The latest “big news” on the cancer front has some cancer specialists fuming, and it’s not only about the research. It’s more about the shifting meaning of “publish or perish.”
Americans of a certain age will remember when Presidential campaigns eventually—but inevitably—included a candidate’s promise that there would be a cure for cancer on his watch. With so much else to lie about now, that may be the only oath to have left the campaign trail.
It does, however, remain an obsession of another species of journalist, the science writer for the lay news outlets, sometimes with comparably dismaying results. We too have on occasion been quick to report another “small step for man” toward the Holy Grail of the cancer cure. With this column we intend to curtail that kind of hype-prone coverage of cancer science without completely leaving the beat.
We remain big fans of the research and breakthroughs; it’s the hidden heartbreaks we’re tired of. Yes, the progress in diagnosis and treatment of cancer will come in careful, if sometimes surprisingly, sometimes agonizingly incremental steps. What we’re going to be more cautious about is following the lay press’s lead in chasing the Grail, like dogs hungry for a scoop.
It’s great that there are now genetic treatments for some cancers that look highly promising, and we applaud the science and the scientists (and the courageous subjects). Still, something doesn’t seem quite right about ringing the bell too loudly about highly specialized treatments still in some, albeit necessary, stage of testing. Some also happen to cost the better part of a million dollars per one-injection treatment in human trials. A certain portion of the hope message gets muted in the experience of less fortunate study subjects.
What we know for sure is that most of the Earthlings eking out their existences in carcinogenic environments are glad to end the day with a handful of rice with fewer rocks in it than yesterday’s and without, god-willing, a beating for their trouble. Six-year-olds mining the world’s scrap heaps for toxic rare earth metals don’t enjoy health coverage. For that matter, health coverage is having a hard time of it in a lot of the developed world.
It’s, as they too often say, complicated.
Now this, for example
What caught our eye recently was a BBC News headline from January 19, “Cancer blood test ‘enormously exciting.’” We read on.
On a careful third and fourth reading, it became clear that health and science correspondent James Gallagher had done a perfectly decent job of reporting the news. It was that a team of researchers at a America’s Johns Hopkins University had conducted trials of a blood test that detects eight forms of cancer: ovary, liver, stomach, pancreas, oesophagus, colo-rectal, lung and breast, to be precise. The test, not incidentally, had a name: CancerSEEK.
That the research was an important step in the long process of finding a blood test that can detect cancer at its very earliest stages—when it is essentially, or effectively, asymptomatic—was not in doubt. In the article, however, unnamed “UK experts” called it “enormously exciting.”
This, too, was in the article: “Dr Cristian Tomasetti, from Johns Hopkins University School of Medicine, told the BBC: ‘This field of early detection is critical. I think this can have an enormous impact on cancer mortality.’
“The earlier a cancer is found, the greater the chance of being able to treat it.
“Five of the eight cancers investigated have no screening programmes for early detection.”
We’ll come back to the subject research in a bit, but first….
(Latex) gloves off
The same day, Cancer Research UK, ran a story of its own, with the headline, “A routine blood test for cancer would be fantastic. Today’s news isn’t it.”
Its authors duly called the research, published in Science, “an important next step for scientists working on a blood test for cancer.” The critique came in words of fewer syllables than scientists are accustomed to using. But they warrant close attention, to wit:
“But some important details were skipped over in the discussion in the news.
“The first thing to know is that this experimental test is a long way off being used to diagnose cancer. As some experts have said, it’s ‘promising but with several caveats and a significant amount of further research is needed’.
“And that’s because using a blood test to confirm that people with cancer have cancer is very different to using that same test to detect the earliest hints of cancer in otherwise healthy people.”
Note that the dispute was not with the published research but with “the discussion in the news.”
Citing the “Holy Grail” deal, the Cancer Research UK critics went on to provide a helpful guide to the extent and significance of the newly published research and to do so in lay language:
“Cancer cells are different to normal cells in many ways – they have changes in their DNA and make different molecules. And in some cases, cancer cells shed these fragments of errant DNA and faulty molecules into a patient’s bloodstream, theoretically leaving them floating for detection by a blood test.
“But so far, finding the right chunks of DNA or molecules to look for has proven tricky. It’s hard to find a marker that is sensitive enough – meaning it finds cancer every time – and accurate enough – meaning it doesn’t ‘find’ cancer when it’s not there.
“Developing a test that worked would mean patients could be diagnosed quickly, potentially sparing them anxiety when they don’t have cancer and speeding up treatment when they do have cancer.
“And it could help find cancers earlier when they’re likely to be easier to treat.”
Their critiques of the research were less than savage and, read calmly, illuminating:
“Their test looks for faulty DNA and molecules from cancer cells that find their way into the blood. And they tested it on 1,005 patients who they already knew had cancer.
“This is a key point. They were looking for cancer in patients who had already been diagnosed with cancer. To truly match the promise of a blood test for screening, as some news reports suggested this might be, the test would have to work in people who haven’t yet been diagnosed.
“Across the 8 cancers the tests picked up cancer in an average of 70 in 100 cases. This is a measure of the test’s sensitivity. And that’s not bad for an experimental test.
“But there was huge variation in sensitivity across the different types of cancer – it found 98 in 100 ovarian cancers, but only 33 in 100 breast cancers.
“Interestingly, the test could also tell the researchers the organ or tissue where the cancer came from in 83 in 100 patients. This would be incredibly useful for doctors if this type of test were to one day be used to diagnose cancer.”
Their critique cited further deficiencies in the study, again, rationally, and the interested reader can find it all in the link given above and below. The gold, to our mind was this, at the end:
“This is really important research, deserving of bigger studies. We need to do more research like this.
“Dr Richard Marais, director of the Cancer Research UK Manchester Institute, said: ‘Hopefully in the future we can develop a blood test such as this that can be used routinely in patients, perhaps once a year, to allow them to know earlier if they have cancer and to get them treated much sooner.’
“But as Turner added: ‘The study does not support use of the blood test outside research studies, as it has not shown yet whether the blood test has the characteristics required for population screening.’
“With further research, the hunt for this scientific ‘Holy Grail’ will continue. And larger studies will test these tests under the right conditions to know for sure if it can be used to detect cancers earlier.”
Audible throughout this little saga are a number of competing voices, to one degree or another competing for money to continue doing what they’re doing:
Once upon a time, “publish or perish” was the motto that hung over academia, complete with its implied menace. There’s enough blame to go around, but if there’s a pressing concern here, it has first to do with dueling media corporations, where “publish or perish” is something of an outright threat, or challenge to a duel, anyway.
In the links in our Sources/Readings section below, you’ll find near the end links to articles in the popular press in which the pulse of mandatory excitement can be taken. For our part, we’re going to respond with greater selectivity about research to report, based principally on its relevance to our readers, who, as our section head declares, are “surviving cancer.”
Ave atque vale
In parting, we refer to the abstract of the research by the Johns Hopkins scientists, mainly to indicate its actual modesty—note the absence of a Holy Grail—in reporting their trial, defining both its intentions within a larger, longer, not yet reached goal:
“Earlier detection is key to reducing cancer deaths. Here we describe a blood test that can detect eight common cancer types through assessment of the levels of circulating proteins and mutations in cell-free DNA. We applied this test, called CancerSEEK, to 1,005 patients with non-metastatic, clinically detected cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung, or breast.”
It seems as good a place as any to start, and for us to shift directions in our reporting of cancer research.
STOP THE PRESSES! SOMETHING JUST HAPPENED
To judge by the dateline (January 24) on the article in the Columbia Journalism Review, as we were writing and posting this item, CJR reported the following. Lewis D’Vorkin, editor in chief of the unredoubtable (we use that word because no one knows what it means, but it has an eye-catching number of syllables) Los Angeles Times, who’s won the sobriquet the “Prince of Darkness” in a book about Forbes, spoke at the Forbes Centennial Celebration last September.
If you find any of this titillating so far, do not deny yourself the manifest and endless pleasures of the complete article. Like many a 21st-century visionary, D’Vorkin is stirring the news-reporting pot with ideas and proposed policies that have left experts, say nothing of his newsroom employees, reading the entrails to unpack their meaning with one hand while calling labor lawyers with the other. We find both to represent digital journalism at its finest and most fundamental.
Sometimes, though, his clarity is blinding. In the article, D’Vorkin is quoted as saying, “Speed is the new accuracy.” And the Oscar goes to … The Prince of Darkness.
http://science.sciencemag.org/content/early/2018/01/17/science.aar3247 (full report text available here)