27 August 2021
This essay summarizes the latest version of our Strategic plan to substantially reduce cancer deaths, click here.
* First, it is important to have an ambitious plan that itemizes what needs to be done and what needs to be better understood. Our plan might fail. But it is important to “dare greatly” (“The Man in the Arena”, 1910, retrieved 27Aug21) and attempt to achieve our actual goals, even if we do not know precisely how to do so.
* Second, reducing the high number of US cancer deaths is a management problem that requires that we optimize each step of cancer’s clinical pathway (prevention, early detection, treatment and failure to respond to treatment). It is not primarily a problem of finding a “silver bullet” or “magic pill”.
* Third, we should study and reduce cancer deaths that occur shortly after diagnosis. These may be preventable if due to (a) overzealous treatment that does not adequately balance treatment side effects, (b) predictable infections or (c) damage to essential physiologic networks that can be normalized.
* Fourth, we speculate that for each cancer type, even the most aggressive, there exists a combination of perhaps 8-10 therapies that individually may be only partially effective but together can be substantially effective. Effective combinations not only target the cancer cells but their surrounding microenvironment; systemic networks involving inflammation, the immune system and possibly hormones; germline variations in DNA and known patient risk factors for this disease.
* Finally, we outline important therapeutic strategies, including:
– Treatment should focus on managing the malignancy to reduce death and disability, not eliminating every possible cancer cell.
– Consider achieving “marginal gains” at all steps of the disease process, which may increase possible treatment options and reduce a sense of futility.
– Therapy should be patient centered to the extent possible because patients may have markedly different therapeutic preferences.
– Aggressively enroll patients into clinical trials so physicians can learn and improve over time.
You can help:
* Sign up for our Curing Cancer Network monthly newsletter by clicking at
* Become an example to others of anti-cancer behavior. Read our American Code against Cancer at http://www.natpernick.com/AmericanCodeAgainstCancer.html, decide what steps you can take to reduce your cancer risk and spread the word through your social networks.
* Contact me with your thoughts and suggestions at Nat@PathologyOutlines.com.