DEVELOPMENT AND INNOVATION IN CANCER MEDICINE - Innovation in the Biopharmaceutical Industry - page 47

monitor serum for fragments of DNA containing defined mutations could ultimately
develop into an implanted gene chip. When a significant mutation is detected, the
chip would signal the holder's home computer and set off a series of investigations
based on the most likely type and site of the primary tumour.
As a result of improved survival, there will be an increase in the total prevalence
of cancer, as well as change of cancer types to those with longer survival, such
as prostate cancer. New challenges will be created in terms of assessing the risk
of recurrence, designing care pathways, use of IT and improvement of service
access. As experience grows with risk factors over the long term, there will be new
opportunities for further targeting and development of existing therapies. Carefully
monitoring a patient's experiences might help to improve results. Cancer might
soon become a long-term management issue for many patients, who would be able
to enjoy a high quality of life despite having a chronic illness (Tritter and Calnan,
2002).
Cancer care funding will become a significant problem (Bosanquet and Sikora,
2006). We are already seeing inequity in access to taxanes for breast and ovarian
cancer, and to gemcitabine for lung and pancreatic cancer. These drugs are merely
palliative. They only add a few months to life. The emerging compounds are likely
to be far more successful, and their long-term administration to be considerably
more expensive. Increasing consumerism in medicine will lead to more informed
and assertive patients who seek out novel therapies and bypass traditional referral
pathways by using global information networks. It is likely that integrated molecular
solutions for cancer will develop, but unless issues related to access are addressed,
this development will lead to far greater inequity than we currently have. Cost
effectiveness analyses will scrutinise novel diagnostic technology and therapies.
The past
The first recorded reference to cancer was in the Edwin Smith Papyrus of 3,000 BC ,
in which eight women are described as having breast cancer. The writings of Hip-
pocrates in 400 BC contain several descriptions of cancer occurring in various sites.
But our understanding of the disease really began in the 19th century, with the
advent of cellular pathology.
Successful treatment through radical surgery became possible in the later part
of the 19th century due to advances in anaesthetics and antiseptics. Radical surgery
involved the removal of the tumour-containing organ along with its draining lymph
nodes in one block. Halstead in Johns Hopkins was the main protagonist of the
radical mastectomy, Wertheim the hysterectomy, Trotter the pharyngectomy and
Miles the abdomino-perineal resection of the rectum. These diverse surgical proce-
dures all followed the same principles. When the 20th century ended, organs could