"The cure rates have changed dramatically, and progressively improved over the last 50 years. Pediatric cancers are a great success story. The cure rates for pediatric cancers in the mid-1960's were in the 5-10% range. Now we have 80% cure rates in pediatric cancers across the board. And with adult cancers, which are much harder to treat, we've had a 25% increase in survival rates," said Dr. Michael Kastan, the Executive Director of the Duke Cancer Institute.
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The Duke Cancer Institute was one of eight national cancer centers founded as a result of the National Cancer Act, and has played a major role in breast cancer and brain tumor treatments, as well as bone marrow recovery following chemotherapy.
Kastan notes decades ago, there were few detection methods, often leading to diagnoses in later stages, which are more difficult to address. Treatment options were far less exacting, and side effects were often extreme, leading to enhanced risk of complications.
Today, thanks to massive advancements in screening and treatment, more people are surviving cancer.
"We have more and more people who are surviving their cancer, who are long-term survivors. We have over 14 million long-term survivors of cancer in the United States. And that's a wonderful thing," said Kastan.
However, while overall there's been marked improvement in outcome, success rates still sharply vary on a cancer-by-cancer basis.
"We do much better with certain cancers like breast cancer, certain lung cancers, leukemias and lymphomas, but there's still a lot of cancers that we're challenged with. Pancreatic cancer, and brain tumors, and others where the cure rates are still not where we need them to be," Kastan said.
Kastan shared hope for the next 50 years.
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"At a definitive level, how to selectively kill the cancer cell without affecting the normal cells, and that way we'll be much more effective. Part of that is how we make diagnoses at an earlier stage," he explained.
Pam Kohl understands the progress - and need for continued work - better than most. She serves as Development Director for the Metastatic Breast Cancer Initiative with the Susan G. Komen Foundation, and currently has stage 4 metastatic breast cancer.
"When I was first diagnosed with MBC, the doctors told me that the average was 2-3 years. Of course that was five years ago. A lot has changed in five years, thank goodness," Kohl said.
She was first diagnosed with stage 1 breast cancer in 2010; a few years after finishing her endocrine therapy, she underwent routine screening which highlighted an abnormality. After she pushed for further testing, doctors determined she had stage 4 metastatic breast cancer.
"The good news is I know a lot, and the bad news is I know a lot," Kohl said.
Kohl continues to undergo treatment, and is about to approach the five-year post-diagnosis mark, which only 27% of MBC patients reach. Her dual role as a patient and advocate helped motivate her and her team at Susan G. Komen to undertake a massive fundraising effort, with the goal of combining local resources.
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In October, the Susan G. Komen Foundation announced $1.5 million in grants for UNC Lineberger and Duke Cancer Institute to collaborate, creating the Metastatic Breast Cancer Collaborative Research Institute.
"I'm just so proud and so hopeful that maybe the cure is going to come from right here from Duke and UNC working together," said Kohl.
She's also pushing for enhanced access across socioeconomic lines, noting disparities in outcomes that exist.
"Oral drugs make it so much more accessible to folks. Until we figure out the disparities issue - Black women for metastatic breast cancer are 41% more likely to die from breast cancer than white women - and if we don't figure that out, we're not going to meet the goals we want to meet on the war on cancer. We know a lot of it is social, economic, the social determinants of health. But we really need to find out if there's a biological issue here. Black women tend to get more aggressive cancers, they get triple negative cancers, those are much harder to treat, there aren't as many options. There's so many things we need to resolve here in North Carolina and around the world," Kohl said, adding she's grateful for the care she's received from Duke Cancer Institute.
While Kohl says she is realistic about her situation, understanding she will need treatment for the rest of her life, she remains confident that further progress is ahead.
"We're going to get there. Whether we get there in time for me, I don't know. But it's important to just step-by-step, live my life, create memories for my family, always have a Plan B in case I'm in treatment or in case I'm not feeling well and keep working so hard to keep the research and the oncologists and doctors focused on the cancers that kill."