I believe no human is limited.
– Eliud Kipchoge, Kenyan marathon runner
As a recreational runner, I watched and read with astonishment and awe the events related to marathons ran over the weekend of October 12 and 13. Escorted by a team of world-class runners rotating shifts as pacemakers, Eliud Kipchoge set out with the lofty goal of breaking the 2-hour “barrier” for the marathon (26.2 miles/42.2 km). Looking remarkably energized, he crossed the finish line in 1:59:40.2, becoming the first person in history to accomplish this feat. While the time will not be recognized as an official world record because it did not occur in an open event, Kipchoge’s run still represents an inspirational display of endurance and determination. His comment that “. . . no human is limited” reflects the indomitable spirit and dedication driving his training and performance under pressure.
Just 1 day later, Kenyan Brigid Kosgei completed perhaps an even greater performance in the Chicago Marathon. Competing under world-record eligible conditions, she finished in 2:14:04, smashing the 16-year-old world record by more than a minute. She finished almost 7 minutes in front of the second-place woman and faster than all but 22 men. While stating she did not expect a record, she just kept “…moving, moving, moving.” Pretty remarkable time for simply moving along the course.
Full disclosure—I cannot run a single mile at anywhere near the marathon pace of Kipchoge (4:34 per mile) or Kosgei (5:07 per mile), which left my spirits a little deflated. Fortunately, a blog post from Dr Francis Collins, Director of NIH (https://directorsblog.nih.gov/tag/moving-through-cancer/), inspired new motivation and scientific curiosity only a few days later. A panel of experts, including persons from the National Cancer Institute and American Cancer Society, released new consensus statements about the positive interactions of exercise with cancer. Highlights include (a) regular exercise reduces risk of seven of the most common cancers; (b) exercise during treatment improves outcomes for patients with breast, prostate, and colon cancer; and (c) exercise during and after cancer therapy improves overall function and quality of life for patients. The panel recommended that care teams in oncology should develop strategies to integrate “exercise prescriptions” into cancer therapy. The optimal type and amount of exercise remains uncertain, but evidence suggests that health benefits in cancer arise from just getting involved and moving more—no world records required.
The story of exercise in cancer is just beginning because most evidence linking exercise to improved outcomes in cancer relies on correlations, not causal mechanisms. Imaging offers powerful approaches to look beyond correlations and identify key processes underlying health benefits of exercise in cancer. In many ways, cancer arises from disordered metabolism affecting single malignant cells and whole organisms. Single cancer cells reprogram metabolism to support unregulated proliferation, upregulating consumption not only of glucose but also amino acids and lipids. Cancer cells also change systemic metabolism to acquire sources of fuel from breakdown of skeletal muscle (cachexia) and elevated glucose levels in blood. Many existing and emerging imaging techniques, including FDG PET, hyperpolarized MRI, and MR spectroscopy, allow quantitative measurements of local and systemic changes in metabolism. These technologies could readily be used to investigate how exercise interventions reverse metabolic abnormalities essential to drive cancer. At the cellular scale, imaging mass spectrometry can identify thousands of individual molecules and metabolites and then reconstruct these data as quantitative images. While not a standard clinical imaging technology, molecular analysis capabilities of imaging mass spectrometry hold the exciting potential to reveal mechanisms of exercise in cancer metabolism and reveal new targets for studies in preclinical models and patients. These imaging methods would be powerful additions to the NIH Molecular Transducers of Physical Activity Consortium (https://www.motrpac.org/), the largest ever NIH program to understand how physical activity affects health. I encourage members of the imaging community to use our collective expertise, curiosity, and innovation to help advance research and clinical care for exercise as an addition to cancer prevention and therapy. Radiology: Imaging Cancer welcomes new research and review articles in this area as we work to make a difference in cancer.
Toward the goal of encouraging moving, I invite those of you at the RSNA Annual Meeting to walk (not run) through McCormick Place and visit those of us on the editorial board and RSNA publications team for Radiology: Imaging Cancer. Bonnie Joe, Lacey McNally, and I will be at the RSNA publications booth (booth 1119) from 10:30-11:30 am on Monday, December 2. We may have special rewards for those with accurately completed versions of the word search from issue 2. Along with editors of the other RSNA journals, I will be presenting information about the journal at 2:00 pm on Sunday. I also will give informal perspectives on the present status and future for Radiology: Imaging Cancer at the Discovery Theater on Monday at 9:35 am. Ashok Srinivasan will be presenting a refresher course, RC706 Essentials of Orbital Imaging, on Thursday from 4:30 to 6:00 pm. We want your input about the journal and are happy to discuss ideas for new submissions. Most of all, we would like to meet many of you at the RSNA Annual Meeting. Radiology: Imaging Cancer celebrated our official launch with a cancer ribbon–decorated cake. Now we are carrying that enthusiasm and energy forward to upcoming issues. We welcome new submissions of original research articles and reviews across all areas bridging imaging and cancer in preclinical and clinical science. Your manuscripts will help shape the direction of Radiology: Imaging Cancer and the direction of our field. Enjoy issue 2, but don’t try to eat the cake. It is only a picture, and it may not help your next run!
RSNA publications group celebrates our launch!
Keywords from this issue. Words (listed below the puzzle) may be at angles, vertical, or horizontal.