) End of cancer atlas prompts rethink: geneticists debate whether focus should shift from sequencing genomes to analysing function. Nature 517, 128–130. [CrossRef] [PubMed] [Google Scholar]
  12. Marquart J, Chen EY, Prasad V (2018) Estimation of the Percentage of US Patients with cancer who benefit from genome-driven oncology. JAMA oncology. [Google Scholar]
  13. Dictionary M-W (2002) Merriam-Webster. http://www.mw.com/home.htm,. [Google Scholar]
  14. Thayer HS (1970) Pragmatism, the Classic Writings: Charles Sanders Peirce, William James, Clarence Irving Lewis, John Dewey, George Herbert Mead. Hackett Publishing. [Google Scholar]
  15. The Stanford Encyclopedia of Philosophy. Available from: https://plato.stanford.edu/. [Google Scholar]
  16. Bohman J (2002) How to make a social science practical: pragmatism, critical social science and multiperspectival theory. Millennium 31, 499–524. [CrossRef] [Google Scholar]
  17. Barnett T (2002) HIV/AIDS and Globalization What is the epidemic telling us about economics, morality and pragmatism? aids and economics 9. [Google Scholar]
  18. Brücher BL (2018), Science belongs to no one—and to everyone, EDP Sciences. [Google Scholar]
  19. Brücher BL, et al. (2016) Genomics, microRNA, epigenetics, and proteomics for future diagnosis, treatment and monitoring response in upper GI cancers. Clin transl med 5, 13. [CrossRef] [PubMed] [Google Scholar]

Cite this article as: Tez M. (2018), Pragmatic cancer approach − time to change? 4open, 1, 2.


© M. Tez, Published by EDP Sciences 2018

Licence Creative Commons
This is an Open Access article distributed under the terms of the Creative Commons Attribution License CC-BY-ND (http://creativecommons.org/licenses/by-nd/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. If you remix, transform, or build upon the material, you may not distribute the modified material.

Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.

Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.

Initial download of the metrics may take a while.