Photographer:Fotograaf: Loraine Bodewes Fotografie
The 50 most important research questions for the Netherlands
Can we beat cancer more effectively?
“One day, we will beat cancer more effectively. I am fairly optimistic about that,” says professor Manon van Engeland, trained as a health scientist and working for Grow, School for Oncology and Developmental Biology. She is one of the two leaders of the oncology division. “Cancer cells are smart, certainly, but are they smarter than doctors and researchers? We don’t have the whole picture yet and that makes it difficult.”
Long live biochemistry and molecular biology! “Those disciplines have really caused a revolution. We now much more about cancer cells, what makes them different to other cells and how they work, which signal routes are on or off (an understanding of the signal routes helps in the fight against cancer, because cancer is often caused by signals that are not incorrectly transferred, ed.). I think that we will gain more detailed knowledge in the next five to ten years, partly due to improved techniques that will also be more affordable. Look at the genome research, for example, where we can look at cancer cells on a DNA level. I can imagine that in the future we can sketch a complete picture of a patient with a certain type of cancer. This can be used to target the treatment.”
Van Engeland thinks that if we want to beat cancer, something will have to happen on various levels. “Firstly, prevention is better than cure. Thanks to epidemiologic research, we know that smoking and lack of exercise increase the risk of many forms of cancer.” Secondary prevention also plays an important role. “Before people get cancer, there are forerunners in the body, a kind of pre-cancer that can be discovered. These may remain benign, but there is also a chance that they become malignant. To detect such forerunners, early diagnosis is required, for example by using imaging or molecular testing.”
For a long time, cancer has been treated in the same way in all patients, says Van Engeland, as only some of them responded well on the medicine. “Now, thanks to molecular biology, we are at a stage where we know that treatment sometimes needs to be adapted. Using prognostic and predictive markers, we can more or less predict how someone will respond to a treatment. This is called personalised medicine, something that for a long time was described as ‘unachievable’, because it was thought to be too expensive. But in the meantime we have discovered that the old way – treating everyone in the same manner – also costs a lot of money. Think of patients who suffer from side effects and need to be rehospitalised.”
The Royal Netherlands Academy of Arts and Sciences (KNAW) has listed the 50 most important research questions for the Netherlands. The 50th is the result of a competition, which was won by two UM researchers.