Dichotomies in cancer research: some suggestions for a new synthesis

Continuing high cancer incidence and mortality raise concern about the prevailing overall approach to the control of this disease. The purpose of this article is to elaborate on fundamental dichotomies between traditional and revisionist viewpoints and then to attempt a synthesis of these contrasting perspectives. Topics considered include the importance of controlling carcinogenesis in its earliest stages; consideration of epigenetic, as well as genetic, factors in cancer; development of appropriate genetic animal models of carcinogenesis; the need for multifunctional agents to prevent and treat cancer; and the limits of reductionism. The need for development of new preventive and therapeutic measures that will maintain quality of life, not merely extend life, is stressed. Finally, the importance of context in cancer biology is emphasized, as epitomized in Walt Whitman's famous quotation that "Nothing out of its place is good and nothing in its place is bad."