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Can we prevent childhood cancer?

More effective treatments for childhood cancers are desperately needed. But we hope they won’t come at the expense of identifying the root causes of these diseases.

President Biden relaunched the "Cancer Moonshot" on Feb. 2 at the White House.Demetrius Freeman/The Washington Post

On Sept. 24, 1955, President Dwight Eisenhower suffered a massive heart attack that required him to be hospitalized for months. This was the first time in US history when a health threat to a sitting president was publicly reported. It was also a pivotal turning point in medicine. President Eisenhower recruited Dr. Paul Dudley White from Massachusetts General Hospital to guide his care as he recovered, and White used the resulting publicity to advocate for the importance of preventive measures to avoid heart attacks. In the ensuing decades, cardiology shifted from a largely reactive discipline to one primarily focused on prevention.

We think something similar can happen with childhood cancer.


Cancer is the leading cause of nonaccidental death in children. And even when a child is cured, harsh chemotherapy and other treatments can cause myriad health problems that have lifelong impact. In 2016, when then-Vice President Joseph Biden announced his Cancer Moonshot initiative, which seeks to end cancer as we know it, the treatment of childhood cancers featured prominently in this effort. President Biden recently announced plans to reignite this program. It will fund the development of more effective and widely available treatments for children, including targeted therapies, cancer vaccines, and immunotherapies. It also aims to diagnose cancer earlier, through better imaging and other diagnostic tests.

However, while better treatments for and early detection of childhood cancers are unquestionably important areas for continued research, the Cancer Moonshot initiative and its global call to action have given little attention to addressing the root causes of these cancers.

Cancers arise when a rogue cell acquires mutations that allow that cell and its offspring to grow without restriction. In many cancers, these mutations are the result of environmental triggers such as cigarette smoking, which predisposes people to lung cancer, or infections such as hepatitis, which is associated with liver cancer. But it is becoming increasingly clear that inherited genetic factors also play a role. While it has been estimated that about 10 percent of childhood cancers have known inherited causes, this estimate is likely low because our knowledge is limited. Population studies have taught us that relatives of people who have had cancer have a much higher risk than the general population. These studies suggest that there may be inherited risk factors in most, if not all, cases of childhood cancer.


A focus on understanding the root causes of childhood cancers more deeply would have far-reaching implications. If we can define these inherited causes and understand the mechanisms by which they elevate a child’s risk, and if we can combine that knowledge with an awareness of the environmental factors and infections that further increase the risk, we may be able to prevent nearly all childhood cancer. It could become possible to deliver well-tolerated therapies — such as a vaccine or a daily pill — to those at the highest risk of developing any particular cancer before it arises. Think of how the human papillomavirus (HPV) vaccination in adolescents has dramatically reduced the incidence of precancerous cervical lesions in young women. This is expected to lead to decreased rates of invasive cervical cancer in the coming years.

As pediatric cancer doctors, we realize the critical need to improve treatments for our patients. However, we also hope that will not come at the expense of trying to understand the root causes of these cancers, which is ultimately our best shot to end childhood cancer as we know it.


Drs. Vijay G. Sankaran and Melissa A. Burns are both pediatric hematologists and oncologists at Boston Children’s Hospital and the Dana-Farber Cancer Institute and members of the Harvard Medical School faculty.