Eventual success in cancer control is achievable but is still distant. Cancer prevention has advanced spottily where tobacco control has been imposed, but the scourge continues. Most chemicals in the marketplace, including in the food chain, are untested and some are suspect. Imaging methods have vastly expanded for the better, but we lack a test of blood, urine, or saliva that has specificity for early cancers. Surgical techniques for primary tumors have improved as a result of new instrumentation. Radiation therapy can be delivered with less collateral damage, but like surgery with little evidence of increased curative effect. Chemotherapeutic agents that target specific genes have led to temporary regressions of a few metastatic cancers, but have not yet been reported of curative potential for micrometastatic neoplasms. Single gene targeting assumes single gene indispensability for the cancer state, as is true in chronic myelocytic leukemia, a singular rarity. Chemotherapeutic agents derived from empiric testing on experimental cancers still dominate therapy of metastatic and micrometastatic cancers with some cures for the record. Specific antibodies augment this effect in a very few neoplasms. Active mobilization of the host immune system, a golden wish, is still imperfect.
We have not significantly interrupted the metastatic process. Final common pathways for the cancer process have been identified, but not successfully interrupted. The distribution of resources for, information about, and application of anti-cancer efforts is markedly disparate, with advantage for the three wealthiest continents. The greater populations of cancer patients in Asia, Africa, and South America are not similarly privileged. Even in Europe, North America, and Australia, economic factors influence cancer incidence treatment and mortality.
A test or tests or body fluids for early cancer, an understanding that underpins prevention of metastasis, achievement of autonomous immunologic defense, and widespread public health measures to prevent cancer and to apply the best program universally will likely come, but not yet.