Joe Biden promised last week that if he is elected to the Oval Office, “we’re gonna cure cancer.”
It was definitive in a way that the statement he made as vice president in 2015 — “If I could be anything, I would have wanted to have been the president that ended cancer, because it’s possible” — was not.
On the one hand, Biden’s sweeping promise, which some online critics derided as irresponsibly optimistic, isn’t as lofty as it might appear at first glance. Some cancers are already considered curable, and scientists believe they’re close to curing others.
On the other hand, cancer is not just one disease; it has more than 100 types, and since former President Richard Nixon declared a “war on cancer” in 1971, the way that scientists think about a cure has changed.
Scientists now understand that cancer is far more complex than was once believed, and that what works to treat one person, or one type of cancer, might not work for another. Even if a person survives 10 years after receiving treatment for cancer, there is always a risk that a cancer can return, or that another kind can spring up that’s fatal.
“These cancers are dormant or they hibernate and then they show up later, so you can almost use ‘cured’ in quotation marks,” said Dr. Eric Haura, chair of the Moffitt Cancer Center and Research Institute’s thoracic oncology program. “The best we can say is, ‘We see no evidence of your cancer,’ but that’s not the same thing as being cured.”
Though there’s no one-size-fits-all treatment for cancer, U.S. outcomes have improved. During the mid-1970s, the five-year survival rate among adults for all cancers combined was 50%. By 2007, it was 68%.
Much of the progress was achieved not just with better treatments for cancer, but also through prevention. Smoking is at a record low, and doctors are screening more people and finding cancer earlier, when it’s easier to treat.
“We now detect earlier, we screen earlier, and people with cancer have been cured,” said Ellen Sigal, founder of the nonprofit Friends of Cancer Research. “It’s not wrong to say that we have cured some cancers. There are other cancers that we have not cured, but some people are living much longer.”
The disease is still devastating to millions of families who have lost loved ones, and took the life of Biden’s son Beau in 2015. It’s the No. 2 cause of death in the U.S., with nearly 610,000 dying from cancer every year.
Researchers have developed several ways to treat cancer, including with surgery, radiation, chemotherapy, and stem-cell transplants. Cancer experts interviewed for this article agreed that a combination of approaches was probably where treatment for cancer would land.
One treatment researchers and drug companies see as promising is called immunotherapy, which uses a patients’ immune system to attack cancer cells. Because every patient and cancer is different, the treatment is catered to the individual and sometimes uses genetic testing. Immunotherapy has had remarkable outcomes in a minority of cases, but scientists don’t know why it hasn’t worked for everyone.
“Cancer is not a fixed, rigid state,” said Haura. “It evolves, it’s elastic, and it can alter itself. We have really appreciated that in the last 10 years.”
The first immunotherapy drug for cancer was approved in 2011, for the treatment of the skin cancer melanoma, and the treatment is still considered new. The Food and Drug Administration has approved dozens of similar treatments since, and more are being tested.
The drugs were being approved when Biden was vice president and as he oversaw the Obama administration’s “cancer moonshot.” The goal of the initiative was to spur 10 years of progress in five years by coordinating the different efforts already underway and funding more research. The legislation that helped build the moonshot was called the 21st Century Cures Act, which provided $1.8 billion for cancer research over seven years.
“We basically said, ‘What do we have now, what is missing, and what can we build on?” said Sigal, who was part of the moonshot’s blue ribbon panel.
Researchers don’t necessarily define success as someone never having cancer again. Doctors sometimes consider it a success if their treatment has helped someone live longer than they would have otherwise. When a person is in “remission,” it means their cancer isn’t currently active.
“I think living with cancer, controlling cancer, is a goal that seems something people should embrace even if it’s not total eradication of the disease,” said Jill O’Donnell-Tormey, CEO and director of scientific affairs of the Cancer Research Institute.
J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society, responded to the idea of a “cancer cure” in a blog post, saying research had entered a “new era” and that cures were “in fact within our grasp.” Though he didn’t cite Biden specifically, the blog came shortly after Biden’s public comments on the matter.
“People in the medical field believe there will be some way to cure some cancers, if not all, but it’s not going to be tomorrow and it’s going to take a lot of effort,” she said.