President Trump made a new promise if voters grant him a second term: “We will come up with the cures to many, many problems, to many, many diseases, including cancer.”
Trump’s statement was part of his 2020 campaign kickoff in Orlando, Fla., this week. It echoed remarks by former vice president and Democratic candidate Joe Biden on the stump last week in Iowa: “I promise you, if I’m elected president, you’re going to see the single most important thing that changes America: We’re going to cure cancer.”
It’s hardly a new political ambition. Way back in 1971, then-President Richard Nixon launched “The War on Cancer” by signing the National Cancer Act, which directed $1.6 billion to research and established the National Cancer Institute.
It’s a compelling promise: Who could be against curing the nation’s second-leading cause of death?
If only it were that simple.
Neither the Trump campaign nor the Biden campaign responded to requests to discuss their comments. But scientists and health experts say that curing cancer is going to take a lot more than promises on the campaign trail. Here are three reasons why:
With cancer, the biology is especially tricky
Cancer is multifaceted and uniquely complex. It’s not so much one disease as a class of related diseases.
“‘One cure’ is not a tenable concept,” said Dr. Edward Giovannucci, a cancer researcher at Harvard. “An analogy I think of is ‘curing infectious disease.’ No one would ever say this.”
For one thing, individual cancers mutate differently. And those different mutations don’t always respond to the same medicines. That means the best therapy for one person’s lymphoma might not work for someone else’s.
And there is consistently potential for new cancer mutations to develop — so in some ways, there is also a consistent need for new treatments.
“One cannot rightfully say, ‘In the next five years, we’re going to cure cancer,’ because cancer is so many different diseases,” said Dr. Philip Kantoff, an oncologist and chairman of medicine at Memorial Sloan Kettering Cancer Center in New York.
Perhaps Trump and Biden didn’t intend for their statements to be taken literally. And, to be fair, pledges like these can yield advances when accompanied by substantial increases in research funding or efforts to encourage interdisciplinary scientific endeavors.
“One of the things Biden has done is generate a much larger public awareness that cancer is a set of problems that, if we direct both science and policy in the right way to it, we can actually transform,” said MIT chemical engineering professor Paula Hammond, who has worked with the nonprofit Biden Cancer Initiative.
We already have treatments. But there’s an affordability problem
Many cancers, including certain types of breast or colon cancer, are already curable. But they need to be promptly diagnosed and treated. That can be a challenge when 27.4 million Americans don’t have health insurance.
Universal prevention, treatment and curing of cancer means anyone with a chance of developing the disease needs health insurance, experts said. The coverage needs to be robust enough that patients will go for preventive screenings and follow-up care, without being deterred by the cost.
“If you’re going to find it early, treat it early and completely, which would be the ‘cure it’ option, that’s something where insurance is going to be required,” said Amy Davidoff, a health economist at Yale who studies how cancer costs affect people. Focusing on treatments without expanding meaningful access to coverage, she said, is “problematic.”
Research by Davidoff and others found that when states expanded eligibility for Medicaid coverage — an option under the Affordable Care Act — gaps between white and black adults closed when it came to timely treatment of advanced cancer.
Health insurance — and universal healthcare, in particular — has already emerged as an election issue.
Trump has not rolled out a healthcare agenda. But his administration’s work thus far has exacerbated insurance barriers.
Some 700,000 more Americans were uninsured in 2018 under Trump. The White House’s stance on a pending Obamacare lawsuit would dismantle the law, leaving millions more Americans without coverage and upending its protections for people with preexisting conditions — including, crucially, cancer.
Biden has not formally released a healthcare platform, but he has favored policies to expand coverage. This week, he suggested making a “Medicare-like public option” generally available, even for uninsured people who live in states that did not expand Medicaid.
But there would still be holes. Currently, even if people have coverage, the price tag for many newer cancer treatments and immunotherapies can put them well out of reach, Davidoff said. That means the generosity of any public option, and indeed of any existing health plans, matters a great deal, too.
The importance of healthy habits
When it comes to advancing cancer treatment, experts stressed the importance of disease prevention.
In practice, that means developing strategies to bring down rates of smoking and obesity, or improving access to nutritious food. Those require funding, political will and a robust public health infrastructure — none of which is easy to come by.
But the potential payoff is far bigger, experts said.
“If we are to make very significant inroads on cancer mortality rates over the next several decades, we need to focus on prevention and early detection,” Giovannucci said. “We know the majority of cancers are, in principle, preventable.”