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Terrorism and Cancer... Four Years After 9/11

On Tuesday, September 11, 2001, America was diagnosed with a serious cancer. Worse, the disease was not local, or even locoregional. Rather, it was already advanced at the time of detection. Getting this cancer ourselves has long been something of a concern since we have often seen the disease diagnosed in others over the years. But surely, it could not happen to us and certainly not with such a devastating initial presentation.

How did this occur? We think we understand the process, but not the reasons for it.

"Cells," which have often lived in apparent harmony with their neighbors for years, are "activated" by an unknown and unheard "signal." The signal is only clear to the cells destined to develop malignant behavior, and this signal sets off a series of apparently irreversible events. Once activated to their malignant phenotype, the cells traffic to "nodes" from whence they percolate into the general circulation. Activated, malignant cells no longer recognize the rules that govern normal cell-to-cell interactions. They use the hosts’ own resources to carry out their deadly mission. Their behavior is disruptive in the extreme and ultimately futile since the malignant cells will also die if they kill their host. The language and consequences of cancer and the language and consequences of international terrorism are eerily similar.

So, too, is the reaction of government to a legitimate threat to the well being of its citizens. First a "War on Cancer" andnow a "War on Terrorism."

But the War on Cancer has not been an easy one, and neither will be this new engagement. What lessons have we learned from the War on Cancer that may be applicable here?

At a political level, cancer is a socioeconomic disease that disproportionately affects the poorest of our population. Terrorism also finds a home among the have-nots of nations. Perhaps improving global economic well-being will help.

Early detection of cancer when it is amenable to definitivelocal treatment is often effective even if there is no good treatment for advanced disease. The role of the Pap smear in reducing cervical cancer mortality and, more recently, the effectiveness of prostate-specific antigen screening in reducing prostate cancer mortality are cases in point. In the War on Terrorism, a global investment in intelligence-gathering and dissemination will be needed for early detection of activated cells and infiltratednodes.

There are other parallels, as well. There will need to be a sustained and considerable investment before the first signs of progress appear. Only after decades of research costing billions of dollars are we beginning to see declines in mortality from common solidtumors of adulthood like lung and breast cancer.

Also, if experience is any guide, experts in their respective fields will argue that the War can be won only with investment in their particular disciplines: etiology, causation, prevention, screening, early detection, focusing on a specific and defined target and destroying it with little collateral damage or implementing large protocols involving many people using more conventional agents with expected toxicities. In actuality, every point of leverage will be needed to turn so big a problem. And finally, because of the talents and commitment of the people involved, as well as the political will to see each challenge to its end, both the War on Cancer and the War on Terrorism will ultimately be won.

During these difficulties, oncologists should not lose their sense of the importance of the War on Cancer. Cancer is to the patient and their family what terrorism is to a free society –a deeply personal threat that must be overcome.

FOOTNOTES

Originally published in The Oncologist in 2001 (The Oncologist 2001;6:401).

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