Recent reports critical of the nation's investment in the war against cancer threaten to undermine important research that will save lives and improve the treatment of millions of Americans. Not only are these criticisms misleading, they may deter patients with newly diagnosed cancers from seeking out potentially lifesaving therapy.
Yes, cancer continues to be a major problem, but it is yielding to our efforts. The past 25 years have seen major advances in understanding the biologic basis for cancer and in improving techniques for treating the disease. In fact, cancer-related deaths in men and women under age 55 have been cut by one-fourth, and death rates for some of the most common forms of cancer are declining: Breast cancer deaths have fallen 23 percent; there has been a slight but definite decline in lung cancer mortality; and deaths from colorectal cancer have dropped 15 percent.
Yet some critics choose to ignore this progress, alleging defeat in the war against cancer. For example, one would never be aware of such progress from the biased and negative interpretation of society's struggle against cancer that appeared this spring in the New England Journal of Medicine: "Cancer Undefeated," by John Bailar III and Heather Gornik. Bailar and Gornik believe that recent reductions in cancer mortality reflect alterations in incidence or early detection; they discount entirely the impact of therapeutic intervention and argue that progress will occur only through an improved national commitment to prevention.
More recently, Thomas J. Moore ["Look at the Mortality Rates: The `War on Cancer' Has Been a Bust," op-ed, July 23] delivers more blatant misinformation. He cites a rise in overall cancer deaths, while underemphasizing the fact that our population has doubled and people are living longer. Hes it a failure that finding a singular cure for cancer has eluded us, and states that the "distressing lack of progress" is occurring as other major causes of death are declining. Yet Moore ignores the fact that cancer is not one disease but many-- with vastly different causes and disease characteristics.
Both Bailar and Moore focus exclusively on mortality rates. But cancer mortality presents a complicated picture, one not easily reduced to a single measure of success. For example, the Bailar article discounts the influence of treatment on the reduction in cancer mortality for individuals under age 55; Moore's does not even mention it. Seventy-five percent of all children with cancer can be cured -- largely because of advances in treatment. We have learned how to cure previously fatal conditions such as testicular cancer and Hodgkin disease in most patients; non-Hodgkin lymphomas can be cured in up to 50 percent of affected people. Systematic clinical studies have shown that post-operative treatment reduces death rates from breast cancer and colorectal cancer by 25-30 percent -- advances that are widely acknowledged.
While important, reduced mortality is not the only measure of success in the fight against cancer and should not be the sole determinant in assessing the value of funding cancer research. Not only have millions of American lives been saved through modern treatments, many others have received added years of high-quality life by virtue of contemporary therapies. In fact, five-year survival rates among all cancers have improved by 20 percent since the 1970s; men diagnosed with testicular cancer today have an 80 percent greater chance of surviving at least five years than men diagnosed 20 years ago. Furthermore, we have improved techniques for administering cancer drugs, increasing their cancer-fighting abilities while reducing painful and dangerous side effects.
To be sure, there is a long way to go. Although cancer deaths are declining among younger Americans, they are increasing among people over 55 years of age, especially women, for a variety of complex reasons. While differences in smoking behavior and lung cancer mortality between the two sexes are in part to blame, factors other than smoking need to be considered in order to understand death rates from cancer in the elderly. As mortality from cardiovascular disease declines, have more people lived long enough to develop cancers they never would have had? Have treatment advances been uniformly applied in all age groups?
There is also some evidence that the elderly may not receive the latest treatments. We know that older Americans have represented only a tiny fraction of participants in some important clinical trials that have established improvements in therapy. This probably relates to physicians being wary of offering potentially toxic therapy to patients they judged to be fragile, and therefore in danger of being harmed by the treatment.
Today there is a general commitment to make modern cancer therapies available to individuals of all ages, based on their general health and individualized capacity to tolerate the treatments. Legislation recently introduced by Sens. Jay Rockefeller and Connie Mack would further this commitment by requiring Medicare to reimburse patient costs associated with clinical trials.
Prevention, too, has made a substantial contribution to reduced mortality, and Bailar and Moore are correct in identifying it as worthy of substantial emphasis. Approximately one-third of the National Cancer Institute's budget is allocated to this category, and new cancer prevention strategies will emerge -- some are already here. But greater focus on cancer prevention should not come at the expense of improved treatments for those who already have the disease.
There has been a recent explosion in our understanding of the biology and genetics of cancer. This is leading to the development of a vast array of new treatment approaches to the disease, many of which are now entering clinical trials. Which will succeed is unknown, but the doctors' armamentarium will be enlarged over the next five to 10 years, and patients' lives will be better for it.
Among the important lessons we have learned in the past 25 years is that victory in the war against cancer is not likely to be achieved through one overpowering strike but through a series of incremental advances, attained through diligence, perseverance, creativity and optimism. Trashing the approach that where we are is shortsighted and contrarian. We need new ideas, not naysayers, optimists not pessimists. Most of all, we need to continue our strong national commitment to all forms of cancer research.
Robert J. Mayer is president of the American Society of Clinical Oncology. Lowell E. Schnipper is chairman of that society's Public Issues Committee.
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