Editors Choice

Rethinking Cancer: We Think Too Narrowly

PATIENTS, FRIENDS, AND FAMILY OFTEN ASK IF WE WILL SOLVE THE CANCER problem soon. My answer is clear: No. We seem trapped in a reductionist mentality — We will solve cancer with targeted therapy, innovative chemotherapy, or gene therapy.

But this reductionist approach does not address the Darwinian aspects of cancer cell development nor how cancer interacts with its microenvironment.

Today, I will share a story of how breast cancer can hijack your pancreas, increasing diabetes risk.

How Breast Cancer Causes Diabetes

Did you know that type 2 diabetes and breast cancer are connected? In the United States, approximately one in eight women will develop invasive breast cancer; only skin cancer is more common.

More than eleven percent of Americans have diabetes, and an estimated 40 percent of us will develop the chronic condition.

Photo by Myriam Zilles on Unsplash

Historical studies demonstrate an association between breast cancer and diabetes. The breast cancer risk among those with diabetes goes up by nearly 1.3-times.

The risk of developing diabetes rises within two years of a breast cancer diagnosis. By ten years after a breast cancer diagnosis, with risk of diabetes is 1.2-times higher compared with age-matched controls.

On the other hand, we see an increased breast cancer incidence and mortality among those with a feature of diabetes known as insulin resistance.

Now, researchers from the University of California San Diego School of Medicine (USA) describe a potential biological mechanism connecting the two breast cancer and diabetes.

Cancer cells have a sweet tooth and consume more sugar (glucose) than healthy cells. Cancer cells need the fuel for growth. Breast cancer cells have figured out how to make their preferred food, depriving the normal cells of the essential nutrient.

Here’s how the cancer cells do their destructive work: The cancer pack signals microRNA-122 into tiny hollow spheres known as extracellular vesicles. The breast cancer cells then excrete these vesicles.

When the spheres reach the pancreas, they enter islet cells responsible for making insulin. The vesicles release their microRNA cargo, damaging the islet cells’ critical function in maintaining a normal blood sugar level.

I hope this mouse model study leads to improvements in breast cancer management. The research is a reminder that a continually evolving cancer interacts with its environment. We have spent so many dollars studying the seed. Perhaps we need to step back and look more holistically at cancer. Seed, soil, and more.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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