There is a danger in being too tightly focused on a single issue.

Jane reminded me of that when she showed up in a dream early this morning. She wasn’t upset with what we have been doing with Walking with Jane, but wanted me to remember that in all things, but especially in science, one never knows where the next game-changing discovery is going to come from. My only real gift is in being able to see the connections between disparate subject areas.

Whether you prefer to see something supernatural in this visitation or the view that this was merely my subconscious kicking in to remind me that I have been overly concentrated on research directed entirely at NET lately is immaterial. What matters is that we sometimes need to look away from something in order to see it.

Two of the most important discoveries on NET in the last two years really came about because someone was looking at something else. The first was a large-scale autopsy study that was really not looking for NETs in particular and discovered those nasty little tumors

in just under one percent of the bodies. One percent seems like an insignificant number until you translate it into what it really means. In the US, one percent of the population translates to three million people walking around with undiagnosed NETs.

But do those cases all matter? Most NETs don’t do what Jane’s or Steve Jobs’ did: produce detectable amounts of a specific hormone or peptide. If most of the tumors are benign and inactive, it makes no economic sense to go around looking for them. Last year, we diagnosed about 12,000 active NETs. There are about 120,000 people living with those NETs. About 10-12,000 of those diagnosed patients die each year. Compared to lung cancer or breast cancer, those numbers are pretty insignificant.

Then I read about a researcher who was trying to figure out why some prostate cancers are more aggressive than others. His findings were pretty disturbing. In many aggressive cases of prostate cancer, there is an NET sitting in the same neighborhood. One of the more aggressive forms of lung cancer also has a NET component–as does a breast cancer.

A peculiar fact of the cancer diagnosis trade is that when multiple tumors are discovered, we tend only to biopsy the largest tumor–and we assume all the smaller tumors are of the same breed as the large tumor. There is a growing body of evidence that says this is not always the case. How often are some of those NETs? The answer is that because we don’t often check them, we honestly don’t know.

One of my questions continues to be, how important are NETs in causing other cancers to become more aggressive than they might otherwise be? And what other problems are NETs causing that we are not picking up?

In my reading of The Emperor of All Maladies, I am struck over and over again by how much trial and error has been involved in our search for cancer cures–and how little research was done into the way cancers work.

My recurring nightmare is that in our hit-and-miss search for cures for the major cancers, we have largely ignored what many think of as among the rarest of cancers. And in ignoring it for nearly 40 years, we may have been ignoring a factor that makes some cancers more aggressive than others–and more deadly.