The Urgent Need to Prioritize Cancer Prevention

I am a survivor of early onset rectal cancer. Chemotherapy, radiotherapy and brutal surgery saved my life, removing my tumour along with my large intestine, bladder, prostate, rectum, pelvic floor and the base of my spine. I now live with two stoma bags and a body irrevocably changed by treatment.

I am likewise a scientist working to prevent the disease that consumed me. From that dual vantage, I’m confronted by an unpleasant truth: we brace for diagnosis and invest in treatments even as neglecting prevention.

Underinvesting in cancer prevention is a choice, a failure of imagination and a lack of confidence in what we already know we can achieve. Preventive strategies could mean people can be joyful for never needing treatment, rather than grateful to have survived.

A Shock Diagnosis

My story began in late 2017. At the age of 27, three months into a research post, I developed fatigue, severe weight loss and a grey pallor. I initially attributed these symptoms to irritable bowel syndrome and adjusting to a new country. However, by April 2018, scans revealed advanced rectal cancer. Despite my professional focus on studying this disease, understanding the diagnosis didn’t lessen its impact.

Genetic testing later confirmed that I was born without a fully working copy of the tumour suppressor gene adenomatous polyposis coli (APC). Within weeks, the tumour had grown so large that emergency surgery was required to divert my bowel through my abdomen to a stoma to prevent sepsis. By June, my weight had dropped to under 8st, and I was largely bed-bound. I was warned by consultants that I was “circling the drain”.

Over the next six months, I endured infections, isolation, and morphine-induced unconsciousness. However, the treatment worked, shrinking the tumour by 95 per cent by December. This led to a 12-hour pelvic exenteration to remove the remaining cancer. I awoke in July 2019 to a body remade by surgery, and slowly began to recover.

While this is considered a success, surviving cancer has brought lasting challenges – the ability to eat without fear, spontaneous travel, and an intimate life feel less natural. Scar tissue from operations can cause blockages requiring hospitalization, and the ongoing management of my condition impacts my daily life.

Despite these challenges, I found unexpected grace and learned to manage my condition with the support of my family and partner. I returned to my research with a renewed urgency, frustrated by the complacency in cancer prevention research.

A Litany of Failures

The projected rise in cancer cases by 2050 – a 77 per cent increase – highlights the need for greater investment in prevention. Up to 40 per cent of cancers are preventable, yet cancer research funding remains heavily skewed towards therapy-orientated biology and drug development. Prevention is the only economically viable path forward.

This underinvestment stems from two key failures. First, a misperception that prevention isn’t profitable. However, the success of cholesterol-lowering statins, with cumulative global sales nearing $1 trillion in 2020, demonstrates a vast market for preventive medicine.

Second, a historical reluctance to invest in prevention due to past failures of dietary supplement trials. However, these trials were limited by the methods available at the time. Modern approaches, focusing on well-defined high-risk groups and utilizing new technologies, offer more promising results.

Genetics and New Tech Give Us an Edge

Advances in genetics and emerging technologies have provided an unparalleled view into the biology of cancer risk. Since the sequencing of the human genome, thousands of cancer-associated genes have been identified. Recent advances in medicines for neurological conditions reveal how targeting ribonucleic acid (RNA) can help stop harm before it fully takes hold. In cancer, this could mean silencing early harmful messages that set cells on the path towards malignancy.

Preventive vaccines, such as those for HPV and hepatitis B, have already demonstrated success in reducing cervical and liver cancers. A new vaccine, funded by Cancer Research UK, is being developed to train the immune system to recognize and clear cells with genetic instability associated with Lynch syndrome, a condition that increases the risk of colorectal cancer.

Make Prevention a Priority

Effective cancer treatment can be life-saving, but surviving cancer is profoundly life-limiting. We need to shift our focus towards prevention, investing in research and recognizing that it is not only viable but also potentially profitable, as demonstrated by the success of statins and other preventive medications.

Cancer prevention currently represents a small and static share of research budgets – approximately 7 to 9 per cent in the United States and 7 per cent in the United Kingdom. Fewer than 4 per cent of European funders support primary prevention. This must change.

We need scientists, pharmaceutical companies, healthcare systems, and political leaders to prioritize cancer prevention. The goal is a future where cancer is no longer a devastating diagnosis, but a preventable disease.