Congress Presentations
Opinion Paper


Eva Kovacs, MD.
Cancer Immunology Research 

Correspondence to: Eva Kovacs, Switzerland
Phone: +41/61/311 16 50
E-mail: evakovacsbenke@hotmail.com


Worldwide, cancer rates could further increase to 15 million new cases in the year 2020. Cancer may affect people of all ages, but the risk increases with age. It is known that the life expectancy is going up and that the number of old people is higher today than 20-30 years ago. There are three ways of fighting cancer: To Prevent, to Cure and to Care (the three letters: PCC). Many patients are still of working age, when they get the disease. We should cure these patients, we must help them to get better and be able to work again. This is the task and the goal of the cancer research. Researchers have worked very intensively in the last decade, the scientific fields are flooded with information every day; The exponential increase of original scientific articles in cancer research makes it difficult for the scientist to keep up to date. Review articles summarize the current state of research on a specified topic and contain valuable data leading to new suggestions and new ideas. Cancer research needs critical and good review publications as a basis for the planning of further projects and for a well-directed and a well-structured research in the future. The author makes proposals to realize this idea and put it into practice.

Cancer research identifies causes of this disease and develops strategies to prevent and to treat it. The researchers worked on different projects, the results of the studies are evaluated, summarized and published to inform other researchers working on the same topic. Research articles have an important significance, however this significance is limited. The research articles do not give basic summaries and an overall view about a topic and the findings related to the topic.

Review articles do not report original research data they summarize the current state of the research on a specified and a particular topic. All findings and/or discoveries are sorted and evaluated according to their high quality and relevance to the subject.
Research can be compared with a “jigsaw puzzle”. Each completed study each research article is like a small piece of this puzzle. For further projects it is necessary and important to summarise the research findings from time to time in a review article. A review article is like a puzzle picture. When the puzzle pieces are put together for a picture, you can see where pieces are missing. These missing pieces are unsolved questions, significant gaps in the research topic.

The exponential increase of original scientific articles in cancer research makes it difficult for the scientist to keep up to date. Fig 1 presents the number of all research articles about four cancer diseases from 1994 up to 2008: Multiple myeloma, lymphoma, lung- and colorectal cancer (1). The incidence of the morbidity world wide is 3-6/100 000 population for multiple myeloma, 4-17/100 000 for lymphoma, 30-120/100 000 for lung cancer and 3-48/100 000 for colorectal cancer (2, 3). The numbers of the research articles in the four topics show the same course, increasing slightly between 1994 and 2003, with an enormous rise in years 2004 and 2006. It is absolutely clear that nobody can possibly keep up to date with this quantity of information. Nobody can read and evaluate many and many thousand of research articles. Table 1 presents the percentage of all review articles. From 1994 to 2008 the percentage of the review articles lay in range of 8-24 % (mean: 16 %) for multiple myeloma , 8-19% (mean: 14%) for lymphoma, 7-18 %  (mean: 13%) for lung cancer and 7-18% (mean: 14%) for colorectal cancer. In year 2005 the percentage of the review articles was very high, in mean: 37-49%. The fact that the number of the research articles and the number of the review articles show the same course in all four topics is unexpected and not explicable at present time. It could be of interest and of importance to test also other tumour types. The review articles can be divided in three groups: Mini-reviews, midi-reviews and large or full reviews. The mini-reviews are the basis for large review articles: they mini-review articles form a small-puzzle-picture, presenting a new puzzle piece in a large picture. For example there were 581large review articles about lung cancer and 78 about multiple myeloma in 2008. That is only 1.8 % and 1.5 % of the research articles.

Table 2 shows that cancer research has four leading partners: The patient, the industry, the clinician and the research foundations. All these partners have different position in cancer research.  

1) Patient as a partner in Cancer Research
The goal of each study is to help tumor patients and to develop new and effective drugs against tumor diseases. Patients have an important position in cancer research. They and/or their family members financially support the different research projects of the cancer leagues, associations, foundations, societies etc. Each person has a right to learn about the use its financial support. The patients have a right to obtain information about the therapies, the development of new drugs and the state of the current research. How can the patients understand the results of a research study/project? They cannot! The patients are non-specialists they are not interested in how many research studies were carried out. The patients are interested in learning more about the content and the significance of the studies. When the results of several research articles are summarized in a review article, a scientific journalist can evaluate and summarize the findings in an informative paper for the general public.

2) Industry as a partner in Cancer Research
Industry is a profit organization. However the chemical industry is well informed about the different research projects, a good review article is a gold mine for the pharmaceutical companies. In a good review article the findings of a specific topic are evaluated, selected and analyzed with conclusions and new ideas. All these factors are helpful in the development of a novel and potential drugs in cancer treatment.

3) Clinican as Partner in Cancer Research
Clinician treats patients with drugs developed by pharmaceutical companies. The clinician evaluates the effects and side-effects of the drugs. This information is very useful for the development of new drugs. For the optimal application of these drugs the clinician should also have theoretical knowledge. What is the best way to obtain this information? The doctors have no time to read a lot of research articles and they do not always have enough experience to understand the results of research articles. Therefore review articles are the best way for the clinicians.

4) Research foundations as partners in Cancer Research
Cancer Research foundations, leagues, associations and societies as non-profit organizations play a very important role and carry responsibility in cancer research. They take place between patients and researchers and have a good connection to clinicians and industry. Fundraising events are organized to support cancer research, sponsors are asked. Special research programs are provided for the scientist. The submitted cancer research projects are evaluated by advisory boards or by scientific committees. For decisions about special defined topics, for the evaluation of the submitted projects it is essential to have a summary of the previous research findings in an overview article This work presents the current state of science on a specific topic, therefore it has a significant place in the planning of further research projects. The task of the cancer research foundations is to plan and connect the different research projects and to steer the research along a direct and promising path.

Where do you publish a review article?
The best way is an Open access journal. The advantage of the Open access journal: The paper will be peer-reviewed and published very fast. The complete article can be read by many potential readers and can obtain more citations. Open access articles are in the interests of the international research community.

The review article as indicator in Cancer Research. Cancer rates could further increase to 15 million new cases in the year 2020 worldwide (4). According to the American Cancer Society 7.6 million people died from the cancer in the world during 2007 (5). The word “Cancer” is still feared and scares patients. Everybody hopes for the “big breakthroughs”. Researchers have worked very intensively in the last decade the scientific fields are flooded with information every day. Cancer research looks more and more like a wood. How do we go for a walk in a wood? We look for the best and direct route we look for a signpost, for an information board. Without orientation, without signpost we could run round and round or come to a dead end. Do we want to do the same in cancer research? No, we do not. Cancer research needs critical and good review publications they are the signpost for us. Without review articles which summarize the scientific information about a specified field, many valuable data could get lost. Valuable data which could lead to a fundamental change and to the long-expected “big breakthroughs” in cancer research. Review articles catch these valuable data leading to new suggestions and new ideas. A well-directed, a well-structured cancer research has a priority in the near future. Such research “style” could help to save the costs of cancer. The American Cancer Society (6) reported that the costs of cancer in 2007 were USD 219.2 billion.

I asked in the title: Do we need review articles in cancer research? Yes we do. Review articles are extremely important in cancer research. The patients need them, the clinicians need them industry needs them: WE NEED THEM.  

(1) Cancer Research foundations, leagues, associations and societies should include review articles in their research programs definitively and should call for writing and completion of review articles.

(2) These cancer research organizations need coordinator (s). This coordinator should incoming submission of the papers (unsolicited or invited), work with the editorial board and keep a specific topic under surveillance. A coordinator is responsible that the review article summarizes the current state of science.

(3) Journals with a specific topic should invite researchers to write overview articles.

(4) Financial support: Review articles have the same value as research projects. The funding should recognize the value of review articles and support scientists planning to write and complete overviews.

(5) Industry should cooperate with cancer foundations and if it is necessary to support overview articles. The scientific value of these articles is more important than the company policy and the profits.

Acknowledgement: The author thanks her daughter for the illustrations and Dr. H. Langemann for the correction of this manuscript.

1) PubMed. htpp://www.ncbi.hlm.nih./gow/pubmed.
2) Cancer Research UK. htpp://www.cancerresearchuk.org/cancerstats/types/
3) Wikipedia, the free encyclopedia. htpp://en.wikipedia.org/wiki.
4) World Health Organization (2003). “Global cancer rates could increase by 50%”
5) American Cancer Society (2007). “Report sees 7.8 million global 2007 cancer
6) American Cancer Society (2008). “Costs of Cancer”. htpp://www.cancer.org/