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10 new things we’ve learned about cancer
Cancer's sweet tooth. Turning cancer cells into fat. Unveiling genetic secrets. Scientists are learning about cancer every day.
- Cancer is a leading cause of death among Americans, second only to heart disease.
- Researchers are unearthing cancer's genetic secrets and, with it, potential new treatments.
- Their efforts have seen the cancer death rate for men, women, and children fall year after year between 1999 and 2016.
The 21st century has been, and will continue to be, shaped by cancer. Although heart disease remains the United States' number one killer, cancer is quickly closing the gap and may soon surpass it. Some oncologists claim a cure is five, 10, certainly no more than 20 years away. Others aren't so sure because, in a way, cancer is the price we pay for evolutionary success.
"It is no coincidence that the very genes that allow our embryos to grow — our hands to grow, our feet to grow — if you mutate them in inappropriate contexts, [they] will ultimately release the disease that kills us," said oncologist Siddhartha Mukherjee, who dubbed cancer the Emperor of All Maladies, also the title of his Pulitzer Prize-winning book.
Whether for five years or forever, cancer won't be going anywhere any time soon. Yet, the more doctors and scientists discover about it, the better we can learn to live with it.
A love-hate relationship: Cancer and antioxidants
Contrary to what many believe, cancer enjoys a nutrient-rich diet as much as the next cell because it helps it grow, even those legendary antioxidants.
In two independent studies published in Cell, Swedish and American research teams found that lung cancer utilizes antioxidants to activate a protein called BACH1. This protein stimulates the cancer cells to metabolize glucose and accelerate metastasis. Even without a ready supply of dietary antioxidants available, the tumor would simply produce its own.
Professor Martin Bergo, who led the Swedish study, hopes this research will help develop new treatments. "We now have important new information on lung cancer metastasis, making it possible for us to develop new treatments, such as ones based on inhibiting BACH1," he said in a release.
Does this mean you should abstain from antioxidant-rich foods? Not at all. Antioxidants do neutralize the free radicals that cause oxidative stress on cells. Preventing such cell damage can help prevent cancer.
However, it's best to avoid antioxidant supplements unless prescribed by a doctor. As reported by the National Cancer Institute, of nine randomized-controlled clinical trials, none provided evidence that such supplements lower cancer risks. A few even found that beta-carotene supplements increased the risk of lung cancer so severely that the trials had to be ended prematurely.
Get your antioxidants from fruits, veggies, and beans instead. Research suggests that these antioxidants work in combination with additional molecules found in the whole foods. It's this tag-team effect that ultimately give antioxidants their salubrious power.
Cancer costs (in more ways than one)
It goes without saying that cancer is costly. The physical strain of treatment. The potential loss of life, whether one's own or the life of a loved one. And even if one survives, there's the emotional cost of the ordeal.
But the toll imposed by cancer is more than physical or psychological. A study released last year found "that 42 percent of patients deplete their life savings during the first two years of treatment." Of the 9.5 million newly diagnosed cancer patients surveyed, the study calculated average losses at $92,098.
Its authors dubbed the effect "financial toxicity" and concluded: "As large financial burdens have been found to adversely affect access to care and outcomes, the active development of approaches to mitigate these effects among already vulnerable groups remains of key importance."
Cancer's sweet tooth
A recent study found a positive association between a daily sugary drink and an increased risk of cancer.
Researchers asked more than 100,000 people to complete surveys looking at their usual consumption of 3,300 foods and beverages. The results? A positive association between daily consumption of a sugary beverage and an increased risk of cancer. The sugary drinks not only included soda but also 100 percent fruit juice and artificially sweetened drinks.
"These data support the relevance of existing nutritional recommendations to limit sugary drink consumption, including 100% fruit juice, as well as policy actions, such as taxation and marketing restrictions targeting sugary drinks, which might potentially contribute to the reduction of cancer incidence," the researchers stated in a release.
Don't go trashing the OJ just yet, though. As an observational study, the data could not establish a cause-effect relationship, and the researchers note the results are only preliminary. Additionally, the results hinge on the memories of the participants. (What exactly did you eat for breakfast the Monday before last?)
But the study helps stress the American Institute for Cancer Research's (AICR) suggestion to limit sugary beverages. Try to remove soda from your diet. Drink 100 percent fruit juices with no added sugar sparingly. And of course, enjoy an active, healthy lifestyle.
Cancer on the grill
It's a summer tradition to throw some meat on the grill alongside a good beer. But grilled meats hide a few furtive carcinogens: polycyclic aromatic hydrocarbons and heterocyclic aromatic amines.
The hydrocarbons are carried in the smoke after fat burns on the flame, while the heterocyclic amines form when sugars, amino acids, and creatine react at high heats. Neither has been proven to cause cancer, but they are known mutagens that can damage DNA after being metabolized.
"Research shows that diets high in red and processed meat increase risk for colon cancer," said Alice Bender, AIRC Senior Director of Nutrition Programs. "And grilling meat, red or white, at high temperatures forms potent cancer-causing substances."
Like sugary drinks, however, you don't have to forever hang up your "Kiss the Cook" apron. The institute has several suggestions for safe summer grilling, such as limiting red meat, marinating foods beforehand, keeping a low flame, and throwing more vegetables into the mix.
A unified theory of leukemia
Acute lymphoblastic leukemia (ALL) afflicts about one in 2,000 children, and Mel Greaves, at the Institute of Cancer Research, London, believes he's found the cause. Researching 30 years of data and medical literature on childhood leukemia, he argues the "delayed infection" is the culprit.
According to this theory, children develop a pre-leukemia mutation in utero. The mutation remains inert until later in life when the child encounters a common infection. The microbes then trigger secondary genetic changes that led to overt leukemia.
Does this mean children are safe only in cleanrooms? Strike that, reverse it. Greaves believes exposure to germs in the first year of life is proactive. It trains the immune system to deal with pathogens, therefore preventing the secondary mutation from triggering.
"Childhood ALL can be viewed as a paradoxical consequence of progress in modern societies, where behavioral changes have restrained early microbial exposure," Greaves writes. "This engenders an evolutionary mismatch between historical adaptations of the immune system and contemporary lifestyles. Childhood ALL may be a preventable cancer."
The future of cancer treatment is genetic
A major stride toward our understanding of cancer came with the Human Genome Project. Why? At its core, cancer is a genetic disease.
Our ability to sequence and read cancerous genomes will be a major step toward cancer treatments. As Eric Green, director of the National Human Genome Research Institute, told Big Think:
"[The] standard of care for many types of cancer is going to be: Get that tumor, read out its DNA, sequence its genome and based on what you've seen what's wrong with that tumor -- not by looking at it under a microscope only or by looking at it in a sort of a gross fashion but actually looking inside its blueprint -- you will be able to have a much better way of deciding what types of treatments to pursue and have a much better idea about what's wrong in that kind of tumor."
A future treatment? The "cancer vaccine"
An airman receives a vaccine. Could the future of cancer treatment be as easy as a shot?
Rather than using chemotherapy to combat cancer with the subtlety of an atomic bomb, immunotherapies aim to uncloak cancer cells, so the body's immune system can go on the offensive
One example of an immunotherapeutic approach is the so-called "cancer vaccine." During its clinical trial, 11 patients had a tumor injected with a steroid to bolster the site's dendritic cells — immune system cells that specialize in processing antigens.
Following a light dose of radiation and a stimulant, the patients' dendritic cells directed T-cells to attack the cancer cells. Once the T-cells could recognize the tumor, they became able to locate cancer cells throughout the body.
Of the 11 patients, three saw their cancer go into regression or remission. Six others had their cancer stymied for at least three months.
"It's really promising, and the fact you get not only responses in treated areas, but areas outside the field [of treatment with radiation] is really significant," Dr. Silvia Formenti, chairwoman of radiation oncology at Weill Cornell Medicine and New York Presbyterian, told CNBC. (Dr. Formenti was not involved in the study.)
Turning tumors into fat
Cancer cells spreading to other parts of the body through the circulatory system.
A deadly tool in cancer's arsenal is cell plasticity, a cell's ability to alter its physiological characteristics. It is one of the reasons cancers can metastasize throughout the body, and it helps the disease resist treatments.
Researchers at the University of Basel, Switzerland, have hijacked this ability and turned it against cancer. Using a drug therapy that combined an anti-diabetic drug and MEK inhibitors, they attacked cancer cells and turned them into adipocytes (a.k.a. fat cells).
While this did not remove the tumor, it did make the cells post-miotic, meaning they could no longer divide. This inhibited the cancer's ability to spread.
"In future, this innovative therapeutic approach could be used in combination with conventional chemotherapy to suppress both primary tumor growth and the formation of deadly metastases," senior study author Gerhard Christofori told Medical News Today.
An image of the E. coli bacteria. Will these become the next breakthrough in cancer therapies?
Another advancement in cancer treatment is synthetic biology, a field in which scientists use the principals of engineering to redesign biological systems. In one example, researchers genetically programmed a non-pathogenic E. coli strain to attack tumors in lab mice.
Once injected, the rewired bacteria took refuge in the tumor, where they self-destructed. These dead bacteria leaked from the tumor, and thanks to encoded nanobodies, drew the attention of T-cells which devoured the bacteria and tumor alike.
Of course, lab tests in mice do not guarantee a successful transition to human patients, but it remains a promising avenue for treatment.
"At some point in the future, we will use programmable bacteria for treatment," Michael Dougan, an immunologist at Massachusetts General Hospital, told the New York Times. "I think there's just too much potential."
A new attitude toward cancer
Medical professionals originally viewed cancer as a disease to be destroyed with extreme prejudice; the treatment was only better than the disease because the disease ended in death.
But as David Agus, professor of medicine and engineering at USC, told us, there are better ways to approach cancer:
"Well, to me cancer is a verb and not a noun. You're cancering, it's something the body does and not that the body gets. And so that philosophy needs a very different way of approaching disease, and it means changing the system in addition to trying to target the cancer."
One way is to approach treatment holistically. Agus points to a trial that gave premenopausal women with breast cancer a bone-building drug. The drug didn't target the cancer, yet it reduced recurrence by 40 percent because breast cancer metastasizes in bone.
Another method is psychosocial oncology. In this relatively new field, the practitioners' goal is to enhance the quality of life for cancer patients through mental health care as a part of physical care.
Living with cancer
Cancer death rates in the United States by cancer type, male and female, age standardized.
Scientists have learned a lot about cancer, but there remains much we don't know. Does that mean we should despair for the future? Quite the contrary. Thanks to the knowledge accumulated by scientists, we have much to be hopeful for.
Headlines are correct that the total number of new cancer cases and deaths continue to increase. However, the rates of cancer diagnoses and death have declined year after year. This is because absolute numbers don't account for metrics like population growth and increased life expectancy. In fact, the Annual Report to the Nation on the Status of Cancer found that the cancer death rate for men, women, and children fell year after year between 1999 and 2016, as did cancer incident rates.
"Death in old age is inevitable. The job of science is to prevent unanticipated deaths in unanticipated times. I find that is a perfectly reasonable goal," said Mukerjee. "If you're saying to me that we will have a more profound, more proximal reconciliation with cancer in the next few decades, I think the answer is absolutely yes."
We may not be able to eradicate cancer as we did with diseases like smallpox and polio. But we're learning how to live with it more and more every day.
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Andy Samberg and Cristin Milioti get stuck in an infinite wedding time loop.
- Two wedding guests discover they're trapped in an infinite time loop, waking up in Palm Springs over and over and over.
- As the reality of their situation sets in, Nyles and Sarah decide to enjoy the repetitive awakenings.
- The film is perfectly timed for a world sheltering at home during a pandemic.
In more than a dozen countries as far apart as Portugal and Russia, 'Smith' is the most popular occupational surname
- 'Smith' is not just the most common surname in many English-speaking countries
- In local translations, it's also the most common occupational surname in a large part of Europe
- Ironically, Smiths are so ubiquitous today because smiths were so special a few centuries ago
Meet the Smiths, Millers, Priests and Imams - the most popular occupational surnames across Europe.
Image: Marcin Ciura<p>Although very few people are smiths by profession these days, there are millions of Smiths by surname the world over. It's the most popular surname in Britain, Australia, New Zealand and the United States, as well as the second most popular surname in Canada and the fifth most popular one in Ireland. And they're a thriving bunch, at least in the U.S.: the 2010 Census (1) counted 2,442,977 Americans called Smith, 2.8% more than in 2000.</p><p>Curiously, 'Smith' also is one of the most popular surnames across most of Europe –translated in the various local vernaculars, of course. This map shows the most common occupational surnames in each country. By colour-coding the professions, this map shows a remarkable pro-smith consistency across Europe – as well as some curious regional exceptions.</p>
‘Smith’ popular throughout Europe<p>'Smith', in all its variations, is the most popular occupational surname throughout Europe. Not just in the UK, but also in:</p> <ul><li>Belgium (<em>Desmet</em>) and Luxembourg, (<em>Schmitt</em>);</li> <li>France (<em>Lefebvre</em>), Italy (<em>Ferrari</em>) and Portugal (<em>Ferreira</em>);</li> <li>Slovenia (<em>Kovačič</em>), Croatia (<em>Kovačevič</em>), Hungary (<em>Kovács</em>), Slovakia (<em>Kováč</em>), Poland (<em>Kowalski</em>), Lithuania (<em>Kavaliauskas</em>), Latvia (<em>Kalējs</em>) and Belarus (<em>Kavalyov</em>);</li> <li>Estonia (<em>Sepp</em>); and</li> <li>Russia (<em>Kuznetsov</em>).</li></ul>
‘Miller’ on top in many Germanic-language countries<p>'Miller' is the most popular occupational surname in many Germanic-language countries, but also in Spain and Ukraine (perhaps because the grain in both countries is mainly in the plain):</p> <ul><li>There's <em>Müller</em> (in Germany and Switzerland), <em>M</em><em>ø</em><em>ller</em> (in Denmark and Norway) and <em>Möller</em> (Sweden);</li> <li><em>Molina</em> (in Spain – the map also shows the most popular surname in Catalonia/Catalan: <em>Ferrer</em>, i.e. 'Smith'); and</li> <li><em>Melnik</em> (in Ukraine).</li></ul>
Clergy surnames rule in the Balkans<p>Catholic clergy must remain celibate, so 'Priest' as a surname is rare to non-existent throughout Europe. Except in the Balkans, where Catholicism is largely absent. Here, the Orthodox and Islamic clergies have passed on the title from father to son, eventually as a surname, to popular effect. Orthodox clergy are addressed as <em>papa</em> or <em>pope</em> (which means 'father' – so the surname rather redundantly translates to 'father's son'). Islamic teachers or imams are known by the Turkish/Persian term <em>hodzha</em>. An overview:</p> <ul><li><em>Popov</em> (in Bulgaria), <em>Popovic</em> (in both Serbia and Montenegro), <em>Popovski</em> (in Macedonia);</li> <li><em>Popa</em> (in Romania); </li> <li><em>Papadopoulos</em> (in Greece); and</li> <li><em>Hodžić</em> (in Bosnia-Herzegovina), <em>Hoxha</em> (in both Kosovo and Albania).</li></ul>
Landowners and other professions<p>Austria and the Czech Republic have different national languages but are neighbours and share a lot of history. Could that explain why they have a similar most popular occupational surname, for 'landowner'?</p> <ul><li><em>Huber</em> (in Austria) and</li> <li><em>Dvořák</em> (in the Czech Republic).</li></ul> <p>Just four professions, that wraps up all but five countries on this map. Those five each have their very own most popular occupational surname:</p> <ul><li><em>Bakker</em> (in the Netherlands): 'Baker'</li> <li><em>Kinnunen</em> (in Finland): 'Skinner'</li> <li><em>Ceban</em> (in Moldova): 'Shepherd'</li> <li><em>Avci</em> (in Turkey): 'Hunter'</li> <li><em>Murphy</em> (in Ireland): 'Sea Warrior' </li></ul>
Even more Smiths<p>Judging from the popularity of these surnames, your generic European village of a few centuries ago really couldn't do without a smithy. It was a much more essential craft even than that of the miller (or the baker, who put the miller's flour to good use) – except in the Balkans, where spiritual sustenance apparently sated a greater need. On the outskirts of <em>Anytown, Europe</em> live the shepherd and the hunter, the skinner and the pirate.<br></p><p>A bit too simplistic? Perhaps not simplistic enough. This map could have been dominated by even more Smiths. As the original poster explains, he always picked the most frequent version of an occupational surname, even if multiple variants point to a more popular alternative. </p><p>In the Netherlands, for instance, people with the surnames <em>Smit, Smits, Smid, de Smit, Smet </em>and <em>Smith</em> collectively outnumber those with the surnames <em>Bakker, Bekker, de Bakker</em> and <em>Backer</em>. So, the Netherlands could be considered another win for 'Smith' – except that the variant <em>Bakker</em> is more frequent than any other single variant.</p><p>Same story in Germany: added up, there are more people named <em>Schmidt, Schmitt, Schmitz </em>and <em>Schmid</em> than <em>Müller</em>. Ditto for Spain: <em>Herrero, Herrera </em>and <em>Ferrer</em> together outnumber <em>Molina</em>. Also in Finland, where <em>Seppä</em>, <em>Seppälä</em> and <em>Seppänen</em> together have a higher count than <em>Kinnunen</em>. </p>
Smiths in other cultures<p>'Smith' was a crucial occupation in other cultures too, judging from the familiar ring it has in these languages:<br></p><ul><li><em></em><em>Demirci</em> (Turkish)</li><li><em>Hadad</em> (Syriac, Aramaic, Arabic)</li><li><em>Nalbani</em> (Albanian)</li><li><em>McGowan</em> (Gaelic)</li><li><em>Faber</em> (Latin)<span></span></li></ul>
Other most popular surnames<p>Take note, though: 'Smith' may be the most popular surname in in the Anglosphere, this map does not mean to show that its variants in French, Russian and other languages also are the most popular surnames in the countries marked grey. They are merely the most popular <em>occupational</em> surnames.<br></p><p>As this sample of most common ones for each country shows, surnames can refer to a host of other things. Personal qualities or physical attributes, for example:</p> <ul><li>Russia: <em>Smirnov</em> ('the quiet one')</li> <li>Turkey: <em>Yilmaz</em> ('unflinching')</li> <li>Hungary: <em>Nagy</em> ('big')</li> <li>Italy: <em>Rossi/Russo</em> ('red', in northern and southern Italy, respectively)</li></ul> <p>Another option: the origin of the name-bearer (be it a place or a person):</p> <ul><li>Sweden: <em>Andersson</em> ('son of Anders')</li> <li>Slovakia: <em>Horvath</em> ('Croat')</li> <li>Kosovo: <em>Krasniqi</em> (refers to the Krasniq tribe and their mountainous home region)</li> <li>Portugal: <em>Silva</em> ('woodland')</li> <li>Latvia: <em>Bērziņš</em> ('little birch tree')</li> <li>Estonia: <em>Tamm</em> ('oak')</li></ul> <p>But sometimes, even for the most popular ones, the exact origin of the surname is lost in time:</p> <ul><li>Spain: <em>Garcia</em> (originally Basque, possibly meaning 'young', 'bear' or 'young bear')</li> <li>Finland: <em>Korhonen</em> ('hard of hearing' or 'dim-witted'; 'village elder'; 'proud'; 'upright'). </li></ul>
Smith popularity theory<p>So why exactly is Smith – and not Miller, for example – the most popular surname in many English-speaking countries? The theory propounded by historian C.M. Matthews in <em>History Today</em> (July 1967) probably also holds for the other-language variants so popular throughout Europe:<br></p><blockquote>"The reason for (the) multiplicity (of the surname 'Smith') is not so much that metal-workers were numerous as that they were important and widespread. On the skill of the smith, both rich and poor depended for the most essential things of life, the tools of husbandry and the weapons of hunting and war. Every community in the land must have one, every castle, every manor; and so distinctive was his trade that he would seldom need another name".<em></em></blockquote><p>That does not mean all people with the surname have a forefather who forged iron into weapons and farm tools. Especially in North America, 'Smith' was adopted by many people precisely because it was already common – as a secret identity or to blend in, for example by natives, slaves and immigrants.</p>
A recent analysis of a 76-million-year-old Centrosaurus apertus fibula confirmed that dinosaurs suffered from cancer, too.
- The fibula was originally discovered in 1989, though at the time scientists believed the damaged bone had been fractured.
- After reanalyzing the bone, and comparing it with fibulas from a human and another dinosaur, a team of scientists confirmed that the dinosaur suffered from the bone cancer osteosarcoma.
- The study shows how modern techniques can help scientists learn about the ancient origins of diseases.
Centrosaurus apertus fibula
Royal Ontario Museum<p>In the recent study, the team used a combination of techniques to analyze the fibula, including taking CT scans, casting the bone and studying thin slices of it under a microscope. The analysis suggested that the dinosaur likely suffered from osteosarcoma, a type of bone cancer that affects modern humans, typically young adults.</p><p>For further evidence, the team compared the damaged fibula to a healthy fibula from a dinosaur of the same species, and also to a fibula that belonged to a 19-year-old human who suffered from osteosarcoma. Both comparisons supported the osteosarcoma diagnosis.</p>
Evans et al.<p style="margin-left: 20px;">"The shin bone shows aggressive cancer at an advanced stage," Evans said in a <a href="https://www.rom.on.ca/en/about-us/newsroom/press-releases/rare-malignant-cancer-diagnosed-in-a-dinosaur" target="_blank">press release</a>. "The cancer would have had crippling effects on the individual and made it very vulnerable to the formidable tyrannosaur predators of the time."</p><p style="margin-left: 20px;">"The fact that this plant-eating dinosaur lived in a large, protective herd may have allowed it to survive longer than it normally would have with such a devastating disease."</p><p>The fossilized fibula was originally unearthed in a bonebed alongside the remains of dozens of other <em>Centrosaurus </em><em>apertus</em>, suggesting the dinosaur didn't die from cancer, but from a flood that swept it away with its herd.</p>
Dinosaur fibula; the tumor mass is depicted in yellow.
Royal Ontario Museum/McMaster University<p>The new study highlights how modern techniques can help scientists learn more about the evolutionary origins of modern diseases, like cancer. It also shows that dinosaurs suffered through some of the same terrestrial afflictions humans face today.</p><p style="margin-left: 20px;">"Dinosaurs can seem like mythical creatures, but they were living, breathing animals that suffered through horrible injuries and diseases," Evans said, "and this discovery certainly makes them more real and helps bring them to life in that respect."</p>
Join the lauded author of Range in conversation with best-selling author and poker pro Maria Konnikova!
UPDATE: Unfortunately, Malcolm Gladwell was not able to make the live stream due to scheduling issues. Fortunately, David Epstein was able to jump in at a moment's notice. We hope you enjoy this great yet unexpected episode of Big Think Live. Our thanks to David and Maria for helping us deliver a show, it is much appreciated.