We need to find the ‘first cell’, says Pakistan-born oncologist
Cancer is a devastating illness with a great human cost. Treatment, which is usually expensive, can often be more damaging than the disease itself. But it doesn’t have to be, says international cancer expert Dr Azra Raza.
We have been approaching treatment all wrong, she adds.
Dr Raza is the director of the Myelodysplastic Syndrome (MDS) Center at Columbia University and has been working on cancer therapy since the ’80s. In her practice, she sees up to 40 patients on a weekly basis.
“We are still using the 1970 model,” she said, during a lecture series organised by the Aga Khan University . “This is a reductionist treatment strategy.”
According to the old model, two thirds of cancers diagnosed today are cured mostly with surgery, chemotherapy and radiation.
But the outcome for the remaining third with advanced disease is no better in 2021 than it was 50 years ago, she says.
According to the American Cancer Society, in 2018 cancer patients in the US paid $5.6 billion out of pocket for treatment.
“The old model says most cancers are the result of random mutations but I challenge the old model,” Dr Raza said.
Mutations are genetic changes due to DNA copying errors in cells. They produce abnormal proteins that direct cells to multiply uncontrollably. This results in the formation of a tumour.
Dr Raza hypothesizes that mutations are the response of normal cells to stressors such as infections, inflammation, autoimmune problems and toxins.
There are thousands of mutations in the body by the time we diagnose the cancer, says the oncologist.
To give a perspective, a tumour of 0.1mm has 300,000 cells, 1mm has three million cells and 1cm has three billion cells.
These mutations start with the development of “giant cells”, which Dr Raza says are the first cells of cancer.
Research shows that 43% of all solid tumours have found giant cells.
The oncologist backs her claims with her own research and unique personal repository of patient cells she has been collecting since 1984.
This repository contains more than 60,000 samples of blood and bone marrow from consenting patients.
“While treating acute myeloid leukaemia I realised this disease won’t be cured during my lifetime,” Dr Raza said.
Acute myeloid leukaemia is a type of blood cancer that results from the development of immature blood cells in blood and bone marrow.
The process of mutation starts years earlier in what is known as the pre-leukaemia stage or Myelodysplastic Syndrome.
If patients with MDS are monitored closely doctors can detect the biomarkers of early AML before it progresses to an end-stage disease.
Most of our resources are invested in trying to understand and treat advanced metastatic cancers, the oncologist laments.
She suggests half of the resources continue to be spent on advanced cancers and the other half should be invested in the new model to find and eliminate the first cell.