more_vert
IN his 2016 State of the Union address US President Barack Obama announced a billion-dollar program to accelerate progress towards curing cancer by achieving 10 years’ progress in 5 years.
It echoed a speech of President John F Kennedy in 1962 in which he announced the program to walk on the moon by the end of that decade – a goal that was reached in 1969.
How could Australia contribute to the Cancer MoonShot like it contributed the Parkes radio telescope to the Apollo lunar program almost five decades ago?
In cancer prevention, Australia is a world leader in tobacco control, being the first country to introduce plain packaging. Along with regular tax increases, there is a realistic goal of achieving adult smoking rates of less than 10% by 2018 and the world can learn from this.
However, regarding the second major preventable cause of cancer – obesity – successive governments have been reluctant to act to regulate advertising of high calorie foods with high fat, sugar and salt content but little nutritional value (junk foods), if only to protect children.
- Related: Podcast with Professor Ian Olver
- Related: MJA — Reassessing rare cancers
Even an initiative to introduce simple front-of-pack labelling of foods so consumers could make choices based on nutritional content was introduced as a half-hearted voluntary exercise. Reducing the harmful use of alcohol to reduce preventable cancer risk does not seem to be on the legislative radar.
In developing vaccines to treat cancer, again Australia led the world with the human papilloma virus vaccine which prevents cancer of the cervix. Backed up by strong government support in making the vaccine available to both boys and girls, there is a realistic chance of eradicating that cancer in future. This is a great example of the value of funding research and of government policy helping translate successes into benefits across the population – a good role model for a Cancer MoonShot.
Research collaboration with the US could be of greater benefit than it is now, but there are logistical and policy barriers.
Single national ethical review of multicentre trials and rationalisation of trial governance reviews in Australia would facilitate international research collaboration, but it is difficult to achieve in a federated structure where state jurisdictions can be reluctant to surrender responsibilities currently under their control.
However, we can share data, as Australia has an impressive series of state-based cancer registries and the ability to provide national data through the Australian Institute of Health and Welfare. This enables our progress in cancer control to be compared with that of other countries and allows us to monitor the impact of screening or treatment policies.
Progress has been made in linking such registries to hospital patient data collections and the Medicare and Pharmaceutical Benefits Scheme (PBS) databases. This enables policy to be based on cancer outcomes. The privacy issues with such data linkage have been adequately addressed, and are balanced against the public good of being able to monitor cancer control. International sharing and linkage of de-identified data should be possible as part of the Cancer MoonShot.
With cancers being divided into smaller subgroups by their genetic fingerprints, research into new treatments, which has until now required randomised clinical trials, may have to rely on smaller studies of efficacy and toxicity, release of the treatment, and then interrogation of large international clinical patient databases for further fine tuning of usage.
Australia will have difficulty contributing here because of the states’ very patchy efforts in digitising medical records. Even a national scheme for patient controlled e-health records has taken years to make limited progress.
Am I naive in believing that a successful app developer could develop a patient-controlled record in months not years? Hopefully, international pressure may focus our governments on how essential digitising our health records will be to taking our place in the medical advances of the future.
Finally, there are common problems that face both the US and Australia.
One is the challenge of funding high-cost drugs. Australia’s PBS system has worked well to date but is under pressure with the number of new targeted therapies and immunotherapies being developed and marketed for hundreds of thousands of dollars per course.
Both countries could collaborate on developing metrics to determine the value of such therapies which would determine what they would be prepared to pay.
Australia has one of the highest cancer survival rates in the world. We have many successful initiatives to share as contributions to the Cancer MoonShot, but we should also commit to addressing gaps to further improve our cancer control.
Professor Ian Olver, AM, is Professor of Translational Cancer Research at the University of South Australia, and Director of the Sansom Institute for Health Research.
I strongly agree with the sentiments expressed by Professor Olver to reduce the cancer burden. For completeness, I would also draw attention to Australia’s world-leading research in skin cancer prevention and control. Skin cancer is often forgotten when discussing approaches to cancer control, yet these cancers are exceedingly common. In fair-skinned populations around the world, cancers of the skin are the commonest cancers and incur a sizeable toll in terms of health system costs, morbidity and mortality. Importantly, we know the cause of these cancers (sunlight, mostly), and we are getting much better at knowing how to stop these cancers from developing. The innovative approaches of Australian agencies to promote awareness and change behaviour in the Australian population have led to measurable declines in the incidence of keratinocyte cancers (BCC and SCC) and melanoma in the Australian population. Australian scientists also lead the world in the genetic analysis of these cancers, and in developing novel therapies to treat them successfully. The rest of the world looks to Australia for leadership in skin cancer prevention and control – we must continue our efforts in this area as much work remains to be done. Our rates of skin cancer remain very high in world terms, and the death toll from cances of the skin (around 2100 p.a. for melanoma and keratinocyte cancers combined) is higher than the national road toll (around 1200 p.a.). Any Australian “moonshot for cancer” must consider cancers of the skin.