Cancer diagnosis and treatment are entering a "new age", brought about by genetic technologies. They will deliver new opportunities for better treatments but will also raise ethical issues, delegates to a cancer conference in Belfast have been told. "Cancer therapies must change," said Dr Richard Klausner, director of the US National Cancer Institute. Dr Klausner delivered a near inspirational speech to the NCI All-Ireland Cancer Conference, which is under way in Belfast. He said molecular studies of what changes took place in the cell to cause cancer were having a profound effect on its diagnosis and treatment.
It was causing a "blurring" between diagnosis and treatment, he said, which would "give us extraordinary opportunities" to improve clinical practice. It would allow medicine to move from an era of chemotherapy, which used unacceptably toxic drugs, to an era of targeted therapies that are designed around a cancer cell's specific internal biochemistry.
The entire concept was a "grand synthesis" built on the idea that a person's genetic make-up had a direct impact on cancer susceptibility, but also on the way that the disease progressed. Cancer, he said, was truly a genetic disease, "a manifestation of the accumulated genetic changes in a single cell", and so "DNA is a crucible" for the disease.
"Diseases are almost always a combination of the environment and genetics," he said, with a person's genes acting as a "filter" for the forces of carcinogenesis. Scientists were trying to understand what the individual genes were doing inside a cell as it "develops from a normal cell to a cancer cell".
If the changes could be catalogued, the hope would be that a person's "risk profile" for cancer could be determined. "We need to be able to develop a model, a measure of a person's cancer risk."
Studies of this "molecular susceptibility" were also raising questions about whether the genetic make-up was preventing the correct diagnosis being given. Resear chers had found that one cancer type might be expressed in very different molecular terms from patient to patient. While there was "one diagnosis, how many diseases?" Dr Klausner asked.
Earlier Dr Harold Varmus, the director of the US National Institutes of Health - of which the NCI is a constituent - said the new technologies were helping to identify inherited genetic mutations that could lead to cancers.
This information carried with it serious ethical questions however - what do you tell the patient, what will the impact on the family be, what are the future risks? "These are issues which we as cancer investigators have to take seriously," he said.
"The power of the new genetics," he said, related to the potential for earlier diagnosis of cancer. This in turn opened up "novel strategies" for treatments that targeted the cancer in a new way.
Dr Varmus and Dr Klausner were yesterday given honorary degrees by Queen's University Belfast for their contributions to cancer research. Each received a degree of DSc honoris causa.