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But how worried should we really be? Every one of us probably has a few strange lumps and bumps by the time we get to a certain age, as shown by autopsies carried out on people who have died in accidents. At least a third of women in their forties have a tiny tumor in their breast. Yet only one in a hundred will be diagnosed with cancer at that age and many of them will live their whole lives without a formal cancer diagnosis. The same is true of prostate cancer - something that was first noticed as far back as the 1930s - and far more men will die with the disease than from it. Virtually every single person between the ages of fifty and seventy has a tiny cancer in their thyroid gland, yet just one in a thousand will be diagnosed with a thyroid tumor. Overall, slightly less than half of us are likely to be diagnosed with cancer at some point in our lifetime.


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[Virchow] was a political liberal and his views on decent living conditions, education, and health for the poor got him on the wrong side of the conservative Prussian chancellor, Otto von Bismarck, who was irritated he challenged the scientist to a duel. According to legend, Virchow’s weapons of choice were two identical sausages, one of which was liberally seasoned with roundworm parasites. Fearing the Wurst, Bismarck refused the duel. (While this is a great story with an excellent joke, it’s sadly not true. Although bismarck did challenge Virchow to a duel, the scientist just turned him down.)


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… they still don’t provide a hard answer to the question that all patients really want to ask: Will this drug give me more time?

We also might expect that new drugs should be tested against the very best options currently available. But that’s not necessarily the case. There are examples of therapies being tested against treatments that are no longer considered to be the best standard of care. Some trials compare survival for people taking a new drug today with historical survival times that may no longer be accurate. Many fast-track drug approvals are often made on the basis of initial progress-free survival or surrogate endpoint against these “straw man controls,” in the hope that companies might follow up with longer-term overall survival figures at a later date …

What’s more, the patients who take part in trials tend to be on the younger side, relatively fit, and without major health problems (other than cancer, obviously). They’re usually highly motivated to take part, monitored on a regular basis, and are more likely to adhere to the treatment. The idealistic setting of a clinical trial is no match for reality: most people with cancer are often older and sicker than typical trial populations. There are all sorts of additional health issues might limit the options available for treatment or the doses that can be used, from heart disease or diabetes to dementia or kidney failure.


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Most usefully, the Eco-Evo index also points toward the best approach for treating each of the sixteen types. …

Getting this right isn’t going to be easy and if we want to make accurate predictions about the behavior of an individual cancer, we’re going to need a lot of data. It also needs to be the right data, capturing the dimensions of space and time, gathered in way that preserves information about three-dimensional organization within tumors, and collected at regular time points. Not just easy genetic data, but holistic information about phenotype, immune cells, the state of the micro-environment and the rest of the body too, which can be crunched through the kind of sophisticated alogorithms and models that are used to understand and predict the outcomes of other complex systems, such as climate.