Summary analysis

Cancer is a disease full of paradoxes. It seems strange that our bodies appear to be so perfectly evolved for our environment and yet this disease has come to threaten the lives of half of the population. In addition, positive new stories about success in cancer therapy are difficult to reconcile with the personal tragedies that continue to blight so many families.

If we step back for a minute and reflect on our evolutionary legacy, then the epidemiology of cancer starts to become comprehensible. It's astonishing—and sobering—that at least half of all cancers could be prevented through lifestyle changes. Evolution didn't prepare us to inhale tobacco smoke into our lungs, carry excess weight or consume so much sugar or alcohol. Relatively simple modifications could completely transform cancer statistics and prevent millions of avoidable deaths.

However, the same evolutionary legacy that has made our bodies susceptible to these environmental challenges seems to have selected for a species that loves to take risks and seek short-term rewards throughout life. A hard question for us to address, then, is this: can we make the changes that will reduce cancer risk? My own view would be that some countries will start to stop the sale of cigarettes completely within the next ten years. However, the extent to which this is successful, or adopted elsewhere, will depend on the political balance that societies will strike between risk and benefit. Likewise, individuals will surely start to change their habits in the face of increasingly strong and definitive evidence about the risk factors for cancer. Of course, an increasing contribution to this debate will be the information gained from studies of our personal genome sequence. 'Predictive genomics' will, despite its limitations, add some power towards defining individual susceptibility and guiding risk reduction.

Despite all this, we won't completely eradicate cancer. So here we'll see step changes in our early detection and in the management of established disease. As mentioned in many of the TED Talks, techniques like advanced imaging and proteomics will permit much earlier detection of malignant tissue—although it will be challenging to predict how important such early lesions will prove to be within an individual patient. We'll see an increasing role for the physical sciences within biomedical research. Technologies such as continuous and remote monitoring, using implantable or cutaneous sensors, will allow populations to be screened in real time for the earliest sign of homeostatic distress.

Finally, when the need arises for definitive treatment, we'll be able to approach cancer therapy in a radically different manner. We'll have a complete genomic understanding of each individual tumor and will be able to identify more targeted drugs from the lexicon of chemical reagents that are currently in development. The hope is that tumors will shrink in the face of combined and 'drug-resistance-proof' combinations.

And yet, perhaps this won't be the future at all. Such a complex approach may not even be required. Cancer therapy has relied on empirical observations and unpredictable advances. It shouldn't surprise us if biochemical pathways that are commonly disordered within many cancer cells become potential targets for treatment – a 'common treatment for all'. In addition, the understanding of how our own immune systems can eradicate malignancy is only just becoming apparent, in the most breathtaking way.

The history of cancer research is littered with unexpected successes and heartbreaking failures. The future will provide just as many, but the balance between these two has changed irrevocably, and those successes cannot come soon enough for all of us.