Cancer is the price we pay for our multicellularity. The initial sculpting of tissues and organs in the embryo, their elaboration in childhood and maintenance for decades thereafter, requires trillions of cell divisions. With a task of that magnitude it is perhaps inevitable that some of those divisions will be mistimed or misplaced. The result of such an error, if left unchecked, is an out-of-control growth: cancer. It is a wonder that cancer doesn't affect more of us--but one in three is still a daunting statistic.

The profound loss of control that is cancer reverberates from skewed molecular signals, to unrelenting cell proliferation, to the invasion of healthy tissues, and finally to the commandeering of the vasculature to not only feed the initial tumor, but to seed tissues near and far. And so it is no surprise that the person newly diagnosed with cancer confronts an overwhelming sense of loss of control, of the lurking of an "other" within oneself that must be ousted, whatever the cost.

Much of the fear of cancer stems from the fact that traditional treatments usually have not sufficiently distinguished errant cells from healthy ones, causing a horrendous litany of side effects. Even new drugs that dominate headlines when they are approved may, in reality, merely extend life by a few miserable months; improved survival does not always mean improved quality of life.

The individualization of cancer treatment promises a new dawn. A refined and targeted armamentarium against cancer will cripple the disease at its roots, sparing healthy tissue and finally ending the parade of patients who suffer through protocols that treat many but save few.

The first wave of change has tempered existing treatments--drugs that dampen the side effects of chemotherapy, or new protocols that attenuate toxicity. And a handful of new drugs has already emerged that truly target cancer cells. But the tsunami of "personalized prescribing" for cancer, based on genomics and proteomics, is not yet a reality, and for good reason: sheer complexity.

Even when the full list of human genes and proteins is cataloged, the daunting tasks remain of identifying cassettes of genes whose underexpression or overexpression fuels cancer, of searching for patterns and correlations, and of validating conclusions on new sets of patients. The approach will work--but it will take time.

In the meantime, while researchers attack cancer from within, there remains much that we can do to reduce our risks from without--behavior changes. It's a simple list, easy to acknowledge, harder to do: stop smoking, exercise regularly, limit sun exposure, eat a diet rich in fruits and vegetables, and avoid obesity.

This supplement celebrates the research that is making personalized cancer care possible. It follows a temporal trajectory, from the more basic science approaches to preventing cancer, dissecting deranged signaling pathways, and understanding the role of the ubiquitin system, to the more clinical highway of diagnosis and treatment, and finally the ultimate goal: if not cure, then the conquering of cancer as a chronic illness. Clearly the roots of cancer lie in biochemistry, genetics, and cell biology.

We have produced this supplement to coincide with the Biofunding Summit 2003 meeting (see www.biofundingsummit.org) that will take place in October. The meeting is jointly sponsored by The Scientist, the National Foundation for Cancer Research, and the International Genomics Consortium.

Ricki Lewis
Richard Gallagher