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The International Agency for Research on Cancer (IARC) was created more than 50 years ago to foster global collaboration on cancer control. Today more effective therapies mean mortality rates no longer reflect incidence rates; there are now more cancer survivors partly due to advances that enable early diagnosis.
However, survival rates for some cancers continue to evade the efforts of the most advanced therapies available. A lot of work remains to be done despite the progress made in the last five decades.
Cancer is now best understood not as a single disease but many different ones linked by genetic mutations continually at work in the body and kept in check by our immune system.
We also recognise the molecular pathways of cancer biology and how environmental risk factors influence our genes. What happens to a patient is encoded in the genetic changes of his or her particular cancer. The variability of survival observed in some cancers, such as leukaemia, is explained by the unique constellations of mutations within the genes of individual patients.
Age is one of the biggest risk factors for developing cancer. With people living longer, there are concerns that incidence rates will rise. Longer life expectancy and changing lifestyles in some regions will contribute to this trend. In addition, many cancers continue to be linked with avoidable risk factors, such as smoking and exposure to workplace hazards.
Despite increasing incidence rates, survival rates are expected to increase worldwide; better mortality and survival represent a welcome boost for life insurers. But cancer will remain the leading cause of claims under Critical Illness (CI) insurance, and exert the strongest impact on insurers’ experience. DNA-based diagnostics and other “liquid biopsy” techniques mean a very different level of cancer incidence rates could emerge in future.
Diagnostics using DNA sequencing methods will eventually detect “micro cancer” activity even earlier. The combination of earlier screening and advanced diagnostics could lead to more CI claims for very tiny tumours. That means insurers need to recognize advances in medical screening and adopt exclusions to maintain the relevance and affordability of the product.
In the future, genome sequencing offers hope of personalised cancer treatment using biomarkers to select the correct medicine for a patient.1 But this is complex. More studies must demonstrate the potential and more drugs must be developed. The prize on offer is targeted treatment that works for individuals and an end to the random shock of cytotoxic therapy that works on average.
It’s even possible to imagine a future without cancer. Engineering of genetic components (the RNA) inside tumour cells may lead to a successful cancer vaccine that would mean the body could mount an immune response to tackle tumours.
In addition, efforts to prevent cancer are likely to intensify. The IARC has just established a new five-year research strategy with a focus on “cancer prevention.” Just a tiny fraction of research money spent globally goes to preventing the disease, compared to the vast amounts spent by health services on treatment. While vaccines, and even targeted therapy, which are now part of routine treatment in medicine, remain some distance in the future for cancer, they may not take another half-century to arrive.
