South Africa won’t conquer cancer if it works alone

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In the fight against cancer, researchers are trying to find not one but two Holy Grails. The first, and most important, is an effective method for early diagnosis. The sooner you recognise cancer, the better the odds of saving lives. 

The problem is that the earlier you spot it, the more infinitesimal the malignancy, ruling out surgical removal as one of the most reliable first responses. If we are able to discover the disease as it forms at the minuscular molecular scale it paradoxically becomes practically invisible to the physical tools of treatment developed over decades. 

There is much variation in cancer and scientists are increasingly convinced that a more effective treatment option for cancer is the other Holy Grail — personalised

treatment. First, if you must wait until a lump is formed to cut it out, it may be too late, but at the same time, using a single treatment regime for a cancer type that is very differently presented in each patient is not effective. 

Fortunately, clues to finding both Holy Grails can be found in the same place: information encoded in the diagnostics can also be used for disease-specific therapeutics. But this requires us to be willing to work outside of our silos. 

Tackling cancer with a variety of tools 

Cancer doesn’t respect the neat boundaries of human-engineered disciplines. Departments and institutions are constructs we have developed to assist in dividing up the research workload. To understand and treat a highly complex disease we have spent decades trying to cure, our approach needs to be problem-based and solution-focused, not discipline-driven. 

You can’t understand and treat a disease as complex as cancer through a single disciplinary approach, just as Ferrari wouldn’t try and repair a complex race

car with one tool. You need an array of tools for the job — some highly tuned, others with a bit more brute force. 

For the Ferrari, tools will vary from the more traditional mechanical spanners and wrenches to sophisticated software that manages the onboard computer systems. Cancer research requires the same varied approach — the only difference is that it’s far more complicated than a high-performance sports car. 

Cutting-edge and multidisciplinary toolsets for cancer range from mathematical, computational and statistical modelling through chemical and biological

laboratories, to the cellular and animal-testing types of laboratories in health sciences departments, and into the space of clinicians, from surgery through to oncology. 

It’s a workflow that spreads from the basics to the top end, from the computer board to the laboratory bench and finally to the patient’s bedside. This wide-ranging assembly of colleagues across disciplines marks the unique edge of pioneering research. 

The promise of cross-disciplinary research 

One of the most significant examples of cross-disciplinary research saving lives came from the Covid-19 vaccination drive, where a scientific discovery fast-tracked in just 10 months is credited with saving tens of millions of lives around the world. The speed of development was only possible because of the enormous amount of work done beforehand through research to find a vaccine for cancer.  

Research done in the cancer space was channelled to a new purpose in a global health emergency of a different kind. It shows the hope and promise of meeting

challenges in science head-on, with multiple tools and from a variety of perspectives. 

To do this, every scientist needs to understand how their research could address a broader, perhaps even unrelated challenge. And talented minds are starting to see the advantages of not only focusing on the work that’s right in front of them, but also lifting their heads to work with colleagues across disciplines and see the broader context in which their contribution can make a difference. 

But despite its promise, interdisciplinary approaches remain difficult to catalyse. And one reason for this, as is so often the case in all advanced research, is a matter of funding and investment. 

Funding in South Africa 

It seems obvious that research and communication must cut across different departments and disciplines. But it’s something easier said than done. Researchers are used to running in their own lanes and have been known to want to protect their turf. This is especially true for those disciplines that traditionally receive more funding.  

Strangely enough, despite the real threat cancer poses and the number of lives it touches across all sections of society, cancer research in South Africa is woefully underfunded. Research cannot run on fresh air so it becomes difficult to convince scientists to direct their focus toward cancer — they risk losing out on funding to finance their students and develop their laboratories in the specialised disciplines in which they have been trained. 

This is all within a broader context of a lack of funding for research in South Africa. To put things into perspective, the total share of the budget for research in South Africa was just 0.75% of GDP in 2018/19 — and it’s on a downward trend. 

That’s for all research. Cancer research gets just a tiny slither of that. The numbers do not add up to the scale of the cancer threat. The result: South Africa is forced to buy expensive solutions from abroad rather than developing them at home. Up-and-coming talented scientists and specialists then move overseas to pursue careers because they find opportunities lacking back home, reinforcing the vicious cycle. 

The tragedy is that South African scientists are talented and passionate people who are already making a substantial contribution to global research, not least in the fight against Covid-19. With the right encouragement to join forces across disciplines — and the resources to support this — we could lead and build on excellent research instead of buying unaffordable care for only a few. 

Professor Kevin Naidoo is director of the Scientific Computing Research Unit at the University of Cape Town, and South African Research Chair in Scientific Computing and is credited with leading a breakthrough in cancer research, which paves the way for early diagnosis and specialised treatment based on each cancer’s unique genetic expression pattern. 

The views expressed are those of the author and do not reflect the official policy or position of the Mail & Guardian