Editor-in Chief, Nature

Optimism Needs To Have Bite So That Pioneering Work In Early Cancer Detection Is Championed and Funded

Thinking of myself as a perennial optimist, I was surprised how challenging this question turned out to be. I realise that it's because my optimism is an attitude, rather than founded on careful estimation, and therefore bears little scrutiny. A corollary of this is that my optimism makes little difference to what I manage to achieve in a typical day apart from, importantly, getting out of bed in the morning.

Turning to a dictionary I confirm that optimism is either "a doctrine that this world is the best possible world" or" an inclination to put the most favorable construction upon actions and events or to anticipate the best possible outcome" (both from Webster). An attitude, therefore, of questionable robustness, and idiotically dangerous in some circumstances. But amongst several similar definitions in the Oxford English Dictionary I also find something less loaded: "Hopefulness and confidence about the future or the successful outcome of something". This permits optimism also to be rational.

And, to get serious, if I look for one aspect of life where both rationality and hope are essential, and where both seem to be paying off, it's in the battle against cancer. I focus my optimism on what currently looks like a peripheral flank in that battle, but could — and I think eventually will — become a more central focus of attention. We should of course be delighted by the few instances of drugs that hit a cancer target, even when the target wasn't the one originally intended. But just as important to me is the prospect of the use of proteins or other markers that permit the early detection and identification of cancer, hugely increasing the prospects of survival.

An early-detection cancer diagnostic needs to show low rates of false positive and false negative outcomes, should be able to distinguish tumours needing therapy from those that will do no harm, and should be acceptable in term of cost and practicality. This combination is a very tall order.

But hope arises from the unprecedented sensitivities of mass spectrometers, of single-molecule detection and of DNA amplification, not to mention the power of high-throughput biological screening. These bring us the almost unimaginable prospect of successful discrimination of cancer or — even better — pre-cancer marker-molecules within the bloodstream. The recent discovery in mice of genetic pathways underlying progression from precursor to advanced stages of ovarian cancer is another milestone to sustain optimism.

Although the US National Institutes of Health has made early detection a priority, it remains relatively underfunded in most cancer agencies. It has big challenges of clinical validation ahead of it. At the policy level, health planners and drug companies will need to be sure of its societal cost-effectiveness.

These considerations, and the fact that diagnostics are less scientifically sexy than 'cures', can deter researchers from pursuing early detection studies. So it's precisely now that optimism needs to have bite, so that pioneering work in early cancer detection is championed and funded despite the daunting obstacles ahead.