Cancer: Malignant Maneuvers

When President Richard Nixon signed the US National Cancer Act into law on December 23, 1971, he declared, “I hope that in the years ahead that we may look back on this day and this action as being the most significant action taken during this Administration.” Nixon killed his hope with bewildering hubris. But his call for a war on cancer remains the most astonishingly ambitious, and ultimately flawed, political commitment to a disease in the history of humankind. With the joy of hindsight, one cannot help viewing Nixon’s juxtaposition of cancer next to man’s successful efforts to split the atom and walk on the moon with admiration mixed with incredulity. It is morbidly ironic that Nixon’s wife, Pat, died from lung cancer in 1993.

Today, cancer is an undefeated epidemic in all industrialized Western societies. Among American women, for example, lung, breast, and colorectal cancers remain some of the leading causes of death. Among American men, the prostate and liver replace the breast as organs of major malignant importance. There are also disturbing disparities: death rates from cancer are highest among African-Americans. Yet despite enormous investments in research, diagnosis, and treatment, one in two men and one in three women will die of cancer. Moreover, once a cancer has spread, or metastasized, the chances of stopping it by radiation or chemotherapy for more than a short period are usually very small. One American dies from malignant disease every minute. By any common-sense measure, the war on cancer has been lost.

The current leaders of that war take a very different view. They point out that in 1978 there were three million cancer survivors in the US. By 2005, that figure had swelled to ten million. They list a plethora of task forces, initiatives, programs, and studies that signify phenomenal activity. They speak of a long list of accomplishments, unprecedented opportunities, a new age of scientific discovery, and their strong sense of mission. The National Cancer Institute (NCI) is the world’s most influential cancer research organization. Its leaders have supported the work of at least twenty Nobel laureates.

To be sure, there have been impressive signs of progress. The year 2003 saw a decline in the number of women diagnosed with breast cancer. The mass abandoning of hormone replacement therapy—an important cause of invasive breast cancer—from 61 million prescriptions in 2001 to 21 million in 2004 is one likely explanation. And new classes of treatment for some of the most intractable types of cancer, such as monoclonal antibodies for colorectal cancer, are prolonging lives.

But these isolated instances of success belie larger failures. Writing twenty-five years after Nixon launched his campaign, the respected cancer scientist Michael Sporn argued that the critical obstacle to large reductions in mortality was a misplaced emphasis on treatment over prevention. Playing catch-up with surgery, radiation, and toxic drugs once cancer has taken hold reflected an inappropriate obsession with the concept of cure. According to Sporn,

We must …

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Letters

Malignant Maneuvers’ June 26, 2008