In 2011 we launched our Understanding Life program. The program embraced the view that cancer is a life threatening disease and a systemic problem. It is among the leading causes of death worldwide. About 12 million people are newly diagnosed with the disease and 7.5 million people die from it every year. The problem is systemic because it results from the interaction of a complex set of influences: biological, social and life histories. Our genes are very important, but so are our cells and organs. The way we eat, drink, what we inhale, move around is critical. Smoking, for example, causes cancers in the lung, and in many countries about 20%-30% of the cancers is due to smoking. And we also have to look at life historically. We are endowed with a body and a set of genes that grows over time: your body is the result of generations of genes combined into new sets of genes, one group derived from your mother and the other derived from your father. Our personal life begins with two merging cells. We grow up, become adults, get children ourselves and get old.

The Root of Inspire2Live

We are deeply committed to improving the treatment of cancer patients. In 2011 Robert Weinberg presented a very important picture of our personal and social relationship to cancer. We are heading for an Iceberg. It could strike on us, the way the Iceberg hit the Titanic.

This picture illustrates what we are up to. We have to understand that life is threatened in two ways: one part visible, the top of the Iceberg and the other chunk is hidden underwater: the cancers that are underway in the life histories of people.

We face a double problem: approaching the Iceberg from two angles. We have to focus on better and more personal treatment: the top of the Iceberg, and we have to deal with the chunk underwater by means of better prevention. Moreover we focus on better care and better quality of life for those who get cancer, are treated for cancer and have to live with the disease.

This is how we are organized, from our root up. We have to understand life in order to deal with cancer. We know that cancer is the result of an aging process of a body that lives a life filled with many interactions: with other bodies, food, alcohol, cigarettes, et cetera. Basically, we want to treat the people who get cancer as good as we can. And we are not powerless before that: we want to prevent as many cancers as possible from becoming illnesses.

The top of the Iceberg: treatment

In the Fall of 2011 a number of cancer scientists and clinicians met in Cambridge UK. The meeting was taking place in the beautiful surroundings of Christ College, the College where Charles Darwin studied.

In this meeting the master of stem cells Hans Clevers from the Hubrecht Institute in Utrecht presented a newly developed technique to grow tissue samples derived from human tumors. The tissue samples are called organoids: living and immortal samples of cells, placed in a 3D gel. Disbelief of the people present changed into full-blown enthusiasm. Maybe for the first time, a significant group of cancer scientists talked about establishing the organoid cultures of tissue samples derived from human tumors. If this could be done effectively and efficiently, thie technique could lead to a transformative medicine in cancer research, translation to the clinic and treatment. At this small and intense conference, the Discovery Network was founded. A network of world class scientists and clinicians who lead the basic, translational and clinical research.

Two years after the conference, the Christ college meeting gave rise to increadible progress. In the summer of 2013 the researchers have reached the point where they can create many kinds of organoids: from the colon (in Utrecht), the pancreas (in Urecht and Cold Spring harbour), the prostate (in Utrecht and Memorial Sloan Kettering). Currently a program is initaited for human lung organoids (in Utrecht and Paris), Mouse breast (Utrecht) and Ovarian cells (Utrecht).

The organoids are enormously powerful. They could lead to better therapy/trial design and to optimization of drug treatment at the level of the individual patient.

The main objective of an organoid culture is twofold:

• Improving our knowledge of what treatments do to cells and their (albeit limited) direct macro environment.
• Improving our knowledge and directly apply it at the time of treating a patient.

Both developments are a big deal for clinical cancer treatment. Better candidates for treatment can be selected in advance of a treatment, and it becomes possible to optimize treatment at the bedside.

The chunk below sea level: the part that is hitting the Titanic

The organoid approach to treatment reflects what should also be done to reducing the incidence of cancer: focus on the root. In the case of treatment, a root is the real cancer stemcell. In the case of reducing incidence, the roots are the metaphorical stemcells of society: young people.

As Robert Weinberg put it, altering our lifestyles would have such a strong impact on the reduction of cancer incidents that it would be comparable to preventing the Titanic from hitting the iceberg. We are talking about individual life histories. Educating people to change their lifestyles – moving more, smoking less, eating healthier, reduction or moderation of alcohol use – is a big challenge. Bad habits are particularly difficult to change once they have been entertained for years and are basically gridlocked, and also the preference for food is set during childhood. The vision for the future is to strengthen competencies in health already in young children even before puberty, starting from age 5-6. The program needs to last 10 years to address children already before puberty, but to also accompany them during puberty, which is a particularly vulnerable phase in life.

The main objective of the health literacy program is twofold:

• Establishing a functioning health literacy curriculum in a local community. The central aim is to affect the community of the current generation and the generations to come, by reducing the incidence of cancer at least 10%.
• Creating kind of toolbox that can be used in any other local community, particularly those in need of better lives.

It is not an arbitrary choice to set the program up in a particular area. The program will be set up in the region of East Groningen, in the North of the Netherlands. In this region, the prevalence of cancer due to unhealthy life styles is high. The program is both a true school’s program and a research project, aiming at creating a school-community health literacy program that is tested and has strong benefit, can be tailored to the specific needs and possibilities of schools and their communities in a large variety of regions everywhere around the world.

Inspire2Live!

Inspire2Live is a supporter of science, but is not itself a science movement. It is driven by the passion of people to live full lives, also when they have to live with cancer. This passion spills over to all of us. Nobody wants to hit the Iceberg. We want to inspire life to prevent us from hitting the underwater threat. But not all cancers can be prevented. Yet a great many can and if we succeed, then we can also make sure that the resources we do have can be put to use most effectively. When cancer does hit us, we want to be able to deliver the best possible treatment. We want to ensure high quality of care and a good quality of life. A life in which cancer is less of a threat. A threat that hits us at a very old age, if it hits us at all.

By Jan Gerrit Schuurman