Why Early Detection Is the Best Way to Beat Cancer

When the first cell in one of Brenda Rosenthal's ovaries mutated and turned cancerous, she felt no symptoms. The telltale pains or lumps that signal cancer were still months, if not years, away. But there were signs, sparks thrown off by the tumor that had begun to smolder in her belly. As more cells were conscripted from the original task coded in their DNA and assigned a new, malignant mission, they produced proteins that leaked into Rosenthal's bloodstream. Had an effort been made to see these molecules, had there been a strategy for detecting them, the 69-year-old wouldn't face such long odds today.

Certainly, there were statistical red flags, if only Rosenthal had known to look for them. Twenty years before, she had survived a bout of breast cancer, increasing her risk for ovarian cancer in the future. That risk was exacerbated by a mutation in her BRCA2 gene that's been associated with much higher rates of breast and ovarian cancers.

Going purely by the numbers, Rosenthal, a New York City native now living in Delray Beach, Florida, was a prime candidate for ovarian cancer. But even after the link between the BRCA2 gene and breast and ovarian cancer was discovered in 1995, Rosenthal didn't think to get tested. "It didn't even register," she says. "I went on with my life, and I didn't think about cancer." It wasn't until 2005, when she first noticed a physical symptom—"this huge lump in my stomach area"—that Rosenthal learned she was once again a cancer patient.

Ovarian cancer, like most cancers, is measured in four stages. Stage I is early, when the disease is contained in the ovaries. In stage II, it may be present in the fallopian tubes or elsewhere in the pelvis. By stage III, it has migrated into the abdomen or lymph nodes. And by stage IV, the malignancy has spread, or metastasized, into major organs like the liver or uterus. (The first three stages are further subdivided into A, B, and C levels.) For ovarian tumors discovered in stage I or II, the survival rate 10 years after diagnosis is reassuringly high—almost 90 percent—because treatment is straightforward: surgery, perhaps followed by low doses of radiation. But survival rates drop precipitously as the diagnosis shifts to stage III or IV, when the cancer is well established and spreading. Here, the survival rate falls to 20 percent and then to 10 percent. Unfortunately, more than two-thirds of ovarian cancers aren't found until these later stages. That was true in Rosenthal's case: By the time she noticed her lump, the disease had spread and progressed to stage IIIC.

Four years later, after two rounds of chemotherapy, Rosenthal's cancer is in remission. But she remains vigilant. Every three months, her blood is tested for levels of CA125, a protein marker used to monitor ovarian cancer. She tracks clinical drug trials in the hope that she will qualify as a subject. Yet she'll always blame herself, if only a little bit, for missing a way to find the disease earlier. "I could live 10 or 15 years more, but I still won't have the quality of life I would've if we'd found the cancer early," she says. "I don't want anyone else to be in my position."

The survival rate for many cancers is similar to the cliff-like curve that defines ovarian malignancies. Find the disease early, thanks to a stray blob on an x-ray or an early symptom, and the odds of survival approach 90 percent. Treatment—surgery—is typically low risk. But find it late, after the tumor has metastasized, and treatment requires infusions of toxic chemicals and blasts of brutal radiation. And here the prognosis is as miserable as the experience.

This reality would seem to make a plain case for shifting research and resources toward patients with a 90 percent, rather than a 10 or 20 percent, chance of survival. But these are largely hypothetical patients. Cancer may be present, but since it hasn't been detected, as a practical matter these cases don't yet exist. People with full-blown cancer, however, are very real. They are our fathers and mothers, our children and friends. They're right in front of us. These are the 566,000 Americans who will die of cancer this year.

The US spends billions of dollars to save these late-stage patients, trying to devise better drugs and chemotherapies that might kill a cancer at its strongest. This cure-driven approach has dominated the research since Richard Nixon declared war on the disease in 1971. But it has yielded meager results: The overall cancer mortality rate in the US has fallen by a scant 8 percent since 1975. (Heart disease deaths, by comparison, have dropped by nearly 60 percent in that period.) We are so consumed by the quest to save the 566,000 that we overlook the far more staggering statistic at the other side of the survival curve: More than a third of all Americans—some 120 million people—will be diagnosed with cancer sometime in their lives. Their illness may be invisible now, but it's out there. And that presents a great, and largely unexamined, opportunity: Find and treat their cancers early and that 566,000 figure will shrink.