From the very 1st edition, the important facts box located at the beginning of the Chapter have been one of the most popular features of the book. The facts boxes provided an easy to find summary of the important information for each subject – a quick reference and review. One can always recognize success when something is repeated by others and the editors have frequently smiled when they have become aware of a similar feature in other reference texts.
Oncologists and their epidemiology colleagues have long recognized that much of cancer was not a simple matter of chance but to a very significant extent was related to our behaviour, the potential carcinogenic exposures we were subjected to in our personal and work environments, and the access individuals had to advances in cancer screening. Everyone is familiar with the documented impact that measures to reduce tobacco usage have had on the incidence of cancer – a prime example of changing behaviour. Many believe that the epidemic of obesity occurring now will have an even greater impact on increasing the risk and incidence of many cancers. There are an increasing number of validated methods available today for detecting cancer at its very earliest stages but the challenge to the use of these technologies will depend ultimately on access and affordability.
Hearing for the first time the words “You have a cancer of ….” is without question a transformative moment in life. My friends who have experience this event in their lives tell me of the overwhelming set of emotions that immediately descends – fear, uncertainty concerning decision making, a realization of one’s mortality, how others will see them, financial burdens and often how this will change their life forever. I believe that one of the most important therapies we as physicians deliver is the message of hope. Telling the story of the progress cancer research has made and continues to make, the transformation in the nature of today’s therapies based on the greater understanding of the underlying biology and genetics of cancer. The new era of immune oncology and cell based therapies. As noted, the progress toward transforming cancer to something we can live with is the message of today.
Rather than selecting one chapter, I would recommend the chapters on Breast, Colon, Prostate, Pancreatic and Lung cancer. These five cancers take the most lives each year. Progress, however, has been significant in fighting these specific diseases and the chapters in the 6th dedicated to these cancers are outstanding in coverage of screening and prevention, diagnosis and staging, molecular pathogenesis, management and treatment.
The 6th edition is once again fortunate to have a great team of editors. Each editor brings a wealth of subject matter expertise to developing the vision for the text. The primary goal is to identify the “faculty” for the writing of each chapter. This is perhaps the greatest challenge. The editors work very hard to ensure that the chapters are products of a team approach to managing the specific cancer focus of the chapter. In addition, the editors work with the chapter authors to ensure a uniformity of presentation throughout the book.
We all have our personal family and close friend experiences that certainly keep us highly motivated. For me, I would also emphasize it is the patients that I care for. Their trust and their spirit are a daily inspiration.
The American Society of Clinical Oncology releases the Advance of the Year that is the single area of research that achieved the greatest progress. For the past two years, the Advance of the Year was immunotherapy. This year, Drs. James Allison and Tasuku Honjo were awarded the Nobel Prize for medicine for discovering how to use the body’s immune system to fight cancer. This therapeutic approach which includes both an active approach directing the immune system to target tumor cells and passive immunotherapies which include the use of antibodies, lymphocytes and cytokines and their combinations has transformed the way cancer is treated. In addition to the chapters in the 6th edition on Cancer Immunology and Immunotherapy and Therapeutic Antibodies and Immunologic Conjugates the author teams for the disease specific chapters were asked to include immunotherapy advances relevant to the treatment strategies.
This is difficult to answer because there is no single response. Of course my first reaction is that we need more financial resources to expand the outstanding work going on to understand the basic genomic alterations that lead to increased risk and ultimately the initiation and progression of the disease. The more we can understand the very basics of the tumor host relationship, the tumor’s microenvironment, and the immune tolerance for progressive tumor growth the more opportunities we will have to continue to develop new highly targeted interventions. But it will take more than this focused effort on cancer biology. We must do much more in the field of prevention for this may be our greatest opportunity to change the course of cancer in the world. We must, as I have noted, address issues of care access and the burden of cost. The latter will be of increasing importance as our therapies become more complex and expensive to deliver.